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LEADING ARTICLE
Year : 1997  |  Volume : 4  |  Issue : 1  |  Page : 30-36  

Pattern of HBsAg positivity in selected groups at King Khalid general hospital - hail region, kingdom of Saudi Arabia


1 Directorate of Health Affairs, Hail, Saudi Arabia
2 King Khalid Hospital, Hail, Saudi Arabia
3 Ain Shams University, Cairo, Egypt

Date of Web Publication31-Jul-2012

Correspondence Address:
Hisham M Mahaba
Director of Research Department, Directorate of Health Affairs, Governmental Complex, Hail
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


PMID: 23008563

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   Abstract 

Background : Hepatitis B virus (HBV9 is endemic in the Kingdom of Saudi Arabia. The acquisition of infection occurs early in life. The availability of safe and efficacious vaccines has led to the feasibility of an effective control of HBV infection. This study compares the pattern of HBsAg positivity among se­lected groups of patients with similar groups in other regions in the Kingdom of Saudi Arabia.
Objectives : This study is conducted to determine the prevalence of HBsAg positive subjects among selected groups of patients attending the main general hospital in the Hail region.
Subjects and Methods : This retrospective study included 14029 subjects that were tested for HBsAg at King Khalid General Hospital, during the period from April 1994 to April 1996.
Results and Discussion : The overall prevalence of HBsAg positive subjects was 3.5%. The prevalence for Saudis was about 3.2% for Saudis. Pakistanis had the highest prevalence of 11.8%. The prevalence was 3.02% for blood donors, and 2.1 % among pregnant women. No significant difference was found among different age groups. Hail region had a lower prevalence of HBsAg positive cases compared to that estimated by previous studies in the Kingdom, suggesting success in efforts applied by the Ministry of Health (110H) for prevention of Hepatitis B viral infection.
Conclusion : We can conclude that the prevalence of HBsAg positive subjects is declining in the Hail region, Kingdom of Saudi Arabia (KSA). This decline suggests the success of preventive efforts such as vaccination of newborns with the HBsAg vaccine. However, screening of pregnant women for HBsAg scents to be necessary.

Keywords: Hepatitis, prevalence; prevention, viral.


How to cite this article:
Mahaba HM, EI-Tayeb AA, EI-Sekibi DK, El Gofaei AF, EI-Baz HS, Ismail NA. Pattern of HBsAg positivity in selected groups at King Khalid general hospital - hail region, kingdom of Saudi Arabia. J Fam Community Med 1997;4:30-6

How to cite this URL:
Mahaba HM, EI-Tayeb AA, EI-Sekibi DK, El Gofaei AF, EI-Baz HS, Ismail NA. Pattern of HBsAg positivity in selected groups at King Khalid general hospital - hail region, kingdom of Saudi Arabia. J Fam Community Med [serial online] 1997 [cited 2019 Dec 8];4:30-6. Available from: http://www.jfcmonline.com/text.asp?1997/4/1/30/98495


   Introduction Top


Hepatitis B virus (HBV) infection is con­sidered an important health problem in most countries. Thanks to the serologic and immunologic tests that were developed following the discovery of the Hepatitis B surface antigen (HBsAg) in 1964 by Blumberg et al, [1] a significant amount of data has been accumulated in the world literature regarding the prevalence, carrier state, and mode of transmission of HBV.

In the Kingdom of Saudi Arabia (KSA), various studies of HBsAg prevalence have been conducted. [2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15] These studies have described the prevalence of HBV, and modes of its transmission. Most of these data are related to the epidemiological aspects of this infection and have high­lighted several interesting differences in HBsAg positive subjects among different population groups, e.g. blood donors, preg­nant women, jaundiced patients, and those undergoing endoscopy. The overall preva­lence of HBsAg in the KSA during the year 1988 was estimated to be 8.3%. [16] However, since then there have been great efforts by the Ministry of Health (MOH) for preven­tion of Hepatitis B virus infections. These include vaccination of all newborns with the Hepatitis B vaccine, pre-employment screening of foreign employees, periodical screening of medical staff, and screening of pregnant women for HBsAg. This study was conducted to describe the pattern of HBsAg positivity among selected groups of patients attending the main general hospital in the Hail region.


   Material and Methods Top


King Khalid General Hospital is the only governmental facility available in the Hail region which can perform serological test­ing for hepatitis markers. All cases in this region for which these tests are needed are referred to the laboratory at King Khalid General Hospital. The private sector does not play an important role in the Hail re­gion and is restricted entirely to the main city, so patients attending this hospital can be considered to have been representive of all cases that required tests for hepatitis markers in the Hail region during the study period.

A retrospective study involved all cases that were tested for HBsAg at the Blood Bank and Laboratory of King Khalid Hospital, in the Hail region of the KSA during the period between April 1994 and April 1996. The study involved 14029 subjects. They included 6418 blood donors that were tested at the blood bank, and 7611 patients that were referred to the laboratory by dif­ferent hospital departments. Available data included age, results of HBsAg test, and indication for testing for HBsAg. In addi­tion to these variables, nationality and re­ferral department were available only for patients tested by the laboratory and missed for blood donors.

