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Prevalence of hepatitis B virus infection in the Gezira State of Central Sudan

Authors:
  • Faculty of Medicine, University of Khartoum, Khartoum, Sudan

Abstract

This is a cross-sectional study to determine the prevalence and risk factors for transmission of hepatitis B virus (HBV) infection in the Gezira state of central Sudan prior to the introduction of blood screening and vaccination against HBV. The study was carried out on the population of Um Zukra village in Gezira state of Central Sudan. The village was surveyed on five consecutive days in Dec 2000. Epidemiological characteristics were recorded and participants were interviewed for risk factors of viral hepatitis. Blood samples were then collected and tested for HBsAg and HBcAb. A total of 404 subjects were screened with a mean age of 35 years; 54.9% were females, HBsAg and HBcAb were reactive in 6.9% and 47.5% of the studied population, respectively. Exposure to HBV increased with increasing age. The only significant risk factor for transmission of infection was a history of parenteral antischistosomal therapy. This study shows that prevalence of HBV infection is high in the studied population and it is hoped that introduction of blood screening and vaccination against HBV would decrease the carrier pool in the next few years.
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Original
ArticleOriginal
Article
Prevalence of Hepatitis B Virus Infection in the Gezira State of
Central Sudan
H. M.Y. Mudawi, H. M. Smith*, S. A. Rahoud**, I. A. Fletcher*, O. K. Saeed**, S. S. Fedail
Department of Internal ABSTRACT
Medicine, University of
Khartoum, Khartoum, Aim: This is a cross-sectional study to determine the prevalence and risk factors for transmission of hepatitis
Sudan, *Institute of Liver B virus (HBV) infection in the Gezira state of central Sudan prior to the introduction of blood screening and
Studies, Kings College vaccination against HBV. Materials and Methods: The study was carried out on the population of Um Zukra
Hospital, London, United village in Gezira state of Central Sudan. The village was surveyed on ve consecutive days in Dec 2000.
Kingdom, **Department Epidemiological characteristics were recorded and participants were interviewed for risk factors of viral hepatitis.
of Internal Medicine, Blood samples were then collected and tested for HBsAg and HBcAb. Results: A total of 404 subjects were
University of Gezira, screened with a mean age of 35 years; 54.9% were females, HBsAg and HBcAb were reactive in 6.9% and 47.5%
of the studied population, respectively. Exposure to HBV increased with increasing age. The only signicant
risk factor for transmission of infection was a history of parenteral antischistosomal therapy. Conclusion: This
Dr. H. M. Y. Mudawi, study shows that prevalence of HBV infection is high in the studied population and it is hoped that introduction
P. O. Box 2245, Khartoum, of blood screening and vaccination against HBV would decrease the carrier pool in the next few years.
E-mail: hmudawi@hotmail. Key Words: Hepatitis B virus, risk factors, vaccination.
Received 11.12.2006, Accepted 13.02.2007
The Saudi Journal of Gastroenterology 2007 13(2):81-3
Hepatitis B virus (HBV) infection is a major health problem populated by approximately 1.5 million individuals and is
causing considerable morbidity and mortality from both an area highly endemic for schistosomiasis and malaria.[2]
acute infection and chronic sequelae including chronic The study area was selected due to the high prevalence of
hepatitis, cirrhosis and hepatocellular cancer. More than S. mansoni infection. Random stool samples were taken
2 billion people show evidence of past or current HBV from different villages in the Gezira state and examined for
infection and over 350 million people are chronic carriers S. mansoni eggs. The highest prevalence (70%) was found
worldwide. Three quarters of the world’s population lives in in Um Zukra village. According to a census performed in
areas with high levels of infection. Sudan is classified among 1999, the population of Um Zukra is approximately 4000
the countries with high HBV endemicity.[1] Screening of individuals.
blood and blood products for HBV was only introduced to
blood banks throughout the country in 2002, before which, The village is surrounded by a cultivated area and the canal
screening was only performed in a very few centers in the is at a distance of only 450 meters from the center of the
capital, Khartoum. Vaccination for HBV was included as village. There are two water pumps (wells) used for drinking
part of the extended program of immunization in 2005. water, the other water source for washing and bathing is the
Our study objectives were to determine the prevalence and canal. The village was surveyed on five consecutive days
risk factors for transmission of HBV infection prior to the in December 2000 when all the villagers appearing in the
introduction of blood screening and HBV vaccination in a study site were enrolled after individual informed consent
village in the Gezira state of central Sudan, an area endemic was obtained. Three physicians interviewed the participants
Gezira, Sudan
Address:
Address:
Sudan.
com
for schistosomiasis and malaria.
