|Year : 2019 | Volume
| Issue : 1 | Page : 29-32
Seroprevalence of hepatitis B virus in blood donors at a large teaching hospital of Pakistan: A potential health policy concern
Sikander Abdullah1, Sarmad Zahoor2, Muhammad Ahmad Rao1, Syed Maaz Abdullah2, Sadia Asif3, Abdul Wajid4, Abdul Rehman Zia Zaidi5
1 King Edward Medical University, Mayo Hospital, Lahore, Pakistan
2 Department of Medicine, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
3 Department of Emergency Medicine, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
4 Medical Officer, Sir Ganga Ram Hospital, Lahore, Pakistan
5 Adult Hematology/BMT, King Fahad Medical City, Riyadh, Saudi Arabia
|Date of Web Publication||30-Apr-2019|
Dr. Syed Maaz Abdullah
11/A, Block W, Model Town C, Bahawalpur
Source of Support: None, Conflict of Interest: None
BACKGROUND: Hepatitis B is an important public health problem for Pakistan. Being asymptomatic in many of the carriers, it needs screening to assess disease burden. Screening blood donors will not only help point out the subliminally diseased individuals but will also offer a boost to treatment rates and preclude the dreaded complications in the affected population.
AIM: The aim of this study is to estimate disease burden and depict current trend of Hepatitis B in healthy blood donors by assessing its prevalence at one of the largest hospitals of Pakistan over a 2-year interval. This will serve to offer a direction to health policymakers to channel their resources in an attempt to accelerate diagnostic, preventive, and therapeutic measures against the disease.
METHODOLOGY: It is a retrospective single-center cross-sectional study. We screened 76,530 healthy blood donors for hepatitis B virus (HBV) visiting Mayo Hospital, Lahore, Pakistan during 2016 and 2017 with rapid test kits which used lateral flow immunoassay based on the principle of double antibody sandwich technique.
RESULTS: Out of 76,530 donors in 2016 and 2017, we detected 1262 donors (1.65%) positive for hepatitis B viral serology.
CONCLUSION: We found a positivity rate of 1.65% of hepatitis B in healthy blood donors during 2 years. Although in comparison to 2016, the positivity rate has somewhat declined in 2017, but it remains worrisome. Our findings endorse the need for policy making to sustain and amplify the current HBV screening and treatment strategies and enhance public awareness.
Keywords: Healthy blood donors, hepatitis B, hepatitis B virus, Pakistan, prevalence
|How to cite this article:|
Abdullah S, Zahoor S, Rao MA, Abdullah SM, Asif S, Wajid A, Zia Zaidi AR. Seroprevalence of hepatitis B virus in blood donors at a large teaching hospital of Pakistan: A potential health policy concern. J Appl Hematol 2019;10:29-32
|How to cite this URL:|
Abdullah S, Zahoor S, Rao MA, Abdullah SM, Asif S, Wajid A, Zia Zaidi AR. Seroprevalence of hepatitis B virus in blood donors at a large teaching hospital of Pakistan: A potential health policy concern. J Appl Hematol [serial online] 2019 [cited 2023 May 29];10:29-32. Available from: https://www.jahjournal.org/text.asp?2019/10/1/29/257466
| Introduction|| |
Hepatitis B, caused by a DNA virus known as hepatitis B virus (HBV) belonging to the family DNA-Viridae, is mainly an infection of the liver which can lead to its cirrhosis, hepatocellular carcinoma and hepatic failure causing 563,000 deaths in a year.,,, Viral hepatitis being a public health problem globally is endemic in developing countries as well. Pakistan being a 3rd world country has met it as a public health problem as well as an endemic., It is estimated that on a worldwide basis, two billion people are exposed to it and 350 million of whom are infected with HBV. HBV is a silent killer with many of its carriers having this life-threatening infection without even realizing it. This has also contributed in increasing its burden due to the widespread unawareness among masses.,
The spread of HBV is contributed by the use of unsterilized injections, sexual contact with affected individuals, tattooing, transfusion of infected blood and vertical transmission from infected mother to child., In Pakistan, use of unsterilized syringes has been proven to be the main culprit for HBV spread.
