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Al-Sadeq DW, Taleb SA, Zaied RE, Fahad SM, Smatti MK, Rizeq BR, Al Thani AA, Yassine HM, Nasrallah GK. Hepatitis B Virus Molecular Epidemiology, Host-Virus Interaction, Coinfection, and Laboratory Diagnosis in the MENA Region: An Update. Pathogens 2019; 8:pathogens8020063. [PMID: 31083509 PMCID: PMC6630671 DOI: 10.3390/pathogens8020063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 04/18/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023] Open
Abstract
Hepatitis B virus (HBV) is an enveloped partial double-stranded DNA virus that can cause acute and chronic hepatitis. According to the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), 257 million people are living with HBV. Moreover, 20,900 acute hepatitis B cases were reported in 2016. Hepatitis B is highly prevalent in the African, Western Pacific, Eastern Mediterranean, South-East Asia, and European regions, respectively. Due to the high mutational rate of HBV and lack of reverse transcriptase proofreading activity, ten different genotypes with different geographical distributions have been identified. HBV pathogenesis and severity of infection depend on several host and viral factors, particularly, the genetic variability of both the host and virus. Although HBV infection is a global health concern, there is a lack of adequate studies and reports in the Middle East and North Africa (MENA) region. Here, we provide a review on HBV epidemiology, pathogenesis, host-pathogen interactions, coinfection with selected viruses, and laboratory diagnosis, focusing on studies conducted in the MENA region to determine the current situation of the HBV infection and outline the future study areas.
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Affiliation(s)
- Duaa W Al-Sadeq
- Biomedical Research Center, Qatar University, Doha 2713, Qatar.
- Biomedical Science Department, College of Health Sciences, Qatar University, Doha 2713, Qatar.
| | - Sara A Taleb
- Biomedical Science Department, College of Health Sciences, Qatar University, Doha 2713, Qatar.
| | - Roan E Zaied
- Biomedical Science Department, College of Health Sciences, Qatar University, Doha 2713, Qatar.
| | - Sara M Fahad
- Biomedical Research Center, Qatar University, Doha 2713, Qatar.
| | - Maria K Smatti
- Biomedical Research Center, Qatar University, Doha 2713, Qatar.
| | - Balsam R Rizeq
- Biomedical Research Center, Qatar University, Doha 2713, Qatar.
- Department of Biological and Environmental Sciences, College of Arts & Sciences, Qatar University, Doha 2713, Qatar.
| | - Asmaa A Al Thani
- Biomedical Research Center, Qatar University, Doha 2713, Qatar.
- Biomedical Science Department, College of Health Sciences, Qatar University, Doha 2713, Qatar.
| | - Hadi M Yassine
- Biomedical Research Center, Qatar University, Doha 2713, Qatar.
| | - Gheyath K Nasrallah
- Biomedical Research Center, Qatar University, Doha 2713, Qatar.
- Biomedical Science Department, College of Health Sciences, Qatar University, Doha 2713, Qatar.