MATERIALS AND METHODS
Study area
This study was carried out in the population of Um Zukra
village in the Managil province, Gezira state of Central
Sudan. The village is about 350 km south of Khartoum, the
capital and 110 km west of Wad Medani town. The Gezira
and Managil irrigation system is spread over an area of about
two million acres cultivated with cotton and other crops,
and completed a questionnaire with basic demographic
data including age, gender and potential risk factors for the
transmission of HBV infection such as previous personal
history of jaundice, surgery, dental treatment, parenteral
antischistosomal therapy and blood transfusion. Patients
were also examined for the presence of tattoos / scarification.
The study was approved by the medical research board of
the University of Khartoum.
Serological analysis
10 ml blood samples were drawn from each subject; sera
81
The Saudi Journal of
Gastroenterology Volume 13, Number 2
Rabi’ al-Awwal 1428 H
April 2007
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Mudawi, et al.
Table 1: Demographic criteria of 404 subjects screened for all hepatitis B virus markers in Um Zukra village
Variable Number tested (%) HBV markers reactive (%) OR P value
Gender
Females 222 97 (43.7) 1.41 0.108
Males 182 95 (52.2)
History of S. mansoni infection No 37 22 (59.5) 0.59 0.176
Yes 367 170 (46.3)
Parenteral antischistosomal therapy* No 327 143 (43.7) 2.25 0.0025*
Yes 77 49 (63.6)
Surgery No 358 169 (47.2) 1.12 0.841
Yes 46 23 (50)
Blood transfusion No 383 181 (47.3) 1.23 0.816
.com).
were separated, aliquoted, labeled within 6 h of collection
and stored at -70ºC. The sera were analyzed at the Institute
of Liver Studies, Kings College Hospital in London where
all samples were tested for HBsAg and HBcAb using ELISA
tests (IMX HBsAg (V2) and AxSYM HBV core antigen
recombinant, Abbott).
Statistical analysis
test with Yates’ correction was used to compare
proportions. Odds ratios (OR) with 95% confidence intervals
(95% CI) were calculated either directly or by the Mantel-
Haenszel method for stratified OR.
A total of 404 subjects were included in the study, the mean
age being 35 years with an age range of 8-90 years. 54.9% of
the subjects were female, 51.2% had a history of jaundice,
30.7% had dental treatment, 18.8% received parenteral
antischistosomal therapy, 11.2% had a previous history of
surgery, 5.1% received a blood transfusion and 2.7% had
a tattoo / scarification on examination [Table 1]. HBsAg
was reactive in 6.9% of subjects; there was no statistically
significant difference regarding infection rate in different age
Yes 21 11 (52.4)
Dental treatment No 278 121 (43.5) 1.35
Yes 126 71 (56.3)
History of jaundice No 197 89 (45.2) 1.20
Yes 207 103 (49.8)
Tattoos / scarication No 393 185 (47.1) 1.97
Yes 11 7 (63.6)
*Signicant P value
Age Number tested
0-10 8
11-20 91
21-30 95
31-40 72
41-50 57
51-60 50
> 60 31
P value 0.702
Table 3: Age groups of 404 subjects in Um Zukra village
screened for hepatitis B virus markers
Age Number tested All hepatitis B virus
markers reactive (%)
0-10 8
11-20 91
21-30 95
31-40 72
41-50 57
51-60 50
> 60 31
P value* 0.000*
*Signicant P value
0.203
0.411
0.436
Table 2: Age groups of 404 subjects screened for HBsAg
in Um Zukra village
HBsAg reactive (%)
1 (12.5)
6 (6.5)
5 (5.1)
4 (5.5)
3 (5.3)
6 (12)
The χ23 (9.7)
RESULTS
1 (12.5)
26 (28.6)
41 (43.2)
34 (47.2)
36 (63.2)
34 (68)
20 (64.5)
groups [Table 2]. HBcAb was reactive in 47.5%. Exposure to
HBV infection was highest in those over the age of 50 years
(68%) and lowest in those under the age of 10 years (12.5%)
[Table 3]. The only significant risk factors for HBV exposure
were a previous history of parenteral antischistosomal therapy
and increasing age [Tables 1, 3].
