Prevalence of Hepatitis B Virus among Febrile Patient in General Hospital Okigwe, Imo State, Nigeria

Introduction: Hepatitis B virus (HBV) infection is a major cause of prenatal death worldwide. Chronic hepatitis B (CHB) infection is associated with an increased risk of cirrhosis, hepatic decomposition, and hepatocellular carci-noma (HCC). Objective: This project work surveyed the prevalence of hepatitis B among febrile patients as well as to detect hepatitis B virus in the blood and the stage of the infection of hepatitis B on the affected patients and carri-er stage or state of immunity of the affected patients. Methodology: A well-designed questionnaire/checklist was used to gather information regarding age, HIV-Status, and sex from 50 febrile patients. 2 ml of blood sample was obtained by venin-puncture using a sterile hypodermic syringe and emptied into a clean dry tube (without anticoagulant) observing the necessary aseptic techniques. The blood was centrifuged and the sera obtained and stored at 2 - 8 c for HBsAg screening. Hepatitis B virus was tested using an in-vitro diagnostic kit called HBsAg one-step rapid test strip. The HBsAg one-step rapid test is a lateral flow chromatographic immunoassay based on were positive. The prevalence of the population concerning HIV status was tested using Pearson’s chi-square and it was concluded that there is a significant association between HIV status and seroprevalence of hepatitis B. Conclusion: In conclusion, this study shows that there is a low prevalence of hepatitis B among febrile patients at the study area, hence limiting fever as a major determinant of hepatitis B infection. Considering the high risk of HBV in HIV co-infected patients, there is a need for the screening of HIV-infected patients for hepatitis B and appropriate therapy followed up on possible HBV-HIV co-infected patients. Appropriate preventive measures especially vaccination against hepatitis B virus should be encouraged among the susceptible population.

in-vitro diagnostic kit called HBsAg one-step rapid test strip. The HBsAg one-step rapid test is a lateral flow chromatographic immunoassay based on the principle of the double antibody-sandwich technique. The membrane is pre-coated with anti-HBsAg antibodies on the test line region of the test. During testing, the serum specimen reacts with the particle coated with anti-HBsAg antibody. The serum moves up with capillary action to react with the coated antibody on the membrane. Then, the colored line (positive) will be generated which shows the presence of the virus. But negative shows absence of the virus. The blood in the test tube was spun using a centrifuge to separate the red cells from the serum. The test pouch, serum, and control were allowed to equilibrate to room temperature before testing. The test strip was removed from the sealed pouch and used immediately. The test strip was

Introduction
Hepatitis B is a viral disease process caused by the Hepatitis B virus (HBV). Hepatitis B virus is a major cause of acute and chronic hepatitis worldwide and is more prevalent in developing countries. More than 2 billion people are infected with HBV worldwide while some 280 million are chronic carriers, harboring the Journal of Biosciences and Medicines virus in their liver. The disease is responsible for 80% of all cases of primary liver cases, which is one of the leading causes of death in Asia and Africa [1]. The infection can be acute or chronic, while adults that acquire acute infection usually recover or can be managed by supportive therapy. The chronic type is usually fatal. Diagnosis of HBV infection is usually through serological and virological markers. Hepatitis B surface antigen (HBsAg) is the hallmark of HBV infection and is the first serological marker to appear in acute HBV infection and persistence of HBsAg for more than 6 months suggests chronic HBV infection. Hepatitis B "e" antigen (HBeAg) is present only in HBsAg positive sea and its positivity denotes a high degree of viral replication, disease activity, and infectivity [2].
Hepatitis B virus is normally transmitted through blood or other body fluids (saliva, sweat, semen, breast milk, urine, faces), and body-contaminated equipment (including shared intravenous needles). The virus can also pass through the placenta to the fetus of an infected mother [3]. Hepatitis B virus (HBV) is an envelope double-stranded circular DNA virus of complex structure. HBV is classified as an orthohepadnavirus within the family hepatnaviridae. Serum from individuals infected with HBV contains three distinct antigenic particles: a spherical 22 nm particle, a 42 nm spherical particle (containing DNA and DNA polymerase) called the Dane particle, and tubular or filamentous particles that vary in length.

Description of Imo State
Imo State is one of the Niger Delta states in Nigeria. The state was formed in The state has a high cultural heritage, they produced palm oil. EPIDEMIOLOGY: About two billion people worldwide have serological evidence of past or present HBV infection, and about 350 million are chronically infected and at risk of developing HBV-related liver diseases. Some 15% -40% of chronically infected patients will develop cirrhosis, progressing to liver failure and or HCC, HBV infection accounts for about 500,000 -1,200,000 deaths each year (WHO, 2013).
The prevalence of HBV varies markedly between different regions of the world.

Types of Hepatitis B
1) Acute Hepatitis B An acute hepatitis B infection may last up to six months (with or without symptoms) and infected persons are able to pass the virus to others during this stage. A patient will test positive for the hepatitis B virus (HBsAg), HBclgM, and possibly the HBs-antigen [7].
2) Chronic Hepatitis B The risk of developing a chronic hepatitis B infection is directly related to the age at which one becomes infected with the virus. 90% of infants exposed to the hepatitis B virus will develop chronic hepatitis B infections. Up to 50% of young children exposed to hepatitis B virus between the age of 1 and 5 years will develop chronic infections. 5% -10% of healthy adults who are infected will develop chronic infection [8].

