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LEADING ARTICLE
Year : 1997  |  Volume : 4  |  Issue : 1  |  Page : 24-29  

Seroepidemiology of hepatitis B virus (HBV) and hepatitis C virus (HCV) and relationship to alanine transferase (ALT) in Saudi workers at Yanbu industrial city


1 Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
2 Department of Immunology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia

Date of Web Publication31-Jul-2012

Correspondence Address:
Rashad H Kashgari
P.O. Box 40997, Jeddah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


PMID: 23008562

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   Abstract 

Objectives : To study the epidemiology of Hepatitis B virus (HBV) and Hepatitis C virus (HCP) in a relatively new industrial community in Yanbu, and to find out whether any relationship exists between increased serum Alanine Transferase (ALT) and HBV infection.
Method : .4 group of Saudi male workers (n=332) (mean age = 32 years) were screened for Hepatitis B core antibody (anti-HBc), Hepatitis B surface antigen (HBsAg), Hepatitis C virus antibody (anti-HCV), and Alanine Transferase (ALT) level and the results were correlated with age and marital status.
Results: Overall, the prevalence of anti-HBc, HBsAg, and anti-HCV were 23.2%, 7.7% and 0.6% respectively. Age-related HBsAg carrier rates were 7.8%, 6.4% and 9.4% for age groups 18-20, 21-30 and over 30 years respec­tively. Anti-HBc positivity rates lucre 7.8%, 24.3% and 23.1 M for the same age groups. Anti-HCV was positive in only two cases (0.6%) of all subjects. Con­sidering marital status, HBsAg and anti-HBc positivity rates were 7.8% and 20.5% for single subjects compared wi t h 7.4% and 24.5% for married subjects (P=> 0.5 and > 0.5). Twenty-two percent of all subjects had ALT levels above 35 U/L with no correlation between the increase of ALT and anti-HBc or HBsAg positivity.
Conclusions : The findings of this work: (1) Support the notion of relatively low prevalence of HCV in the Saudi Population as compared to HBV. (2) Provide clues regarding possible routes of transmission of HBV in Saudis that may help in vaccination policies for control of HBV infection. (3) Emphasize the fact that ALT level is an independent factor of HBV infection, and (4) Signify the need to screen industrial workers fir non-viral causes of liver disease.

Keywords: Hepatitis B virus (HBI), Hepatitis C virus (HCV), Alanine Transferase


How to cite this article:
Kashgari RH, Mohamad AA. Seroepidemiology of hepatitis B virus (HBV) and hepatitis C virus (HCV) and relationship to alanine transferase (ALT) in Saudi workers at Yanbu industrial city. J Fam Community Med 1997;4:24-9

How to cite this URL:
Kashgari RH, Mohamad AA. Seroepidemiology of hepatitis B virus (HBV) and hepatitis C virus (HCV) and relationship to alanine transferase (ALT) in Saudi workers at Yanbu industrial city. J Fam Community Med [serial online] 1997 [cited 2019 Dec 6];4:24-9. Available from: http://www.jfcmonline.com/text.asp?1997/4/1/24/98450


   Introduction Top


Saudi Arabia is considered an area of en­demic HBV infection. By adult age, 7% of the population has HBsAg and about 70% has one or more HBV markers. [1],[2] The epidemiology of HBV in Saudi Arabia has largely been established. Probably no fur­ther large-scale studies are needed to de­termine the prevalence of HBV in the country.

Studies on the prevalence and epidemiology of HCV infection in Saudi Arabia have also been conducted [3],[4],[5],[6],[7] but further studies are still needed. Also still war­ranted are studies on the epidemiology of HBV in areas which have not yet been screened. Earlier studies on the major modes of transmission of HBV have justi­fied and led to the establishment of a na­tional mass neonatal HBV vaccination programme in Saudi Arabia in October 1989 as a part of the Expanded Programme of Immunization (EPI) following a Royal decree in 1988. [8]

Such a vaccination programme should eventually lead to the control of HBV infection in Saudi Arabia, however, questions on expanding the HBV vaccination pro­gramme to include other population groups have occasionally been raised, warranting the need for more understanding of the major modes of transmission of HBV in different population groups. This study rep­resents an effort to address these concerns.


   Material and Methods Top


Over a period of three months during 1994, Saudi males working in Yanbu industrial city and listed as potential blood donors were randomly selected for this study. Each subject completed a brief questionnaire with personal data that included age, na­tionality, sex and marital status.

Blood was collected from each subject and serum separated within 1 hour and analyzed freshly for ALT level. Aliquots were stored at -70° C until further serologi­cal analysis. ALT was measured using an International Federation of Chemistry rec­ommended reagent (Boehringer: Mann­heim, Germany) on a Hitachi chemistry analyzer. HBsAg, anti-HBc, and anti-HCV were measured using commercial enzyme immunoassays (for anti-HCV, second gen­eration enzyme immunoassay-Elisa) from Abbott Laboratories (Chicago, USA).

Statistical analysis of the results, where applicable, was performed by constructing contingency tables and calculating the chi­squares (with Yates correction when appli­cable).


