European Journal of Epidemiology

, Volume 17, Issue 8, pp 721–728

Prevalence, risk factors and evaluation of a screening strategy for chronic hepatitis C and B virus infections in healthy company employees

  • V. Sypsa
  • E. Hadjipaschali
  • A. Hatzakis


A cross-sectional study was carried out in employees of 17 Greek companies with the aim of assessing the prevalence of hepatitis B (HBV) and hepatitis C (HCV) virus, identifying associated prognostic/risk factors and evaluating the effectiveness of a questionnaire as a pre-screening tool. All participants were asked to complete a questionnaire and a random sample of them was asked to provide a blood sample for hepatitis B core antibody (anti-HBc), hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C (anti-HCV) testing. Individual questions or combinations of them were evaluated in terms of their ability to detect HBV or HCV(+) cases. Of 9085 eligible employees, 6074 (67%) completed the questionnaire. Of 990 samples obtained, 19.9% were anti-HBc(+), 2.6% HBsAg(+) and 0.5% anti-HCV(+). All anti-HCV(+) cases had multiple parenteral risk factors. Multiple logistic regression identified associations between anti-HBc and older age, family members with chronic hepatitis, job category and history of transfusion before 1992. HBsAg(+) was associated with older age and history of transfusion before 1992. None of the risk/prognostic factors had sufficient sensitivity and specificity for HBV but report of at least one risk factor identified all HCV(+) cases. Anti-HCV screening of those with at least two parenteral risk factors not only identified all anti-HCV(+) cases but also resulted in 86% decrease in the screening cost. Under the light of recent treatment advances, targeted questionnaire-based screening of asymptomatic people may prove to be a cost-effective way to face hepatitis C.

