Prevalence of hepatitis B and C virus infections in Lao People’s Democratic Republic: The first national population-based cross-sectional survey

Shinsuke Miyano; Chansay Pathammavong; Yasunori Ichimura; Masaya Sugiyama; Kongxay Phounphenghack; Chankham Tengbriacheu; Bouaphane Khamphaphongphane; Phonethipsavanh Nouanthong; Lauren Franzel; Tae Un Yang; Hendrikus Raaijimakers; Tomomi Ota; Masafumi Funato; Kenichi Komada; Masahiko Hachiya

doi:10.1371/journal.pone.0278933

Peer Review History

Original SubmissionMay 6, 2022
24 Aug 2022 Decision Letter - Livia Melo Villar, Editor PONE-D-22-13251Prevalence of hepatitis B and C virus infections in Lao People’s Democratic Republic: a population-based cross-sectional surveyPLOS ONE Dear Dr. Miyano, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== Please submit your revised manuscript by Oct 08 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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We will update your Data Availability statement to reflect the information you provide in your cover letter. 4. Thank you for stating the following financial disclosure: “This work was supported by the Grants for the National Center for Global Health and Medicine [grant number 19A01] and the Grant for the National Immunization Program [FY2019], Lao PDR. However, the funding source was not involved in design of the study, collection, analysis, and interpretation of data, or writing of the manuscript.” Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. Additional Editor Comments: Dear Author, Thanks for sending the paper intitled: "Prevalence of hepatitis B and C virus infections in Lao People’s Democratic Republic: a population-based cross-sectional survey". This is the first population-based prevalence investigation of hepatitis B and C viruses in the Lao People's Democratic Republic. The study is significant however some issues were raised by reviewers and I suggest major revision of this article. Sincerely, Livia [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear authors, The paper entitled has has merit and will probably give a significant contribution to the field. However, some improvements should be made to make it suitable for publication. -Table 1 is disorganized and needs to be better structured. For example, it would be better to have separate columns for the studied population and the "n" sample. Furthermore, it would be better to use it in comparison with the results obtained in the study rather than in the introduction. Methods -Lines 129-131: In the sentence: “For the third stage, 42 participants 130 (including 8, 6, 6, 16, and 6 in the 1–2, 5–14, 15–19, 20–39, and ≥40 year age groups, 131 respectively) were randomly selected...” What do these numbers mean? Please, clarify. Results: -In general, tables could be better structured and organized. Table 2, for exemple, could be summarized by classifying age groups every 10 years. -Page 18, line 219: “those WHO REPORTED sharing needle for drug injection showed...” -As no variables were statistically significant, table 4 is not necessary. Discussion Page 20, line 238: “In addition, female HBV carriers have lower viral loads than male carriers...” The authors did not performed viral load analysis in this study. If this comment refers to another study (reference 42), this needs to be clarified. Page 21, lines 245-255: Could this difference be related to the sexual behavior of individuals aged 20-29 years? Are they more likely to be single? Multiple partners? Non condom users? Page 22, line 267: “...the differences in sexual practice and parent-to-child transmission...” it would be better to replace "parent-to-child" with "vertical transmission". Page 22, lines 275-277: The sentences “Hmong people have been recognized as having a high prevalence of HBV infection by the studies in the US [49-52] and Thailand [53-55] due to their sexual risk behaviors.” And “Some papers indicated that Khmu people had higher likeliness of aspiration to the commercial sex industry due to their economic restriction...” Please check if these affirmations complies with ethical criteria, as associating an ethnicity with risky sexual behavior can give rise to discrimination. I suggest rewriting these sentences observing this criteria. Reviewer #2: The study presented by Miyano et al is the first population-based prevalence investigation of hepatitis B and C viruses in the Lao People's Democratic Republic. The study is significant since it is the first population-based prevalence study in this country, bringing new information to the region. Despite its merits, the article contains some major aspects that must be corrected and clarified: - Title: To highlight the significance of the work, the authors should mention in the title that it is the first population-based prevalence study made in the country. - Abstract: Line 44 - phrase is not clear, needs adjustment - Instroduction Line 89 - phrase is not clear, needs adjustment - Materials and methods: Section "Sample size calculation" Lines 112 to 120 - We know that the authors used a sample size from the rubeola and measles studies, but it would be clearer and more straightforward to begin with the sample size for hepatitis B and C. Line 130 - Why were the age groups divided in this way? Is there a reason? Was it based on the population's average age? Please elaborate on this point. - Results: Line 169 - Is the population based on the rubella and measles survey? or is it the population already estimated for hepatitis B and C? This is not very clear. Line 171 - The same goes for this sentence, it is noticed here that the population examined is