   Results Top


The prevalence of anti-HBc was 23.2% (77/332) reflecting mostly the overall expo­sure rate to HBV infection in this group of the study. HBsAg carrier rate was 7.7% (25/332). The anti-HCV prevalence rate, however, was approximately 0.6% (2/332), which is comparatively much lower than the HBV infection rate.

Age-specific analysis of these results, shown in [Table 1] and [Figure 1], indicated an anti-HBc prevalence of 7.8% (1/13) for the age group 18-20 years, 24.3% (49/202) for the age group 21-30 years and 23.1% (27/117) for the age group over 30 years. The age-specific prevalence of HBsAg was 7.8% (1/13) for age group 18-20 years, 6.4% (13/202) for the age group 21-30 years, and 9.4% (11/117) for the age group over 30 years.
Figure 1: Age related HBV exposure and carrier rates

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Table 1: Distribution of HBV exposure and carrier rates by age and marital status

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Categorizing the subjects by marital status [Table 1] and [Figure 2], the anti-HBc prevalence rate was 20.5% (21/102) and 24.5% (56/230) while the HBsAg preva­lence rate was 7.8% (8/102) and 7.4% (17/230) for single and married subjects respectively.
Figure 2: HBV exposurea nd carrier rates in relation to marital status

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Assessment of ALT as a marker of dis­turbed liver in relation to HBV infection is summarized in [Table 2]. ALT levels higher than 35 U/L were found in 22% (73/332) of all subjects. At a cut-off value of 45 U/L, high ALT levels were found in 15% (51/332) of the subjects. ALT values higher than 70 U/L were found in 4.5% (15/332) of all subjects. Categorizing the subjects into two groups of normal (<35 U/L) and high ALT level, anti-HBc positivity rates were 23.5% (61/259) and 22% (16/73), and HBsAg carrier rates were 7.7% (20/259) and 6.8% (5/73) for both groups respec­tively. Using the 70 U/L of ALT as a cut­off, anti-HBc was positive in 40% (6/15 of subjects with ALT > 70 U/L compared to 22.4% (71/317) of subjects with ALT < 70 U/L. HBsAg was also positive in 20% (3/15) of subjects with ALT > 70 U/L com­pared to 6.9% (22/317) of subjects with ALT < 70 U/L..
Table 2: Distribution of HBV exposure and carrier rates by ALT level

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   Discussion Top


During the last 15 years, various studies have been conducted in Saudi Arabia to examine the epidemiology of HBV and HCV among other hepatitis viruses and their relationship to liver disease in the Kingdom. A large volume of data has been collected by analysis of blood donors, school children, and outpatient populations from urban and rural areas all over the country. [9],[10],[11],[12],[13],[14],[15],[16],[17] The average overall prevalence of HBsAg in Saudi Arabia was estimated to be about 8.3% which puts the Kingdom among the highly endemic areas in the world. The HBV exposure rate was esti­mated to range from 30% to 80% in different regions of the Kingdom.' Our results of an HBsAg carrier rate of 7.7% and anti-HBc positivity rate of 23.2% support the nationally estimated rates of HBV in­fection through the 1990s.

The overall prevalence of anti-HCV in this group was 0.6%. Al-Mofarreh [3] et al and Fathalla [6] et al reported a similar low incidence of anti-HCV (1.24% and L 15%,) among Saudis in Riyadh and Dammam respectively. The relatively low number of subjects did not help meaningful epidemi­ological study for HCV in this group.

Studies on the transmission routes of HBV infection in Saudi Arabia demon­strated that perinatal transmission plays a minimal role, if any, in the transmission of HBV and that HBV infection occurs mainly horizontally with a first peak during the preschool childhood age and a second peak around the early adulthood ages of 20-30 years. [9],[10],[11],[12],[13],[18],[19]

Our results of age-specific HBV infection fates continue to suggest a peak of HBV infection early in life, before 18 years, contributing for the most part to the estab­lishment of the HBsAg carrier status in the population. This early peak is followed by a second peak of HBV infection during the early adulthood ages of 20-30 years.

Folk traditions in Saudi Arabia like cir­cumcision by folk practitioners, "hijama," skin cautery [20] and head shaving with non­disposable razors, are potential contribut­ing factors to the transmission of HBV in the Kingdom. "Hijama" is letting blood by incising the skin, mostly on the back. Het­erosexual contact has been suggested as possibly responsible for the second peak of HBV infection in the Kingdom. [1] Interest­ingly, our results suggest that marital status, being the major means of heterosex­ual contact in Saudi Arabia, did not seem to correlate statistically with the risk of acquiring HBV infection or developing HBsAg carrier status. Thus, although pre­marital screening may be optional at the individual level, it may not be cost-effective to adopt it as a national health policy. Al­ternatively, however, a precollege screen­ing program may be more beneficial to implement for 12-15 years to come until the first generation who have been vacci­nated during their neonatal age, reach the pre-college age.

The analysis of the ALT results suggests that HBV infection and increased ALT are not necessarily predictors of each other. Interestingly however, at a level of ALT higher than 70 IU/L, a statistically signifi­cant correlation with HBV infection is pre­sent. Noticeably, the majority of subjects with increased ALT were negative for HBsAg and anti-HBc. Since the study has been conducted in an industrial commu­nity, it will be interesting to look for pos­sible chemically or environmentally in­duced toxic liver disease in Yanbu Indus­trial city.