A literature review of published data on HBV from 1996 to 2009 showed a seropositive occurrence of HBV to be 3.09%, 3.28%, 4.8%, 4.51%, and 2.12% in Punjab, Islamabad, Baluchistan, Sindh, and N. W. F. P, respectively, among blood donors. In Pakistan, distribution of its seroprevalence is 2.4% (range 1.4%–11.0%) in the general population. A study of healthy blood donors of Southern Pakistan during 1994–1998 gave a result of 2.28% for HBV and 3.3% in Northern Pakistan during 1996–2000 in another study with a decreasing trend from 5.22% (1996) to 2.60% (2000)., A study of Lahore at Shaukat Khanum Hospital among blood donors, over a period of 10 years (1996–2005) proved to have an overall seroprevalence of 2.2% for HBV which continued to increase till 1998 from 2.16% to 2.99% with a later decrease from 2.69% to 1.65% during the next years. Few other studies of Lahore proved seroprevalence for hepatitis B to be 1.70% (2008), 3.36% (2005), and 1.52% (2007).,, Other major cities of Punjab also have a considerable occurrence of HBV in blood donors with Multan having a prevalence of 3.37%, Islamabad of 3.91%, and Rawalpindi of 2.45%.,,
It is very difficult to screen the whole population for HBV to assess its burden in countries like Pakistan with low budget and poor health facilities. Blood transfusion being an important source of its transmission can be used to assess disease burden in recent past in addition to prevent the spread of disease. Since around 1.5 million people donate blood in Pakistan each year, screening of healthy donors can give us an estimate of disease prevalence although not accurately exhibiting the situation of the whole population., Here, we have screened healthy blood donors visiting a tertiary care center of Lahore with a referral base from all over Pakistan to assess the magnitude of disease prevalence.
| Methodology|| |
This was retrospective single-center cross-sectional study.
The present study was conducted at Mayo Hospital, Lahore, one of the largest teaching hospitals, with a referral base from all over Pakistan.
Data of 76,530 healthy blood donors were collected from hospital blood bank for a period of 2 years (from January 2016 to December 2017).
The age group of patients between 19 and 60 who are not known to have any chronic illness or are at high risk of developing hepatitis were included in the study.
During pre-donation screening, potential donors <19 and >60 years of age, high-risk populations, including IV drug abusers, sex workers and those with chronic kidney disease or chronic liver disease (due to any other cause) were excluded from the study.
Donors were screened for hepatitis B surface antigen (HBsAg) by using rapid test kits. In this study period, DS (Diagnostar) kits were used. These are qualitative test kits for the detection of HBsAg in the blood or plasma. In this method, a combination of polyclonal and monoclonal antibodies was used to selectively detect raised levels of HBsAg in the plasma or serum. This test is a lateral flow immunoassay which is based on the principles of double antibody sandwich technique. The membrane in the test is coated with HBsAg antibodies in the region of the test line. Serum or plasma when applied to sample well migrates by capillary action to test line region where it reacts with HBsAg antibodies. The presence of a colored line is an indicator of reaction with antibody and hence signals the presence of HBsAg in the specimen.
| Results|| |
We screened a total of 76,530 healthy blood donors in the year 2016 and 2017 following said inclusion and exclusion criteria visiting Mayo hospital, Lahore. We found that among these, a total of 1262 (1.65%) donors were screened positive for both years collectively. The seroprevalence came out to be 1.78% (696) and 1.51% (566) for years 2016 and 2017, respectively.
| Discussion|| |
Hepatitis B, a disease mainly affecting the architecture and function of the liver, causes 563,000 deaths annually around the world, is endemic in Pakistan. Hepatitis B infection can be transmitted through blood transfusion. Screening of blood donors gives an idea about the magnitude of the disease in the community and helps to treat asymptomatic carriers of HBV.
