Is Hepatitis B more common in people from Southeast Asia and sub-Saharan Africa?

Hepatitis B Prevalence in Southeast Asia and Sub-Saharan Africa

Yes, Hepatitis B is significantly more common in people from Southeast Asia and sub-Saharan Africa, where these regions represent the highest endemic areas globally with prevalence rates exceeding 8%. 1

Geographic Distribution and Endemicity

HBV is especially endemic in Asia, the South Pacific Region, and sub-Saharan Africa, where chronic infection rates are substantially higher than in developed nations 1. The epidemiologic data clearly demonstrates:

• High endemicity regions (>8% prevalence) include most of Asia, sub-Saharan Africa, the South Pacific, and certain indigenous populations in the Arctic 1
• Sub-Saharan Africa shows particularly high HBsAg prevalence, with some areas reaching 23.5% in certain populations 2
• Southeast Asia and East Asia maintain prevalence rates of 5-10% in adults with chronic HBV infection 2
• Approximately 45% of the world's population lives in these high-endemicity regions 3

Transmission Patterns by Region

The mode of HBV transmission differs significantly between these endemic regions and developed countries:

• In Asia (particularly Southeast and East Asia), perinatal transmission from HBeAg-positive mothers is the predominant route, with 90% risk of chronic infection in newborns 1, 3
• In sub-Saharan Africa, Alaska, and Mediterranean countries, person-to-person transmission during childhood is more common than perinatal transmission 1
• These childhood transmission patterns (first 5 years of life) carry a 25-30% risk of developing chronic infection 1, 3

Clinical Significance and Disease Burden

The high prevalence in these regions translates to devastating health consequences:

• In China and sub-Saharan Africa specifically, HBV-associated hepatocellular carcinoma (HCC) is one of the leading causes of cancer in men 1
• HBV causes 53% of all hepatocellular carcinoma cases worldwide 3
• Asia is home to 75% of the world's 400 million HBV carriers 1
• The prevalence of chronic HBV carriers ranges from 8-20% in Southeast Asia, China, Central Asia, and the Middle East 1

Screening Recommendations

Persons born in hyperendemic areas should be routinely screened for HBV infection, as this population shows 13% HBsAg prevalence and 70-85% prevalence of any HBV serologic markers 1. This screening is critical because:

• Most infected individuals in these regions acquired HBV perinatally or during early childhood 1
• The "immune tolerant" phase is prolonged in perinatally-acquired infections, with many patients having high HBV DNA levels but normal ALT 1
• Early identification allows for appropriate monitoring and treatment to prevent cirrhosis and HCC 1

Important Clinical Caveat

When evaluating patients from Southeast Asia versus sub-Saharan Africa, recognize the different natural history patterns:

• Southeast Asian patients (particularly those with perinatal transmission) often remain HBeAg-positive longer and may not seroconvert until adulthood 1
• Sub-Saharan African patients more commonly acquire infection through childhood horizontal transmission, with HBeAg seroconversion typically occurring near or shortly after puberty 1

HIV Co-infection Consideration

Co-infection with HIV is more common in persons from regions where both viruses are endemic, such as sub-Saharan Africa 1. Between 6-13% of HIV-infected persons are co-infected with HBV, and these patients experience higher HBV DNA levels, lower rates of spontaneous HBeAg seroconversion, more severe liver disease, and increased liver-related mortality 1.