Tests for the Hepatitis B surface antigen were performed using the enzyme immunoassay kits supplied by Abbott, North Chi­cago, Illinois (Auszyme). Sera were tested either on the day of collection or were stored at 0° C and thawed only once before testing. Repeated positive HBsAg results for the same patient were carefully checked and counted only once. Analysis of the collected data was done with the Statistical Package for the Social Science (SPSS) program.


   Results Top


A total of 2444 patients were tested for HBsAg during the period between 1 April 1994 and 1 April 1995. In addition, 3177 blood donors were tested for HBsAg during the same period. A total of 5167 patients were tested during the period between 1 April 1995 and 1 April 1996. Moreover, 3241 blood donors were tested for HBsAg during the same period.

Data about nationality were missed for all blood donors. Thus, the prevalence of HBsAg positive subjects among different nationalities was studied only among pa­tients referred to the laboratory by different departments for HBsAg testing.

[Table 1] compares the prevalence of HBsAg positive patients among different nationalities. Saudis had a total prevalence of about 3.2% during the year 1995-1996, which is less than that of the preceding year. Egyptians showed a similar decline in HBsAg positive cases, although the dif­ference was not statistically significant (P>0.05). This was also true for non-Saudis other than Indians, Pakistanis, and Ben­galis. Those nationalities did not show obvious decline in positive cases for HBsAg. Pakistanis and Filipinos had obvi­ously higher prevalence of HBsAg positive cases than for other countries, namely 13.5% for Pakistanis and 9.6% for Filipinos during the year 1994-1995.
Table 1: Prevalence of HBsAg++ cases among different nationalities

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The prevalence of HBsAg positive cases did not differ significantly between differ­ent age groups [Table 2].
Table 2:Prevalence of HBsAg++ cases in different age groups

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[Table 3] shows the prevalence of HBsAg positive subjects according to the indica­tions for their testing during the two years studied. This prevalence significantly de­clined during the year 1995-1996 among those routinely tested (blood donors, preg­nant women, and those undergoing laparoscopic cholecystectomy). The prevalence of HBsAg positive subjects among jaundiced patients and those with liver problems during the year 1994-1995 was about 6.98%. It experienced insignificant de­crease to 5.97% during the year 1995-1996. Prevalence of HBsAg positive cases among those undergoing dialysis was 2.29%, and it declined to 1.2% during the year 1995­1996. The total prevalence of HBsAg positive subjects declined significantly from 4.08% during the year 1994-1995 to 3.2% during the year 1995-1996.
Table 3: Prevalence qf HBs4g++ cases according to indication for their testing

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[Table 4] shows the prevalence of HBsAg positive subjects among blood donors, and different departments. The Department of General Medicine included those patients referred for HBsAg testing from all other hospitals and PHCCs in the Hail region. It showed the highest prevalence of HBsAg positive cases, 11.1% for the year April 1995 to April 1996. The prevalence of HBsAg positive subjects among blood do­nors was 3.02% during the year April 1995 to April 1996.
Table 4: Prevalence of HBsAg++ cases among blood donors and in different deptartments

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   Discussion Top


Hepatitis B virus (HBV) is endemic in the KSA where about 8% of apparently healthy adults are carriers of HBsAg. [7],[15] The ac­quisition of infection occurs early in life. By the age of ten years, 20% of Saudi children are positive for at least one of HBV markers. [20],[21] The availability of safe and efficacious vaccines has led to the feasibility of an effective control of HBV infection. [22],[23],[24] A decline of 20% per year in the incidence of Hepatitis B viral infection was reported in the USA after adoption of national pro­grams for vaccination of newborns and screening of pregnant women for HBsAg. [17]

Vaccination of all newborns with Hepati­tis B surface antigen vaccine started in the KSA on October 1989. [25] High vaccination coverage of newborns with this vaccine exceeded 94% for those receiving the 3 doses of the vaccine in the Hail region during the year 1995. [18] Moreover screening of blood donors, medical staff, and pre­employment screening of all foreigners for HBsAg is routinely conducted all over the KSA. Screening pregnant women for HBsAg is recommended by the MOH and is carried out to a varying degree in different regions in the KSA including the Hail re­gion. In our study only 1466 pregnant women, representing about 8% of the total pregnant women registered at PHCCs, were screened for HBsAg in the Hail region during the year 1995-1996. [18]

