Bureau of Infectious Disease and Laboratory SciencesHepatitis B Virus Infection 2019 Surveillance Report

Bureau of Infectious Disease and Laboratory Sciences

Massachusetts Department of Public HealthJamaica Plain Campus/State Public Health Laboratory305 South StreetJamaica Plain, MA 02130

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AcknowledgmentsThis report was prepared by the following MDPH staff: Lindsay Bouton, MScT. Scott Troppy, MPH

Suggested citation:Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences. Hepatitis B Virus Infection 2019 Surveillance Report. https://www.mass.gov/lists/infectious-disease-data-reports-and-requests. Published April 2019. Accessed [date].

Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

Hepatitis B Virus (HBV) Infection Data Summary 2009-2018

Table of Contents

Introduction 1Technical note (case classifications) 2Chronic HBV cases by year 3Chronic HBV cases by race and year 5Chronic HBV cases by ethnicity and year 6Chronic HBV cases by country of birth and year 7Chronic HBV cases by age group and year 8Chronic HBV cases in females 14-44 by year 9Chronic HBV cases by county and year 10Acute HBV cases by year 12Acute HBV cases by race and year 13Acute HBV cases by ethnicity and year 14Acute HBV cases by ethnicity and year 15Acute HBV cases by age group and year 16Acute HBV cases by county and year 17Acute HBV cases by reported injection drug use (IDU) and year 18Map: 2009-2018 chronic HBV cases by city/town (count) 19Map: 2009-2018 chronic HBV cases by city/town (rate) 20Map: 2018 chronic HBV cases by city/town (count) 21Map: 2018 chronic HBV cases by city/town (rate) 22

Introduction

Each year, between 1600 and 2300 cases of probable and confirmed chronic hepatitis B virus (HBV) infection are newly reported to the Massachusetts Department of Public Health (MDPH). The majority of these cases are Asian and non-Hispanic (where race and ethnicity are known) and many were born outside the US. The highest rate of newly reported cases is in the 30-39 year age group. Suffolk County, Norfolk County, and Middlesex County have chronic HBV rates higher than the Massachusetts state average.

Between 30 and 70 cases of confirmed acute HBV infection are also reported each year. Acute cases are predominantly white, non-Hispanic, and US-born (where demographic characteristics are known). Injection drug use (IDU) is a significant, and increasingly important, risk factor for acquisition of acute HBV infection. In 2017 and 2018, MDPH investigated and responded to an outbreak of 29 acute cases associated with IDU in Bristol County.

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Case classification: Chronic HBV

Confirmed: IgM antibodies to hepatitis B core antigen (IgM anti-HBc) negative AND a positive result on one of the following tests: hepatitis B surface

antigen (HBsAg), hepatitis B e antigen (HBeAg), or nucleic acid test for hepatitis B virus DNA (including qualitative, quantitative and genotype testing), OR

HBsAg positive or nucleic acid test for hepatitis B virus DNA (including qualitative, quantitative and genotype testing), or HBeAg positive two times at least 6 months apart (Any combination of these tests performed 6 months apart is acceptable.)

Probable: A case with a single HBsAg positive or HBV DNA positive (including qualitative, quantitative and genotype testing), or HBeAg positive lab result when no IgM anti-HBc results are available

Case classification: Acute HBV

Clinical Presentation: An acute illness with a discrete onset of symptoms consistent with acute viral hepatitis (e.g., fever, headache, malaise, anorexia, nausea, vomiting, diarrhea, and abdominal pain) and either a) jaundice or b) elevated serum alanine aminotransferase levels > 100 IU/L

Confirmed:Clinically compatible case* not known to have chronic hepatitis B and

1. HBsAg positive, AND2. IgM antibody to hepatitis B core antigen (IgM anti– HBc) positive, if done

* A documented negative hepatitis B surface antigen (HBsAg) laboratory test result within 6 months prior to a positive test (either HBsAg, Hepatitis B “e” antigen (HBeAg), or hepatitis B virus nucleic acid testing (HBV NAT) including genotype) result does NOT require an acute clinical presentation to meet the surveillance case definition.

Suspect:Positive IgM antibody to hepatitis B core antigen (IgM anti-HBc) that does not meet the clinical definition

Note that confirming a chronic HBV case can involve a significant time delay because of the requirement for two tests at least 6 months apart. Thus, it is expected that cases in the most recent year would be more likely to be classified as “probable.”

