Virology & Mycology
Open Access
ISSN: 2161-0517
ISSN: 2161-0517
Research Article - (2023)Volume 12, Issue 1
Hepatitis B and C are liver affecting viral infections being transmitted by blood contamination. They are endemic in Pakistan and have put a great burden on its low budget. To cope with it, one must have an idea about disease burden at present and prediction for the future which will help policymakers.
66308 healthy blood donors were screened for HBV and HCV using kit method and data was analyzed using SPSS 20. Results obtained were subjected to Least square method of time series to predict HBV and HCV in 2030.
715 (1.08%) and 1846 (2.78%) were screened as positive for HBV and HCV from 66,308 respectively. Predicted percentages of HBV and HCV for 2030 were 3.25% and 6.36% respectively.
The study showed a higher burden of HBV and HCV in the recent past and predicted a much lethal percentage for the future. This necessitates both preventive and therapeutics measurements to be taken to save precious human lives.
Hepatitis B and C are mainly viral infections of liver affecting 350 million and 185 million people worldwide and have caused 786000 and 399000 deaths respectively. Their causative agent is Hepatitis B virus (HBV) and hepatitis C virus (HCV).(1,2,3,4) The chronic stage of HBV and HCV can lead to cirrhosis of the liver and hepatocellular carcinoma. (5) HBV and HCV are blood-borne infections transmitted mainly through blood and its products. (6) Viral Hepatitis has emerged as a huge problem for health facilities since it has been ranked 5th as the commonest cause of death globally. (5)In developing countries like Pakistan HBV and HCV are endemic. Both of them are a major health concern. Their Prevalence among the general population is 4.33% for HBV and 4.9% for HCV.( 7, 8, 9)
Pakistan is a country with a low budget (0.75% of GDP) for health and limited resources.HBV and HCV have put a great burden on it. (10) To cope with it, strict surveillance is required. With these resources, it is difficult to screen the whole population. Almost 1.5 million people donate blood annually in Pakistan. Being blood-borne infections, screening of healthy donors will not only prevent the disease spread but also will give an estimate of disease burden.(11,12,13)
However, it may underestimate or overestimate the disease but can help know the disease burden in general. (14) The literature on the prevalence of HBV and HCV in healthy blood donors suggested being a percentage of 1.4 _ 2.99% and 3.1_4.99% respectively in a ten-year study of Shoukat Khanum. This has proved a decreasing trend in the prevalence of HBV and an increasing percentage for HCV. (15) In Northern and Southern Pakistan it was found to be 3.33% and 2.28% for HBV and 4.0% and 1.18% for HCV respectively with the same trend.(16,17) However, we could not find any study specifically of Gujranwala. In our study, we screened Healthy donors visiting DHQ Teaching hospital Gujranwala to estimate disease burden and predicted its future prevalence to perceive an upcoming burden.
Retrospective cross-sectional study.
DHQ Teaching Hospital, Gujranwala.
66,308 healthy blood donors.
Six years (from January 2010 to December 2015).
Blood donors of age ranging from19 to 60, non-drug abusers, not suffering from any chronic disease like diabetes, Chronic kidney disease, and tuberculosis were included in the study. All those ages below 19 and above 60, High-risk populations like drug abusers, sex workers, those on dialysis, Diabetics, and patients of TB were excluded. This was done with a proforma stating the patient's history.
To detect HBV, a qualitative test based on lateral flow immunoassay using diagnostic kits (DS) was used. The double-antibody sandwich technique using a combination of polyclonal and monoclonal antibodies was applied to detect raised levels of HBsAg for HBV.
This was done with a diagnostic kit, IHC-302 - HCV Rapid Test Cassette by Vaxpert, Inc. Miami, Florida that uses principles of lateral flow immunoassay to qualitatively detect HCV. The membrane of the HCV kit was coated with both antigen and antibodies in the test zone and control zone respectively. The presence of HCV antibodies produced a dark line in both zones.
