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ORIGINAL ARTICLE |
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Volume 25 |
July - September 2009 |
Number 4 |
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Published by : PROFESSIONAL MEDICAL PUBLICATIONS |
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ISSN 1681-715X |
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ORIGINAL ARTICLE |
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Volume 25 |
July - September 2009 |
Number 4 |
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Prevalence of Hepatitis B and C infection in patients
admitted at Tertiary Eye Care Centre: A Hospital based study
Sameen Afzal Junejo1, Nisar Ahmed Khan2, Arshad Ali Lodhi3
ABSTRACT
Objective: To determine the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and the risk factors in patients admitted for ocular treatment at a tertiary eye care centre in Sindh Pakistan.
Methodology: Nine hundred thirty one patients admitted at Liaquat University Eye hospital Hyderabad for ocular treatment, were screened for HBV and HCV. Patients of either sex, with more than thirty years of age were included. Screening for HBV surface antigen (HBsAg) and antibodies against HCV (anti-HCV) was performed through chromatography method. Samples repeatedly reactive for HBsAg or anti-HCV were considered positive.
Results: Out of 931 registered patients, 497 (53.3%) were male and 434 (46.7%) female. Hepatitis B and C was detected in 167 (17.9%) subjects. The overall seroprevalence of HBV infection within the study period was 4.6%, HCV 13.3%, and for HBV and HCV both was 3.9%. Regarding the predisposing factors, past history of blood transfusion was present in 08.3% subjects, needle injection 89.2%, barber shaving 52.6%, and 46 (27.5%) patients presented with past history of surgery.
Conclusion: For the prevention of transmission of HBV and HCV infection, the community awareness regarding vaccination against Hepatitis – B and risk factors for spread of HBV & HCV, implementation of population based screening and vaccination for HBV on large scale should be ensured.
KEY WORDS:
Hepatitis B and C, Risk Factors, Hyderabad Sindh, Pakistan.Pak J Med Sci July - September 2009 Vol. 25 No. 4 597-600
How to cite this article:
Junejo SA, Khan NA, Lodhi AA. Prevalence of Hepatitis B and C infection in patients admitted at Tertiary Eye Care Centre: A hospital based study. Pak J Med Sci 2009;25(4):597-600.
1. Dr. Sameen Afzal Junejo, MCPS, DOMS, FCPS
2. Dr. Nisar Ahmed Khan, FCPS
3. Dr. Arshad Ali Lodhi, FCPS
1-3: Liaquat University of Medical and Health Sciences,
Jamshoro - Sindh, Pakistan.
Correspondence
Dr. Sameen Afzal Junejo, MCPS, DOMS, FCPS
Associate Prof. Ophthalmology, Incharge Unit-III,
Liaquat University Eye hospital Hyderabad.
Liaquat University of Medical and Health Sciences,
Jamshoro / Hyderabad, Pakistan.
E-Mail: sameenafzal1@gmail.com
* Received for Publication: January 30, 2009
* Revision Received: February 9, 2009
* Revision Accepted: June 29, 2009
INTRODUCTION
Hepatitis B virus has become a universally established health challenge due to its world wide distribution, chronic persistence and complications. Hepatitis C virus was first identified in 1988.
1 HBV and HCV infection is found in blood recipients, shaving of face by barbers, and following dental surgery.2About 8 to 16 million HBV and 2.3 to 4.7 million HCV infections may result every year from unsafe injections.
3The clinical presentation of hepatitis B and C virus infection is usually the abdominal pain, malaise, appearance of jaundice. 4 Hepatitis C virus can also cause silent infection, and persist for 10 to 30 years without producing symptoms.
5 Complications of hepatitis B and C virus are portal hypertension, Cirrhosis, ascitis and esophageal varices.6According to one global survey, about two billion people are infected with hepatitis B virus,
7,8 and more than 350 million of population is a carrier for hepatitis B virus.9 In India HBV infection is nearly 3-4%, and chronic hepatitis B is reported in more than 50% of chronic hepatitis cases.10In Hiroshima Japan, the existence of HBV infection was 2.78 per 100,000 persons per year and with HCV about 1.86 per 100,000 persons per year.
11 In China nearly 10% of China’s total population are suffering from HBV infection.12In Pakistan HBV infected patients are estimated around 7 million.