DISCUSSION
The prevalence of HBV infection in this study is less than
82 The Saudi Journal of
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Volume 13, Number 2
Rabi’ al-Awwal 1428 H
April 2007
that reported in previous studies from Sudan where HBsAg
and all HBV markers were reactive in 14% and 68% of cases
respectively.[3,4] The risk of acquiring chronic HBV infection
were not statistically significant among different age groups.
This is different from results from countries such as Saudi
Arabia[5] and countries in South East Asia where a large
percentage of chronic carriers were noted to be children
and which had resulted from perinatal transmission.[6]
Almost half the population screened had evidence of
This PDF is available for free download from
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HBV infection in the Gezira state of central Sudan
exposure to HBV in concordance with previous studies
from Sudan.[3,4] A significant risk factor for infection in this
study as well as in a previous study conducted in Sudan[3]
was prior exposure to parenteral antischistosomal therapy;
a practice abandoned in 1980 after introduction of oral
antischistosomal therapy. Introduction of HBV vaccination
in children and screening of blood and blood products
should reduce the rate of HBV infection in this country.
Mass vaccination programs for HBV in infants and school
children in Saudi Arabia have resulted in significant rates
of drop in overall HBsAg seroprevalence from 6.7% to 0.7%
REFERENCES
1. Expanded program on immunization, hepatitis B vaccine, making
global progress. EPI update, WHO: October 1996.
2. el Gaddal AA. The Blue Nile Health Project: A comprehensive approach
to the prevention and control of water-associated diseases in irrigated
schemes of the Sudan. J Trop Med Hyg 1985;88:47-56.
3. McCarthy MC, Burnas JP, Constantine NT, el Hag AA, el Tayeb ME, el
Dabi MA, et al. Hepatits B and HIV in Sudan: A serosurvey for hepatits
B and HIV antibodies among sexually active heterosexuals. Am J Trop
Med Hyg 1989;41:726-31.
4. Hyams KC, al Arabi MA, al Tagani AA, Messiter JF, al Gaali AA, George
and of HBcAb seroprevalence from 4.2% to 0.46% over a JF. Epidemiology of hepatitis B in the Gezira region of Sudan. Am J
period of eight years.[7] Trop Med Hyg 1989;40:200-6.
5. al-Faleh FZ, Ayoola EA, Arif M, Ramia S, al-Rashed R, al-Jeffry M, et
al. Seroepidemiology of hepatitis B virus infection in Saudi Arabian
CONCLUSION children: A baseline survey for mass vaccination against hepatitis B. J
Infect 1992;24:197-206.
It can be concluded that prevalence of HBV infection is 6. Stevens CE, Beasley RP, Tsui J, Lee WC. Vertical transmission of hepatitis
high in the studied population. Hopefully, introduction B antigen in Taiwan. N Engl J Med 1975;292:771-4.
of blood screening and vaccination of infants against 7. Al-Faleh FZ, Al-Jeffri M, Ramia S, Al-Rashed R, Arif M, Rezeig M, et al.
Seroepidemiology of hepatitis B virus infection in Saudi children 8 years
HBV should reduce the HBV infection carrier pool and after a mass hepatitis B vaccination programme. J Infect 1999;38:167-
eventually prevent infection in both children and adults 70.
over the next few years. A repetition of a similar survey
after 10 years should be made in order to measure such a
reduction and monitor the effectiveness of the screening Source of Support: National center for gastrointestinal and liver disease,
and vaccination program. Khartoum, Sudan. Conict of Interest: None declared.