In conclusion, this study allows new in­ sights into the epidemiology of HBV and liver disease in Saudi Arabia and prompts further studies for the future.

 
   References Top

1.AI-Faleh FZ. Hepatitis B infection in Saudi Arabia. Ann Saudi Med 1988; R8:474-79.  Back to cited text no. 1
    
2.Arya SC. Viral hepatitis in Saudi Arabia. Saudi Tied J 1989; 10:267-72.  Back to cited text no. 2
    
3.Al-Mofarreh M, Fakunle YM, El-Karamany WM, Ezzat HO, Ballesteros MN, Khawaji MZ, et al. Prevalence of antibodies to hepatitis C virus in blood donors in Riyadh. Ann Saudi toted 1991; 11:501­503.  Back to cited text no. 3
    
4.Bernvil SS, Andrews VJ, and Kariem AA Hepatitis C. Antibody prevalence in Saudi Arabian blood do­nor population. Ann Saudi Med 1991; 11:563-7.  Back to cited text no. 4
    
5.Bakir TMF. Age-specific prevalence of antibody to hepatitis C virus among the Saudi population. Saudi Med J 1991; 13:321-4.  Back to cited text no. 5
    
6.Fathalla SE, Al-lama AA, Badawy MS, Sabry HS, Awad OA, Abdulaziz FM, et al. Prevalence of hepatitis C virus in the Eastern Province of Saudi Arabia by Re-DNA second generation and supple­mental tests. Saudi Med J 1994; 15:281-5.  Back to cited text no. 6
    
7.Abdelaal M, Rowbottom D, Zawawi T, Scott T, Gilpin C. Epidemiology of Hepatitis C Virus: A study of male blood donors in Saudi Arabia. Trans­fusion 1994; 34:135-7.  Back to cited text no. 7
    
8.Al-Faleh FZ, Ayoola EA, Aref Al, Ramia S, Al­Rashed R, Al-Jeffrey AI, Al-Mofarreh Al, et al. Seroepidemiology of hepatitis B virus infection in Saudi children: A baseline survey for a mass vacci­nation against hepatitis. J Infect 1992; 24:197-206.  Back to cited text no. 8
    
9.Talukder NIA, Gilmore R, Bacchus RA. Prevalence of hepatitis B surface antigen among male Saudi Arabians. J Infect Dis 1992;146:466.  Back to cited text no. 9
    
10.Habayeb S. Twenty-Five months' epidemiological observations at King Faisal Military Hospital, Khamis Mushayt. Saudi Med J 19R2;3:35-39.  Back to cited text no. 10
    
11.Ramia S, Abduljabbar F, Bakjir TM, Hossain A. Vertical transmission of hepatitis B surface antigen in Saudi Arabia. Ann Trop Pediatr 1984;4:213-216.  Back to cited text no. 11
    
12.Fathalla SS, Namnyak SS, Al-Jams AA, Rbaria­Baustista MM. The prevalence of HBsAg in healthy subjects residing in the Eastern Province of Saudi Arabia. Saudi Med J 1985;G:236-241.  Back to cited text no. 12
    
13.Arya SC, Ashraf SJ, Parande CAI, El-Sayed AI, Sahay R, Ageel AR, et al. Hepatitis B virus in Gizan, Saudi Arabia. J Med Virol 1985;17:267­274.  Back to cited text no. 13
    
14.El-Hazmi MAF. Hepatitis B markers in Saudi Ara­bia: a comparative study in different regions. Ann Saudi Med 1986;6:185-190.  Back to cited text no. 14
    
15.El-Hazmi MAF, AI-Faleh FZ, Warsy AS. Epidemiology of viral hepatitis among the Saudi population: A study of viral markers in Khaibar. Saudi Med J 1986;7:122-9.  Back to cited text no. 15
    
16.Takieddne FN, Tafunkeji HT, Sheth KV, Ghandour MH. Prevalence of HBV markers in adult Saudis in relation to age and sex. Ann Saudi Med 1986; 6:205-9.  Back to cited text no. 16
    
17.Al-Admawy AM, Talukder MA, Gilmore R. Preva­lence and acquisition rates of hepatitis HBsAg in Riyadh Al-Kharj hospital programme. Saudi bled J 1987;8: 142-6.  Back to cited text no. 17
    
18.Basalamah Al-I, Sebour F, Kazim E. Materno-Fetal Transmission of hepatitis B in Saudi Arabia. J Infect 1994;8:200-4.  Back to cited text no. 18
    
19.Ashraf SJ, Anna SC, Parande CAI. Prevalence of H B V marker among neonates and females of child­bearing age in Gizan. Ann Saudi Med 1987;7:71-3.  Back to cited text no. 19
    
20.Mohammed N, Nielsen B, Forunate F, Hawash T, Abdulhamid I, Abdu K, et al. Skin cauterization marks on patients in Saudi Arabia. Lancet 1983; 1:714.  Back to cited text no. 20
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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