Hepatitis B/C Prevalence Risk factors Screening Sensitivity Specificity 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Alter HJ. To C or not to C: These are the questions. Blood 1995; 85(7): 1681–1695.Google Scholar
  2. 2.
    WHO. Hepatitis C – global prevalence (update). Wkly Epidemiol Rec 1999; 49: 425–427.Google Scholar
  3. 3.
    Kane M. Global programme for control of hepatitis B infection. Vaccine 1995; 13(Suppl. 1): S47–S49.Google Scholar
  4. 4.
    CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998; 47(RR-19): 1–39.Google Scholar
  5. 5.
    Bellentani S, Tiribelli C, Saccoccio G, et al. Prevalence of chronic liver disease in the general population of Northern Italy: The Dionysos study. Hepatology 1994; 20(6): 1442–1449.Google Scholar
  6. 6.
    Guadagnino V, Stroffolini T, Rapicetta M, et al. Prevalence, prognostic/risk factors, and genotype distribution of hepatitis C virus infection in the general population: A community-based survey in Southern Italy. Hepatology 1997; 26(4): 1006–1011.Google Scholar
  7. 7.
    Kaur S, Rybicki L, Bacon BR, et al. Performance characteristics and results of a large-scale screening program for viral hepatitis and prognostic/risk factors associated with exposure to viral hepatitis B and C: Results of the national hepatitis screening survey. Hepatology 1996; 24(5): 979–986.Google Scholar
  8. 8.
    Dubois F, Desenclos JC, Mariotte N, Goudeau A and the Collaborative Study Group. Hepatitis C in a French population-based survey, 1994: Seroprevalence, frequency of viremia, genotype distribution, and prognostic/risk factors. Hepatology 1997; 25(6): 1490–1496.Google Scholar
  9. 9.
    Garcia-Fulgueiras A, Tormo MJ, Rodriguez T, Perez-Flores D, Chirlaque D, Navarro C. Prevalence of hepatitis B and C markers in the south-east of Spain: An unlinked community-based serosurvey of 2,203 adults. Scand JInfect Dis 1996; 28(1): 17–20.Google Scholar
  10. 10.
    Stroffolini T, Guadagnino V, Chionne P, et al. A population based survey of hepatitis B virus infection in a southern Italian town. Ital JGastroenterol Hepatol 1997; 29(5): 415–418.Google Scholar
  11. 11.
    Monica F, Lirussi F, Nassuato G, Castelletto MR, Mottola A, Okolicsanyi L. Hepatitis C virus infection and related chronic liver disease in a resident elderly population: The Silea Study. JViral Hepat 1998; 5(5): 345–351.Google Scholar
  12. 12.
    Dal-Re R, Aguilar L, Coronel P. Current prevalence of hepatitis B, A and C in a healthy Spanish population. A seroepidemiological study. Infection 1991; 19(6): 409–413.Google Scholar
  13. 13.
    Blakely T, Salmond C, Tobias M. Hepatitis B virus carrier prevalence in New Zealand: Population estimates using the 1987 police and customs personnel survey. N Z Med J 1998; 111(1064): 142–144.Google Scholar
  14. 14.
    Sasaki F, Tanaka J, Moriya T, et al. Very low incidence rates of community-acquired hepatitis C virus infection in company employees, long-term inpatients, and blood donors in Japan. J Epidemiol 1996; 6(4): 198–203.Google Scholar
  15. 15.
    Chang HC, Yu MW, Lu CF, Chiu YH, Chen CJ. Prognostic/risk factors associated with hepatitis C virus infection in Taiwanese government employees. Epidemiol Infect 2001; 126(2): 291–299.Google Scholar
  16. 16.
    Andenaes S, Lie A, Degre M. Prevalence of hepatitis A, B, C, and E antibody in flying airline personnel. Aviat Space Environ Med 2000; 71(12): 1178–1180.Google Scholar
  17. 17.
    Seymour CA. Screening asymptomatic people at high risk for hepatitis C. The case for. Br Med J 1996; 312(7042): 1347–1348.Google Scholar
  18. 18.
    Allison MC, Mills PR. Screening asymptomatic people at high risk for hepatitis C. The case against. Br Med J 1996; 312(7042): 1349–1350.Google Scholar
  19. 19.
    Manns MP, McHutchison JG, Gordon SC, et al. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: A randomised trial. Lancet 2001; 358(9286): 958–965.Google Scholar
  20. 20.
    Feagan BG, Trepo C, Lindsay KL, et al. The impact of pegylated interferon alfa-2b on health-related quality of life in chronic hepatitis C patients. Hepatology 2000; 32(4): 307A.Google Scholar
  21. 21.
    Malik AH, Lee WM. Chronic hepatitis B virus infection: treatment strategies for the next millennium. Ann Intern Med 2000; 132(9): 723–731.Google Scholar
  22. 22.
    Malliori M, Sypsa V, Psichogiou M, et al. A survey of blood borne viruses and associated risk behaviours in Greek prisons. Addiction 1998; 93(2): 243–251.Google Scholar
  23. 23.
    Roumeliotou-Karayannis A, Tassopoulos N, Karpodini E, et al. Prevalence of HBV, HDV and HIV infections among intravenous drug addicts in Greece. Eur Jepidemiol 1987; 3(2): 143–146.Google Scholar
  24. 24.
    Tsakris A, Kyriakis KP, Chryssou S, Papoutsakis G. Infection by hepatitis B and C virus in female and transexual Greek prostitutes with serological evidence of active syphilis. Int JSTD AIDS 1997; 8(11): 697–699.Google Scholar
  25. 25.
    Malamitsi-Puchner A, Papacharitonos S, Sotos D, et al. Prevalence study of di.erent hepatitis markers among pregnant Albanian refugees in Greece. Eur J Epidemiol 1996; 12(3): 297–301.Google Scholar
  26. 26.
    Dalekos GN, Zervou E, Karabini F, Tsianos EV. Prevalence of viral markers among refugees from Southern Albania: increased incidence of infection with hepatitis A, B and D viruses. Eur JGastroenterol Hepatol 1995; 7(6): 553–558.Google Scholar
  27. 27.
    Lionis C, Koulentaki M, Biziagos E, Kouroumalis E. Current prevalence of hepatitis A, B and C in a well de.ned area in rural Crete, Greece. JViral Hepat 1997; 4(1): 55–61.Google Scholar
  28. 28.
    Papaevangelou G, Roumeliotou-Karayannis A, Tassopoulos N, et al. Evaluation of methods of pre-vaccination screening for markers of hepatitis B infection. Eur Jepidemiol 1985; 1(2): 100–103.Google Scholar
  29. 29.
    Yannitsiotis A, Bossinakou I, Louizou C, Panayotopoulou A, Mandalaki T. Jaundice and hepatitis B surface antigen and antibody in Greek haemophiliacs. Scand JHaematol Suppl 1997; 30: 11–15.Google Scholar
  30. 30.
    Panis B, Roumeliotou-Karayannis A, Papaevangelou G, Richardson SC, Mitsis F. Hepatitis B virus infection in dentists and dental students in Greece. Oral Surg Oral Med Oral Pathol 1986; 61(4): 343–345.Google Scholar
  31. 31.
    Lionis C, Frangoulis E, Koulentakis M, Biziagos E, Kouroumalis E. Prevalence of hepatitis A, B and C markers in school children of a rural area of Crete, Greece. Eur Jepidemiology 1997; 13(4): 417–420.Google Scholar
  32. 32.
    Goritsas C, Plerou I, Agaliotis S, et al. HCV infection in the general population of a Greek island: Prevalence and risk factors. Hepatogastroenterology 2000; 47(33): 782–785.Google Scholar
  33. 33.
    CDC. Recommendations to prevent hepatitis B virus transmission-United States. MMWR 1999; 48: 33–34.Google Scholar
  34. 34.
    Deuffic S, Buffat L, Poynard T, Valleron AJ. Modeling the hepatitis C virus epidemic in France. Hepatology 1999; 29(5): 1596–1601.Google Scholar
  35. 35.
    Wong JB, McQuillan GM, McHutchison JG, Poynard T. Estimating future hepatitis C morbidity, mortality, and costs in the United states. Am JPublic Health 2000; 90(10): 1562–1569.Google Scholar
  36. 36.
    Zou S, Tepper M, El Saadany S. Prediction of hepatitis C burden in Canada. Can Jgastroenterol 2000; 14(7): 575–580.Google Scholar

Copyright information

© Kluwer Academic Publishers 2001

Authors and Affiliations

  • V. Sypsa
    • 1
  • E. Hadjipaschali
    • 1
    • 2
  • A. Hatzakis
    • 1
  1. 1.Department of Hygiene and EpidemiologyAthens University Medical SchoolAthensGreece
  2. 2.Schering-Plough SAGreece

Personalised recommendations