The year into which a case is categorized is based upon the case’s “Event Date”, which can be calculated from the following case characteristics, in decreasing order of specificity, dependent on availability of information: symptom onset date, specimen collection date, diagnosis date, or case creation date.

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Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

Number of confirmed and probable chronic HBV cases reported in MA by year, 2009-2018N=18830

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

CONFIRMED 1104 1081 1084 1069 915 1012 977 919 610 210

PROBABLE 763 678 718 760 693 912 861 1057 1402 2005

TOTAL CASES 1867 1759 1802 1829 1608 1924 1838 1976 2012 2215

The surveillance case definition for chronic HBV requires two positive tests; for certain test types, these two tests must taken at least 6 months apart. Reported cases are classified as "probable" following the initial test result and are re-classified as "confirmed" if additional test results are received. During the most recent year of data, 2018, some cases currently reported as probable may be converted to confirmed in future

reports as additional information is obtained.

Data are current as of March 5, 2019 and are subject to change.

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Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

Number and percent of confirmed and probable chronic HBV cases reported in MA by race and year, 2009-2018N=18830

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

N % N % N % N % N % N % N % N % N % N %

Asian 686 36.7 664 37.7 728 40.4 746 40.8 632 39.3 684 35.6 657 35.7 644 32.6 749 37.2 641 28.9

Black 241 12.9 278 15.8 224 12.4 267 14.6 250 15.5 272 14.1 267 14.5 307 15.5 221 11.0 196 8.8

White 304 16.3 250 14.2 273 15.1 260 14.2 228 14.2 260 13.5 200 10.9 270 13.7 245 12.2 266 12.0

Other 183 9.8 151 8.6 159 8.8 136 7.4 130 8.1 197 10.2 154 8.4 188 9.5 171 8.5 187 8.4

Unknown 453 24.3 416 23.6 418 23.2 420 23.0 368 22.9 511 26.6 560 30.5 567 28.7 626 31.1 925 41.8

Total 1867 100.0 1759

100.0 1802 100.0

1829 100.0

1608 100.0 1924

100.0 1838 100.0

1976 100.0 2012

100.0 2215 100.0

Data are current as of March 5, 2019 and are subject to change.

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Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

Number and percent of confirmed and probable chronic HBV cases reported in MA by ethnicity and year, 2009-2018N=18830

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

N % N % N % N % N % N % N % N % N % N %

Hispanic 112 6.00 108 6.14 99 5.49 112 6.12 103 6.41 123 6.39 83 4.52 89 4.50 76 3.78 68 3.07

Non-Hispanic984

52.70 974

55.37 1029 57.10 1025

56.04 925

57.52 1069 55.56

1000 54.41 1125

56.93 1163 57.80 1083 48.89

Unknown771

41.30 677

38.49 674 37.40 692

37.83 580

36.07 732 38.05 755 41.08 762

38.56 773 38.42 1064 48.04

Data are current as of March 5, 2019 and are subject to change.

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Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

Number of confirmed and probable chronic HBV cases reported in MA by country of birth and year, 2009-2018N=18830

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

N % N % N % N % N % N % N % N % N % N %

Born in US217

11.62 177 10.06 177 9.82 177 9.68 165

10.26 140 7.28 116 6.31 126 6.38 123 6.11 41 1.85

Born outside US884

47.35 830 47.19 855

47.45 819 44.78 751

46.70 772

40.12 696 37.87 735 37.20 612 30.42 170 7.67

Unknown766

41.03 752 42.75 770

42.73 833 45.54 692

43.03 1012

52.60 1026 55.82 1115 56.43 1277 63.47 2004 90.47

Data are current as of March 5, 2019 and are subject to change.

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Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

Number and rate of confirmed and probable chronic HBV cases per 100,000 population reported in MA by age group and year (when first reported), 2009-2018

N=18757

Age in years2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

N Rate N Rate N Rate N Rate N Rate N Rate NRate N

Rate N

Rate N Rate

0 to 19 68 4.2 70 4.3 73 4.5 66 4.1 41 2.5 36 2.2 48 3.0 39 2.4 29 1.8 30 1.9

20 to 29 372 40.6 299 32.6 362 39.5 329 35.9 262 28.6 317 34.6 280 30.5 305 33.3 277 30.2 277 30.2

