Prevalence of chronic viral hepatitis infections in Karaj, Iran

Prevalence of chronic viral hepatitis infections in Karaj, Iran

Kourosh Kabir¹, Hassan Hoseini^2,3, Mohammad Miri^2,3, Fatemeh Amrollahi^2,3, Elham Bahraini⁴, Parviz Afrogh⁵, Enayatollah Kalantar^6,&

 

¹Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran, ²Blood Transfusion Researcher Center, High Institute for Education and Research in Transfusion Medicine, Tehran, Iran, ³Karaj Regional Blood Transfusion Center, Karaj, Iran, ⁴Biochemistry Department of Medicine Faculty, Iran University of Medical Sciences, Tehran, Iran, ⁵Mycobacteriology and Pulmonary Research Department, Pasteur Institute of Iran, Tehran, Iran, ⁶Department of Microbiology and Immunology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran

 

 

^&Corresponding author
Enayatollah Kalantar, Department of Microbiology and Immunology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran

 

 

 

 

Infections due to hepatitis are a major public health concern all over the world [1, 2]. Individuals with chronic infections have a higher risk of developing liver cirrhosis and hepatocellular carcinoma. This has an important role in disease burden [3-5] and there is a significant financial cost for managing the problem [6]. Blood donation has an important role in the transmission of viral hepatitis particularly hepatitis B and C and is considered a significant challenge to blood safety [7]. The world health organization estimates that over 2 billion people have been exposed to the hepatitis B virus. Approximately 350 million people are chronically infected with HBV [8] and 780 000 people die every year due to complications of hepatitis B [3]. Infected people or asymptomatic carriers are the only reservoir of hepatitis B and C infection. Prevalence of HBsAg carriers in the world has been reported from 0.1% - 20% with high percentage in tropical countries [9-13]. Theoretically the elimination of hepatitis B and c is possible. There are new and accurate strategies for screening of donated blood [7, 14] preventing transfer to others. There are safe vaccines for hepatitis B and effective treatments for chronic infections. The underlying problem lies with the differing approach and strategies by countries based on their resources and access to them, hence the problem continues. There are different studies on the frequency of HBV and HCV in blood donors all over the world which show different prevalence's [9-13, 15]. These studies have shown the frequency and trend of hepatitis B and C infections in the different societies and also a way to show the safety of donation. The Frequency of infected people with hepatitis B and C differs based on region, study type and when the study was carried out [13, 15-18]. Karaj is the capital city of the Alborz Province which is located west of Tehran and has more than 2 million inhabitants in the 2011 census being the fourth most populous city of Iran. There is little information on hepatitis infection in Karaj. Each year about 50,000 residents donate blood giving the opportunity to study the blood borne diseases in the region. The study aims to determine the prevalence of HBV and HCV in Karaj blood donors over a four year period from 2010 to 2013.

 

 

This study reports the results of a cross sectional seroepidemiological study of hepatitis B and C in blood donors of Karaj within a 4 year period from March 2010 - 2013. The blood transfusion organization registries were used for data collection. During the study period 202814 people donated in Karaj. 67828 people were first time donors whilst 134986 people were frequent donors. Multiple donation information was removed from the study by using frequent donors last donation for the analysis. Based on the screening protocol for blood donation in Iran, individuals who were at least 16 years old and in a healthy state were eligible for blood donation. Blood donors were also screened for high risk behaviors by a questionnaire and people with high risk behaviors such as drug use and having multiple partners were not eligible for blood donation. . The selected study group went through a blood donation process and a sample of their blood was sent for screening to identify blood infections like hepatitis B and C. All the samples were tested by standard operating procedure (SOP) of Iranian blood transfusion organization. Third and fourth generation ELISA kits respectively were used for screening of HBV and HCV and Confirmatory tests were done for reactive samples of donations. Data on blood donors transferred to SPSS V.19 software. Frequency of hepatitis B and C were described with numbers and percentages within 95% confidence interval. Chi square was used to compare categorical variables. Multivariate logistic regression (using backward Stepwise-Wald method) was used to evaluate demographic variables with Hepatitis B and C in first time donors. Results of logistic regression are presented as OR and 95% CI. Formal written consent was given by blood donors as a part of donation protocol. This study had been approved by the ethics committee of Alborz University of Medical Sciences.

