Lack of immunity to hepatitis B virus among the expatriates residing in southern Taiwan

Taiwan is an endemic area for hepatitis B virus (HBV) infection. There are more than 3‐million carriers on this island. Chronic HBV infections may result in liver cirrhosis and hepatocellular carcinoma, which are common in Taiwan. However little information is available concerning the immunity and the susceptibility to HBV among the expatriate‐population (non‐permanent residents from foreign countries) in Taiwan. Thus controversies exist on the indications for HBV vaccination among the foreign visitors and expatriates. This study evaluated the serological status of those who attended the Kaohsiung Adventist Clinic between May 1986 and August 1989. Hepatitis B surface antigen (HBsAg) and antibody (anti‐HBs) were determined by ELISA. A total of 152 expatriates (85M, 67F, aged 5 to 64 years, duration of residence in Taiwan: 2 weeks to 11 years) without previous HBV vaccination, were tested. HBsAg and anti‐HBs were not detected in 125 (82%). Anti‐HBs was found in 22 (15%). There was no correlation between the duration of residence and anti‐HBs positivity. However, there was an increased prevalence of anti‐HBs with increasing age after 30. For those expatriates who were anti‐HBs positive, 64% had a history of sexual contact with a partner from an endemic area of HBV. HBsAg was detected in 5 (3%). Three were symptomatic with abnormal liver function tests. Four had a history of sexual exposure. Their children were not antigenemic. It is concluded that most (>82%) of the expatriates residing in southern Taiwan have no immunity to HBV and sexual contact is a major route (70%) of transmission. Vaccination is therefore strongly recommended for those expatriates who may have intimate relationships with local residents.