Prevalence of Hepatitis B Virus among Febrile Patient in General Hospital Okigwe, Imo State, Nigeria ()
1. 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 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. The viral genome is 3.2 kb in length, consisting of four partially overlapping, open-reading frames that encode viral proteins. Viral multiplication takes place predominantly in hepatocytes. The infecting virus encases its double-shelled Dane particles within membrane envelopes coated with hepatitis B surface antigen (HBsAg). The inner nucleocapsid core-antigen (HBcAg) encloses a single molecule of double-stranded HBV and an active DNA polymerase [4]. HBsAg in body fluid is: 1) an indicator of hepatitis B infection; 2) used in the large scale screening of blood for HBC, and 3) the bases for first the vaccine for human use developed by recombinant DNA technology. Diagnosis of HBV is made by the detection of HBsAg in unimmunized individuals or HBsAg antibody or detection of HBV nucleic acid by PRC [5]. The clinical signs of hepatitis B vary widely. Most cases are asymptomatic. However, sometimes fever, loss of appetite, abdominal discomfort, nausea, fatigue, and other symptoms gradually appear following an incubation period of 1 to 3 months. The virus infects hepatic cells and causes liver tissue degeneration and the release of liver-associated enzymes (transaminases) into the bloodstream. This is followed by jaundice, the accumulation of bilirubin (a breakdown product of hemoglobin) in the skin and other tissues with a resulting yellow appearance. Chronic hepatitis B infection also causes the development of primary liver cancer, known as hepatocellular carcinoma [6].
2. Methodology
2.1. Description of Imo State
Imo State is one of the Niger Delta states in Nigeria. The state was formed in 1976. It is located in the southeast region of the country. The state has a border with Abia state, Anambra state, Rivers state, Delta state. Its capital is Owerri. 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.
2.2. 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].
2.3. 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].
3. 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
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Table 1. Socio-demographic characteristic of the respondents.
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
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Table 2. Prevalence of hepatitis B in relation to sex.
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.
4. 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 developed a four-prong strategy aimed at raising awareness/mobilizing resources, policy, preventing transmission and screening and treatment. While 180 countries
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Table 3. Prevalence of hepatitis B in reaction to HIV status.
included hepatitis B vaccination as part of their routine vaccination schedule and the worldwide coverage approached 80% in 2011, disparities remain between developed and undeveloped countries (WHO, 2013). The result showed that the highest prevalence of HBV infection was found among patients of 21 - 30 years. There could be explained by the relationship between hepatitis infection and high risk sexual practices which is noted to be higher among the younger age group. This observation is similar to the results that were obtained in Zaria and Ethiopia [4].
Similarly, Emechebe et al. (2014) [2] studied hepatitis B virus infection in Nigeria, with the highest prevalence rate at 14.8% found among the age of 20 - 30 years. This was explained to the high sexual activity among these age groups. Inverse relationship between HIV-status and HBsAg positivity with HIV positive patients showed the highest positivity has been noted [4]. However, in this study, it was noted that HIV co-infection includes the risk of hepatitis B infection with the result showing 42.86% positive.
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.
5. 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.
2) Pre-Exposure Prophylaxis
A comprehensive strategy for elimination HBV transmission should start with a pre-exposure vaccination program. This should include universal vaccination of all infants at birth, particularly those born to pregnant women who test positive when screened for hepatitis B surface antigen.
3) Post-Exposure Prophylaxis
Post-exposure prophylaxis should be considered for individual who have had recent exposure (either parenteral or sexual) to blood or other body fluids, if it can be carried out in a timely fashion. Evaluation of the hepatitis B surface antigen 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.
6. 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 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.