Birth Cohort Screening for Chronic Hepatitis During Colonoscopy Appointments

Dawn M Sears MD; Dan C Cohen MD; Kimberly Ackerman DO; Jessica E Ma; Juhee Song PhD


Am J Gastroenterol. 2013;108(6):981-989. 

In This Article


Chronic Hepatitis B and C

A total of 500 patients were consecutively offered participation in the study. Of those, 17 (4.5%) patients had a known diagnosis of chronic hepatitis C, making our total number of eligible patients 483. Three hundred seventy-six (78%) of eligible patients agreed to participate in the study and completed our risk factor questionnaire (see Figure 1). Of the 376 participants, 158 (42%) were men. There were 297 (80%) Caucasians and 76 (20%) non-Caucasians (45 (12%) African Americans, 26 (7%) Hispanics, 3 (0.8%) Asian and Pacific Islanders) enrolled in the study (see Table 1 ). Only 36 of our patients were born outside the United States.

Figure 1.

Study flow chart. This flow chart outlines the findings of chronic viral hepatitis (Hep) screening for all patients invited into the study. Hep B antigen test was not done for seven patients. Hep C antibody test was not done for five patients. Frequencies; percentages (95% confidence interval (CI) for the percentages) were presented.

Thirty patients had inadequate blood draws (due to lack of quantity of blood to run assays), thus data for chronic viral hepatitis infection were available for 346 patients. Four patients (percentage (95% confidence interval for the percentage) 1.2% (0.3–3.0%)) were found to be anti-HCV positive. No patients were found to have HBsAg. All four patients who were anti-HCV positive complied with HCV PCR testing and follow-up within the 12-month follow-up time monitored. Ultimately, only 1 patient had detectable virus. He is following up in the liver clinic regularly, has been vaccinated against hepatitis A and B, has stopped alcohol, is eating healthier, and is awaiting non-interferon based therapy for his genotype 1 virus. None of the four patients with HCV-antibody positivity were know to have a history of any liver abnormalities or hepatitis.

Of the 376 patients who filled out the risk factor questionnaires before blood draw, 136 (36%) had at least one risk factor for chronic hepatitis and 31 (8%) had multiple risk factors (see Table 2 ). High-risk sexual activity and tattoo placed before the year 2000 were the most common risk factors, 29 (8%) patients, followed by injecting or snorting drugs, 26 (7%) patient. The risk factors of having HIV or hemophilia were not found in our study population. Two hundred and forty (64%) of patients had no risk factors for chronic HCV or HBV (see Table 3 ). All four participants who were anti-HCV positive had at least one risk factor.

Hepatitis A and B Immunity

Six patients declined HAV and HBV immunity testing, thus our total number of patients checked for immunity was 340 (see Figure 2). Three hundred and fifteen (93%) patients were not immune to HAV, HBV, or both. Two hundred and forty (71%) patients were found to be HAV antibody negative and 283 (83%) were found to be HBV antibody negative.

Figure 2.

Vaccination flow chart. Three hundred and fifteen (84%) of patients did not have full antibody protection against both hepatitis (Hep) A and Hep B. Fifty-one (16%) ultimately completed vaccination within 1 year of follow-up. Only available test result was used to determine the requirement of vaccination (e.g., for Hep A positive and Hep B test was not done, then classified as no vaccination required. For Hep A negative and Hep B test was not done, then classified as Hep A only required). Frequencies; percentages (95% confidence interval (CI) for the percentages) were presented.

At both 6 and 12 months electronic medical record chart review was performed to assess vaccination compliance. Patients were deemed "Vaccination Complete" if they had vaccination clinic records from either two shots for hepatitis A or three shots for hepatitis B in that time period. At the conclusion of the study 51 patients (percentage (95% confidence interval for the percentage), 16.2% (12.3–20.7%) of those vulnerable) had completed the offered vaccinations at a Scott & White Vaccination clinic (Figure 2). There was no difference in the baseline demographics ( Table 1 ), number or type of hepatitis risk factors between those who completed vaccinations and those who did not ( Table 2 ). Univariate logistic regression analyses did not identify any significant factors associated with increased odds of getting vaccination (results not shown, all P values were greater than 0.05). Multivariable logistic regression selected by stepwise selection did not include any of factors as significant factors.

Patients were offered vaccination solely based on having a negative antibody. No known history of occupation, specific risk, liver function, history of viral hepatitis, or underlying liver disease was considered. Patients were encouraged to discuss this more fully with their primary care physicians if they had specific concerns regarding vaccinations. This is in compliance with the CDC's recommendation that "anyone who wishes to be protected from hepatitis" be offered vaccination.