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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 8  |  Issue : 3  |  Page : 186-189

Epidemiology and trend of hepatitis B infection in Hamadan Province during 2011–2016


1 Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
2 Department of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
3 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
4 Department of Epidemiology and Biostatistics, Neurology and Neurosciences Research Center, Qom University of Medical Sciences, Qom, Iran

Date of Web Publication24-Sep-2018

Correspondence Address:
Manoochehr Solgi
Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AIHB.AIHB_24_18

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  Abstract 


Background: Hepatitis B virus (HBV) is a major public health problem worldwide. The objective of this study was to investigate the epidemiological pattern and to analyse the trend of hepatitis B infection in Hamadan province over 7 successive years (2011–2016). Materials and Methods: This cross-sectional study was conducted on the recorded HBV cases (n = 1132) by the Deputy of Health affiliated to Hamadan University of Medical Sciences during 2011–2016. Cochran–Armitage test was used to investigate the changes in trend of the infection according to demographical and clinical characteristics. Incidence rates of HBV were estimated by districts for 2016. Results: Overall, 708 (62.54%) were male and 733 (64.75%) were urban dwellers; the highest proportion of the cases (41.17%) belonged to the age group of 25–44 years. There was a significant decreasing trend of HBV incidence in 15–24 years of age group (P for trend = 0.038). Overall, incidence rate of HBV infection in Hamadan province was 7.59/100,000 in 2016, while southern counties had higher incidence rates as compared to northern parts. Conclusion: Our results showed that HBV was prevalent in the age group of 25–44 years. In spite of effective vaccination programmes against hepatitis B, the increasing trend of HBV in southern parts of the province and reduced trend of hepatitis B in the northern counties should be further explored to find the role of other risk factors in the HBV process and the reporting system.

Keywords: Hepatitis B infection, incidence, Iran, trend


How to cite this article:
Khazaei S, Mofarrah-Zat A, Nematollahi S, Mirzaei M, Mohammadbeigi A, Bathaei SJ, Solgi M. Epidemiology and trend of hepatitis B infection in Hamadan Province during 2011–2016. Adv Hum Biol 2018;8:186-9

How to cite this URL:
Khazaei S, Mofarrah-Zat A, Nematollahi S, Mirzaei M, Mohammadbeigi A, Bathaei SJ, Solgi M. Epidemiology and trend of hepatitis B infection in Hamadan Province during 2011–2016. Adv Hum Biol [serial online] 2018 [cited 2020 Mar 29];8:186-9. Available from: http://www.aihbonline.com/text.asp?2018/8/3/186/241926




  Introduction Top


Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic hepatitis. The virus is transmitted through contact with blood or other body fluids of infected individuals.[1] It is estimated that 257 million people are living with hepatitis B virus (HBV) infection (defined as the presence of hepatitis B-positive antigen level), while it resulted in 887,000 deaths in 2015, mainly due to the complications (e.g., cirrhosis or hepatocarcinoma).[2] Hepatitis B is a potentially life-threatening hepatic infection caused by HBV, which is one of the main health concerns worldwide. It can cause chronic infections and death due to liver cirrhosis and liver cancer. Despite the presence of safe and effective vaccines, hepatitis B is still an important occupational risk factor for health workers.[3] The prevalence of hepatitis B is highest in the WHO Western Pacific Region and African Region (6.2% and 6.1% of adults, respectively). Furthermore, 3.3%, 2.0%, 1.6% and 0.7% of adults are infected in the WHO offices of Eastern Mediterranean, Southeast Asia, European and Americas, respectively.[4] The investigation on the trend of hepatitis B infection in Iran showed that the overall incidence rate of HBV was 9.57, 5.83, 16.26, 12.44, 21.89 and 13.93 (per 100,000 population) from 2008 to 2013, respectively.[5] In another study, the overall prevalence of HBV infection in the general population was estimated to be 2.2%. The prevalence of HBV infection was highest in Golestan province (8.9%) and was lowest in Kermanshah province.[6] One systematic review estimated a pooled prevalence of 3% for HBV in Iran which varies in different provinces from 0.87% to 8.86%.[7] Various studies have shown that the prevalence of hepatitis B in Iran has declined due to the implementation of the hepatitis vaccination programme.[8],[9] With the aim of depicting a more up-to-date picture of the situation of HBV infection, the present study was conducted to evaluate the epidemiology and trend of hepatitis B infection in Hamadan province during 2011–2016.


  Materials and Methods Top


Study area

Hamadan province is located in the west of Iran, with 19,546 km2 surface area. According to the National Population and Housing Census on 2011, the population of the province is 1,758,268 and consists of nine districts, namely Asadabad, Bahar, Hamadan, Famenin, Kabudarahang, Malayer, Nahavand, Tuyserkan and Razan.