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The Saudi Journal of
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... Since the majority of infections are subclinical, 80% of all hepatitis infections go undetected, therefore, patients' medical history is unreliable in determining if they are hepatitis B virus infected. 1 Sudan is classified among the countries with high hepatitis B virus endemicity. 1 Dental healthcare workers are susceptible to contracting HBV from needle-stick injuries or contact with bodily fluids like blood or other bodily fluids. 2 Higher prevalence of HBV infection among dentists, especially dental surgeons, has been reported in serological studies from different parts of the world in comparison with the general population. [3][4][5] Dentists can play a significant role in the prevention of hepatitis by treating every patient as a possible hepatitis carrier. ...
... 1 Sudan is classified among the countries with high hepatitis B virus endemicity. 1 Dental healthcare workers are susceptible to contracting HBV from needle-stick injuries or contact with bodily fluids like blood or other bodily fluids. 2 Higher prevalence of HBV infection among dentists, especially dental surgeons, has been reported in serological studies from different parts of the world in comparison with the general population. [3][4][5] Dentists can play a significant role in the prevention of hepatitis by treating every patient as a possible hepatitis carrier. ...
... Hepatitis B virus infection is highly prevalent among dentists. 1 The aim of our study was to evaluate dental healthcare workers' knowledge, attitudes, and practices toward HBV. Findings of such study will be beneficial to design and apply preventive measures to control transmission and potential complications. ...
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Objective: The aim of the present study is to evaluate dental healthcare workers' knowledge, attitudes, and practices toward hepatitis B infection. Materials and methods: This study was a cross-sectional self-administered, structured questionnaire survey that was conducted in Khartoum/Sudan. The questionnaire was completed by 177 dental healthcare providers who practice in public dental clinics in Khartoum state. The completion rate was 100%. Results: The study participants showed relatively acceptable knowledge of hepatitis B virus (HBV) infection. The majority (98.3%) were familiar with hepatitis B infection. About 93% answered correctly that blood, blood products, and needles/sharps are the route of transmission of HBV. About 65.5% completed HBV vaccination. About 59.3% had a history of needle sticks and only 16% reported their injury. Dentists and nurses almost had the same knowledge, but dentists were slightly having better knowledge in some aspects. Statistical Package for Social Sciences (SPSS) version 20 was used. Chi-square test was used to determine the relationship between categorical variables. Conclusion: Most of the study participants were aware of HBV infection, routes of transmission, prevention, and necessity of vaccination, but they are deficient in some areas, like needle-stick injury protocol and post-exposure prophylaxis (PEP). The study revealed a low level of HBV vaccination coverage rate. Further strategies for preventing workplace exposure, training programs on HBV infection, including PEP, and increasing the vaccination coverage rate of all healthcare workers are highly recommended. Clinical significance: Dental healthcare workers are at high risk of acquiring hepatitis B infection. The majority of exposure in dentistry is preventable. Understanding the knowledge and awareness of dental health toward hepatitis B is crucial to design and apply preventive measures to control transmission and potential complications.
... [7] A screening program introduced throughout Sudan in 2002 as a part of an international program for safe blood transfusion and a vaccination program implemented as a part of immunization protocols later in 2005 significantly reduced the transmissible transfusion of the HBV. [8] Importantly, among the vaccinated and unvaccinated Chinese populations, there was a significant association between unvaccinated people with respect to gender, residence, and infected partner (husband or wife) and infection by HBV. [9] In North India, males were more likely to be infected with HBV than females, with the viral distribution being 77% versus 23%, respectively, whereas the age groups 31-40 and 21-30 years had the highest risk to contract the viral infection in both the genders. ...
... This is the case in an incidental detection of the virus in healthy blood donors, as reported in many studies carried out in Sudan. [6] Our study finding was similar to the observations of studies performed in China, northern India, and the USA, [8,10,12] there was a significant increase in HBV seroprevalence in male gender (OR = 1.375, 95% CI = 0.14-13.6; P = 0.000). ...
... This explains the fact that vaccination is the most effective tool to get protection from HBV infection. [8] Similar to our suggestion, some authors reported a significant increase in the prevalence of virus among unvaccinated people. [12] Our finding showed that HBV is significantly associated with illiterate status (OR = 558.4, ...
