Frequency of Asymptomatic Hepatitis Types B and C in an Inner City Community and Relation to Possible Risk Factors

The frequency of asymptomatic carriage of the hepatitis virustypes B and C in an inner city area (South London) was assessedin a survey of 1002 subjects attending their General Practitionerfor minor, non-hepatic complaints. Ten subjects were seropositivefor hepatitis B surface antigen (HBsAg) (1 per cent), but onlyone, who declined liver biopsy, had any clinical laboratoryevidence of hepatitis B virus-related chronic liver disease.Carriage of, and exposure to, hepatitis B virus was significantlymore frequent among people born outside the UK/Eire and thosewith a history of jaundice. Among people of Caribbean originthe frequency of hepatitis B virus markers fell from 31 percent among those born in the Caribbean to 11 per cent amongstsecond generation subjects born in this country. Despite carefulcounselling, offers of further investigation and treatment ofthose affected, and vaccination of vulnerable children or partners,were often declined. Four percent of the same population hadantibodies to the hepatitis C virus using the Ortho anti-hepatitisC virus enzyme-linked immunosorbent assay but this figure fellto 0.9 per cent when a second test, based on synthetic peptidesrather than a recombinant antigen, was used. None had any abnormalityof standard liver function tests. Chronic asymptomatic carriage of hepatitis, particularly ininner city areas, may be more common than previously recognized.Effective use of antiviral agents and vaccination will be limiteduntil appropriate health education dispels the widespread misconceptionsand fears associated with a diagnosis of chronic viral hepatitis.