Data source

In this cross-sectional study, we used data of HBV-infected cases that were recorded in the Deputy of Health affiliated to Hamadan University of Medical Sciences from March 2011 to March 2016. According to the national guidelines, notification of HBV infections is mandatory in Iran; therefore, all public and private laboratories, blood transfusion organisation, hospitals and health centres are required to report all positive test results of serologic markers of HBV infections to the relevant district health centre on a monthly basis. All subjects whose serologic markers were positive for HBsAg were considered as suspected positive cases of HBV infections and were entered into the study. Patients who lived in other provinces and cases whose infections were already diagnosed in previous years were excluded from the study and only incidence cases were included into the study.

Then, the examination form including demographic characteristics of the patients (age, gender, marital status and residence), occupational status, examination cause and source of reporting for reported cases was filled out by health experts.

Statistical analysis

Descriptive statistics such as frequency tables and charts were used for presenting data. Cochran–Armitage test was used to investigate the changes in trend of the disease according to the aforementioned demographical and clinical characteristics. Spatial distribution for incidence rates of HBV (per 100,000 populations) was depicted using ArcView GIS software.

All the analyses were done using Stata (Version 11.2, StataCorp, College Station, Texas, USA) and ArcView GIS software version 10.3 (trademarks of ESRI; http://www.esri.com). P ≤ 0.05 was considered as significance level.


  Results Top


During the 6 years (2011–2016), a total of 1132 cases of HBV infection were registered in Hamadan province. [Table 1] shows the baseline characteristics of the study participants. Among all the cases, 708 (62.54%) were male and 733 (64.75%) were urban dwellers; the highest proportion of the cases (41.17%) belonged to the age group of 25–44 years. Mean age of the patients was 45.53 (16.34) years (range: 5–90). The majority of the cases were married (85%). In addition, there was a significant decreasing trend for incidence of HBV for 15–24 age groups, while this proportion was highest in 2011 and lowest in 2016 (11.61% and 4.55%, respectively, P for trend = 0.038).
Table 1: Trend of hepatitis B infection in Hamadan province (2011-2016)

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The highest incidence rate of hepatitis B infection in 2016 was observed in Malayer and Asadabad with 14.9/100,000 and 12.88/100,000 populations, while the lowest incidence rate (1.58 in 100,000) was observed in Kabudarahang [Figure 1]. Overall incidence rate of HBV infection in Hamadan province was 7.59/100,000 in 2016, and the southern counties had the higher incidence rate compared to the northern parts.
Figure 1: Incidence rate of hepatitis B infection in different districts of Hamadan province in 2016.

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[Figure 2] shows the occupational status of the patients. HBV infection was more common in housekeepers, self-employed and farmers. Sources of reporting in 52.12% and 21.91% of the cases were laboratory and public health sectors. 20.14% of the cases were examined voluntarily and only 10.42% were assessed due to clinical symptoms [Figure 3].
Figure 2: Occupational status of hepatitis B-infected patients in Hamadan province (2011–2016).

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Figure 3: Source of reporting and examination cause of hepatitis B-infected patients in Hamadan province (2011–2016).

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  Discussion Top


In the present study, demographical and clinical information of 1132 HBV-infected patients was assessed for 7 successive years (2011–2016) in Hamadan province. Our findings indicated that HBV distributed mainly among males, individuals aged 25–44 years, married people and urban dwellers. Overall incidence rate of HBV infection in Hamadan province was 7.59/100,000 populations in 2016, while the southern counties had the highest incidence rate. The source of report for more than half of the patients was laboratory. Our findings are consistent with previous epidemiological studies, suggesting a downward trend in the incidence of hepatitis B.[5],[6],[9],[10] Consistent with other reports, we found a significantly decreasing trend of HBV incidence among individuals aged 15–24 years.[11] According to the studies, it appears that the incidence of hepatitis B in Hamadan province is decreasing. This can be attributed to various reasons such as implementation of vaccination programmes for hepatitis B. Since 1996, there has been an extensive vaccination programme for high-risk groups, health-care workers along with public education programmes in communities. In addition to the national vaccination, 17-, 18- and 19-year-olds have been undergone free vaccination against HBV in the recent years in Iran.

Consistence with other studies,[5],[12],[13] the frequency of the HBV infections was higher in males. More prevalent of risky behaviours such as intravenous drug abuse using shared syringes among males can justify this inequality. We found that HBV infection was more common among housekeepers, self-employed and farmers. Our findings were similar to those carried out in other areas.[5],[13] One reason may be due to high proportion of these jobs in the province. In this study, 85% of cases were married. In another national study, being married was the possible risk factors for the spread of hepatitis B;[14] it goes back to the older age of married people and lack of national HBV vaccination for them. Greater number of urban dwellers in Hamadan province justifies the higher percentage of infection in urban areas.

There are some limitations of this study. The first limitation was using the health records based on passive surveillance system, which were prone to under-reporting. Second, HBV infection usually is without symptoms and patients usually diagnosed accidentally during blood donation or screening during pregnancy; therefore, the results were strongly prone to underestimation.[15],[16] Therefore, in this study, only about 10% of cases were assessed due to clinical symptoms. Along with the mentioned limitations of passive surveillance systems, some advantages such as low cost and ease of carrying out the study compared to the active surveillance motivated us to use this system to monitoring trends over time and provide critical information for monitoring a community's health.[17]


  Conclusion Top


Our results showed that HBV was prevalent in the age group of 25–44 years. In spite of effective vaccination programmes against hepatitis B, the increasing trend of HBV in southern parts of the province and reduced trend of hepatitis B in the northern counties should be further explored to find the role of other risk factors in the HBV process and the reporting system.