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Background: Hepatitis B virus (HBV) is considered one of the most paternally transmissible viruses. Therefore, education about its risk factors and transmission is vital in decreasing the prevalence of the disease burden in Sudan. The aim of the present study was to investigate the relative risk factors of HBV and its impact on the society. Materials and methods: A facility-based, descriptive, cross-sectional study was conducted among those who were incidentally detected with HBV surface antigen (HbsAg) and their contact family members by ICT and enzyme-linked immunosorbent assay (ELISA) in Tropical Diseases Teaching Hospital, Omdurman locality, Khartoum state, Sudan. Results: The study recruited 112 participants, among whom 63 individuals incidentally attended for screening for HBV and this led to contact tracing of 49 individuals (contact relative group). Among 63 patients of the incidental group, there were 83.9% males and 16.1% females. In the contact tracing group consisting of 49 individuals, there were 83.3% males and 16.7% females (odds ratio [OR] = 1.375, 95% confidence interval [CI] = 0.14-13.6; P = 0.000). All the participants were screened for HBsAg. HBV was found to have a significant association with male gender (OR = 1.375, 95% CI = 0.14-13.6; P = 0.000), marital status (OR = 627.084, 95% CI = 48-8195; P = 0.000), working as police officers (OR = 524.2, 95% CI = 43.5-6314; P = 0.000), residing in Khartoum (OR = 520.173, 95% CI = 43-6290; P = 0.000), being illiterate (OR = 558.4, 95% CI = 47.7-6544.7; P = 0.000), vaccination status (OR = 625.4, 95% CI = 48.9-7996.3; P = 0.000), and with some concomitant diseases (OR = 559.193, 95% CI = 47.7-6561.5; P = 0.000). Conclusion: The HBV is still considered a very critical, highly infectious disease; therefore, primary care physicians have an important role in the investigation, prevention, and health education, in order to prevent the viral spread.
... Hepatitis B virus (HBV) infection is a global health dilemma with approximately 296 million chronically infected individuals by 2019 [9], and during the past five decades, developing countries remained the most endemic regions [10]. Sero-positivity as an indicator of HBV spread was found to be high in Sudan especially in Gezira State [11]. Generally, HBV infection is diagnosed by the presence of HbsAg in the blood; which is an outer protein expressed in excess when the virus replicates in the liver. ...
... These observations may justify the high prevalence of OBI due to lack of knowledge, attitudes about HBV vaccination, modes of transmission, its consequences, its preventive measures, the improvement in diagnosis and documentation of HBV infection. The discrepancy in the reported incidences of HBV from different parts of Sudan [11] ...
... Challenges such as weak funding and inadequate logistics services contribute to limited control of HBV, especially in poor countries [10]. In Sudan, according to Mudawi and his group, immunization against hepatitis b virus began in 2005 [11]. The current study aimed to determine the immune response resulting from vaccination with recombinant hepatitis B virus rDNA among students in two medical laboratory colleges in Wad Madani city in Sudan. ...
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Introduction: The level of immune response to hepatitis B virus vaccine is an indicator of whether the expected protection has been achieved in the target population. Objective: the study aimed to determine the immune response to recombinant hepatitis B virus rDNA among students in two medical laboratory colleges in Wad Madani city in Sudan. Methods: A cross-sectional laboratory based study conducted during 2019. The assigned subject was 72 medical laboratory students who completed all three doses of HBV rDNA vaccine. Immune response indicated by quantitatively measuring of HbsAbs (anti-HBs) using a sandwich ELISA approach. Data was collected after verbal meeting with each participants, and descriptively analyzed accomplished by SPSS computer program. Results: Enrolled participants were 50 % (36 /72) from Gezira University while the other 50 % were from Wad Medani College for Medical Science and Technology. Males represented 22% (16/72) while 78% (56/72) were females. Titers of anti-HBs ranged from 0.000 to 9478 mIU/ml, only 6 students (three males and three females) were non-responders. The overall index of significant titer detected in 78% (56/72) of participant whereas 22% (16/72) showed insignificant titer. Strong immune response with titer above 100 mIU/ml recorded in 46% (33/72). Conclusion: The level of immune response to the HBV rDNA vaccine among studied students was below the internationally recognized index.
... Sudan is categorized as one of the nations where there is a high prevalence of hepatitis B surface antigen (HBsAg), exceeding 8% [1] . The prevalence of hepatitis B varies widely across different regions of Sudan, with rates ranging from 6.8% in central Sudan [2] to as high as 26% in southern Sudan [3] . HBV infection can lead to a variety of complications, including cirrhosis, liver failure, and hepatocellular carcinoma (HCC). ...