larger than the estimated sample n for HBV and HCV. Is this population based on the rubella and measles survey, or on the estimated population for hepatitis? Please clarify. Table 2 - The sum of the individuals in this "Sex" category does not match the total of the analyzed population, nine individuals are missing. Are they missing their sex? Provide the missing data in the table, either as a new column or footnote identifiable by a marker. Table 2 - The same occurs for the ethnicity category, 73 individuals are missing in the sum to reach the total value. And also in the "Education history" category, 199 individuals are missing for the total sum of the population. In the paragraph of the section "Seroprevalence of HBsAg" (lines 182 to 195) and "Seroprevalence of HCV-Ab" (lines 210 o 220), provide the absolute number of the number of cases for the data presented. Table 3 and 4 - Provide the absolute number of cases for the data presented. - Discussion: Lines 239 to 240 - Because the study offered as a comparison was conducted on a relatively specific group, the placement should be interpreted with caution. Studies in different communities and areas may demonstrate different or equal prevalences for HCV, where women may have a greater or equal soprevalence for HCV than males. (Niu et al, 2016 [DOI: 10.1186/s40064-016-3224-z]; Peliganga et al, 2021 [DOI: 10.3390/pathogens10121633]; Rangel et al, 2021[DOI: 10.1016/j.clgc.2020.08.006]; Bisseye et al, 2018). Lines 258 to 259 - The placement presented was unclear. However, there were no cases in adults under the age of 30, and was maternal-infant transmission suspected? Did you mean to mean those over the age of 40? In addition, the fact that the prevalence of hepatitis C grows with age, as studies have demonstrated, is an interesting approach to consider and discuss. (Peliganga et al, 2021 [DOI: 10.3390/pathogens10121633]; Abdella, et al, 2020 [DOI: 10.1371/journal.pone.0241086]; Vermeulen et al, 2017 [DOI: 10.3201/eid2309.161594]). Lines 269 to 270 - The term used is out of date and should be replaced by sexually transmitted infections. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0278933.r001
Revision 1
14 Sep 2022 Author Response Reviewer #1: 1. Table 1 is disorganized and needs to be better structured. For example, it would be better to have separate columns for the studied population and the "n" sample. Furthermore, it would be better to use it in comparison with the results obtained in the study rather than in the introduction. We appreciate the reviewer's suggestion. We have re-organized Table 1 by adding the columns for “study location” and “number of the population”. In addition, we have relocated this Table to the Discussion section and put it as Table 4. 2. Lines 129-131: In the sentence: “For the third stage, 42 participants (including 8, 6, 6, 16, and 6 in the 1–2, 5–14, 15–19, 20–39, and ≥40 year age groups, respectively) were randomly selected...” What do these numbers mean? Please, clarify. We appreciate the reviewer's clarification. Due to the stratification of age groups, we randomly selected 42 participants per village which included 8 participants in 1–2 year, 6 participants in 5–14 year, 6 participants in 15–19 year, 16 participants in 20–39 year, and 6 participants in ≥40 year age groups, respectively. We revised this sentence as we wrote here. 3. Results: In general, tables could be better structured and organized. Table 2, for exemple, could be summarized by classifying age groups every 10 years. We appreciate the reviewer's suggestion in Table 2. We have revised the table, especially age groups, as the reviewer suggested. 4. Page 18, line 219: “those WHO REPORTED sharing needle for drug injection showed...” We appreciate the reviewer's pointing out our writing error. We have revised the sentence as the reviewer suggested. 5. As no variables were statistically significant, table 4 is not necessary. We appreciate the reviewer's suggestion in Table 4. Although we understand the reviewer's reasonable suggestion, for the transparency of the results/data, we would like the reviewer to accept that we keep Table 4. 6. Page 20, line 238: “In addition, female HBV carriers have lower viral loads than male carriers...” The authors did not perform viral load analysis in this study. If this comment refers to another study (reference 42), this needs to be clarified. We appreciate the reviewer's clarification. We have rephrased the sentence like, “In addition, another study reported that female HBV carriers had lower viral loads than male carriers [42], which might have contributed to the higher prevalence of HBsAg in men than in women.” 7. Page 21, lines 245-255: Could this difference be related to the sexual behavior of individuals aged 20-29 years? Are they more likely to be single? Multiple partners? Non condom users? We appreciate the reviewer's important comments. We found the reference (the Lao Social Indicators Survey II (LSIS II) in 2017) showing that those aged 20-29 years were more likely to have multiple partners and less likely to use condoms. We added an assumption on relation between sexual behaviour and the higher prevalence among those aged 20-29 years as the reviewer suggested. 8. Page 22, line 267: “...the differences in sexual practice and parent-to-child transmission...” it would be better to replace "parent-to-child" with "vertical transmission". We appreciate the reviewer's suggestion. We have replaced "parent-to-child" with "vertical transmission" as the reviewer suggested. 