• Vol. 39 No. 8, 591–598
  • 15 August 2010

Changing Seroprevalence of Hepatitis B Virus Markers of Adults in Singapore



Introduction: We presented the findings from 2 seroprevalence studies conducted 6 years apart, so as to determine changes in the hepatitis B surface antigen (HBsAg) positivity rate and immunity to hepatitis B virus (HBV) among Singapore residents aged 18 to 69 years, and to assess the impact of a 4-year catch-up hepatitis B immunisation programme for adolescents and young adults launched in 2001.

Materials and Methods: Two hepatitis B seroprevalence studies (HBSS) were conducted in 1999 and 2005 based on stored blood samples collected from 4698 participants aged 18 to 69 years during the national health survey (NHS) 1998 and from 3460 participants during the NHS 2004, respectively. Serology for HBsAg, hepatitis B e antigen (HBeAg) and antibody to HBsAg (anti-HBs) were tested by enzyme immunoassay in HBSS 1999 and electrochemiluminescence in HBSS 2005.

Results: Results: The overall age-standardised prevalence of HBsAg among Singapore residents aged 18 to 69 years decreased significantly from 4.0% in HBSS 1999 to 2.8% in HBSS 2005 (P = 0.002). The age-standardised prevalence of HBsAg in males (4.9% in 1999) and Chinese (4.7% in 1999) both decreased significantly to 2.7% and 2.8%, respectively in 2005. The overall age-standardised population immunity to HBV (anti-HBs >10mIU/ml) increased from 39.7% in 1999 to 42.1% in 2005 (P = 0.019). In particular, the age-specific prevalence of anti-HBs showed a significant increase among those in the age group of 18 to 29 years from 27.9% in 1999 to 41.7% in 2005 (P <0.001) and among those in the age group of 30 to 39 years from 39.9% in 1999 to 44.7% in 2005 (P = 0.021).

Conclusion: There was an overall decline in the HBsAg positivity rate as well as an overall increase in population immunity to HBV. Following the 4-year catch-up immunisation programme, there was a significant increase in the immunity to HBV infection in the younger population aged 18 to 29 years.

In Singapore, epidemiological surveillance and research on hepatitis B virus (HBV) infection were initiated when acute viral hepatitis was made a notifiable disease under the Infectious Diseases Act in 1976. Based on the findings of epidemiological investigations of reported cases and the results of seroepidemiological studies, a national hepatitis B prevention and control programme was formulated and implemented.

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