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Background Sudan has a high prevalence of hepatitis B surface antigen, exceeding 8%. The prevalence of hepatitis B varies across different regions of Sudan, ranging from 6.8% in central Sudan to as high as 26% in southern Sudan. Hepatitis D virus (HDV) relies on HBV for replication and can accelerate the progression of HBV-related liver diseases, leading to more severe outcomes. This study aims to determine the prevalence of HDV infection among Sudanese patients with HBV-related liver diseases and to investigate the clinical characteristics of patients with HDV co-infection. Design/Method This descriptive cross-sectional hospital-based study was conducted in Sudan between June and September 2022. Ninety HBV patients aged 16 years and above were included. Patients were interviewed using a structured questionnaire, and medical histories and examinations were recorded. Investigations included liver function tests, abdominal ultrasounds, and ELISA for Anti-HDV-IgG. Results In this study of 90 HBV patients, most were male (68.9%) and under 40 years old (58.9%). HDV-IgG antibodies were found in 8 patients (8.9%), all male. Among the HDV-positive patients, one (12.5%) had jaundice and one (12.5%) had ascites. Elevated ALT levels were seen in 50% of HDV-positive patients. One (12.5%) HDV-positive patient had low albumin. Cirrhosis was present in 25% of HDV-positive patients, and HCC was present in 12.5% of HDV-positive patient. Conclusion The prevalence of HDV infection among Sudanese patients with HBV-related liver diseases is 8.9%. This highlights the need for enhanced screening and diagnostic measures in Sudanese populations. Further research is needed to develop targeted interventions.
... Challenges such as weak funding and inadequate logistics services contribute to limited control of HBV, especially in poor countries [10]. In Sudan, according to Mudawi and his group, immunization against hepatitis b virus began in 2005 [11]. The current study aimed to determine the immune response resulting from vaccination with recombinant hepatitis B virus rDNA among students in two medical laboratory colleges in Wad Madani city in Sudan. ...
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Full-text available
Introduction: The level of immune response to hepatitis B virus vaccine is an indicator of whether the expected protection has been achieved in the target population. Objective: the study aimed to determine the immune response to recombinant hepatitis B virus rDNA among students in two medical laboratory colleges in Wad Madani city in Sudan. Methods: A cross-sectional laboratory based study conducted during 2019. The assigned subject was 72 medical laboratory students who completed all three doses of HBV rDNA vaccine. Immune response indicated by quantitatively measuring of HbsAbs (anti-HBs) using a sandwich ELISA approach. Data was collected after verbal meeting with each participants, and descriptively analyzed accomplished by SPSS computer program. Results: Enrolled participants were 50 % (36 /72) from Gezira University while the other 50 % were from Wad Medani College for Medical Science and Technology. Males represented 22% (16/72) while 78% (56/72) were females. Titers of anti-HBs ranged from 0.000 to 9478 mIU/ml, only 6 students (three males and three females) were non-responders. The overall index of significant titer detected in 78% (56/72) of participant whereas 22% (16/72) showed insignificant titer. Strong immune response with titer above 100 mIU/ml recorded in 46% (33/72). Conclusion: The level of immune response to the HBV rDNA vaccine among studied students was below the internationally recognized index.
... By utilizing a straightforward score based on HBeAg and ALT for choosing patients for HBV therapy (TREAT-B) score, this study examines and confirms a diagnostic prediction score for treatment eligibility in people with HBV infection. [20][21][22][23]. [24][25][26]. ...
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... But, more than the frequency revealed in the Sudanese border area of Sudan in Southern Darfur State during 2017 which reached 6% by the nested PCR method [22]. The subsequent increase is attributed to the prevalence of hepatitis B virus infection in Gezira State [23], as well as the disparity in population. ...