In this study, 1262 (1.65%) donors from a total of 76,530 healthy blood donors were positive for HBV which is still a high percentage in community despite the availability of vaccination and gradually evolving improved treatment regimens.,,, Seroprevalence of HBV among healthy blood donors is found to be different in different cities of Pakistan such as 3.91% in Islamabad, 3.37% in Multan, and 2.45% in Rawalpindi.,, Other studies done at Lahore among healthy blood donors have retrospectively suggested comparable percentages such as 1.52% (2007) and 1.78% (2008).,
An encouraging fact that is evident from the result of our study is a decreasing trend in the percentage of HBV prevalence from 2016 to 2017. The literature on this subject is also suggestive of the same trend. Examples of such a trend include a 10 years' experience at Shaukat Khanum memorial hospital, 5-year experience in Northern Pakistan and a study at Agha Khan Hospital, Karachi., All these studies have shown a decreasing trend in the prevalence of HBV in healthy donors over time which implies a decreasing burden of disease. Our results are in accordance with previous studies and depict improvement in the situation disease burden in our community of blood donors. This indicates that the current preventive and curative practices are being channeled to the right direction, although slowly.
Nevertheless, HBV is still putting a great load on health budget and is a big challenge for health policy makers because it remains far from being eradicated. This necessitates measures to intercept the spread of HBV and treat the infected patients. Proper HBV vaccination should be given to children as recommended by the WHO and has been included in expanded program on immunization. Treating HBV at an early stage and in asymptomatic patients diagnosed incidentally on screening can reduce disease burden. Treatment of HBV should be made available at low cost and should be made easily accessible to people particularly those at higher risk. Following treatment initiation, patients' compliance with treatment should be ensured by scheduling regular follow-ups. Governmental and voluntary projects are needed to limit disease spread by mass education, awareness campaigns about disease transmission and prevention methods using social media, seminars, pamphlets, etc., Each blood donation must be screened for HBV. To channelize limited resources in the middle of increasing general population, regular screening of high-risk groups is recommended. In addition, health policies should be formulated which involve surveillance and interception of high-risk behaviors like IV drug abuse etc. Thus, adopting pertinent preventive measures and stepping up treatment coverage may help in reducing HBV prevalence in the population.
| Conclusion|| |
In our study, a positivity rate of 1.65% of hepatitis B in healthy blood donors was found during 2 years. Although in comparison to 2016, the positivity rate has somewhat declined in 2017, but it still remains significantly considerable. Our findings endorse the need for policy making to sustain and amplify the current HBV screening and treatment strategies and enhance public awareness in order to maintain the current decreasing trend in disease burden ultimately to a goal of disease free state.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Barker LF, Shulman NR, Murray R, Hirschman RJ, Ratner F, Diefenbach WC, et al.
Transmission of serum hepatitis 1970. JAMA 1996;276:841-4.
Pungpapong S, Kim WR, Poterucha JJ. Natural history of hepatitis B virus infection: An update for clinicians. Mayo Clin Proc 2007;82:967-75.
Zuckerman AJ. Hepatitis viruses. In: Baron S (ed.); Baron's Medical Microbiology, 4th
ed. Galveston (TX), University of Texas, Medical Branch, Texas. 1996.
Perz JF, Armstrong GL, Farrington LA, Hutin YJ, Bell BP. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006;45:529-38.
Deinhardt F, Abb J, Assad F. Viral hepatitis. Bull WHO 1983;61:203-6.
Zuberi SJ, Lodi TZ, Alam SE. Spectrum of viral hepatitis. J Pak Med Assoc 1991;41:288.
Dienstag JL. Hepatitis B virus infection. N Engl J Med 2008;359:1486-500.
Samuel D, Muller R, Alexande G. Educational research, national hepatitis B virus programme. Infect Dis 2004;234:221-332.
Ahmad K. Pakistan: A cirrhotic state? Lancet 2004;364:1843-4.
Gitlin N. Hepatitis B: Diagnosis, prevention, and treatment. Clin Chem 1997;43:1500-6.
Francisci D, Antonelli S, Preziosi R, Mecozzi F, Stagni G, Pauluzzi S, et al.
Risk factors for acute parenterally transmitted viral hepatitis: A 20-year study. Eur J Epidemiol 1993;9:625-8.
Usman HR, Akhtar S, Rahbar MH, Hamid S, Moattar T, Luby SP, et al.
Injections in health care settings: A risk factor for acute hepatitis B virus infection in Karachi, Pakistan. Epidemiol Infect 2003;130:293-300.
Khan NU, Siddique L, Ali I, Iqbal A, Munir I, Rashid F, et al
. Prevalence of hepatitis B in the blood donors of NW.F.P and FATA regions and the current scenario of HBV infection in Pakistan. Afr J Biotechnol 2010;9:6162-6.
