Hepatitis B is a Serious Health Problem in Some Parts of Iran; Sistan and Baluchestan Province

authors:

avatar Seyed Moayed Alavian ORCID 1 , *

Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran

how to cite: Alavian S M. Hepatitis B is a Serious Health Problem in Some Parts of Iran; Sistan and Baluchestan Province. Int J Infect. 2015;2(2):e17937. https://doi.org/10.17795/iji-17937.

Chronic Hepatitis B Virus (HBV) infection affects approximately 350 million people worldwide and the majority of infected peoples are living in China and Taiwan (1). Iran is located in the intermediate to a low-endemicity area of HBV prevalence (2). Hepatitis B virus infection is the main cause for liver cirrhosis and hepatocellular carcinoma in Iran. Recent studies from Iran showed that the prevalence rate of HBV infection has decreased significantly and it is a reflection of HBV vaccination of infants and high-risk groups during 20 years in Iran (3-8).

In the previous studies, it was estimated that over 35% of Iranians have been exposed to the HBV and around over 5% of the general population in Sistan and Baluchestan Province were HBsAg- positive (9). A recently published study from Sistan and Baluchestan (rural and urban areas) has shown that the prevalence rates of HBsAg and HBcAb are 3.38% and 23.58%, respectively (10). The rate of HBV infection in Sistan and Baluchestan is higher than other parts of Iran, except Golestan Province (11). Approximately 25% of general population in Sistan and Baluchestan had previous exposure to HBV and 3.38% are HBsAg carriers. In the multivariate analysis, age, addiction, and marital status were independent risk factors for HBV seropositivity. Older subjects and married individuals had higher probability of HBV seropositivity. Age is a common risk factor that almost is reported in all of seroepidemiologic studies of HBV infection (12-14). The reason is that the risk and cumulative frequency of high-risk behaviors increase with age and consequently increase the likelihood of HBV infection. However, it seems that age, addiction and intrafamilial transmission are major determinants of HBV infection in general population of Sistan and Baluchestan. In another study from Zahedan City, overall seroprevalence of HBsAg reported to be 2.5% (15). In this study, the enrolled study group was chosen from urban area (Zahedan City). It means that the rural populations are at higher risk for acquiring HBV infection in this province.

In a cross-sectional study from Sistan-Baluchestan, data were collected from the total number of 454 HBsAg-positive cases and 1817 members of their family, the prevalence rates of HBsAg and HBcAb-positivity among household members were 19.3% and 51%, respectively (16). Importantly, the mothers of index cases had the highest prevalence of HBsAg-positivity compared to their spouses who had the lowest proportion (53.2% vs. 8.4%, P < 0.001) (16). Intrafamilial and addiction are major routes of HBV transmission in this province (10). Chronic HBsAg carriers in this province can be a reservoir for transmission of HBV infection through close contacts, sharing needles or nosocomial interventions and they are a significant threat to the public health. A study in blood donors in Zahedan has shown that some risk factors, such as receiving dentistry services, hospital admission, living with HBsAg-positive cases and addiction are the main risk factors for acquiring the infection among young people (17).

Following the HBV neonatal vaccination in Iran and in some other Middle East countries including Bahrain, and Kuwait, which all reach over 80% of the population as part of their Expanded Program on Immunization (EPI), it is expected that by now the prevalence of HBsAg carrier rates in general population in these countries decreased to fewer than 2% (13). In recently published data from different parts of Iran has shown the rate of 2% or less for HBsAg-postivity in general populations of Kurdistan (5), Kermanshah (4), Qom (18), Amol (19), Chaharmahal and Bakhtiari Provinces and Cities (20).

In conclusion, If we like to stop the viscous cycle in transmission of HBV infection in Sistan and Baluchestan Province, we should employ some strategies to control HBV infection, such as assurance of the identification of all HBsAg-positive women and all exposed infants receive Hepatitis B Immunoglobulin (HBIG) and 1st dose of HBV vaccine w/in 12 hours of birth, as well as assurance of completion of 3 doses of the HBV vaccine and postvaccination testing of exposed infants.

Combination of hepatitis B and HBIG cannot guarantee successful prevention, as at least 3% of infants will still acquire the infection (21). We should be assured that all susceptible household and sexual contacts are vaccinated against HBV infection. Higher seroprevalence of HBsAg in rural areas should motivate us to be more active in these areas and we should try to decrease the main risk factors and change them to safer with more education and follow-up. Although, the conclusions and plans of the new viral hepatitis prevention board are commendable, they should be expanded to include region of the country where the control of hepatitis B still needs much additional external help.

Acknowledgements

References

  • 1.

    Dienstag JL. Hepatitis B virus infection. N Engl J Med. 2008;359(14):1486-500. [PubMed ID: 18832247].

  • 2.

    Poustchi H, Mohamadnejad M, Malekzadeh R. Hepatitis B virus infection in Iran. Iran J Clin Infect Dis. 2007;2(1):37-51.

  • 3.

    Alavian SM, Lankarani K. Hepatitis B Virus Infection; A Vanishing Disease in Iranian Children. Journal of Comprehensive Pediatrics. 2012;3(1):1-2. https://doi.org/10.5812/jcp.4058.