Acknowledgment

We would like to thank the Deputy of Health, Hamadan University of Medical Sciences, who collaborated in the data collection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lok AS, McMahon BJ; Practice Guidelines Committee, American Association for the Study of Liver Diseases (AASLD). Chronic hepatitis B: Update of recommendations. Hepatology 2004;39:857-61.  Back to cited text no. 1
    
2.
World Health Organization. Hepatitis B; 2017. Available from: http://www.who.int/mediacentre/factsheets/fs204/en/. [Last updated on 2017 Jul 05].  Back to cited text no. 2
    
3.
Miranda J, Cabezas C. Hepatitis B among health workers. Rev Gastroenterol Peru 2001;21:128-35.  Back to cited text no. 3
    
4.
World Health Organization. Hepatitis; 2017. Available from: http://www.who.int/hepatitis/publications/global-hepatitis-report2017/en/. [Last updated on 2017 Apr 07].  Back to cited text no. 4
    
5.
Khazaei S, Karami M, Ayubi E, Mohammadbeigi A, Hasanbeigi A, Mansori K, et al. Trends in epidemiology of hepatitis B and C infections in Ilam province: National notifiable diseases surveillance system data. Caspian J Intern Med 2018;9:16-21.  Back to cited text no. 5
    
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Salehi-Vaziri M, Sadeghi F, Almasi Hashiani A, Gholami Fesharaki M, Alavian SM. Hepatitis B virus infection in the general population of iran: An updated systematic review and meta-analysis. Hepat Mon 2016;16:e35577.  Back to cited text no. 6
    
7.
Mohammadi Z, Keshtkar A, Eghtesad S, Jeddian A, Pourfatholah AA, Maghsudlu M, et al. Epidemiological profile of hepatitis B virus infection in iran in the past 25 years; a systematic review and meta-analysis of general population studies. Middle East J Dig Dis 2016;8:5-18.  Back to cited text no. 7
    
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Moezzi M, Imani R, Khosravi N, Pourheidar B, Ganji F, Karimi A. Hepatitis B seroprevalence and risk factors in adult population of chaharmahal and bakhtiari province in 2013. Hepat Mon 2014;14:e17398.  Back to cited text no. 8
    
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Saffar H, Ajami A, Saffar MJ, Shojaei J, Sotudeh-Anvari M, Shams-Esfandabad K, et al. Prevalence of hepatitis B virus seromarkers in young adults vaccinated at birth; impact on the epidemiology of hepatitis B infection in Iran. Hepat Mon 2014;14:e17263.  Back to cited text no. 9
    
10.
Kabir A, Alavian SM. Comment on: Epidemiology of hepatitis B virus infection in hamadan, west of iran. J Res Health Sci 2011;11:121-3.  Back to cited text no. 10
    
11.
Fathimoghaddam F, Hedayati-Moghaddam MR, Bidkhori HR, Ahmadi S, Sima HR. The prevalence of hepatitis B antigen-positivity in the general population of mashhad, iran. Hepat Mon 2011;11:346-50.  Back to cited text no. 11
    
12.
Ghannad MS, Hojati SA, Mirzaei M, Sahebkar A. Prevalence of hepatitis B and hepatitis C in patients referred to health centers in the Hamadan province, Iran: An epidemiologic study of infections between 2004 and 2007. Asian Biomed 2013;7:619-25.  Back to cited text no. 12
    
13.
Poorolajal J, Mirzaei M, Bathaei SJ, Majzoobi MM. Hepatitis B and C infections in hamadan province during 2004-2009. J Res Health Sci 2011;11:51-7.  Back to cited text no. 13
    
14.
Shahnaz S, Reza B, SeyedMoayed A. Risk factors in chronic hepatitis B infection: A case-control study. Hepat Mon 2005;2005:109-15.  Back to cited text no. 14
    
15.
Salkic NN. Intrafamilial transmission of hepatitis B: Experience and Lessons learned in Bosnia and Herzegovina. Hepat Mon 2009;9:169-70.  Back to cited text no. 15
    
16.
Hosseien K, SeyyedMohammad M, Mohsen A, Hassan A, Bashir H, Farshid A, et al. Trends in seroprevalence of hepatitis B, hepatitis C, HIV, and syphilis infections in Iranian blood donors from 2003 to 2005. Hepat Mon 2009;2009:24-8.  Back to cited text no. 16
    
17.
Nsubuga P, White ME, Thacker SB, Anderson MA, Blount SB, Broome CV, et al. Public health surveillance: A tool for targeting and monitoring interventions. In: Amison DT, Breman JG, Measham AR, editors. Disease Control Priorities in Developing Countries. 2nd ed. New York: Oxford University Press; 2006.  Back to cited text no. 17
    


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