30 to 39 537 65.3 506 61.6 497 60.5 500 60.8 421 51.2 511 62.2 507 61.7 506 61.6 520 63.3 536 65.2

40 to 49 394 40.0 377 38.3 365 37.1 387 39.3 360 36.6 408 41.4 388 39.4 400 40.6 429 43.6 485 49.3

50 to 59 268 28.8 283 30.4 274 29.5 277 29.8 278 29.9 337 36.2 288 31.0 326 35.1 332 35.7 389 41.8

60+ 215 16.9 223 17.5 222 17.4 262 20.6 245 19.2 305 24.0 318 25.0 387 30.4 423 33.2 491 38.6

73 cases with missing age were excluded.Rate denominators are based on 2010 Census data.

Data are current as of March 5, 2019 and are subject to change.

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Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

Number of confirmed and probable chronic HBV cases in females aged 14-50 reported in MA by year, 2009-2018N=5650

N % of cases

2009 617 33.05

2010 546 31.04

2011 569 31.58

2012 578 31.60

2013 479 29.79

2014 580 30.15

2015 520 28.29

2016 575 29.10

2017 595 29.57

2018 591 26.68

98 cases were missing gender or age.These cases represent women of childbearing age who are at risk to transmit vertically.

Data are current as of March 5, 2019 and are subject to change.

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Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

Number of confirmed and probable chronic HBV cases reported in MA by county and year, 2009-2018N=18830

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

BERKSHIRE COUNTY 12 6 21 8 9 12 6 11 15 20

BRISTOL COUNTY 53 55 74 64 57 60 73 71 109 95

CAPE AND ISLANDS 18 26 26 23 20 14 15 24 23 29

ESSEX COUNTY 150 125 144 161 137 190 175 163 138 155

FRANKLIN COUNTY 3 3 7 3 7 6 7 2 4 3

HAMPDEN COUNTY 112 79 85 88 66 65 72 86 58 77

HAMPSHIRE COUNTY 13 11 11 13 11 11 14 16 12 19

MIDDLESEX COUNTY 505 467 442 494 445 509 485 520 468 590

NORFOLK COUNTY 191 221 247 242 203 264 253 300 393 322

PLYMOUTH COUNTY 56 69 98 86 64 91 91 140 132 115

SUFFOLK COUNTY 365 368 361 373 353 407 398 374 415 469

WORCESTER COUNTY 154 167 151 162 144 146 168 169 150 192

UNKNOWN 235 162 135 112 92 149 81 100 95 129

TOTAL CASES 1867 1759 1802 1829 1608 1924 1838 1976 2012 2215

The Cape and Islands is comprised of Barnstable, Dukes, and Nantucket Counties.

Data are current as of March 5, 2019 and are subject to change.

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Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

Rate of confirmed and probable HBV cases per 100,000 population reported in MA by county and year, 2009-2018N=17591

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

ALL MASSACHUSETTS 25.0 24.4 25.5 26.2 23.2 27.3 26.9 28.7 29.4 32.0

BERKSHIRE COUNTY 9.1 4.6 16.0 6.1 6.9 9.1 4.6 8.4 11.4 15.2

BRISTOL COUNTY 9.7 10.0 13.5 11.7 10.4 10.9 13.3 12.9 19.9 17.3

CAPE AND ISLANDS 7.4 10.7 10.7 9.5 8.2 5.8 6.2 9.9 9.5 12.0

ESSEX COUNTY 20.2 16.8 19.4 21.7 18.4 25.6 23.5 21.9 18.6 20.9

FRANKLIN COUNTY 4.2 4.2 9.8 4.2 9.8 8.4 9.8 2.8 5.6 4.2

HAMPDEN COUNTY 24.2 17.0 18.3 19.0 14.2 14.0 15.5 18.6 12.5 16.6

HAMPSHIRE COUNTY 8.2 7.0 7.0 8.2 7.0 7.0 8.9 10.1 7.6 12.0

MIDDLESEX COUNTY 33.6 31.1 29.4 32.9 29.6 33.9 32.3 34.6 31.1 39.3

NORFOLK COUNTY 28.5 32.9 36.8 36.1 30.3 39.4 37.7 44.7 58.6 48.0

PLYMOUTH COUNTY 11.3 13.9 19.8 17.4 12.9 18.4 18.4 28.3 26.7 23.2

SUFFOLK COUNTY 50.6 51.0 50.0 51.7 48.9 56.4 55.1 51.8 57.5 65.0

WORCESTER COUNTY 19.3 20.9 18.9 20.3 18.0 18.3 21.0 21.2 18.8 24.0

1239 cases did not have a confirmed Massachusetts address and were excluded from calculation of rates.Rate denominators are based on 2010 Census data.

