Seroprevalence of Hepatitis B and Hepatitis C virus

The New Iraqi Journal of Medicine

Research Report

Seroprevalence of Hepatitis B and Hepatitis C virus infection in Iraq

Lazim Hamied *, Rana Mujahid Abdullah**, Arwa Mujahid Abdullah***

Abstract Background: Hepatitis B virus and Hepatitis C virus are common causes of acute and chronic liver disease. Objective: To determine the prevalence of Hepatitis B and Hepatitis C virus infection. Patients and Methods: This study was carried out on (8679) patients selected from Al- Karama hospital in Baghdad from January 2001 to December 2002 .The patients were divided into two groups: outpatient and inpatient. They were screened for Hepatitis B surface antigen (HBs Ag) and anti Hepatitis C (Anti HCV) by Enzyme Linked Immunosorbent Assay (ELISA). The patient's ages ranged (0-70) years amongst male and female. Results: The frequency of HBs Ag 73(9.12%) and anti-HCV 727(90.87%), the result were indicative of much higher probable prevalence of HCV amongst population than hepatitis B. Positive cases amongst male (63.6%) and female (36.37%) , male being more affected than female .The highest prevalence of Hepatitis B was detected in the Health care workers followed by the dialysis group and the highest prevalence rat of Hepatitis C was detected in the Health care workers followed by Renal transplant group. Conclusion: The prevalence of HBs Ag and anti-HCV in patients is very high. It has been recommended that properly screened blood, using a reliable method like ELISA. Keywords: HBV, HCV, ELISA. The N Iraqi J Med, December 2010; 6(3): 69-73.

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epatitis B and C are the most common cause of chronic liver disease (1). Over 20 million people are infected annually with hepatitis B globally and there are 350 million chronic carriers. The aim of this paper to determine the prevalence of Hepatitis B and Hepatitis C virus infection.

PATIENTS AND METHODS Total of (8,679) patients were selected randomly from Al-Karama hospital in Baghdad from January 2001 to December 2002. (Ph.D.) Lecturer, Department of Microbiology. College of Medicine / University of Al_ Nahrain. ** (Ph.D.) Lecturer Department of Microbiology. Ibin alhaythim college / University of Baghdad *** (M.Sc) Assistant Lecturer Department of Microbiology College of Medicine / University of Al_ Nahrain e-mail : Lazem_Altaie *

The patients were divided into two groups: outpatient included (friseur, marriage examination, dentistry, laboratory, blood bank, internal medicine, other professions and total Health care workers ) and inpatient included (renal transplant and dialysis). The data requested included age, sex and month of the year. Serological analysis:All samples were examined using enzyme linked immunosorbant assays; For HBs-Ag, kits were purchased from Omega diagnostics limited, pathozyme HbsAg, UK. For HCV Ab detection; Kits used were either from Ortho-Diagnostics, UK or Innogenetics, Innotest, Belgium according to the purchasing order. Five ml venous blood was collected from each patient. Clear serum was obtained by centrifugation. The serum was transferred to a disposable container for HBVAg and anti HCV antibodies determination using ELISA technique. Third generation enzyme immuosorbent assay EIA for screening for anti HCV


. Lazim Hamied , Rana M. Abdullah, Arwa Mujahid Abdullah

using the commercially available kits. Thirdgeneration micro particle Enzyme Immunoassay (EIA) was used for HBsAg assessment.

patients of hepatitis C according the month of the year and source of isolate.

Sera from all these groups of population were examined for HBsAg and HCV Ab. For HBsAg markers, ELISA techniques (Bio test ) was used as a screening test which is later confirmed by using RANDOX ELISA and it s a confirmatory test. For detection of anti HCV Ab marker, (UBI 4.0) test was used as a screening test, which is, then validated by Lia Tek ELISA test.

The highest prevalence of Hepatitis B was detected in Health care workers followed by the Dialysis group and those of Renal transplant and Laboratory group were also at risk of exposure but to a lesser extent. The highest prevalence rate of Hepatitis C was detected in the Health care workers followed by the Renal transplant; Dialysis group and Laboratory group (Table 3).

Statistics analysis:The data were entered in computer and analysis by SPSS for windows. The means, percentages were calculated.

