Prevalence of Hepatitis B infection in married women of

child bearing age in District Islamabad

Dr. Najma Javeed Awan

Senior Medical Officer

Pakistan Medical Research Council

Back ground

World wide infection of HBV: More than two billion people (one third of the

world’s population)

Chronic liver infection: About 350 and 400 million people are positive

for Hepatitis B surface antigen (HBsAg)

HCC & Cirrhosis: About 25% ~ 40% of patients eventually

develops the complications

Prevalence of chronic HBV infection :

Prevalence is classified into three groups: High prevalence (> 8%) Intermediate prevalence (2% ~ 8%) Low prevalence (< 2%)2,5.

Pakistan: Intermediate endemicity 2.5% prevalence.

Objectives

To determine the seroprevalence of hepatitis B virus surface antibodies, hepatitis B virus surface antigen (HBsAg) and e antigen (HBeAg) among married women of child bearing age in district Islamabad

Why to do HBsAg & HBeAg in mothers???

HBsAg: become positive 2 to 12 weeks after infection

HBeAg: a marker for infectivity

If the mother is HBsAg positive and is also positive for HBeAg (a marker for infectivity) than there is a 90% chance that she will transmit the disease to her newborn.

If the mother is HBsAg positive and not HBeAg positive, than the probability goes down to 20-30%.

Why to select Islamabad???

The results of the National Survey on Prevalence of Hepatitis B & C in general population of Pakistan conducted by Pakistan Medical Research Council (PMRC) conducted in 2009 showed

Prevalence of HBsAg in district Islamabad

5.6%, second highest after Dera ghazi khan(5.7%) among 36 districts of Punjab being surveyed

Subjects & Methods

Study Design

It was a cross-sectional, community-based,

sero-epidemiological survey.

1. Inclusion & Exclusion Criteria

Inclusion criteria Married women of age 15-45 years residing in

District Islamabad Women with no signs & symptoms of liver

diseases.

Exclusion Criteria: Female already suffering from Hepatitis B

infection

2. Multi Phase Sampling Technique:

First phase: Islamabad was divided into urban and rural clusters

Second Phase: Random selection of 03 urban and 03 rural clusters

Urban Clusters: Bara Kahu, Karach Company, Sector I

Rural Clusters: Bani gala, Kuri shehr, Gokina Village

In rural clusters as houses were not properly numbered, started sampling from the mosque and selected a lane at random from there and then enrolled every 2nd house.

3. Questionnaire

Socio-demographic parameters Number of children Place & mode of deliveries Hepatitis B vaccination status of female History HBV infection in any member of

household

4. Sample Collection

Collection of 3 ml whole blood in labeled gel tube

Tests performed: Hepatitis B surface antibodies (anti HBs)Hepatitis B surface antigen (HBsAg) Hepatitis B e antigen (HBeAg)

Technique: “Microparticle enzyme Immunoassay”. on

ARCHITECT of Abbott

Results

38

30

3

13.7110.83

1.080

5

10

15

20

25

30

35

40

number 38 30 3

Percentage 13.71 10.83 1.08

HBsAb HBsAg HBeAg.

Positivity of HBV serological markers among study population

Frequency of HBV serological markers in different age groups

Age (Y)

n(%)

HBV Serological markers

HBsAb HBsAg HBeAg

(n) (%) (n) (%) (n) (%)

(15-25)

98(35.37) 13 13.26 11 11.22 Nil Nil

(26-35)

143(51.62)

21 14.68 14 9.79 Nil Nil

(36-45)

36(30.01) 04 11.11 05 13.88 03 8.33

Total 277(100) 38 13.71 30 10.83 03 1.08

Distribution of HBV serological markers among

selected rural and urban clusters of District Islamab

Demographical variables among study population.

S.No.

Demographical variables

Yes No

1. Prior knowledge of HBV vaccine 

56 20.21%

221

80.01%

2.  Ever been tested for HBV during any of the pregnancy 

121 43.61%

156

56.31%

3.  HBV positive house hold contact 

29 10.46%

248

89.53%

4.  History of blood transfusion

19 6.85% 258

93.14%

Conclusion:

Overall HBsAg seroprevalence among married women of District Islamabad is 10.83%, which is alarmingly high as compared to the general population i.e. 5.6%.

About 10% cases from HBsAg positive group were also HBeAg positive showing presence of active replicating virus (Highly infective stage) and if women were pregnant at that time than there would be 90% chances to transmit virus to their newborn.

Recommendations:

Vaccination program should be implemented not only in infants and children but also in adults.

Further, the routine maternal HBsAg screening should be promoted and strengthened so as to prevent mother-to-child transmission of HBV.

Thank you