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Introduction: Transmission of hepatitis B virus (HBV) through the blood is a significant risk, especially in poor countries with high endemicity. Occult transmission of HBV (OBI) is an important acquisition scenario. Objective: A cross-sectional laboratory-based study followed to detect OBI in blood of accepted donors admitted to Mad Medani Blood Bank, Sudan. Methods: During the study, 200 accepted blood units were examined for HBsAg by ELISA technique and negative samples were tested for total anti-HBc antibo-dies using electroluminescence immunoassay (ECLIAS). HBV DNA amplification was performed for units that showed total anti-Hbc positivity. Results: Of the 200 blood units, 3 appeared positive by ELISA. Total anti-HBc antibo-dies were present in 34% (67/197) of blood units. HBV DNA was successfully amplified in 52.2% (35/67) of total anti-HBc positive samples. A significant association was observed between reactive total anti-HBc and age group (p < 0.001), marital status (p < 0.001) and HBV vaccination (p-value 0.012) of blood donors. Conclusion: OBI was recorded at a high rate in the blood of donors, which necessitates the implementation of detection methods to protect the recipients.
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Hemodialysis patients are more susceptible to HBV infection because they have low immunity and can be inflicted through an improperly sterilized machine or through a tainted blood transfusion. A cross-sectional study aimed to study the prevalence of HBV among hemodialysis patients in Aljazeera State, Hospital for Renal Disease and Surgery during the period between March and August 2018. A total of ninety-one blood samples were obtained randomly from hemodialysis patients. The plasma was examined for the presence of HBsAg using a sandwich Enzyme-Linked Immuno-Sorbent Assay (ELISA). Data collected by a structured questionnaire included sociodemographic data such as age, sex, marital status, education level, duration of dialysis, previous HBV vaccination, history of surgical operation, history of jaundice and history of blood transfusion. Detectable marker for HBV infections (HBsAg) were found in 21 (23.1%) patients, while the remaining 70 patients (76.9%) were negative. We noted that education level and a history of jaundice had a significant effect on the seroprevalence of HBV, with a P value <0.05. The study concluded that HBV infection among hemodialysis (HD) patients is high. So, extensive effort to enroll HD patients in a vaccination programme against HBV is recommended. Moreover, periodically screening for early detection of HBV infection among hemodialysis patients is deemed essential in order to for therapeutic measures to be promptly initiated, and for the prevention and protection of other patients and staff in the hemodialysis unit.
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To determine the frequency of vertical transmission of hepatitis B antigen (HB5 Ag) from asymptomatic carrier mothers in Taiwan to their offspring, HB5 Ag was sought by radioimmunoassay and complement fixation. Of 158 babies born to carrier mothers, antigenemia developed in 63; 51 of these antigenemic babies had become antigen positive within the six months of life. Three inter-related factors were found to increase the risk that antigenemia would develop in the infant: a high maternal complement-fixation titer for HB5 Ag: presence of HB5 Ag in the baby's umbilical-cord blood: and antigenemia in siblings. In contrast to previous studies, these findings indicate that vertical transmission from carrier mothers frequently occurs, at least in Taiwan, and may partially explain Taiwan's high prevalence of HB5 Ag.
Article
Saudi Arabia is considered to be an area of endemic hepatitis B virus (HBV) infection. By adult age, 7% persons have hepatitis B surface antigen (HBsAg) and about 70% have one or more HBV markers. In order to provide a baseline for the integration of hepatitis B vaccine into the extended programme of immunisation (EPI), a population-based survey of HBV markers was made among Saudi children. The overall prevalence of HBsAg was 6.7%, with at least one HBV marker being positive in 19.7% persons tested. Two peaks of HBV prevalence were observed in the 7- and 10-year-old children respectively. The prevalence of HBsAg was steady in all age groups with identifiable but insignificant peaks in children aged 4 and 7 years respectively. Despite the apparent homogeneity of the Saudi population, the prevalence rates of HBV varied among the regions and were higher in urban dwellers. There was no significant difference in the HBsAg prevalence for the sexes (7.3% for males and 6.0% for females). Socioeconomic factors and family size did not significantly influence the prevalence of HBV among children. Of 307 HBsAg-positive children, 55 (17.9%) were positive for HBeAg. The early acquisition of HBV in the Saudi population is confirmed. The most effective strategy for HBV control, therefore, is by mass vaccination of all Saudi infants. An extension of the immunisation programme so as to include all pre-school children should further reduce the reservoir of HBV in Saudi Arabia. A repetition of a similar survey after 5 and 10 years should be made in order to measure this reduction.