The total prevalence for HBsAg carrier state was found to be 3.3% during the pe­riod between April 1995 to April 1996. This level is less than that during the period between April 1994 and April 1995 (4.08%). The reduction was true mainly for Saudis. Moreover it is remarkably less than the total prevalence of 8.3% estimated for KSA during the year 1988. [16] This reduction was also true for blood donors in Hail, 3.02% compared to 6.1% level estimated in Riyadh, [1],[6],[13],[14],[18] and Medinah. [26] Pregnant women showed slightly lower prevalence for HBsAg (2.1%), than that previously reported of about 3.1%. [12],[27],[28] In addition prevalence of HBsAg among those under­going laparoscopic cholecystectomy, 2.0%, showed a lower level than those reported before the year 1988, 5.4% for the same group of patients. The prevalence of HBsAg positive subjects among patients with jaundice and liver problems, 11%, was similar to that found in the Asir region, KSA. [18] Although the prevalence of HBsAg positive subjects may differ in different regions in the country, [17],[20] the Hail region is not expected to have lower prevalence than other more socio-economically devel­oped regions in the KSA, e.g., Riyadh. In addition, an obvious decline was noted in the total prevalence of HBsAg positive subjects during the year 1995-1996 com­pared to the preceding year. This decline was also noticed in adolescents and young adults [Table 2] and in different depart­ments studied [Table 3],[Table 4] (although statis­tical significance was inconsistent). Thus, we can safely suggest that the prevalence of the HBsAg carrier state is declining in the KSA. This decline is probably partly due to reduction of horizontal transmission through careful sterilization of surgical instruments and screening of blood donors, and partly due to decrease in vertical trans­ mission of Hepatitis B virus (from mothers to their newborns) through vaccination of newborns with HBsAg vaccine. Absence of a significant difference, however, between the prevalence of HBsAg positive cases among different age groups was found. The disease was found to affect infants and young children as well as adults.

Our findings direct attention that infec­tion is acquired during infancy and that vertical transmission plays a role in trans­mission of Hepatitis B virus. Therefore, adoption of a national program for screen­ing pregnant women for HBsAg appears to be of significant importance to prevent vertical transmission of Hepatitis B virus. Infants delivered to pregnant women that are positive to HBsAg should receive HBIG and the first dose of hepatitis vaccine with­in 12 hours of birth, and completion of the vaccine series within the first 6-8 months of age. [17] Prevention of HBV infection in in­fancy prevents the spread of infection to older ages and reduces its prevalence. [17]

The unexpected low prevalence of HBsAg positive cases among dialysis pa­tients also reflects the careful screening of such patients and successful prevention of transmission of this infection in the Hail region. The Artificial Kidney Unit (AKU) at King Khalid Hospital is the only referral site for renal dialysis patients in the Hail region, so patients attending this center represent all cases of renal dialysis in the region and the prevalence of HBsAg among these patients reflects the prevalence of HBsAg in dialysis patients all over the region. A higher prevalence reported in different regions might be due to consider­ing the repeated positive results for the same patients treated more than once.


   Conclusion Top


We can conclude that the prevalence of HBsAg positive subjects is declining in the Hail region, KSA. This decline suggests the success of preventive efforts such as HBsAg vaccination of newborns and screening of blood donors and at risk groups for preven­tion of Hepatitis B viral infection. However screening of pregnant women for HBsAg also seems to be necessary.

 
   References Top

1.Blumberg GS, Alter HJ, Visnich S. A "new" antigen in leukemia sera. JAMA 1965; 191:541-6.  Back to cited text no. 1
    
2.Ramia S, Abdul Jabber F, Bakir TM, Hossain A. Vertical transmission of hepatitis B surface antigen in Saudi Arabia. Ann Trop Paediatr 1984; 4(4):213-6.  Back to cited text no. 2
    
3.Talukder MA, Gilmore R, Baccus RA Prevalence of hepatitis B surface antigen among mate Saudi Arabians. J Infect Dis 1982; 1146(3):446.  Back to cited text no. 3
    
4.AI-Admawy AM, Talukder NIA, Gilmore R. Prevalence and acquisition rates of hepatitis rates of hepatitis BsAg in Riyadh AI-Kharj Hospital Pro­gram. Saudi kited J 1987; 8(2)142-6.  Back to cited text no. 4
    
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6.Jamjoom GA, Ramia S, Bakir T, Buckey P, George M, Kurien CR, et al. A two-year survey of diagnostic virus laboratory services of King Saud University Hospitals, Riyadh. Saudi Med J 1986; 7(2):122-9.  Back to cited text no. 6
    
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8.EI-Hazemi MAF. Hepatitis B markers in Saudi Arabia: a comparative study in different regions. Ann Saudi Med 1986; 66(3):185-90.  Back to cited text no. 8
    
9.El-Hazemi MAF, AI-Faleh FZ, Warsy AS. Epidemiology of viral hepatitis among the Saudi popula­tion: 1. A study of viral markers in Khaiber. Saudi Med J 1986; 7(2):122-9.  Back to cited text no. 9
    
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13.Jamjoom GA, Higham R. Prevalence of viral hepatitis type B surface antigen (HBsAg) in pa­tients with liver disease and in the general patient population at King Abdulaziz Hospital, Riyadh. Proceedings of the 5th Saudi Medical Meeting, Ri­yadh, 1980:331-9.  Back to cited text no. 13
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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