9. Page 22, lines 275-277: The sentences “Hmong people have been recognized as having a high prevalence of HBV infection by the studies in the US [49-52] and Thailand [53-55] due to their sexual risk behaviors.” And “Some papers indicated that Khmu people had higher likeliness of aspiration to the commercial sex industry due to their economic restriction...” Please check if these affirmations comply with ethical criteria, as associating an ethnicity with risky sexual behavior can give rise to discrimination. I suggest rewriting these sentences observing these criteria. We appreciate the reviewer's very important suggestion. We agree that we need to be more sensitive on such a matter. We decided to write just the epidemiological fact from other papers and remove the parts mentioning the association between ethnicity and risky sexual behavior to avoid rising discrimination. Reviewer #2: 1. Title: To highlight the significance of the work, the authors should mention in the title that it is the first population-based prevalence study made in the country. We appreciate the reviewer's very positive suggestion. We have revised the title as the reviewer recommended. 2. Abstract:　Line 44 - phrase is not clear, needs adjustment We appreciate the reviewer's suggestion. We have rewritten the phrase to make it clear by adding the cut-off value for both HBsAg and HCV-Ab. 3. Introduction：Line 89 - phrase is not clear, needs adjustment We appreciate the reviewer's suggestion. This phrase wanted to indicate that there is no seroprevalence studies in the general population since the first prevalence survey in 2012 covered only children and their mothers. We have rewritten the phrase to make it clear. 4. Materials and methods:　Section "Sample size calculation"　Lines 112 to 120 - We know that the authors used a sample size from the rubeola and measles studies, but it would be clearer and more straightforward to begin with the sample size for hepatitis B and C. We appreciate the reviewer's suggestion. We began this part straightforward with the sample size for hepatitis B and C and removed the sample size calculation for measles and rubella. We have revised this part as the reviewer recommended. 5. Materials and methods: Line 130 - Why were the age groups divided in this way? Is there a reason? Was it based on the population's average age? Please elaborate on this point. We appreciate the reviewer's clarification. Since the primary objective of this survey was to compare the seroprevalence of measles and rubella between 2014 and 2019, this survey design required to be the same with the one in 2014. In 2014, the age groups were divided based on the exposure history to routine immunization services and supplementary immunization activities (SIAs) services. We stratified the age groups for strategic sampling and estimated the prevalence in each age group. That is the reason why the age groups were divided in this way. 6. Results: Line 169 - Is the population based on the rubella and measles survey? or is it the population already estimated for hepatitis B and C? This is not very clear. We appreciate the reviewer's clarification. The numbers are absolute numbers of blood samples. We have collected 2,043 samples in the survey. After excluding inappropriate samples, 1,927 samples were tested for both measles/rubella and hepatitis B/C. While the number of the samples was less than required sample size for measles/rubella prevalence estimation (88.2% of the required sample size, which was 2,184), it was more than required sample size for hep B/C prevalence estimation (103.0% of the required sample size, which was 1,872). To avoid the confusion, we have removed the “93.5% of required samples size” since this information is based on the required samples size for the measles/rubella survey and added the percentage (103.0%) against the required sample size for hepatis B/C (1,872 samples). 7. Results: Line 171 - The same goes for this sentence, it is noticed here that the population examined is larger than the estimated sample n for HBV and HCV. Is this population based on the rubella and measles survey, or on the estimated population for hepatitis? Please clarify. We appreciate the reviewer's clarification. As mentioned above, the numbers are absolute numbers of blood samples. We have collected 2,043 samples in the survey. After excluding inappropriate samples, 1,927 samples were tested for both measles/rubella and hepatitis B/C. While the number of the samples was less than required sample size for measles/rubella prevalence estimation (88.2% of the required sample size, which was 2,184), it was more than required sample size for hep B/C prevalence estimation (103.0% of the required sample size, which was 1,872). To avoid the confusion, we have removed the “93.5% of required samples size” since this information is based on the required samples size for the measles/rubella survey and added the percentage (103.0%) against the required sample size for hepatis B/C (1,872 samples). 8. Table 2 - The sum of the individuals in this "Sex" category does not match the total of the analyzed population, nine individuals are missing. Are they missing their sex? Provide the missing data in the table, either as a new column or footnote identifiable by a marker. We appreciate the reviewer's pointing out our error. The number was our typo. We have corrected the number in Table 2. 9. Table 2 - The same occurs for the ethnicity category, 3 individuals are missing in the sum to reach the total value. And also in the "Education history" category, 199 individuals are missing for the total sum of the population. We appreciate the reviewer's pointing out our error. The number for Ethnicity category was our typo. We have corrected the number in Table 2 (no missing for the ethnicity category). The information on the Education History of 199 individuals were missing. We have added the footnote for the information. 