 

 

During the study period (March 2010 to 2013) a total of 202814 donation were carried out by 109817 donors. All donations were screened; among which 193 people (0.18%) were positive for HCV and 444 people (0.40%) for HBV. Most of the study group were male (93.7%); moreover 78.6% were married and 27.2% of them had university degrees. Some of the study samples had repeated donations (38.2%) while 61.8% were first time donors (Table 1). Table 1 also shows the frequency of HBsAg positive in relation to gender, age groups, educational level, marital status and history of blood donation. There was no significant difference between male and female HBsAg positive rates but were higher in older age groups (P<0.001). Donors with lower educational levels had higher frequencies of Hepatitis B infection (P<0.001). Married people (P<0.001) and first time donors (P<0.001) also showed higher Hepatitis B infection rates.

 

Table 2 shows the relationship between HBsAg with demographic variables in first time donors. Age, sex, education and marital state was entered intothe model. After adjustment, education and marital status were related to being HBs Ag positive. The risk of being HBs positive in people with primary education and high school education was 3.59 (OR=3.59; 95% CI between 2.68-4.80) and 2.05 (OR=2.05; 95% CI between 1.55-2.73) times greater respectively than people with a university degree Single people were at lower risk to have Hepatitis B infection (OR=0.69; 95% CI between 0.51-0.93). Table 3 shows the relationship between Hepatitis C infections (HCV) with demographic variables in first time donors. Age, sex, education and marital status was entered into the model. After adjustment; education and gender were associated with Hepatitis C infection. Comparing people with university degrees the risk of being HCV positive was 4.8 times greater in people with primary education (OR=4.81; 95% CI between 2.82-8.21) and 4.1 times greater in people with high school education level (OR=4.07; 95% CI between 2.48-6.68) and 2.21 times in people with diploma (OR=2.21; 95% CI between 1.36-3.60). Male donors had higher risk of Hepatitis C infections Trend of hepatitis infection in first time blood donors of Karaj are shown in Figure 1. Frequency of hepatitis B infection has decreased significantly (P<0.001) but frequency of Hepatitis C infection has remained unchanged over the years.

 

 

Out of 202814 donation during 2010-2013 (from 109817 blood donors), 444 people (0.40%) and 193 people (0.18%) were HBV and HCV positive respectively. The present study shows a low level of endemicity of hepatitis infection in Karaj blood donors´ population. The Frequency of hepatitis B and C infections over the years [2, 10, 19] differs within the geographical location within the countries and varies worldwide [17, 20-23]. The Prevalence of hepatitis B and C in blood donors is a reflection of the infections in different communities and they show the same variations [8]. The frequency of hepatitis B and C in Karaj blood donors is relatively low, Comparing to the other regions of Iran, [17, 21, 24] and similarly is lower than some of other Middle Eastern countries such as Jordan which is 1.53%[14]. Our study is also compatible with low frequencies of viral hepatitis in Iranian blood donors. Kafi-abad et al have reported a prevalence of 0.4% for HBV infection (from 1998-2007 A.C) [15] and a prevalence of 0.56% and 0.13% for hepatitis B and C (from 2004-2007 A.C) in Iranian blood donors [25]. Another study among blood donors from 2005-2011 has reported 0.39% and 0.11% frequencies for Hepatitis B and C infection respectively [13] and a study on Shiraz blood donors showed similar frequencies [26].

 

On the other hand, there are some population based studies which have reported higher prevalence of hepatitis B and C in Iran but these results are from studies carried out over a decade ago. A study on HBV infection of the general public in 1997 reported a frequency over 5% [20] and Abdolahi et al., in 2006 reported a 9.7% prevalence in Golestan province [17]. A systematic review by Mohammadi et al, shows a decreasing trend of hepatitis B infections especially after 2006. Due to the heterogenic nature of information used the writer suggests carrying out more accurate studies to be able to estimate the point prevalence [27] of the hepatitis B infection. Looking at the results of these studies, [13, 15, 25, 26] there is a decreasing trend of hepatitis B [19, 28] which is compatible with our study results. National vaccination program for hepatitis B which started since 1993 has been successful in decreasing the hepatitis B infection. Furthermore, programs for controlling mother to child transmission, safer blood transfusions and health education campaigns on hepatitis has played a preventative role. Merat et al has shown the frequency of 0.5% (by RIBA) for hepatitis C infection [16] and another study reported 2.6% (by ELISA) and 1% (by RIBA) for hepatitis C infection in Golestan province [29]. On the other hand, our study doesn't show such a decreasing pattern of hepatitis C infection during the study period in Karaj. Men and women didn't have different positivity rates but donors who were older, had lower educational levels, were married and first time donors, had a higher frequency of HBs Ag. It was the same for hepatitis C positivity rates, except there was no significant difference based on marital status. Some studies have shown that infection rates are similar in both genders [22] but in other studies men generally have higher rates [16, 17, 30]. In our study women were at higher risk of Hepatitis B infection. This was probably due to having hepatitis B positive partners or having more high risk behaviors than other communities. This must be considered as a real public health concern [31] because of the probability of vertical transmission from mothers to child especially for hepatitis B transmissions.

