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[afro-nets] RFI: Most common Mode of Transmission of Hepatitis-B Virus (2)

  • From: "Savanna Reid" <inkwell_11@yahoo.com>
  • Date: Wed, 22 Jul 2009 09:53:04 -0700 (PDT)

Dear Dr. Gotam Kumar,

I am presently working on a review on this topic, with a focus on HBV transmission to children in Africa. I think Africa may be more similar to the situation in Pakistan than in southeast Asia as far as modes of HBV transmission, although clinical outcomes may differ according to differences in HBV genotype, so I would like to offer a few general insights. See below an annotated page of notes. Many of the key sources are open source papers published by BMC Infectious Diseases.

Hepatitis B Transmission in Pakistan

HBV infection is more often persistent if acquired in early childhood, however there are also risk factors for HBsAg positivity among adults. Risk factors for children include oral (saliva contact, e.g. casual contact in home or sharing personal items[1]) and parenteral (small blood exposures other than transfusions) exposures (e.g., receiving injections,[1]scratching a siblingâs back, or biting fingernails,[2] or eating from a common bowl with fingers[3]). Among adults, risk factors include the same and additional parenteral risks (shaving,[4] surgery, unsafe dental care,[5] injection drug use[6]), and male prostitution.[7] Vertical HBV transmission is more common in Asia than in Africa due to higher HBeAg prevalence among women of childbearing age, and Pakistani adults are more similar to Africans in that HBeAg carriage is relatively uncommon in adults (<15% of HBsAg positive adults have HBeAg).[8]
Unsafe medical injections are a leading risk factor for HBV infection among adults in Pakistan, explaining over 50% of infections in Karachi (Odds ratio 4.0 for one injection, Odds Ratio 6.3 for multiple injections).[9] Household transmission is also likely, as casual contact has been strongly associated with HBV transmission within households in Africa and is associated with large family size and crowding in both Africa and Pakistan.[10,11,1]
In northern Pakistan through 2000, HBsAg prevalence among b
.3%, and here although HBV and HCV share transmission routes, HBsAg positive blood donors were a decade younger than HCV positive blood donors.[12] In Islamabad through 2004 HBsAg prevalence was only 2.6%, lower than HCV prevalence (5.3%), and a similar but smaller difference in age of hepatitis infected persons was observed.[13] In Karachi through 2002, HBsAg prevalence in blood donors was only 2.0% but varied according to ethnicity (greater in Pathan and Balochi) as well as age (greater in >26).[1,5] HBV exposure rates are much higher however, at 17% of young adults donating blood at military hospitals in Pakistan.[14] Prevalence may be higher in rural areas (up to 4%).[8] Prevalence does range as high as 6.2% in interior Sindh.[15]

1 Jafri W, Jafri N, Yakoob J, Islam M, TIrmizi S, Jafar T, Akhstar S, Hamid S, Shah H, Nizami S. Hepatitis B and C: prevalence and risk factors associated with seropositivity among children in Karachi, Pakistan. BMC Infect Dis 2006; 6: 101
2 Martinson F, Weigle K, Royce R, Weber D, Suchindran C, Lemon S. Risk factors for horizontal transmission of hepatitis B virus in a rural district in Ghana. Am J Epidemiol 1998; 147(5): 478-487.
3 Marie-Cardine A, Mouterde O, Dubuisson S, Buffet-Janvresse C, Mallet E. Salivary transmission in an intrafamilial cluster of hepatitis B. J Pediatr Gastroenterol Nutr 2002; 34: 227-230
4 Janjua N, Nizamy M. Knowledge and practices of barbers about hepatitis B and C transmission in Rawalpindi and Islamabad. J Pak Med Assoc 2004; 54(3): 116-119
5 Akhtar S, Younus M, Adil S, Hassan F, Jafri S. Epidemiologic study of chronic hepatitis B virus infection in male volunteer blood donors in Karachi, Pakistan. BMC Gastroenterol 2005; 5: 26.
6 Alam M, Zaidi S, Shaukat S, Sharif S, Angez M, Naeem A, Saleha S, Butt J, Malik S. Common genotypes of hepatitis B virus prevalent in injecting drug abusers (addicts) of North West Frontier Province of Pakistan. Virol J 2007; 4: 63
7 Bagi S, Shah S, Baig M, Mujeeb S, Memon A. Seroprevalence of HIV, HBV and syphilis and
transvestites (Hijras) in Karachi, Pakistan. J Pak Med Assoc 2006; 56(S1): S17-S21
8 Alam M, Zaidi S, Malik S, Naeem A, SHaukat S, Sharif S, Angez M, Khan A, Butt J. Serology based disease status of Pakistani population infected with Hepatitis B virus. BMC Infect Dis 2007; 7: 64
9 Usman H, Akhtar S, Rahbar M, Hamid S, Moattar T, Luby S. Injections in health care settings: a risk factor for acute hepatitis B virus infection in Karachi, Pakistan. Epidemiol Infect 2003; 130(2): 293-300
10 Hyams K, al-Arabi M, al-Tagani A, Messiter J, al-Gaali A, George J. Epidemiology of hepatitis B in the Gezira region of Sudan. Am J Trop Med Hyg 1989; 40(2): 200-206.
11 Ryder R, Whittle H, Sanneh A, Ajdukiewicz A, Tulloch S, Yvonnet B. Persistent hepatitis B virus infection and hepatoma in The Gambia, west Africa. A case-control study of 140 adults and their 603 family contacts. Am J Epidemiol 1992; 136(9): 1122-1131.
12 Khattak M, Salamat N, Bhatti F, Qureshi T. Seroprevalence of hepatitis B, C and HIV in blood donors in northern Pakistan. J Pak Med Assoc 2002; 52(9): 398-402
13 Khokhar N, Gill M, Malik G. General seroprevalence of hepatitis C and hepatitis B virus infections in population. J Coll Physicians Surg Pak 2004; 14(9): 534-536
14 Bhatti F, Ullah Z, Salamat N, Ayub M, Ghani E. Anti-hepatitis B core antigen testing, viral markers, and occult hepatitis B virus infection in Pakistani blood donors: implications for transfusion practice. Transfusion 2007; 47(1): 74-79
15 Mujeeb S, Pearce M. Temporal trends in hepatitis B and C infection in family blood donors from interior Sindh, Pakistan. BMC Infect Dis 2008; 8: 43

Best regards,


Savanna Reid
MPH student, School of Public Health