Hepatitis B and Hepatitis C in Pakistan: prevelence and risk factors

Institute for Global Health, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee, 37203-1738, USA.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases (Impact Factor: 1.86). 11/2008; 13(1):9-19. DOI: 10.1016/j.ijid.2008.06.019
Source: PubMed


Pakistan carries one of the world's highest burdens of chronic hepatitis and mortality due to liver failure and hepatocellular carcinomas. However, national level estimates of the prevalence of and risk factors for hepatitis B and hepatitis C are currently not available.
We reviewed the medical and public health literature over a 13-year period (January 1994-September 2007) to estimate the prevalence of active hepatitis B and chronic hepatitis C in Pakistan, analyzing data separately for the general and high-risk populations and for each of the four provinces. We included 84 publications with 139 studies (42 studies had two or more sub-studies).
Methodological differences in studies made it inappropriate to conduct a formal meta-analysis to determine accurate national prevalence estimates, but we estimated the likely range of prevalence in different population sub-groups. A weighted average of hepatitis B antigen prevalence in pediatric populations was 2.4% (range 1.7-5.5%) and for hepatitis C antibody was 2.1% (range 0.4-5.4%). A weighted average of hepatitis B antigen prevalence among healthy adults (blood donors and non-donors) was 2.4% (range 1.4-11.0%) and for hepatitis C antibody was 3.0% (range 0.3-31.9%). Rates in the high-risk subgroups were far higher.
Data suggest a moderate to high prevalence of hepatitis B and hepatitis C in different areas of Pakistan. The published literature on the modes of transmission of hepatitis B and hepatitis C in Pakistan implicate contaminated needle use in medical care and drug abuse and unsafe blood and blood product transfusion as the major causal factors.

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    • "The prevalence of HBsAg in limited and specific groups of Afghans has been reported between 1.23% and 8.3% (6-11). In studies from Pakistan, the prevalence of hepatitis B infections is between 1.7% and 5.5% in the children (13). There is no data available concerning the prevalence of HIV or HCV in Pakistan or Afghanistan. "
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    • "Among IDUs in USA and Europe, transmissions occur via sharing injection equipments such as syringes, needles and other paraphernalia (Mathei et al. 2006). Both modes of HCV transmission (unsafe blood transfusion and IDUs) are significant for certain communities [studies indicate prevalence percentages of 48.67 ± 1.75 % and 57 ± 17.7 %, respectively, in Pakistan (Waheed et al. 2009) see also Ali et al. (2009)]. "

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    • "Prevalence of HCV has been noticed to be highly variable in different regions and even in different groups of the same community [9]. According to various studies, the presence of HCV infections among different categories (excluding chronic liver disease patients), was 5.31% in Islamabad [10], 0.4-31.9% in various regions of Punjab province [6,7,11-13], 4-6% in Sindh province [6,7,13,14], 1.1-9% in Khyber Pakhtunkhwa province [6,7,13,15-17], 1.5% in Quetta region [12,13] and 25.7% in Gilgit Baltistan province [18,19]. While in Lahore, the second largest city of Pakistan with a population of more than 7 million [20], HCV prevalence was estimated from 0.58-17.78% "
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