HBs Antigen Screening

Key Points

Based on a random sample of 2,008 laboratories selected at random (1,079 participating laboratories), it is estimated that in 2016 in France:

• 4.3 million serological tests for hepatitis B (HBs antigen (Ag)) were performed (+14% since 2013), predominantly (71%) in the private sector

• the number of screening serology tests per capita is estimated at 65 per 1,000 inhabitants; it is particularly high in Île-de-France, especially in Paris (172 per 1,000)

• The positivity rate (control indicator) for HBsAg screening is estimated at 0.8%: it is higher in the public sector (1.1%) than in the private sector (0.6%), and in certain overseas departments and regions such as Mayotte in the public sector (3.8%) or French Guiana (1.5%). In mainland France, this indicator is highest in Île-de-France (1.4%).

• The majority of people confirmed positive for hepatitis B for the first time in 2016 were men (54%). The most represented age group among both men and women is 30–39 years old.

This new edition of the LaboHep survey shows that HBsAg screening activity continues to increase compared to previous years. The 2016 survey highlights marked regional and departmental disparities, particularly in the DROMs and in Île-de-France, in mainland France. As in 2013, men and women aged 30 to 39 represent the age group most frequently testing positive for HBsAg in France.

Participation

The overall participation rate of laboratories in this survey is 54%: this rate is higher for public laboratories (64%) than for private laboratories (51%). It is higher in mainland France (54%) than in the Overseas Departments and Regions (DROM) (39%). The highest participation rate was observed in Brittany (74%) and the lowest in French Guiana (18%).

Overall serological screening activity for the HBs antigen

The overall serological screening activity for the (Ag) HBs is estimated at 4.3 million [95% CI: 4.0–4.6] in France in 2016, 71% of which were performed in private-sector laboratories (i.e., 3.0 million [95% CI: 2.9–3.2]). HBsAg screening activity increased by 11% between 2010 and 2013 and by 14% between 2013 and 2016. Relative to the French population (provisional INSEE estimates as of late 2016), HBsAg screening activity is estimated at 65 tests per 1,000 inhabitants (53 per 1,000 in 2010 and 58 per 1,000 in 2013). Screening rates are higher in Île-de-France (100 per 1,000), particularly in Paris (172 per 1,000), and in the departments of Val-de-Marne (133 per 1,000), Seine-Saint-Denis (96 per 1,000), and Hauts-de-Seine (92 per 1,000).

• In the French Overseas Departments (DFA), HBsAg screening rates are also high (French Guiana 120 per 1,000, Guadeloupe 108 per 1,000, and Martinique 101 per 1,000)

• In mainland France, significant screening activity is observed in the Provence-Alpes-Côte d’Azur region, particularly in the departments of Alpes-Maritimes (96 per 1,000) and Bouches-du-Rhône (92 per 1,000) (Figure 1).

Figure 1 - Number of HBsAg tests performed per 1,000 inhabitants, by department LaboHep 2016, France

Number of HBsAg tests confirmed positive

The number of HBsAg tests confirmed positive for the first time in 2016 is estimated at 33,962 [95% CI: 28,265–39,659], with nearly 58% performed in private medical laboratories. After a 45% increase between 2010 and 2013, the number of tests continued to rise but at a slower rate between 2013 and 2016 (+6%) and only in the private sector (+14%).Note: The number of positive tests does not reflect the number of people newly diagnosed as positive for HBsAg in 2016, as the same person testing positive for the first time in different laboratories may be counted multiple times.

Relative to the population (provisional INSEE estimates as of late 2016), the number of laboratory-confirmed positive HBsAg tests for the first time was estimated at 51 per 100,000 inhabitants (34 per 100,000 inhabitants in 2010 and 49 per 100,000 in 2013).

• In the overseas departments and regions (DROM), the number of confirmed positive HBsAg tests was high in French Guiana (183 per 100,000) and in the public sector in Mayotte (344 per 100,000)

• In mainland France, the highest number of confirmed positive HBsAg tests was observed in Île-de-France (145 per 100,000), primarily in Paris (318 per 100,000), Seine-Saint-Denis, and Seine-et-Marne (185 and 128 per 100,000, respectively)

Number of confirmed positive HBsAg tests* per 100,000 inhabitants, by department LaboHep 2016, France

*Tests confirmed positive for the first time in the laboratory

Positivity rate (Control Indicator) for HBsAg screening

The positivity rate (control indicator) for HBsAg screening is estimated at 0.8% [95% CI: 0.7%–0.9%] for all of France in 2016 and remains stable compared to 2013.

The positivity rate is higher in public laboratories (1.1%) than in private laboratories (0.6%).

The highest HBsAg positivity rates are observed:

• in the overseas departments and regions (DROM): in Mayotte in the public sector (3.8%) and in French Guiana (1.5%)

• in mainland France: in the Île-de-France region (1.4%).

Description of individuals confirmed positive for HBsAg

Individuals confirmed positive for the first time in 2016 were predominantly men (54%).

The average age for men is 43 years (median 41 years) and for women is 41 years (median 38 years).

The 30–39 age group is the most represented among men (25%) as well as among women (33%), followed by the 40–49 age group (22%) for men and the 20–29 age group (19%) for women. (Figure)

Distribution of confirmed positive* tests for the HBs antigen (Ag) by sex and age of individuals. LaboHep 2016 Survey, France

*Tests confirmed positive for the first time in the laboratory