Article
A serosurvey was conducted in Port Sudan and Suakin, Sudan in October and March 1987 to determine the prevalence and risk factors associated with the transmission of hepatitis B, human immunodeficiency virus type 1 (HIV-1), and syphilis among sexually active heterosexuals on the coast of Sudan. A total of 536 subjects, including 202 female prostitutes, 95 long-distance truck drivers, 103 soldiers, 72 Ethiopian refugees, and 54 Sudanese outpatients, were enrolled in the study. Seventy-eight percent (202/259) of the female study subjects were engaged in prostitution, and 57% (157/277) of the men admitted to prior sexual relations with prostitutes. Serologic markers for hepatitis B and syphilis were detected in 68% and 17% of the entire study population, respectively. In contrast, antibody to HIV-1 was detected in none of the 536 sera tested. Risk factors found to be independently predictive of hepatitis B infection by multivariate analysis included prostitution, positive serology for syphilis, and a history of anti-schistosomal therapy. The absence of HIV-1 infection among the prostitutes enrolled in this study is in marked contrast to the current AIDS epidemic in neighboring sub-Saharan countries, suggesting that HIV-1 has not been widely introduced on the coast of Sudan. The high prevalence of serologic markers to hepatitis B and syphilis, however, indicates a potential for HIV-1 in this region.
Article
To determine the prevalence of and risk factors for hepatitis B infection in rural Sudan, 2 villages in the Gezira were surveyed. There were 851 subjects (age 1-89 years; mean age 24.6 years) of equal sex distribution, 408 from Khalawaat and 443 from Saleim. HBsAg was found in 18.7%, and seropositivity for any hepatitis marker (HBsAg, anti-HBs, or anti-HBc) was found in 63.9%. The prevalence of HBsAg was highest in subjects less than 5 years of age (32.3%). Seropositivity for any hepatitis marker increased from 48.4% in subjects less than 5 years to 88.5% in persons greater than or equal to 50 years of age. HBeAg was present in 70% of HBsAg-positive women of childbearing age. Residence in Khalawaat and parenteral therapy for malaria were found to be independent risk factors for HBsAg-positivity. Age, residence in Khalawaat, crowding, and having had a tattoo were predictive of seropositivity for any hepatitis marker. The reason for increased markers of hepatitis B in Khalawaat compared to Saleim was not apparent.
Article
This is a general report on the Blue Nile Health Project in the Sudan. The project was initiated in 1979 to develop better strategies for controlling the major water-associated diseases in tropical irrigation schemes. The 10-year programme will cost about $154 million (1978 prices). The Gezira, Managil and Rahad irrigation systems, all irrigated from the Blue Nile River, were selected for the project area as typical of irrigation systems throughout Africa and the Middle East where malaria, diarrhoeal diseases and schistosomiasis are endemic, and as the areas most urgently in need of disease control in the Sudan. The methods used for control of the water-associated diseases emphasize permanent improvements in water supply and sanitation, in environmental and agricultural practices, in health education, community participation and primary health services, and a reduction in dependence on pesticides and drugs.
Hepatits B and HIV in Sudan: A serosurvey for hepatits B and HIV antibodies among sexually active heterosexuals
  • M C Mccarthy
  • J P Burnas
  • N T Constantine
  • A A El Hag
  • M E Tayeb
  • M A Dabi
McCarthy MC, Burnas JP, Constantine NT, el Hag AA, el Tayeb ME, el Dabi MA, et al. Hepatits B and HIV in Sudan: A serosurvey for hepatits B and HIV antibodies among sexually active heterosexuals. Am J Trop Med Hyg 1989;41:726-31.
George and of HBcAb seroprevalence from 4.2% to 0.46% over a JF. Epidemiology of hepatitis B in the Gezira region of Sudan. Am J period of eight years
  • K C Hyams
  • M A Arabi
  • A A Tagani
  • J F Messiter
  • A A Gaali
Hyams KC, al Arabi MA, al Tagani AA, Messiter JF, al Gaali AA, George and of HBcAb seroprevalence from 4.2% to 0.46% over a JF. Epidemiology of hepatitis B in the Gezira region of Sudan. Am J period of eight years. [7]