Ali SA, Donahue RM, Qureshi H, Vermund SH. Hepatitis B and hepatitis C in Pakistan: Prevalence and risk factors. Int J Infect Dis 2009;13:9-19.
Kakepoto GN, Bhally HS, Khaliq G, Kayani N, Burney IA, Siddiqui T, et al.
Epidemiology of blood-borne viruses: A study of healthy blood donors in Southern Pakistan. Southeast Asian J Trop Med Public Health 1996;27:703-6.
Khattak MF, Salamat N, Bhatti FA, Qureshi TZ. Seroprevalence of hepatitis B, C and HIV in blood donors in Northern Pakistan. J Pak Med Assoc 2002;52:398-402.
Sultan F, Mehmood T, Mahmood MT. Infectious pathogens in volunteer and replacement blood donors in Pakistan: A ten-year experience. Int J Infect Dis 2007;11:407-12.
Manzoor I, Hashmi N, Daud S, Ajmal S, Fatima H, Rasheed Z, et al
. Seroprevalence of transfusion transmissible infections (TTIS) in blood donors. Biomedica 2009;25:154-8.
Asad UI, Fuad S, Naveed A, Mahmood NM, Riaz Q. Hepatitis B and hepatitis C in blood donors. Ann King Edward Med Coll 2007;13:59-61.
Sirhindi GA, Khan AA, Alam SS, Ghori MA, Rehman R, Soomro NA, et al
. Frequency of hepatitis B, C and human immunodeficiency virus in blood donors at Shaikh Zayed hospital, Lahore. Proceeding SZPGMI 2005;19:33-6.
Mahmood MA, Khawar S, Anjum AH, Ahmed SM, Rafiq S, Nazir I, et al
. Prevalence of hepatitis B, C and HIV infection in blood donors of Multan region. Ann King Edward Med Coll 2004;10:459-61.
Waheed U, Khan H, Satti HS, Ansari MA, Malik MA, Zaheer HA. Prevalence of transfusion transmitted infections among blood donors of a teaching hospital in Islamabad. Ann Pak Inst Med Sci 2012;8:236-9.
Chaudhary IA, Ullah S, Khan SS, Masood R, Sardar MA, Mallhi AA, et al
. Seroprevalence of hepatitis B and C among the healthy blood donors at Fauji foundation hospital, Rawalpindi. Pak J Med Sci 2007;23:64-7.
Akram M, Khan FJ. Health care services and government spending in Pakistan. Pakistan Institute of Development Economics, Islamabad. PIDE Working Papers, 3; 2007.
Jain R, Perkins J, Johnson ST, Desai P, Khatri A, Chudgar U, et al.
Aprospective study for prevalence and/or development of transfusion-transmitted infections in multiply transfused thalassemia major patients. Asian J Transfus Sci 2012;6:151-4.
] [Full text]
Niqur JM. Blood Safety in Pakistan. January–February, 1995, in WHO/EMRO document WHO-EM/GPA/91/E/R/05.95/27. Alexandria: World Health Organization Regional Office for the Eastern Mediterranean; 1995.
Afzal MS. Does HCV prevalence in blood donors reflects the incidence in general population? A study for global impact. J Antivir Antiretrovir 2017;9:65-8.
Williams JR, Flowerdew AD. Uptake of immunisation against hepatitis B among surgeons in Wessex regional health authority. BMJ 1990;301:154.
Hosaka T, Suzuki F, Kobayashi M, Seko Y, Kawamura Y, Sezaki H, et al.
Long-term entecavir treatment reduces hepatocellular carcinoma incidence in patients with hepatitis B virus infection. Hepatology 2013;58:98-107.
Zoutendijk R, Reijnders JG, Zoulim F, Brown A, Mutimer DJ, Deterding K, et al.
Virological response to entecavir is associated with a better clinical outcome in chronic hepatitis B patients with cirrhosis. Gut 2013;62:760-5.
Wong GL, Chan HL, Mak CW, Lee SK, Ip ZM, Lam AT, et al.
Entecavir treatment reduces hepatic events and deaths in chronic hepatitis B patients with liver cirrhosis. Hepatology 2013;58:1537-47.
World Health Organization. Integrating hepatitis B vaccine into EPI programs. WHO special report. Pak Paed J 19;17:85-7.
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