CROSS SECTIONAL STUDY OF PREVALENCE AND RISK FACTORS OF HEPATITIS B AND HEPATITIS C INFECTION IN A RURAL VILLAGE OF INDIA

HBV prevalence in Sub-continental countries: A systematic review and meta-analysis

BACKGROUND

Hepatitis B virus (HBV) is a major source of disease burden worldwide, with an estimated 296 million individuals living with infections worldwide. Although vaccine programs exist to control infections, certain sub-populations around the world continue to have very high prevalence of HBV infection.

METHODS

A systematic search of studies of HBV published after 2010 was conducted for India, Pakistan, Bangladesh, Nepal, Sri Lanka and Bhutan. Each paper was independently screened for risk of bias and inclusion. Data were extracted from included studies before being analysed to estimate pooled prevalence, and to conduct sub-group analyses. Random-effects models were used for estimating summary prevalence due to a high level of heterogeneity between studies, and funnel plots were combined with Egger's test to assess publication bias. Meta-regression was conducted to investigate sources of between-study heterogeneity.

RESULTS

The pooled prevalence of HBV across all studies was 3% (95% CI 0.02, 0.05). For countries with multiple studies, the pooled prevalence in India was 3% (95% CI 0.02, 0.04), in Pakistan 6% (95% CI 0.03, 0.09), in Bangladesh 5% (95% CI of 0.02, 0.12), and in Nepal 1% (95% CI 0.00, 0.08). There was some evidence of publication bias, and a high level of heterogeneity across studies. Risk of bias analysis found most studies to be of fair or moderate quality.

CONCLUSIONS

The prevalence of HBV among countries in the sub-continent was higher than the global average, but was not as high as some other regions. Countries with greater numbers of displaced persons had higher prevalence of HBV, with a wide range of prevalence between subpopulations likely reflecting differential uptake, and implementation, of vaccination programs.

Prevalence of viral hepatitis infection in India: A systematic review and meta-analysis

BACKGROUND

Nowadays, Viral Hepatitis can be comparable to the big three communicable diseases: tuberculosis, HIV/AIDS, and malarial infections. The main purpose of this study was to summarize the prevalence of viral Hepatitis in India from peer-reviewed articles published from February 2000 to February 2021.

MATERIALS AND METHODS

We conducted a systematic search on Science Direct, Scopus, Medline, PubMed, Web of Science, Google Scholar, and other open access journals. We evaluated all relevant papers that looked into the prevalence of viral Hepatitis systematically. Finally, 28 studies on viral Hepatitis published from February 2000 to February 2021 have been selected. These studies have been conducted across the northern, southern, central, eastern, and western regions of India.

RESULTS

Twenty-eight full-text publications were obtained and evaluated consisting of 45,608 research participants. Hepatitis A was found to range from 2.1% to 52.5%. Hepatitis B was found in a wide range of individuals, ranging from 0.87% to 21.4% of the population. Hepatitis C was found to range from 0.57% to 53.7%. The majority of the children were affected by hepatitis A, and 47.4% of third-trimester pregnant mothers were affected by hepatitis E. Diabetes, hospital admission, history of jaundice, history of surgeries, and heterosexual contact were the leading modes of acquiring HBV and HCV infections. As a result of its great magnitude, this disease poses a severe threat to the national healthcare system.

CONCLUSION

Effective public health measures are urgently needed to minimize the burden of viral Hepatitis and eliminate the disease.

Prevalence of Hepatitis B and Hepatitis C Infections in a Tertiary Care Hospital, Telangana, India - Comparison of Pre-Pandemic and COVID-19 Pandemic times