 

There are also higher rate of infection in older people as shown in other studies [22] which could be explained by being at risk for longer periods of time and infection rates being higher in previous decades. On the other hand having implemented national hepatitis B vaccination program since 1993 in Iran may be another important factor for lower rates of infection in younger groups [32]. According to CDC estimation about 3.9 million people worldwide are infected with HCV, with highest prevalence among the age group 30-39 years [19] which is compatible to the current study carried out on blood donors in Karaj. Blood donors with lower educational level in our study had higher rates of hepatitis B and C, a finding which is being confirmed by other studies [13, 33]. First time blood donors had higher rates of hepatitis infections compared to frequent donors which is comparable to other studies [13, 30]. This is a result of screening method used for blood safety checks in their first donation. Safety of blood products are important especially in platelets and factors [7, 14]. The low rates of hepatitis infections in Karaj from first time donors by the use of sensitive screening methods results in low residual risk of transmission and the preparation of a safe blood product.

 

 

It seems that chronic hepatitis B and C infection in Karaj is relatively low and blood products have low residual risk of transfusion of hepatitis infections. The relative equal infection rates in men and women must be considered in controlling the transmission of infection in our province.

 

 

The authors declare no competing interests.

 

 

Kabir and kalantar designed the study. Hoseini, Miri, Amrollahi and Bahraini worked with the concept, data gathering and data purification. Kabir analyzed the data and Afrough and Kalantar explained results and prepared the report. Kabir and Kalantar wrote the manuscript.

 

 

The study couldn't be executed without cooperation of Alborz blood transfusion organization management and staff. Sara Dehghani and Leila Shahbazi helped us with data gathering from the registry. We appreciate their help and thank them for their assistance. This study has been done as a research project in Alborz and has been approved by Blood Transfusion Research Center and supported by Alborz Blood Transfusion Organization.

 

 

Table 1: frequency of hepatitis B and C infection in Karaj blood donors and in relation to some of demographic factors

Table 2: adjusted Odds Ratio for Risk factors of hepatitis B infection in blood donors

Table 3: adjusted Odds Ratio for Risk factors of hepatitis C infection in blood donors

Figure 1: trend of hepatitis B and C infection in Karaj first time blood donors from 2010 to 2013

 

 

1. Schlipköter U and F A. Communicable diseases: achievements and challenges for public health. Public Health Reviews. 2010; 32(1): p 90-119. Google Scholar


2. Aljarbou AN. The Emergent Concern of Hepatitis B globally with special attention to Kingdom of Saudi Arabia. Int J Health Sci (Qassim). 2013; 7(3): p 333-40. PubMed | Google Scholar


3. Lozano R et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380(9859): p 2095-128. Google Scholar


4. Global Burden of Disease Cancer Cet al. The Global Burden of Cancer 2013. JAMA Oncol. 2015; 1(4): p 505-27. Google Scholar


5. Hsu YC, Wu CY, Lin JT. Hepatitis C virus infection, antiviral therapy, and risk of hepatocellular carcinoma. Semin Oncol. 2015; 42(2): p 329-38. PubMed | Google Scholar


6. Makara M B. Hunyady, Financial burden of hepatitis C infection and its treatment. Orv Hetil. 2015; 156(21): p 862-8. Google Scholar


7. Laperche S et al. Blood transfusion: control of infectious risks. Presse Med. 2015; 44(2): p 189-99. Google Scholar


8. Ott JJ et al. Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine. 2012; 30(12): p 2212-9. Google Scholar


9. Karuru JW et al. Prevalence of HCV and HIV/HCV co-infection among volunteer blood donors and VCT clients. East Afr Med J. 2005; 82(4): p 166-9. Google Scholar


10. Kupek E and Petry A. Changes in the prevalence, incidence and residual risk for HIV and hepatitis C virus in Southern Brazilian blood donors since the implementation of NAT screening. Rev Soc Bras Med Trop. 2014; 47(4): p 418-25. Google Scholar


11. Namululi BA, Guerrieri C and Dramaix MW. Prevalence and incidence of HIV and hepatitis B among blood donors and estimated residual risk of transmission of HIV and HBV virus by blood transfusion: a study at the Provincial General Referee Hospital Bukavu, Democratic Republic of the Congo. Rev Epidemiol Sante Publique. 2013; 61(2): p 139-44. PubMed | Google Scholar