These variations in the prevalence of HBV and HCV among patients group were not statistical significant.

Statistical analysis was done using descriptive statistics. Chi- square test and student t test were used to test statistical difference between patients with HBV and HCV. P Value < 0.05 was considered indicative of statistically significant differences.

The frequency of HBsAg was detected. Male being more affected than female (0.668- 0.172) % in patient with hepatitis B (Table 4). In contrast, very high positivity has been detected for HCV antibodies. Male has been detected to an extent of (5.19) % while in female as (3.18) % as shown in Table 5. No significant statistical difference in anti-HCV and HBV Ag seropositivity was observed between males and females. The age range of all patients was 0-70 years. The highest prevalence of Hepatitis B was in age 21-30 years followed by age 11-20 years and 31-40 years while the highest prevalence of Hepatitis C was in age 11-20 years followed by age 0-10, and 21-30 years. The statistic analysis show no significantly different between the age patients and the type of hepatitis.

RESULTS A total of (800) positive patient from (8,679) samples were selected randomly from Al-Karama hospital in Baghdad from January 2001 to December 2002. The frequency of HBsAg was 73 (0.84%) and that of anti-HCV was 727(8.37%), the result was indicative of much higher probable prevalence of HCV amongst population than HBsAg. Table 1 shows the distribution of positive patients of hepatitis B according to the month of the year and the source of isolate. Table 2 shows the distribution of positive

Tables 6 and 7 show the distribution of hepatitis B and C according to patient age.

Table (1): Distribution of Hepatitis (B) Patient According The Month of The Year Year January February March April May June July August September October November December Total

Test 136 142 197 365 230 189 112 93 347 185 139 162 2297

+Ve 2001 3 7 2 1 2 1 2 7 25

Test 436 263 283 10 63 82 63 112 281 130 125 143 1991

+Ve 2002 3 9 4 6 1 2 3 5 7 5 3 48

Total (%) 3(0.034) 9(0.10) 7(0.08) 7(0.08) 6(0.069) 3(0.034) 3(0.034) 5(0.057) 5(0.057) 8(0.09) 7(0.08) 10(0.115) 73(0.84)

The N Iraqi J Med August 2010; 6(3):69-73 70



Table (2): Distribution of Hepatitis (C) Patient According The Month of The Year. Year January February March April May June July August September October November December Total

Test 136 220 232 365 230 189 137 135 347 185 139 162 2400

+Ve 2001 20 9 59 46 26 7 20 24 73 40 54 12 390

Test 436 263 283 10 63 82 63 112 281 185 125 143 1991

+Ve 2002 45 57 48 12 5 7 13 57 35 37 21 337

Total (%) 65(0.74) 66(0.76) 107(1.23) 46(0.53) 38(0.43) 12(0.138) 27(0.311) 37(0.426) 130(1.49) 75(0.86) 91(1.048) 33(0.38) 727(8.37)

Table 3: Prevalence of Hepatitis (B ) And (C) Among Different Patient Groups Patient Outpatient Friseur Group Marriage Examination Dentistry Group Laboratory Group Blood Bank Internal Medicine Other Professions Total Health Care Workers Inpatient Renal Transplant Dialysis Group Total (%) * Mean of Hepatitis B (7.3) * Mean of Hepatitis C (72.7) *** P Value < 0.05

Hepatitis B No. + ve

Mean ±SD

Hepatitis C No. + ve

49 100 200 150 129 78 73 350

3 5 7 3 3 2 25

0 ±0.0589 ±0.03151 ±0.00411 ±0.0589 ±0.0589 ±0.0726 ±0.242466

33 183 84 215 155 69 263 382

27 55 15 112 36 44 30 155

±0.06286 ±0.02435 ±0.07937 ±0.054058 ±0.05048 ±0.03948 ±0.05873 ±0.113205

1753 1406 4288(49.4)

8 17 73(0.84)

±0.009589 ±0.132877

1500 1707 4391(50.59)

150 103 727(8.37)

±0.107015 ±0.041678

Table (4): Distribution of Hepatitis B According Patient Sex. Sex Total Male 58 Female 15 Total 73 *Mean of sex 36.5 ** P Value < 0.05

Mean ±SD ±0.294521 ±0.29452

Mean ±SD

(%) (0.668) (0.172) (0.84)