WHO estimates show that 296 million people were living with chronic hepatitis B infection in 2019 with 1.5 million new infections occurring every year and approximately 290 000 people died from hepatitis C, mostly from cirrhosis and hepatocellular carcinoma. The prevalence and trends of Hepatitis B and Hepatitis C infections were affected during the pandemic, hence this study aimed to compare the difference in prevalence rates, trends, demographic data, and outcomes of Hepatitis B and Hepatitis C cases in pre-pandemic and pandemic era. The study was carried out in a 1060 bedded tertiary care teaching hospital located 90 kilometers away from Hyderabad, Telangana catering to a majorly rural population from around 200 villages. This study was a retrospective observational study where data of 4 years (March 2018 to Feb 2022) of patients whose samples were sent to Microbiology laboratory and were found to be positive for Hepatitis B surface antigen (HBsAg) or antibodies to Hepatitis C (Anti-HCV) were included. The medical records of Hepatitis B and Hepatitis C positive cases were analysed for demographic data like age, sex, address, requesting department, and present status retrieved from the hospital information system. The prevalence rates of Hepatitis B and Hepatitis C infections and trends every year were calculated and compared. Out of the total 39,578 samples tested for Hepatitis B surface antigen, 413 were positive with a seroprevalence of 1.04%. Among the 20,394 samples tested for anti-Hepatitis C antibodies, 53 samples were found to be positive showing a seroprevalence of 0.25%. There was a 23.63% decrease in the number of samples received during the pandemic period demonstrating the impact of COVID-19 on various laboratory testing. Male predominance was observed for both Hepatitis B (65.37%) and Hepatitis C (56.60%) positivity in this study. Hepatitis B was highest in the 61-80 years age group before the pandemic but during the pandemic, Hepatitis B positivity was equally distributed in the 41 to 60 years and 61-80 years age groups. Hepatitis C positive cases were equally distributed in the 41 to 60 years and 61-80 years age groups before the pandemic whereas during the pandemic Hepatitis C positivity was highest among the 41 to 60 years age group. Among the 413 positive cases of Hepatitis B, 315 (76.27%) cases belonged to the rural population and among the 53 Hepatitis C positive cases, 37 (69.81%) cases were from rural areas. The seroprevalence for Hepatitis B surface antigen displayed a decreasing trend in the pandemic era when compared to the pre-pandemic era. Seroprevalence for anti-HCV antibodies showed a small increase in the pandemic era when compared to the pre-pandemic era. Male predominance was observed for both Hepatitis B and Hepatitis C positivity in this study. Hepatitis B was highest in the 61-80 years age group before the pandemic but during the pandemic, Hepatitis B positivity was equally distributed in the 41 to 60 years and 61-80 years age groups. Hepatitis C positive cases were equally distributed in the 41 to 60 years and 61-80 years age groups before the pandemic whereas during the pandemic Hepatitis C positivity was highest among the 41 to 60 years age group. Detailed analysis of these variations in the trends during the pandemic will aid in guiding tertiary care hospitals on the way forward in the retrieval of medical services after the pandemic.

Increased prevalence of transfusion-transmitted diseases among people with tattoos: A systematic review and meta-analysis

Whether having a tattoo increases the risk of transfusion-transmitted diseases (TTDs) is controversial. Although a few studies have suggested a strong association between having tattoos and TTDs, other studies have not shown the significance of the association. In addition, previous studies mainly focused only on hepatitis C viral infections. The objective of our study was to identify the prevalence and risk of TTDs in people with tattoos as compared with the non-tattooed population. A systematic review of the studies published before January 22, 2021, was performed using the Pubmed, Embase, and Web of Science databases. Observational studies on hepatitis C virus (HCV), hepatitis B virus (HBV), human immunodeficiency virus (HIV), and syphilis infections in people with and without tattoos were included. Studies that reported disease status without serological confirmation were excluded. A total of 121 studies were quantitatively analyzed. HCV (odds ratio [OR], 2.37; 95% confidence interval [CI], 2.04–2.76), HBV (OR, 1.55; 95% CI, 1.31–1.83), and HIV infections (OR, 3.55; 95% CI, 2.34–5.39) were more prevalent in the tattooed population. In subgroup analyses, the prevalence of HCV infection was significantly elevated in the general population, hospital patient, blood donor, intravenous (IV) drug user, and prisoner groups. IV drug users and prisoners showed high prevalence rates of HBV infection. The prevalence of HIV infection was significantly increased in the general population and prisoner groups. Having a tattoo is associated with an increased prevalence of TTDs. Our approach clarifies in-depth and supports a guideline for TTD screening in the tattooed population.