13 In one study from Hafiz Abad, Punjab, HBV Seroprevalence was 4.3% and HCV infection in 6.5% of the total studied population.14 In a national survey from northern Pakistan, 2.5% of blood donors had HBV, and 5.1% were HCV victims.15The global Seroprevalence of hepatitis C is estimated about one hundred and seventy million of population per year and the spread of three to four million.
16METHODOLOGY
Study Area: This descriptive hospital based study was conducted between July, 2007 to June, 2008 at Liaquat University Eye Hospital, Hyderabad. This hospital is a ninety bed university based hospital of Liaquat University of Medical and Health Sciences Jamshoro, Sindh, that offers both emergency eye care and specialized care for patients of all ages. The pathological research laboratory is situated in the hospital premises.
Patient’s Assessment: After getting verbal consent from all eligible subjects, pre-test counseling was done with the assurance that all information obtained would be kept confidential and for the purpose of research only.
Inclusion Criteria: All Patients above thirty years, with either sex, having no documented past history of chronic liver disease, HBV or HCV infection, admitted for ocular treatment were included, Patients requiring urgent surgical intervention were excluded from screening.
The subjects were interviewed on a structured questionnaire regarding age, sex, place of residence, literacy level, exposure to blood transfusions, visit to barber shops, any history of surgery, family history etc.
Screening for HBV and HCV:
A two to three-milliliter blood sample was collected by venepuncture aseptically into a sterile test tube from each patient and tested for HBsAg and anti HCV antibodies within first 24 hours of collection. The screening was performed through rapid chromatography immunoassay for qualitative detection of surface antigen of hepatitis-B and antibodies for hepatitis-C virus, using a kit, Accurate / Acou device (Made IN USA). All investigations were performed under the supervision of a consultant pathologist.Samples positive for either HBV or HCV were re-tested for second time by the same method. Samples repeatedly reactive for HBsAg or anti-HCV were considered positive. The subjects positive for HBV or HCV were referred to the department of Medicine for further evaluation and treatment.
RESULTS
A total of nine hundred and thirty one (931) admitted patients under went screening for HBV and HCV. General characteristics of study population are given in Table-I.
Hepatitis B and C virus infection was detected in one hundred and sixty seven (17.9%) patients out of 931. The overall seroprevalence of HBV infection within the study period was 4.6% (43 patients), for HCV 13.3% (124 patients), and HBV and HCV both 3.9% (37 subjects).
Details regarding sero-prevalence of Hepatitis B & C are given in Table-II while risk factors are shown in Tables-III.
DISCUSSION
The burden of HBV and HCV disease is increasing globally and Pakistan is no exception. Sindh province, which is one of four provinces in Pakistan, has a population of 30,439,893. The rural proportion of Sindh province (interior Sindh) is 74% of total population of Sindh. Hyderabad is the second largest city after Karachi, in Sindh and fifth largest in Pakistan.
17In one retrospective survey from Pakistan, the prevalence of HBV in Lahore in 1999 was 5.05%, Karachi in 2000 was 5.46% and in the year 2004, was 5.83%, Rawalpindi in 2002 was 3.53%, Islamabad in the year, 2004 was 2.56%, and in Fuji Foundation hospital Rawalpindi in 2006, prevalence of hepatitis B was 2.28%, for hepatitis C was 7.56%.
18 Collectively the prevalence of hepatitis B virus in Pakistan was reported from 3.16% to 10.4% in studies conducted at different places in the past.19 In this study the Seroprevalence of hepatitis B was 4.6%. World Health Organization estimates that about sixty seven million new hepatitis B infections occur every year.20The seroprevalence of HCV is 14.4% in southern Italy.
21 While in general adult population of Japan it is 0.4%, in Turkey the seroprevalence of HCV is 2.4%.22 According to one general survey, approximately ten million people in Pakistan (6% of the population) are suffering from hepatitis C infection.23,24In one retrospective national survey from Pakistan, the seroprevalence of HCV in Karachi in the year 2003 was 2.2%, Lahore in 2004 was 13.5%, Rawalpindi in 2005 was 11.26%.
21 The prevalence of hepatitis C in Buner NWFP Pakistan was 4.57% in general.25 In this study, the seroprevalence for HCV was 13.3%.The prevalence of dual infection by HBV and HCV in this study was 3.9%, as compared to another study from India where it was 5%.
26CONCLUSION
Timely identification of people suffering from HBV or HCV infection is mandatory to control rapid spread in Pakistan. Special consideration should include training of medical and paramedical staff, awareness of public on large scale, proper sterilization of instruments, double gloving, and proper disposal of used needles in order to save our future generation.
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