Max Rady College of Medicine
Concept: Hepatitis B - Method of Identification
Last Updated: 2013-07-17
This concept provides a working definition of
describes the method used at MCHP to investigate hepatitis B in the administrative data held in the Manitoba Population Research Data Repository, and lists the codes that are used in laboratory tests to investigate its presence in the population.
Definition of Hepatitis B
Hepatitis B is a
sexually transmitted and blood-borne infection (STBBI)
of the liver caused by the
hepatitis B virus (HBV)
belonging to the
family. As an infectious disease, hepatitis B is transmitted from one individual to another through percutaneous or mucosal contact with infectious bodily fluids
(Public Health Agency of Canada Website - Canadian Immunization Guide - Hepatitis B Vaccine),
such as unprotected sexual contact, sharing of contaminated needles and drug-using equipment, sharing personal care articles (e.g., razors, scissors, nail clippers or toothbrush), or from mother-to-child transmission during childbirth
(Public Health Agency of Canada Website - Hepatitis B).
In Manitoba, the most common method of transmission is unprotected sexual activity
(Manitoba Health - Communicable Disease Control Unit - Communicable Disease Management Protocol - Hepatitis B).
Those acquiring HBV sexually are at high risk for other
sexually transmitted infections (STIs),
such as HIV, gonorrhea, chlamydia, and syphilis, and should be tested accordingly
(Public Health Agency of Canada Website - Hepatitis B).
Approximately 90% of adults will expel HBV on their own within six months of becoming infected (acute hepatitis B) and develop lifelong immunity against the virus (Public Health Agency of Canada Website - Hepatitis B). Of those infected with acute hepatitis B, 50 - 70% are asymptomatic, and those presenting symptoms often have non-specific symptoms, such as fatigue, nausea, vomiting, anorexia, rash or arthralgia (Public Health Agency of Canada Website - Hepatitis B). The remaining 10%, who are unable to clear the virus, are said to be chronically infected and infectious and may experience serious health implications, such as scarring of the liver or liver cancer (Public Health Agency of Canada Website - Hepatitis B).
Because of the significant public health implications, hepatitis B is a notifiable disease in Canada since 1969 (Lix et al. 2012) . All positive laboratory-confirmed cases of hepatitis B are reportable to Manitoba Health, Public Health Surveillance Unit. However, unlike other STIs hepatitis B can be prevented through vaccination (Public Health Agency of Canada Website - Hepatitis B). For more information on hepatitis B, see the Public Health Agency of Canada Website - Notifiable Diseases On-Line - Hepatitis B and the Government of Manitoba Public Health Website - Hepatitis B (HBV).
MCHP Hepatitis B Algorithms
The following method has been used at MCHP to determine testing and to identify individuals with hepatitis B.
1. Brownell et al. (2012)
The number of cases of hepatitis B for Manitoban youths was not reported in Brownell et al. (2012). Information from the Manitoba Monthly Surveillance Unit reports for the year 2010 (Manitoba Health - Epidemiology and Surveillance - Reports) was examined but could not be reported because the cases were not disaggregated by age groups. Without the disaggregation, identifying the number of cases was not possible.
Furthermore, data from the Cadham Provincial Laboratory (CPL) within the administrative records at the MCHP Population Health Repository was examined. However, because the counts for Manitoban youths were small, the data was not reported. In Manitoba, CPL is responsible for hepatitis B surface antibody (HBsAb) and hepatitis B surface antigen (HBsAg) testing (Manitoba Health - Communicable Disease Control Unit - Communicable Disease Management Protocol - Hepatitis B).
Table 1 lists the AUXCD5 codes used to identify hepatitis B testing in the Serology Section of CPL. For more information, see the CADHAM Provincial Laboratory (CPL) - Overview of Services and Data concept and the section titled Hepatitis B in Brownell et al. (2012) .
Table 1 - Hepatitis B: Serology Section
In the deliverable Long-Term Outcomes Of Manitoba's Insight Mentoring Program: A Comparative Statistical Analysis by Ruth et al. (2015), the same set of code values listed above were used to identify hepatitis B serology testing in first trimester.