Current status of knowledge, attitudes, and practices of barbers regarding transmission and prevention of hepatitis B and C virus in the north-west part of Bangladesh: A cross-sectional study in 2020

Objectives

The objective of this study was to assess knowledge, attitudes, and preventative practices among barbers regarding Hepatitis B (HBV) and Hepatitis C (HCV) viral infection in Rajshahi city of Bangladesh.

Study design

This was a prospective observational study.

Methods

This study was conducted from January to June 2020. A questionnaire was adapted from existing knowledge attitude and practice surveys regarding HBV and HCV infection. Data were collected from barbers by face to face interview by trained interviewers. A knowledge score was calculated by giving one point for each correct response to the knowledge-related items, with a maximum score of 17. Associations between knowledge and patient characteristics were assessed by Welch’s t-test.

Results

A total of 403 barbers were enrolled with a mean age of 29.2 ​± ​7.4 years. Of participants, the majority of barbers were either illiterate or had education up to primary school (232, 57.5%). 41.2%, 33.7%, and 25.1% barbers knew that HBV and HCV could be transmitted through sexual route, blood transfusion, and shaving instruments respectively. A lower knowledge level was associated with a lower level of education (P ​< ​0.001). Most of the participants agreed that it was essential to have periodic screening tests for HBV and HCV infection (318, 78.9%). Only 12.2% of the barbers were vaccinated against HBV. 57.1% of the barbers cleaned their instruments with disinfectant between clients. Most of them used a new blade on new clients (401, 99.5%) and disposed of the used blades into the regular garbage system (371,92.1%)

Conclusions

Poor knowledge regarding transmission and prevention of HBV and HCV was found among barbers which could be one of the major causes of transmission of those infections in the community. The concerned authority should pay attention to the problems and can take specific measures to increase awareness of the barbers to prevent transmission of HBV and HCV from the barber’s shop.

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Majority of the barbers didn’t know that the viruses can be transmitted through their shaving instruments.

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Most of the barbers are not vaccinated against Hepatitis B virus.

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A large proportion of the barbers didn’t clean instruments with disinfectant between clients.

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Most of the barbers disposed of the used blades into the regular garbage system.

Burden of hepatitis C virus infection in India: A systematic review and meta-analysis

BACKGROUND AND AIM

Burden of hepatitis C in India is not known. We therefore conducted a systematic review of the available data on anti-hepatitis C virus (HCV) seroprevalence in the Indian population.

METHODS

We searched several publication databases for English language papers that reported data on anti-HCV seroprevalence from India and also identified other unpublished sources of such data. Data on groups likely to represent seroprevalence in general population and in selected high-risk groups were extracted and subjected to meta-analysis.

RESULTS

Of the 3995 published papers and 94 additional data sources identified, 327 were selected; these provided 414 anti-HCV seroprevalence data points. Pooled anti-HCV seroprevalence rates in community-based studies, blood donors, and pregnant women were 0.85% (95% confidence interval: 0.00-3.98%), 0.44% (0.40-0.49), and 0.88% (0.21-1.90), respectively. Among groups considered at high risk of HCV, pooled anti-HCV seroprevalence rates were as follows: people living with HIV (40 studies from 17 states: 3.51% [2.43-4.76]), persons on maintenance hemodialysis (37, 13; 19.23% [13.52-25.65]), people who inject drugs (46, 14; 44.71% [37.50-52.03]), multi-transfused persons (38, 12; 24.06% [20.00-28.36]), persons with sexually transmitted diseases (7, 5; 4.10% [0.98-9.04]), and those with high-risk sex behavior (6, 5; 4.06% [1.79-7.10]).

