Epidemiology and molecular analysis of hepatitis A, B and C in a semi-urban and rural area of Crete

Eur J Intern Med. 2013 Dec;24(8):839-45. doi: 10.1016/j.ejim.2013.08.003. Epub 2013 Aug 26.


Aim: An observational seroepidemiological study was carried out in a well-defined primary-care district on the island of Crete in order to determine the recent endemicity of viral hepatitis in Cretan-population.

Setting and participants: The setting consisted of a semi-urban group and a remote & rural group. Serum samples were collected from 876 subjects (437 males, 439 females) aged 15 years or above. Subjects were randomly selected from the permanent population of the area that consisted of 5705 individuals. The aim was to measure the prevalence of selected viral-hepatitis markers.

Results: Hepatitis B surface-antigen (HBsAg) was found positive in twenty-nine individuals, (3.3%). Antibodies to hepatitis B virus core-antigen (HBcAb) were detected in 287 subjects (32.8%) and antibodies to hepatitis C virus (anti-HCV) were detected in nineteen subjects (2.2%). Seropositivities for the semi-urban group were: 3.4%, 19.1%, 2.1% and 3.2%, 48.8%, 2.2% in remote & rural group respectively. Virtually, all subjects >45 years old were seropositive for antibodies to hepatitis A, whereas approximately 80% of those in the 15-44 age-group were found to be seropositive.

Conclusion: A threefold increase in the HBV exposure and carrier proportion was found in Cretan native-population and in rural-areas compared to older studies carried out in other rural-populations of the island. It is still unknown whether the recent economic crisis or the demographic changes in Cretan-population contributed to these findings. HCV endemicity remains relatively constant, however an alteration of hepatitis C genotypes was observed. Exposure to HAV was found to be higher in remote and rural areas compared to semi-urban areas.

Keywords: AHC; Anti-HBe; Anti-HBs; Arkalochori Health Centre; Crete; Greece; HAV; HBcAb; HBsAg; HCV; Markers; Prevalence; Viral-hepatitis; anti-HAV; anti-HCV; antibodies to hepatitis A virus antigen; antibodies to hepatitis B core-Ag; antibodies to hepatitis B e-core antigen; antibodies to hepatitis B surface antigen; antibodies to hepatitis C virus antigen; hepatitis A virus; hepatitis B surface antigen; hepatitis C virus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • DNA, Viral / genetics*
  • Female
  • Greece / epidemiology
  • Hepacivirus / genetics*
  • Hepatitis A / epidemiology*
  • Hepatitis A / immunology
  • Hepatitis B / epidemiology*
  • Hepatitis B / immunology
  • Hepatitis B / virology
  • Hepatitis B Antibodies / immunology
  • Hepatitis B Surface Antigens / immunology
  • Hepatitis B virus / genetics*
  • Hepatitis C / epidemiology*
  • Hepatitis C / immunology
  • Hepatitis C / virology
  • Hepatitis C Antibodies / immunology
  • Humans
  • Male
  • Middle Aged
  • Molecular Epidemiology
  • Prevalence
  • RNA, Viral / genetics
  • Rural Population / statistics & numerical data
  • Seroepidemiologic Studies
  • Urban Population / statistics & numerical data
  • Young Adult


  • DNA, Viral
  • Hepatitis B Antibodies
  • Hepatitis B Surface Antigens
  • Hepatitis C Antibodies
  • RNA, Viral