Hepatitis D Co-Infection
Hepatitis D is a type of viral hepatitis caused by the hepatitis D virus (HDV), which needs the hepatitis B virus to exist. Only people who are already infected with hepatitis B can be infected with hepatitis D. Transmission of hepatitis D is through same the route as hepatitis B [4].
Prevention of HDV infection is by presenting hepatitis B infection. There is no effective treatment for HDV infection, only supportive care for symptoms can be provided. For a chronic HDV infection, interferon-alpha may slow down disease progression [4].

Results
After interpretation of the result of the test on fifty patients, Table 1 shows the age range of the population. The total distribution of subjects concerning age was as follow: 4 out of 50 populations (8%) were observed for the age range of 0 -10; 7 out of 50 (14%) were observed of the age range of 11 -20; 28 out of 50 (56%) were observed for a range of 21 -30; 9 out of 50 (18%) were observed for the age range of 31 -40, 2 out of 50 (4%) were observed at the age range of 21 -30 with percentage seroprevalence of 4%. There is no significant correlation in  the age group concerning percentage seroprevalence (P = 0.05). Also, the sex of the study population as seen in Table 2 shows that 21 were males and 29 were females. Out of the 21 males population, 3 (14.24%) were positive. In the female population, 5 out of 29 (17.24%) were positive. The prevalence of the population concerning their sex was tested using Pearson's chi-square and it was concluded that there is no significant association between sex and seroprevalence of hepatitis B. Table 2 shows the HIV of the study population and it shows that 6 out of 14 HIV positive patients (42.56%) were positive and 3 out of 36 HIV-negative patients (4.55%)) were positive. The prevalence of the population concerning HIV status was tested using Pearson's chi-square and it was concluded that there is a significant association between HIV status and seroprevalence of hepatitis B.
The gender distribution of the respondents shows that out of the 100 respondents, females constituted the majority with 67 (67%) as against 33 (33%) males.
This implies that the females were more willing to participate in the study than their male counterparts, couple with the fact that nursing staff most of who are  females may also explain the higher representation of females in the study. The age distribution reveals that the matured health professionals constituted majority of the respondents in General hospital Okigwe Imo state. Regarding the age distribution of respondents, Table 1 shows respondents within the age bracket of 61 and above were 5 (5%), while respondents between the ages of 51 -60 were 20 (20%), respondents between the ages of 41 -50 years 32 (32%), while those within 30 years and below are 28 representing (28%) of the respondents. The table also shows that majority of the respondents who participated in the study, 60 (60%) were married, while 35 (35.0%) were single, 3 (3.0%) of the respondents were widows/widower, 1 (1.0%) were separated and another two (1.0%) persons were divorced. This can be attributed to the fact that majority of the respondents were within the age range 36 -41 years and above and it is therefore believed that most people of this age categories were usually married, which is a true reflection in the variable indices of the respondents. It is worth noting that respondents in Table 3. Regarding religious affiliation of respondents, 85 (85%) were of the Christian faith, while 15 (15%) persons were identified as a Traditional worshiper. Concerning the academic qualification of the respondents, Table 1 has 74 (37.6%) respondents with tertiary education, these include graduates from universities, colleges, polytechnics and other higher institutions, 74 (74%) were secondary school certificate holders, 13 (13%), while 5 (5%) of the respondents posses other qualifications. The high percentage of respondents with tertiary education signifies the high level of awareness on the prevention of infant and under-five mortality. The above table shows the prevalence of hepatitis B with respect to age of the study population, with the age of 21 -30 showing the highest prevalence following by 31 -40. The table above shows the prevalence of hepatitis B virus infection with respect to sex of patients, with the more prevalence in the male patients than the females. Since Cal is greater than Xtab, we concluded that there is no significant difference in the prevalence with respect to age.
The table above shows the prevalence of hepatitis B virus infection with respect to HIV status, with more prevalence in HIV positive patients.

Discussion
In 2010, the world Health Organization Assembly adopted resolution 62.18 to recognize viral hepatitis as a global health problem. In response, the WHO de-  The results parallel with the findings of Nassal, 2010 [7], where females had a significantly higher HBsAg prevalence (26.0%) than males with 18.0. These findings suggest that sex difference in HBsAg prevalence appears to be probably due to their body anatomy.

Recommendations
1) Immunization with hepatitis B vaccine is the most effective means of preventing HBV infection based on this studied objective. Hepatitis B vaccination is highly cost-effective, in that it prevents infection with HBV and thus reduces the incidence of chronic hepatitis, cirrhosis, and HCC in the vaccinated population.
Hepatitis B vaccination is recommended for all unvaccinated adults at risk for hepatitis infection and for all adults requesting protection from hepatitis B infection. gen status of the infective source and the anti-HBs status of the exposed person should be carried out before the vaccine is administered. Individuals without prior vaccination should receive both HB/g must be at a different infection site.

Conclusion
In conclusion, this study shows that there is a low prevalence of hepatitis B among febrile patients in the study area, hence limiting fever as a major deter-