  • 4.

    Alavian SM, Tabatabaei SV, Nourizad S, Mansouri F, Khademi N, Amini Kafi-abad S, et al. Seroepidemiology of HBV Infection in Kermanshah- West of Iran; a Population Based Study. Jundishapur Journal of Microbiology. 2012;5(4):564-9. https://doi.org/10.5812/jjm.4156.

  • 5.

    Alavian SM, Tabatabaei SV, Ghadimi T, Beedrapour F, Kafi-Abad SA, Gharehbaghian A, et al. Seroprevalence of Hepatitis B Virus Infection and Its Risk Factors in the West of Iran: A Population-based Study. Int J Prev Med. 2012;3(11):770-5. [PubMed ID: 23189228].

  • 6.

    Mirrezaie SM, Saber HR, Hajibeigi B, Salekmoghaddam E, Abbasian A, Alavian SM. Impact of HBV Vaccination on Prevalence of Hepatitis B Virus Infection Among Volunteer Blood Donors in Tehran-Iran. Shiraz E-Med J. 2014;15(2).

  • 7.

    Alavian SM, Fallahian F, Lankarani KB. The changing epidemiology of viral hepatitis B in Iran. J Gastrointestin Liver Dis. 2007;16(4):403-6. [PubMed ID: 18193122].

  • 8.

    Alavian SM. Ministry of Health in Iran Is Serious about Controlling Hepatitis B. Hepat Mon. 2007;7(1):3-5.

  • 9.

    Farzadegan H, Shamszad M, Noori-Arya K. Epidemiology of viral hepatitis among Iranian population--a viral marker study. Ann Acad Med Singapore. 1980;9(2):144-8. [PubMed ID: 7425524].

  • 10.

    Salehi M, Alavian SM, Tabatabaei SV, Izadi S, Sanei Moghaddam E, Amini Kafi-Abad S, et al. Seroepidemiology of HBV infection in South-East of iran; a population based study. Iran Red Crescent Med J. 2012;14(5):283-8. [PubMed ID: 22829987].

  • 11.

    Abdolahi N, Keshtkar AA, Semnani SH, Roshandel GHR, Beshrat S, Joshaghani HR, et al. [HBV Seroprevalence among Golestan Adults]. Iranian J Epidemiology. 2006;4(1):35-40.

  • 12.

    Ozer A, Yakupogullari Y, Beytur A, Beytur L, Koroglu M, Salman F, et al. Risk factors of hepatitis B virus infection in Turkey: A population-based, case-control study: Risk Factors for HBV Infection. Hepat Mon. 2011;11(4):263-8. [PubMed ID: 22087152].

  • 13.

    Nokhodian Z, Kassaian N, Ataei B, Javadi AA, Shoaei P, Farajzadegan Z, et al. Hepatitis B Markers in Isfahan, Central Iran: A Population-Based Study. Hepat Mon. 2009;9(1):12-6.

  • 14.

    Hajiani E, Hashemi S, Masjedizadeh A. Seroepidemiology of Hepatitis B Virus Infection in Khuzestan Province, Southwest of Iran. Hepat Mon. 2009;9(1):34-8.

  • 15.

    Ansari-Moghaddam A, Ostovaneh MR, Sharifi Mood B, Sanei-Moghaddam E, Modabbernia A, Poustchi H. Seroprevalence of hepatitis B surface antigen and anti hepatitis C antibody in zahedan city, iran: a population-based study. Hepat Mon. 2012;12(9). ee6618. [PubMed ID: 23087764]. https://doi.org/10.5812/hepatmon.6618.

  • 16.

    Hatami H, Salehi M, Sanei E, Khosravi S, Alavian SM. Intra-familial Transmission of Hepatitis B virus Infection in Zahedan. Iran Red Crescent Med J. 2013;15(1):4-8. [PubMed ID: 23487536]. https://doi.org/10.5812/ircmj.2282.

  • 17.

    Alavi-Naini R, Sanei-Moghadam E, Khosravi S, Salahshour H. Changes in risk factors of HBsAg positive blood donors in Zahedan, Iran. Zahedan J Res Med Sci. 2013;13(3):41-6.

  • 18.

    Ghadir MR, Belbasi M, Heidari A, Jandagh M, Ahmadi I, Habibinejad H, et al. Distribution and risk factors of hepatitis B virus infection in the general population of Central Iran. Hepat Mon. 2012;12(2):112-7. [PubMed ID: 22509188]. https://doi.org/10.5812/hepatmon.822.

  • 19.

    Keyvani H, Sohrabi M, Zamani F, Poustchi H, Ashrafi H, Saeedian F, et al. A population based study on hepatitis B virus in northern iran, amol. Hepat Mon. 2014;14(8). ee20540. [PubMed ID: 25237372]. https://doi.org/10.5812/hepatmon.20540.

  • 20.

    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(5). ee17398. [PubMed ID: 24910705]. https://doi.org/10.5812/hepatmon.17389.

  • 21.

    Alavian SM. Transmission of HBV infection from mothers HBsAg positive to infants need to more attention. J Clin Virol. 2012;54(2):201. [PubMed ID: 22418455]. https://doi.org/10.1016/j.jcv.2012.02.001.