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Ethnic variation in medical and lifestyle risk factors for B cell non-Hodgkin lymphoma: A case-control study among Israelis and Palestinians. PLoS One 2017; 12:e0171709. [PMID: 28196110 PMCID: PMC5308607 DOI: 10.1371/journal.pone.0171709] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/12/2017] [Indexed: 12/31/2022] Open
Abstract
Background Risk factors for B-cell non-Hodgkin lymphoma (B-NHL) have not been assessed among Palestinian Arabs (PA) and Israeli Jews (IJ). Methods In a case-control study we investigated self-reported medical and lifestyle exposures, reporting odds ratios (ORs) and 95% confidence intervals [CIs], by ethnicity, for overall B-NHL and subtypes. Results We recruited 823 cases and 808 healthy controls. Among 307 PA/516 IJ B-NHL cases (mean age at diagnosis = 51 [±17] versus 60 [±15] years, respectively) subtype distributions differed, with diffuse large B-cell lymphoma (DLBCL) being prominent among PA (71%) compared to IJ (41%); follicular lymphoma (FL), was observed in 14% versus 28%, and marginal zone lymphoma, in 2% versus 14%, respectively. Overall B-NHL in both populations was associated with recreational sun exposure OR = 1.43 [CI:1.07–1.91], black hair-dye use OR = 1.70 [CI:1.00–2.87], hospitalization for infection OR = 1.68 [CI:1.34–2.11], and first-degree relative with hematopoietic cancer, OR = 1.69 [CI:1.16–2.48]. An inverse association was noted with alcohol use, OR = 0.46 [CI:0.34–0.62]. Subtype-specific exposures included smoking (FL, OR = 1.46 [CI:1.01–2.11]) and >monthly indoor pesticide use (DLBCL, OR = 2.01 [CI:1.35–3.00]). Associations observed for overall B-NHL in PA only included: gardening OR = 1.93 [CI:1.39–2.70]; history of herpes, mononucleosis, rubella, blood transfusion (OR>2.5, P<0.01 for all); while for IJ risk factors included growing fruits and vegetables, OR = 1.87 [CI:1.11–3.15]; and self-reported autoimmune diseases, OR = 1.99 [CI:1.34–2.95]. Conclusions In these geographically proximate populations we found some unique risk factors for B-NHL. Heterogeneity in the observed associations by ethnicity could reflect differences in lifestyle, medical systems, and reporting patterns, while variations by histology infer specific etiologic factors for lymphoma subtypes.
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Qawasmi M, Samuh M, Glebe D, Gerlich WH, Azzeh M. Age-dependent decrease of anti-HBs titers and effect of booster doses using 2 different vaccines in Palestinian children vaccinated in early childhood. Hum Vaccin Immunother 2016; 11:1717-24. [PMID: 25996579 DOI: 10.1080/21645515.2015.1041687] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Immunization against hepatitis B virus (HBV) has proven to be highly effective and led to significant reduction of new infections worldwide. However, protective immunity measured by anti-HBs titers may decrease to critical levels in the years after basal immunization, particularly in case of exposure to HBV variants different from the vaccine strain. We tested 400 Palestinian children between one and 19 years of age for their anti-HBs titer, challenged the immune memory of those with low or absent anti-HBs with 2 types of hepatitis B vaccines and determined thereafter the anti-HBs titer. At the age of one, 92.2% of the children presented with protective anti-HBs titers (≥ 10 mIU/ml) with the majority having ≥ 100 mIU/ml. Protective immunity was still high at ages 2 (87.5%) and 4 (95%), declining by age 5 and 6 (from 69.2% to 66.7%) and down to an average of 39.8% between the ages of 7 and 19. 160 children with a nonprotective or low immune response challenged with either the yeast-derived Engerix-B or the mammalian cell-derived preS1-containing Sci-B-Vac vaccine showed an anamnestic immune response. 92.4% and 85.9% of the children challenged with one dose Sci-B-Vac and Engerix-B presented with anti-HBs titers >100 mIU/ml respectively. Our results reveal that vaccine-induced protective anti-HBs titers against HBV decrease rapidly beyond the age of 6 in Palestinian children, but can be strongly enhanced with a single booster vaccine dose, independent of brand and antigen composition. Our data suggest that a booster vaccine dose against HBV during school years may be useful.