The Cape and Islands is comprised of Barnstable, Dukes, and Nantucket Counties.

Data are current as of March 5, 2019 and are subject to change.

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Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

Number of confirmed and suspect acute HBV cases reported in MA by year, 2009-2018N=1366

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Acute confirmed 43 42 68 61 42 36 34 33 52 46

Acute suspect 67 67 59 63 82 102 90 115 118 146

TOTAL CASES 110 109 127 124 124 138 124 148 170 192

Data are current as of March 5, 2019 and are subject to change

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Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

Number of confirmed acute HBV cases reported in MA by race and year, 2009-2018N=457

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Asian 1 3 7 2 4 2 1 4 0 1

Black 4 7 9 5 5 4 3 5 7 8

White 28 22 37 47 25 23 19 15 25 28

Other 7 4 8 6 7 4 5 2 8 2

Unknown 3 6 7 1 1 3 6 7 12 7

Total 43 42 68 61 42 36 34 33 52 46

Data are current as of March 5, 2019 and are subject to change.

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Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

Number of confirmed acute HBV cases reported in MA by ethnicity and year, 2009-2018N=457

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Hispanic 7 7 8 8 5 7 2 2 7 5

Non-Hispanic 26 25 43 38 27 23 25 23 28 30

Unknown 10 10 17 15 10 6 7 8 17 11

Data are current as of March 5, 2019 and are subject to change.

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Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

Number of confirmed acute HBV cases reported in MA by country of birth and year, 2009-2018N=457

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Born in US 19 23 33 29 24 20 17 11 15 14

Born outside US 10 8 19 9 11 5 5 8 7 5

Unknown 14 11 16 23 7 11 12 14 30 27

Data are current as of March 5, 2019 and are subject to change.

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Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

Number of confirmed acute HBV cases reported in MA by age group and year, 2009-2018N=457

Age in years 2009 2010 2011 2012 2013 2014 2015 2016 2017

2018

0 to 19 1 0 2 0 0 0 0 0 0 0

20 to 29 2 4 5 5 3 5 4 3 6 9

30 to 39 14 16 20 15 11 12 10 13 18 10

40 to 49 10 10 26 17 10 10 4 7 17 17

50 to 59 8 5 9 15 12 7 11 6 8 6

60+ 8 7 6 9 6 2 5 4 3 4

No confirmed acute cases were missing age information.

Data are current as of March 5, 2019 and are subject to change.

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Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

Number of confirmed acute HBV cases reported in MA by county and year, 2009-2018N=457

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

BERKSHIRE COUNTY 0 0 0 0 0 1 0 0 0 0

BRISTOL COUNTY 8 4 10 18 3 0 2 1 18 6

CAPE AND ISLANDS 4 2 1 6 1 1 0 0 1 3

ESSEX COUNTY 3 5 2 6 2 6 3 8 3 3

FRANKLIN COUNTY 0 0 1 0 0 0 1 0 0 0

HAMPDEN COUNTY 2 2 3 2 1 0 1 0 3 2

HAMPSHIRE COUNTY 0 0 0 0 0 0 0 1 1 1

MIDDLESEX COUNTY 11 7 11 7 9 8 11 8 7 9

NORFOLK COUNTY 2 3 9 1 1 5 3 7 2 0

PLYMOUTH COUNTY 1 3 4 3 3 3 1 3 7 3

SUFFOLK COUNTY 9 10 16 14 14 5 10 3 7 10

WORCESTER COUNTY 2 5 11 3 6 7 2 2 3 9

UNKNOWN 1 1 0 1 2 0 0 0 0 0

Data are current as of March 5, 2019 and are subject to change.

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Massachusetts Department of Public HealthBureau of Infectious Disease and Laboratory Sciences

Number of confirmed acute HBV cases reported in MA by reported injection drug use (IDU) history and year, 2009-2018N=457

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Reported IDU in past 7 10 11 7 5 10 7 10 22 25

Reported no IDU in past 10 6 20 21 14 7 16 12 14 15

Unknown 26 26 37 33 23 19 11 11 16 6

Data are current as of March 5, 2019 and are subject to change.

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