10. In the paragraph of the section "Seroprevalence of HBsAg" (lines 182 to 195) and "Seroprevalence of HCV-Ab" (lines 210 o 220), provide the absolute number of the number of cases for the data presented. We appreciate the reviewer's comment on this point. As we mentioned in the Methodology section, the survey results should be demonstrated in "estimated prevalence (95% CI)", considering the sampling weight of each sample to elicit representative and unbiased results. Showing "absolute numbers" in the Result section might confuse the readers. Instead, we have added the absolute numbers in Table 3 and 4. We would appreciate if the reviewer could accept our response. 11. Table 3 and 4 - Provide the absolute number of cases for the data presented. We appreciate the reviewer's suggestion in Table 3 and 4. We have added the absolute numbers of cases for the date presented in Table 3 and 4 as the reviewer suggested. 12. Discussion: Lines 239 to 240 - Because the study offered as a comparison was conducted on a relatively specific group, the placement should be interpreted with caution. Studies in different communities and areas may demonstrate different or equal prevalences for HCV, where women may have a greater or equal soprevalence for HCV than males. (Niu et al, 2016 [DOI: 10.1186/s40064-016-3224-z]; Peliganga et al, 2021 [DOI: 10.3390/pathogens10121633]; Rangel et al, 2021[DOI: 10.1016/j.clgc.2020.08.006]; Bisseye et al, 2018). We appreciate the reviewer's very important comment, together with some helpful reference papers. We have agreed on this point and decided to remove the sentence related to the epidemiology in gender to avoid misinterpretation. 13. Discussion: Lines 258 to 259 - The placement presented was unclear. However, there were no cases in adults under the age of 30, and was maternal-infant transmission suspected? Did you mean to mean those over the age of 40? In addition, the fact that the prevalence of hepatitis C grows with age, as studies have demonstrated, is an interesting approach to consider and discuss. (Peliganga et al, 2021 [DOI: 10.3390/pathogens10121633]; Abdella, et al, 2020 [DOI: 10.1371/journal.pone.0241086]; Vermeulen et al, 2017 [DOI: 10.3201/eid2309.161594]). We appreciate the reviewer's clarification. Since our survey did not find any positive cases in younger age group (under 30 years old), we assumed that the transmission might be circulated mainly among adults (horizontal transmission) rather than mother-to-child (vertical transmission). We also appreciate the reviewer’s suggestion on the discussion point with some reference papers. We have added the sentence, using those papers as references. 14. Discussion: Lines 269 to 270 - The term used is out of date and should be replaced by sexually transmitted infections. We appreciate the reviewer's suggestion. We have replaced the term as the reviewer recommended. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0278933.r002
27 Oct 2022 Decision Letter - Livia Melo Villar, Editor PONE-D-22-13251R1Prevalence of hepatitis B and C virus infections in Lao People’s Democratic Republic: the first national population-based cross-sectional surveyPLOS ONE Dear Dr. Miyano, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Dec 11 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Livia Melo Villar Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments : Dear Author, Thanks for sending the revision of this manuscript. After reading the comments of reviewers, I suggested minor revision, Sincerely, Livia Villar [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear authors, The manuscript was improved considerably. Most of my queries were addressed. However, I would suggest that a careful review of the language be carried out before publication. Reviewer #2: I don't have any other observations. All comments have been addressed. I congratulate the authors for their work. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0278933.r003
Revision 2
28 Oct 2022 Author Response Reviewer #1: Dear authors, The manuscript was improved considerably. Most of my queries were addressed. However, I would suggest that a careful review of the language be carried out before publication. We appreciate the reviewer's suggestion. We requested English proofreading by native English speakers and made some corrections and revisions. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0278933.r004
24 Nov 2022 Decision Letter - Livia Melo Villar, Editor Prevalence of hepatitis B and C virus infections in Lao People’s Democratic Republic: the first national population-based cross-sectional survey PONE-D-22-13251R2 Dear Dr. Miyano, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Livia Melo Villar Academic Editor PLOS ONE Additional Editor Comments (optional): Dear Author, Thanks for sending me the paper for my evaluation. After reading reviewer's comments and author's response, I recommend the publication of this paper, sincerely, Livia Reviewers' comments: https://doi.org/10.1371/journal.pone.0278933.r005
Formally Accepted
20 Dec 2022 Acceptance Letter - Livia Melo Villar, Editor PONE-D-22-13251R2 Prevalence of hepatitis B and C virus infections in Lao People’s Democratic Republic: the first national population-based cross-sectional survey Dear Dr. Miyano: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Livia Melo Villar Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0278933.r006

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