Introduction
Hepatitis B virus (HBV) infection is a chronic lifelong infection. Hepatitis B virus (HBV) infects more than 400 million people worldwide and is common cause of liver disease and liver cancer. HBV, a member of the Hepadnaviridae family, is a small DNA virus with unusual features similar to retroviruses. HBV replicates through an RNA intermediate and can integrate into the host genome. The unique features of the HBV replication cycle confer a distinct ability of the virus to persist in infected cells.1
In India, it is estimated that there are 40 million people chronically infected with HBV infection. HBV causes a spectrum of disease from self-limiting hepatitis to acute fulminant and chronic hepatitis which may result in liver cirrhosis and hepatocellular carcinoma.2, 3 World Health Organization (WHO) has classified HBV prevalence in to high endemicity (>8%), intermediate (2-7%) and low endemicity (<2%). HBV prevalence in India is in intermediate range. 100,000 Indians die due to HBV infection related illness every year.3 HBV infection can occur parenterally, sexually and perinatally. Hepatitis B spreads most commonly from mother to child at birth. The development of chronic infection is very common in infants infected from their mother or before the age of 5 years.1 It also spread through saliva, vaginal, and seminal fluid. Infection in adulthood leads to chronic hepatitis in less than 5% of cases. HBV is also one of the transfusion transmissible infection. Singh et al studied the low seroprevalence of hepatitis B virus infection among blood donors of costal Karnataka, India.4, 5 Many studied have also shown the hepatitis B infection among pregnant women in India. The current study was conducted to estimate the burden of HBV infection in Bidar district of North Karnataka.
Objective of the Study
This current study was designed to find out the HBsAg Seropositivity among rural & urban population attending outpatients at tertiary care center with special consideration to childbearing age women.
Materials and Methods
This retrospective study was conducted in the Department of Microbiology, Bidar Institute of Medical Sciences, Bidar. Samples included from admitted patients, outpatients, and patients attending ART centres and pregnant women attending ANC clinic and patients for whom HBsAg test and detection was sought as the basis of clinical findings and socio economic risk factor and for preoperative evaluation of HBsAg status of teaching hospital, Bidar Institute of Medical Sciences, Bidar. Institutional ethical committee clearance was taken before the study. Blood sample was collected by vene-puncture and serum was separated as per standard procedure. All samples were tested by rapid one step immune-chromatographic assay (IMA) kit for the qualitative detection of hepatitis B surface antigen (HEPACARD - J. Mitra & Co Pvt. Ltd). Immunochromatographic assay are rapid and sensitive for detection of HBsAg. They are economical and easy to perform and give fast results within 20 min and have been recommended for routine use in clinical microbiology laboratories.6
Results
A total of 12,142 (serum samples) patients were tested for HBsAg for a period of one year from February 2016 to February 2017. 284 patients tested positive with prevalence of 2.34%. In the Whole study tenure, an average of 2- 3% prevalence rate was showed, except in the month of October 2014 which was 10.96% (Table 1). The infection is more in female (59. 90%) as compared to male (40.05%) and among age group between 21-30 which is 47.53% out of 284 positives (Table 2). 30.91% of the positivity found among pregnant women attending ANC clinic and 4.83% among HIV AIDS patients attending ART centre.
Table 1
Prevalence of HBsAg month wise
Discussion
Our study is hospital based comprised of large number of samples and the prevalence of HBsAg was 2.34%. The study was conducted for only one year duration and exposes the prevalence rate of HBsAg among Bidar population and every year wise study also can be done to check the prevalence rate retrospectively. Many studies have done in India and Karnataka on HBsAg prevalence. Patil et al studied prevalence of HBsAg in Sholapur of Maharashtra district which is nearer to our study place (150 km) and found to be 2.99% and was below intermediate endemicity.7 Quadri SA et al studied the prevalence of HBsAg in Bijapur of North Karnataka and the prevalence rate was 1.63% indicating low endemicity.8
Singh et al found out the Seroprevalence of HbsAg among blood donors of costal Karnataka India and the prevalence was 0.62% which comes under low prevalence zone (<2%).4 One more study was conducted by Preeti B. Mindolli and Manjunath P. Salmani in Bijapur of North Karnataka which was also a hospital based study to check prevalence in the year 2012 and 2013. The study results shown a slight increase hepatitis infection from 1.54% in 2012 to 1.65% in 2013.9
Our study results are bit higher (2.34) than the low endemicity range which is <2% but almost equal to intermediate zone as per the WHO guidelines.5 These all studies states that there is slight to intermediate endemicity of HBsAg in Bidar and North Karnataka. Our study also showed the highest infection rate in the month of October 2016 and it was high infectivity among females as compared to other studies where it has been shown high among males i.e 35.3% and 19.3% in female in the study conducted by Datta S et al.10 The prevalence of HBV is 4% amongst the general population in India. As the infection is asymptomatic, most people are unaware of their infection but untreated chronic HBV can result in liver cirrhosis and liver cancer.
Conclusion
India has documented low awareness about viral hepatitis in community and amongst population with high risk behaviour. Policies and strategies for prevention and control needs to be tailored to the specific national or sub national context. Bidar, a district in North Karnataka is one of the backward district in the state with population of 17.03 lacks and occupies a low position in economic as well as human development. Our study highlights the HBV infection rate in this district of North Karnataka which provides reference to the future studies on the epidemiology of HBV infection.
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