Table (5): Distribution of Hepatitis (C) According Patient Sex Sex Male Female Total *Mean of sex 363.5 ** P Value < 0.05

Total 451 276 727

Mean ±SD ±0.120358 ±0.12036

(%) (5.19) (3.18) (8.37)

Table (6): Distribution of hepatitis B according to patient age. Age 0-10 11-20 21-30 31-40 41-50 51-60 61-70 Total *Mean of age: - (10.42) 31-40

2001 3 13 25 4 3 48

2002 1 3 6 10 4 1 25

Total (%) 4 (0.046) 16 (0.184) 31 (0.357) 14 (0.161) 7 (0.080) 1 (0.01) - (0) 73 (0.84)




Table (7): Distribution Of Hepatitis C According To Patient Age. Age 0-10 11-20 21-30 31-40 41-50 51-60 61-70 Total *Mean of age: - (103.85) 31-40

2001 57 180 55 33 10 2 337

2002 84 205 61 25 12 3 390

Total (%) 141 (1.624) 385 (4.435) 116 (1.912) 58 (0.668) 22 (0.253) 5 (0.057) - (0) 727(8.37)

Education level, male sex, higher age and positive family history of jaundice may be considered as important risk factors (5).

DISCUSSION In this study patients were tested for HBsAg and anti HCV antibodies by ELISA. We found that the prevalence of hepatitis B was (0.84%). This result is comparable with Shah et al. and Mohmet et al. who found that 0.84 % (2).

The problem of viral hepatitis in hospital populations around the world has not been adequately studied, although hospitalized patients overall and especially certain high risk groups among them, represent a possible source for viral hepatitis infection of medical, nursing and auxiliary personnel caring for them as well as for their relatives at home. The prevalence of HBV and HCV markers in hospitalized patients has been published, in isolated groups of high-risk patients or hospital workers worldwide (9) .

Genotyping is important because it provides information as to strain variation and potential association with disease severity. In addition, it is of epidemiologic value because it sheds light on whether prevalent HCV strains are similar to that endemic in a certain region, such as herein in the Middle East. The most common genotype of Yemen, Kuwait, Iraq, and Saudi Arabia is type 4 (3) .

In our study male (63.6) % and female (36.37) %, this comparable with the studied of Masood et al. and Koulentaki et al. (9, 10). The results are also indicative of much higher probable prevalence of HCV amongst normal population than hepatitis B. Results reveal that male dominates female. It may be due to gender preference, commonly seen in access to health care facilities (2) .The higher prevalence of HBV in age 21-30 years, anti-HCV prevalence increases with age reaching the higher prevalence in the age group of 11-20 years. The low level of prevalence in children category 0-1 years of age may be due to the effect of maternal immunity.

Egypt is a developing country where hepatitis B and C infections are still prevalent. The overall prevalence of antibodies to HCV in the general population is around 15-20%, this apparently high prevalence of HCV infection in Egypt is of importance, because of the potential adverse impact of HCV on the public health of Egyptians (4) . Another study showed that the prevalence of HBV infection in the South Eastern region of Turkey is at an intermediate level. The ratio of HBsAg positivity, which might represent chronically HBV carriers, was 7% for this southeastern region and this ratio was higher than in urban (5). Chronic renal failure is by itself a risk factor for HBV and HCV infection even if these patients are not on dialysis; hemodialysis on the other hand was associated with very high prevalence for HCV Ab and for HBsAg. Different studies on prevalence of HCV in these patients showed different results. In Saudi Arabia it was 50-90% (6), Iran 28.1% (8) , Romania, 91.7% (8).In this study the highest prevalence of hepatitis B and C were detected in the Health care Workers followed by the dialysis group and those of renal transplant.

CONCLUSION Further studies are recommended to include data about anti-HBs; HCV-RNA levels in the patients as it give us information about post infections and immunization level. Also study the correlation between HBV and HCV infection to ALT level in the tested patients.




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Lazim Hamied, Rana Mujahid Abdullah, Arwa Mujahid Abdullah Seroprevalence of Hepatitis B and Hepatitis C virus infection in Iraq

The New Iraqi Journal of Medicine Research Report December 2010; 6(3): 69-73


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