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Affiliation(s)
- Mohammad Qawasmi
- a Virology Research Laboratory; Medical Research Center; Al-Quds University ; Abu Dies-East Jerusalem, Palestine
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Gasim GI. Hepatitis B virus in the Arab world: where do we stand? Arab J Gastroenterol 2013; 14:35-43. [PMID: 23820498 DOI: 10.1016/j.ajg.2013.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 03/28/2013] [Accepted: 04/21/2013] [Indexed: 12/12/2022]
Abstract
The epidemiology of viral hepatitis is of great importance for planning and managing health provision for all the countries in the Arab world. However, data on viral hepatitis are not readily available in a large percentage of Arab countries. Hepatitis B virus (HBV) is considered to be one of the most important causes of chronic hepatitis, cirrhosis and hepatocellular carcinoma. A systematic electronic search of published literature was conducted to extract data on epidemiology and risk factors for the analysis of HBV infection among the countries in the Arab world. The prevalence of chronic HBV infection was found to be decreasing in some Arab countries although it was still unacceptably high. This was particularly evident in the Arabian Gulf region, in Lebanon, Egypt and Libya. The age-specific prevalence varied from country to country with decline in prevalence being noted among children in the Gulf States and among Libyan women. These declines in prevalence are most likely to be related to the Expanded Immunization Programme. The alarmingly high prevalence of chronically infected patients in some areas and the widespread differences in HBV prevalence between Arab nations may be explained by the variation in risk factors involved. This situation calls for targeted approaches to tackle HBV-related mortality and morbidity. Precise HBV infection prevalence data are needed at the national and the sub-national level to estimate the disease burden, guide health intervention programmes and evaluate vaccine efficiency.
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El-kader Y El-Ottol A, Elmanama AA, Ayesh BM. Prevalence and risk factors of hepatitis B and C viruses among haemodialysis patients in Gaza strip, Palestine. Virol J 2010; 7:210. [PMID: 20809985 PMCID: PMC2942824 DOI: 10.1186/1743-422x-7-210] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 09/01/2010] [Indexed: 01/04/2023] Open
Abstract
Background The prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) and its associated risk factors among haemodialysis (HD) patients in Gaza strip was investigated using serological and molecular techniques. Results The overall prevalence of HBV among the four HD centers was 8.1%. The main risk factors were HD center (p = 0.05), history of blood transfusion (p < 0.01), and treatment abroad (p = 0.01). The overall prevalence of HCV among the four HD centers was 22%. The main risk factors were HD center (p < 0.01), time duration on HD (p < 0.01), history of blood transfusion (p < 0.01), treatment abroad (p < 0.01), and history of blood transfusion abroad (p < 0.01). Serum aminotransferases levels decreased in HD patients compared with normal population but still there was a direct association between the activity of liver enzymes and both HBV (p < 0.01) and HCV (p < 0.01) infection. Conclusion The much higher prevalence of Hepatitis viruses among HD patients compared to the normal population of Gaza strip indicates a causative relation between HD and hepatitis viruses transmission. Therefore extremely careful observation of preventive infection control measures is essential to limit Hepatitis viruses' transmission in HD centers.
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Affiliation(s)
- Abed El-kader Y El-Ottol
- Microbiology Department, Central Laboratory, Al-Shifa Hospital, and Medical Technology Department, Islamic University, Gaza, Palestine.
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Novack L, Sarov B, Goldman-Levi R, Yahalom V, Safi J, Soliman H, Orgel M, Yaari A, Galai N, Pliskin J, Shinar E. Impact of pooling on accuracy of hepatitis B virus surface antigen screening of blood donations. Trans R Soc Trop Med Hyg 2008; 102:787-92. [DOI: 10.1016/j.trstmh.2008.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Revised: 04/03/2008] [Accepted: 04/03/2008] [Indexed: 12/27/2022] Open
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Alam MM, Zaidi SZ, Shaukat S, Sharif S, Angez M, Naeem A, Saleha S, Butt JA, Malik SA. Common genotypes of Hepatitis B virus prevalent in injecting drug abusers (addicts) of North West Frontier Province of Pakistan. Virol J 2007; 4:63. [PMID: 17597548 PMCID: PMC1910598 DOI: 10.1186/1743-422x-4-63] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 06/28/2007] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The epidemiological significance of Hepatitis B virus genotypes has been well established and becoming an essential concern day by day however, much little is known about the mixed infection with more than one Hepatitis B virus genotypes and their clinical relevance. METHODS Intravenous drug abusers are considered as a major risk group for the acquisition and transmission of blood borne infections like hepatitis B, however, in Pakistan, no such data has ever been reported about the epidemiology of HBV and its genotypes in Injecting Drug Users. 250 individuals were analyzed for hepatitis B virus genotypes after prior screening with serological assay for the detection of HBsAg. RESULTS 56 (22.4%) individuals were found positive on ELSIA for HBsAg. The genotype distribution was found to be as: genotype D, 62.5%; genotype A, 8.92% while 28.57% individuals were found to be infected with a mixture of genotype A and D. CONCLUSION There is an urgent need of the time to develop public health care policies with special emphasis towards the control of HBV transmission through high risk groups especially Injecting Drug Users.