CONCLUSIONS

Community-based data on HCV seroprevalence in India were limited. Large amount of data on blood donors and pregnant women were identified, with pooled anti-HCV seroprevalence rates of 0.44% and 0.88%, respectively. Among high-risk groups, anti-HCV prevalence was higher among people living with HIV, those with sexually transmitted diseases, high-risk sex behavior or injection drug use, and those receiving hemodialysis or frequent transfusions.

Prevalence of hepatitis B and hepatitis C infection from a population-based study in Southern India

OBJECTIVES

This study aims to estimate the prevalence of hepatitis B (HBV) and C (HCV) in the population through field-screening camps conducted by Chennai Liver Foundation, in the southern state of Tamil Nadu, India. This is the largest population-based study from Tamil Nadu.

PATIENTS AND METHODS

A total of 75 camps were conducted across 14 districts of Tamil Nadu (2014-2017). Screening was done by rapid point-of-care assays (SD-bioline tests) and confirmed by enzyme-linked immunosorbent assay (Monolisa tests). Those tested negative were offered first dose of HBV vaccine. Positive patients with HBV count of more than 2000 IU/ml or HCV-RNA positive on quantitative analysis were treated.

RESULTS

A total of 18 589 people were screened, with HBV infection detected in 303 (prevalence 1.63%) and HCV infection in 56 (prevalence 0.3%), with significant variation among districts. Males contributed to about three-fourths of detected HBV [233/303 (77%)] or HCV [41/56 (73%)] infection. Screening detected a higher overall HBV/HCV infection rate in rural [203 (2.52%) infections in 8047 people] than in urban [156 (1.47%) infections in 10 542 people] areas (P<0.0001). Slum areas had a HBV prevalence of 5%. In a dialysis unit, all patients were found to have either HBV/HCV infection. A total of 162/303 (54%) people with HBV and 27/56 (48%) with HCV infection were treated, and 7704 people received the first dose of HBV vaccine.

CONCLUSION

The prevalence of HBV was 1.63% and HCV was 0.30% in Tamil Nadu. Three-fourths of HBV/HCV infected people were males. Prevalence of HBV/HCV was higher in rural areas. Slum area and dialysis unit had high HBV and HCV prevalence.

Status and progress of hepatitis B control through vaccination in the South-East Asia Region, 1992-2015

In 2016, the Immunization Technical Advisory Group of the South-East Asia Region (SEAR) endorsed a regional goal to achieve ≤1% prevalence of hepatitis B surface antigen (HBsAg) among 5-year-old children by 2020. Chronic hepatitis B virus (HBV) infection is largely preventable with a birth dose of hepatitis B vaccine (HepB-BD) followed by two to three additional doses. We reviewed the progress towards hepatitis B control through vaccination in SEAR during 1992-2015. We summarized hepatitis B vaccination data and reviewed the literature to determine the prevalence of chronic HBV infection pre- and post-vaccine introduction. We used a mathematical model to determine post-vaccine prevalence of HBsAg among 5 year olds in countries lacking national serosurvey data and estimated the impact of vaccination on disease burden. Regional coverage with three doses of hepatitis B vaccine (HepB3) increased from 56% in 2011 to 87% in 2015. By 2016, 7 of 11 countries had introduced universal HepB-BD. Regional HepB-BD coverage increased from 9% in 2011 to 34% in 2015. In 2015, estimated HBsAg among 5 year olds was 1.1% with variability among countries. Myanmar (3.8%), Timor-Leste (2.7%), Indonesia (1.8%), and India (1%) had the highest prevalence of HBsAg. During 1992-2015, vaccination prevented approximately 16 million chronic HBV infections and 2.6 million related deaths. In 2015, around 197,640 perinatal HBV infections occurred in SEAR with majority occurring in India (62%), Bangladesh (24%), and Myanmar (8%). Myanmar had the highest rate of perinatal chronic HBV infections at 16 per 1000 live births. Despite significant progress in the control of HBV, SEAR needs to secure political commitment for elimination and consider additional strategies, such as promoting health facility births, universal birth dose administration, developing strong coordination between health sectors, and using alternative vaccine delivery methods, to improve HepB-BD coverage and subsequently achieve HBV control and elimination.