Hepatitis B virus (HBV) is an infectious agent that is distributed worldwide and which is perpetuated among humans in a large reservoir of chronic carriers. On a global scale, there are approximately 200 million carriers of HBV, i.e. 5% of the earth’s population are infected. The prevalence of infection with this virus, however, is not uniform throughout the world. Instead, there is a geographic gradient in the distribution of HBV, lowest in North America and western Europe, where the virus can be detected in 0.1 to 0.5% of the population, and highest in Southeast Asia and sub-Saharan Africa, where the frequency of current infection may approach 5 to 20% of the population. This skewed distribution parallels that of hepatocellular carcinoma and provides strong epidemiologic evidence for an association between chronic HBV infection and this type of malignancy. If all these carriers were ill and temporarily or permanently disabled, the opportunities for spread to others in the community would be few. Unfortunately, a substantial proportion of infected persons are asymptomatic and, via routine interactions with others, serve as insidious, unrecognized sources for the dissemination of infection. Because those areas of the world with the highest prevalences of infection tend also to be the poorest, prospects for prevention with expensive prophylactic interventions are limited. Moreover, because of increasing travel, primarily by emigration, by persons from high-risk areas to countries with low prevalences of infection (and immunity), the potential exists for introduction of new foci of infection into low-risk areas.
KeywordsSexual Intimacy Perinatal Spread Percutaneous Exposure HBsAg Particle Percutaneous Inoculation
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