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Affiliation(s)
| | - Sohail Zahoor Zaidi
- Head of Department of Virology; Principal Investigator-WHO Regional Reference Laboratory for Polio Eradication Initiative, National Institute of Health, Islamabad, Pakistan
| | - Shehzad Shaukat
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Salmaan Sharif
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Mehar Angez
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Asif Naeem
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Shamim Saleha
- Research Student, Department of Virology, National Institute of Health, Islamabad Pakistan
| | - Javed Aslam Butt
- Head of Department of Gastroenterology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Salman Akbar Malik
- Head of Department of Biochemistry, Quaid-i-azam University, Islamabad, Pakistan
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Akhtar S, Younus M, Adil S, Hassan F, Jafri SH. Epidemiologic study of chronic hepatitis B virus infection in male volunteer blood donors in Karachi, Pakistan. BMC Gastroenterol 2005; 5:26. [PMID: 16086833 PMCID: PMC1208878 DOI: 10.1186/1471-230x-5-26] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2005] [Accepted: 08/08/2005] [Indexed: 11/26/2022] Open
Abstract
Background The magnitude of chronic infection with hepatitis B virus (HBV) varies substantially between the countries. A better understanding of incidence and/ or prevalence of HBV infection and associated risk factors provides insight into the transmission of this infection in the community. The purpose of this investigation was to estimate the prevalence of and to identify the risk factors associated with chronic infection with HBV, as assessed by HBV surface antigen (HBsAg) positivity, in asymptomatic volunteer male blood donors in Karachi, Pakistan. Methods Consecutive blood donations made at the two large blood banks between January 1, 1998 and December 31, 2002 were assessed to estimate the prevalence of HBsAg positivity. To evaluate the potential risk factors, a case-control study design was implemented; cases (HBsAg positives) and controls (HBsAg negatives), were recruited between October 15, 2001 and March 15, 2002. A pre-tested structured questionnaire was administered through trained interviewers to collect the data on hypothesized risk factors for HBV infection. Sera were tested for HBsAg using commercially available kits for enzyme linked Immunosorbant assay-III. Results HBsAg prevalence in the male volunteer blood donors was 2.0 % (7048/351309). Multivariate logistic regression analysis showed that after adjusting for age and ethnicity, cases were significantly more likely than controls to have received dental treatment from un-qualified dental care provider (adjusted odds ratio (OR) = 9.8; 95% confidence interval (CI): 2.1, 46.1), have received 1–5 injections (adjusted OR = 3.3; 95% CI: 1.1, 9.6), more than 5 injections (adjusted OR = 1.4; 95% CI: 1.4, 12.7) during the last five years or have received injection through a glass syringe (adjusted OR = 9.4; 95% CI: 2.6, 34.3). Injury resulted in bleeding during shaving from barbers (adjusted OR = 2.3; 95% CI: 1.1, 4.8) was also significant predictor of HBsAg positivity. Conclusion Prevalence of HBsAg positivity in the male volunteer blood donors in Karachi was 2%. Infection control measures in health-care settings including safe injection practices and proper sterilization techniques of medical instruments and education of barbers about the significance of sterilization of their instruments may reduce the burden of HBV infection in this and similar settings. There is also an urgent need of developing locally relevant guidelines for counseling and management of HBsAg positive blood donors.
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Affiliation(s)
- Saeed Akhtar
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University PO Box 24923, Safat 13110, Kuwait
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan
| | - Muhammad Younus
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan
| | - Salman Adil
- Department of Pathology and Microbiology, Aga Khan University, Karachi 74800, Pakistan
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