STARTDT 1 STOPDT 2 AUXCD5 DESCR40 01/01/90 03/18/02 AHBCG ANTIBODY TO HEPATITIS B CORE IGG 01/01/90 01/01/99 AHBCM ANTIBODY TO HEPATITIS B CORE IGM 03/18/02 01/01/99 AHBCT ANTIBODY TO HEP. B CORE ANTIGEN (TOTAL) 01/01/90 01/01/99 AHBEA HEPATITIS B "E" ANTIBODY 01/01/90 01/01/99 AHBS ANTIBODY TO HEPATITIS B SURFACE ANTIGEN 01/01/90 01/01/99 HBEG HEPATITIS B "E" ANTIGEN 01/01/90 01/01/99 HBSAG HEPATITIS B SURFACE ANTIGEN 11/28/94 01/01/99 HBVD HEPATITIS B DNA 07/20/07 01/01/99 HBVGT HEPATITIS B VIRUS GENOTYPING 11/13/01 04/01/09 HBVL HEPATITIS B VIRAL LOAD 07/15/94 01/01/99 HBVN HBSAG CONFIRMATION 04/01/09 01/01/99 HBVVL HEPATITIS B VIRAL LOAD 05/11/92 05/01/06 HPAHB ANTIBODY TO HEPATITIS B SURFACE ANTIGEN 01/01/90 01/01/99 HPHBS HEPATITIS B SURFACE ANTIGEN
1 - The date that the code was created in the file.
2 - The date that the code became inactive. Codes with stop dates recorded as "01/01/99" are still active as this is a default system date.
A value of P [Positive] to identify a positive test result in the POSNEG field [Positive-Negative] for specific AUXCD5 codes in the Cadham Provincial Laboratory (CPL) data was used to determine a positive test result.
- The AUXCD codes used to identify hepatitis B in the Serology Section should be verified at the beginning of each new study to ensure that the list of codes from the CPL data is up-to-date.
- CADHAM Provincial Laboratory (CPL) - Overview of Services and Data
- Chlamydia - Method of Identification
- Gonorrhea - Method of Identification
- Syphilis - Method of Identification
- Cadham Provincial Laboratory (CPL) Data
- Hepatitis B
- Hepatitis B Serology Testing in First Trimester
- Hepatitis B Virus (HBV)
- Hepatitis C
- Human Immunodeficiency Virus (HIV)
- Infectious Disease
- International Classification of Diseases, 10th Revision, with Canadian Enhancements (ICD-10-CA)
- International Classification of Diseases, 9th Revision, with Clinical Modifications (ICD-9-CM)
- Notifiable Disease
- Sexually Transmitted and Blood-Borne Infections (STBBIs)
- Sexually Transmitted Infections (STIs)
- Cadham Provincial Laboratory - Guide to Services 2013 pdf
- Cadham Provincial Laboratory - Website Home Page
- Government of Manitoba Public Health Website - Hepatitis B (HBV)
- Public Health Agency of Canada Website - Hepatitis B - Get the Facts
- Brownell M, Chartier M, Santos R, Ekuma O, Au W, Sarkar J, MacWilliam L, Burland E, Koseva I, Guenette W. How are Manitoba's Children Doing? Winnipeg, MB: Manitoba Centre for Health Policy, 2012. [Report] [Summary] [Updates and Errata] [Additional Materials] (View)
- Lix L, Smith M, Azimaee M, Dahl M, Nicol P, Burchill C, Burland E, Goh C, Schultz J, Bailly A. A Systematic Investigation of Manitoba's Provincial Laboratory Data. Winnipeg, MB: Manitoba Centre for Health Policy, 2012. [Report] [Summary] (View)
- Ruth C, Brownell M, Isbister J, MacWilliam L, Gammon H, Singal D, Soodeen R, McGowan K, Kulbaba C, Boriskewich E. Long-Term Outcomes Of Manitoba's Insight Mentoring Program: A Comparative Statistical Analysis . Winnipeg, MB: Manitoba Centre for Health Policy, 2015. [Report] [Summary] [Additional Materials] (View)
Manitoba Centre for Health Policy
Community Health Sciences, Max Rady College of Medicine,
Rady Faculty of Health Sciences,
Room 408-727 McDermot Ave.
University of Manitoba
Winnipeg, MB R3E 3P5 Canada