Data were analyzed in SPSS 20 for simple frequencies. Based on data obtained for six years we predicted the prevalence of HBV and HCV in 2030. To predict for future (2030), Least Square method among Time Series analysis of regression was used. It was applied since a prediction was needed in time for the individual variable. This was found using the following formulas:
We screened 66,308 healthy donors in which 715 (1.08%) and 1846 (2.78%) were positive for HBV and HCV respectively. We predicted the percentage of HBV and HCV for 2030 to be 3.25% and 6.36% respectively. The contribution of each year with predicted values for 2030 is given below. (Table 1)
Table 1: Prevalance Of HBV and HCV in Healthy Blood Donors
| Years | Total | + ve Hep-B | + ve Hep-C | B% | C% |
|---|---|---|---|---|---|
| 2010 | 10970 | 79 | 270 | 0.072 | 2.96 |
| 2011 | 10813 | 96 | 235 | .0887 | 2.17 |
| 2012 | 11473 | 118 | 299 | 1.028 | 2.606 |
| 2013 | 10513 | 117 | 288 | 1.11 | 2.74 |
| 2014 | 10691 | 131 | 359 | 1.22 | 3.35 |
| 2015 | 11898 | 174 | 395 | 1.466 | 3.33 |
| Cumulative Value | 66308 | 715 | 1846 | 1.08% | 2.78% |
| For 2030 | 12584 | 409 | 801 | 3.25% | 6.36% |
Table 2: For HCV.
| Years | Y | X | XY |
|---|---|---|---|
| 2010 | 79 | -5 | -395 |
| 2011 | 96 | -3 | -288 |
| 2012 | 118 | -1 | -118 |
| 2013 | 117 | 1 | 117 |
| 2014 | 131 | 3 | 393 |
| 2015 | 174 | 5 | 870 |
∑ = 715 |
0 |
∑= 579 |
Figure1:Graph Showing HBV prevalence throughout these years.
Figure2:Graph Showing HCV prevalence throughout these years.
HBV and HCV are viral infections of the liver, disrupting its architecture, causing its cirrhosis and hepatocellular carcinoma. They are endemic in Pakistan. Both of these are putting a great burden on the economy of the state. In order to reduce the burden, special policies are the need of the hour. Since they are blood-borne infections, screening for healthy donors is a good tool to assess disease burden. This will prevent transmission of the disease, in addition, to offer treatment to asymptomatic carriers diagnosed through screening.In our study, a six-year screening of blood donors provided a percentage of 1.08% for HBV and 2.78% for HCV. An increasing trend in their percentages was observed for HBV throughout these years. This has also been found in other studies for HCV but not for HBV.
We found an increasing percentage of HCV throughout these years except for a small dip 2011 the reason for which is not known to us. However, HCV percentage was relatively higher in our study but was comparable with other studies of Pakistan.HCV percentage should decrease since a very good treatment is available for it.(18,19) This is not decreasing probably due to a lack of knowledge of the disease.
The HBV prevalence was found increasing in our study. But HBV percentage has been fodecreasing in other studies of Pakistan. This is probably due to vaccination and the availability obetter treatment. (20,21) However, our study revealed a contrasting fact to the literature showing an increasing percentage of HBV in healthy donors but this was lower than HCV. This contr might be due to poor sterilization of surgical instruments being used, the use of unsteri syringes, lesser awareness of the disease transmission, decreased the availability of resources for treatment and non-compliance of people to treatment and vaccination. This is an alarming situation that needs to be addressed properly and seriously by health facilities.
We predicted the percentage of HBV and HCV for 2030 which was 3.25% and 6.36% respectively. These are seriously higher percentages, casting a lethal shadow of the future. The need of the hour is to come up with better policies obeying the limitations of resources. Prevention is the first target that can be achieved by educating the masses and health care workers. This is possible with seminars, pamphlets, and special training courses. Proper sterilization and efficient screening are other tools to reduce the spread of disease. A well organized and well-developed plan of vaccination will provide strength to the target. The government should provide treatment either free of cost or at a lower price to make treatment feasible for the whole community.
The limitation of our study is that it has not depicted the true load of the disease in the community. This is due to the fact that most of the donors were males and were younger. This has excluded old age patients, children, and females which constitute a major portion of the population. Demographic statistics of donors were lacking in our study. However, Our study is a good tool to visualize the disaster of HBV and HCV in the future. In a nutshell, HCV and HBV must be addressed both at the government and community level to eradicate them.
The study showed a higher burden of HBV and HCV in the recent past and predicted a much lethal percentage for the future. This drastically higher percentage would not only kill and deteriorate the quality of thousands of human beings but also will put a great burden on the economy of the Country. This necessitates both preventive and therapeutics measurements to be taken to save precious human lives.
Citation: Zahoor S (2023). Past and Future Perspectives for Hepatitis B and C in Pakistan.Virol Myco 12:254
Published: 01-Mar-2023
Copyright: Zahoor S © 2023. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.