12. Willand L et al. HIV, HCV, HBV and syphilis infections among blood donors in Germany 2006: Report from the Robert Koch Institute in accordance with Article 22 of the Transfusion Act. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008; 51(8): p 902-14. Google Scholar


13. Mohammadali F and Pourfathollah AA. Changes in frequency of HBV, HCV, HIV and syphilis infections among blood donors in Tehran province 2005 - 2011. Arch Iran Med. 2014; 17(9): p 613-20. Google Scholar


14. Marwaha N and Sachdev S. Current testing strategies for hepatitis C virus infection in blood donors and the way forward. World J Gastroenterol. 2014; 20(11): p 2948-54. Google Scholar


15. Kafi-abad SA, Rezvan H, Abolghasemi H. Trends in prevalence of hepatitis B virus infection among Iranian blood donors, 1998-200. Transfus Med. 2009; 19(4): p 189-94. PubMed | Google Scholar


16. Merat S et al. Seroprevalence of hepatitis C virus: the first population-based study from Iran. Int J Infect Dis. 2010; 14 Suppl 3: p e113-6. Google Scholar


17. Abdolahi N et al. HBV Seroprevalence among Golestan Adults. Iranian Journal of Epidemiology. 2006; 2(3): p 35-40. Google Scholar


18. Zali MR et al. Epidemiology of hepatitis B in the Islamic Republic of Iran. 1996;2(2):1996. Google Scholar


19. Apata IW et al. Progress toward prevention of transfusion-transmitted hepatitis B and hepatitis C infection-sub-Saharan Africa, 2000-2011. MMWR Morb Mortal Wkly Rep. 2014; 63(29): p 613-9. Google Scholar


20. Malekzadeh R, Khatibian M, Rezvan H. Viral hepatitis in the world and Iran. J Iran Med Council. 2012 May; 14(5): 283-288. Google Scholar


21. Salehi M et al. Seroepidemiology of HBV infection in South-East of iran; a population based study. Iran Red Crescent Med J. 2012; 14(5): p 283-8. Google Scholar


22. Alavian SM et al. Seroprevalence of Hepatitis B Virus Infection and Its Risk Factors in the West of Iran: a population-based Study. Int J Prev Med. 2012; 3(11): p 770-5. Google Scholar


23. Zamani F et al. Prevalence and Risk Factors of Hepatitis C Virus Infection in Amol City, North of Iran: a population-Based Study (2008-2011). Hepat Mon. 2013; 13(12): p e13313. Google Scholar


24. nokhodiyan Zet al. Hepatitis B Markers in Isfahan, Central Iran: a population-Based Study. Hepat Mon. 2009; 9(1): p 12-16. Google Scholar


25. Kafi-abad SA et al. Prevalence and trends of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus among blood donors in Iran, 2004 through 2007. Transfusion. 2009; 49(10): p 2214-20. Google Scholar


26. Kasraian L and Torab Jahromi SA. Prevalence of major transfusion transmitted viral infections (HCV, HBV, HIV) in Shiraz blood donors from 2000 to 2005. The Scientific Journal of Iranian Blood Transfusion Organization. 2007; 3(5): p 373-378. Google Scholar


27. Mohammadi Z et al. Epidemiological Profile of Hepatitis B Virus Infection in Iran in the Past 25 years; a systematic review and meta-analysis of general population studies. Middle East Journal of Digestive Diseases. 2016; 8(1): p 5-18. Google Scholar


28. Alavian SM, Fallahian F and Lankarani KB. The changing epidemiology of viral hepatitis B in Iran. J Gastrointestin Liver Dis. 2007; 16(4): p 403-6. PubMed | Google Scholar


29. Ghadir M et al. Hepatitis C in Golestan Province-Iran. Govaresh. 2006; 11(3): p 158-162. Google Scholar


30. Namululi BA, Guerrieri C and Dramaix M. Impact of method of recruitment of blood donors on the prevalence of HIV and HBV in Bukavu, DR Congo. Med Sante Trop.2012; 22(1): p 69-74. PubMed | Google Scholar


31. Schillie S et al. Outcomes of infants born to women infected with hepatitis B. Pediatrics. 2015; 135(5): p e1141-7. Google Scholar


32. Rezaee R et al. Prevalence of National Responsiveness to HBV Vaccine After 22 Years of Iranian Expanded Program on Immunization (EPI): a systematic review and meta-analysis study. Hepat Mon. 2015; 15(5): p e23618. Google Scholar


33. Dahl TFet al. Health literacy in patients with chronic hepatitis B attending a tertiary hospital in Melbourne: a questionnaire based survey. BMC Infect Dis. 2014; 14: p 537. Google Scholar