1. Prevalence of Hepatitis B infection in married women of child bearing age in District Islamabad Dr. Najma Javeed Awan Senior Medical Officer Pakistan Medical Research Council

2. Back ground World wide infection of HBV: More than two billion people (one third of the world’s population) Chronic liver infection: About 350 and 400 million people are positive for Hepatitis B surface antigen (HBsAg) HCC & Cirrhosis: About 25% ~ 40% of patients eventually develops the complications

3. Prevalence of chronic HBV infection : Prevalence is classified into three groups: High prevalence (> 8%) Intermediate prevalence (2% ~ 8%) Low prevalence (< 2%)2,5. Pakistan: Intermediate endemicity 2.5% prevalence.

4. Objectives To determine the seroprevalence of hepatitis B virus surface antibodies, hepatitis B virus surface antigen (HBsAg) and e antigen (HBeAg) among married women of child bearing age in district Islamabad

5. Why to do HBsAg & HBeAg in mothers??? HBsAg: become positive 2 to 12 weeks after infection HBeAg: a marker for infectivity If the mother is HBsAg positive and is also positive for HBeAg (a marker for infectivity) than there is a 90% chance that she will transmit the disease to her newborn. If the mother is HBsAg positive and not HBeAg positive, than the probability goes down to 20-30%.

6. Why to select Islamabad ??? The results of the National Survey on Prevalence of Hepatitis B & C in general population of Pakistan conducted by Pakistan Medical Research Council (PMRC) conducted in 2009 showed Prevalence of HBsAg in district Islamabad 5.6%, second highest after Dera ghazi khan(5.7%) among 36 districts of Punjab being surveyed

7. Subjects & Methods Study Design It was a cross-sectional, community-based, sero-epidemiological survey.

8. 1. Inclusion & Exclusion Criteria Inclusion criteria Married women of age 15-45 years residing in District Islamabad Women with no signs & symptoms of liver diseases. Exclusion Criteria: Female already suffering from Hepatitis B infection

9. 2. Multi Phase Sampling Technique: First phase: Islamabad was divided into urban and rural clusters Second Phase: Random selection of 03 urban and 03 rural clusters Urban Clusters: Bara Kahu, Karach Company, Sector I Rural Clusters: Bani gala, Kuri shehr, Gokina Village In rural clusters as houses were not properly numbered, started sampling from the mosque and selected a lane at random from there and then enrolled every 2nd house.

10. 3. Questionnaire Socio-demographic parameters Number of children Place & mode of deliveries Hepatitis B vaccination status of female History HBV infection in any member of household

11. 4. Sample Collection Collection of 3 ml whole blood in labeled gel tube Tests performed: Hepatitis B surface antibodies (anti HBs) Hepatitis B surface antigen (HBsAg) Hepatitis B e antigen (HBeAg) Technique: “Microparticle enzyme Immunoassay”. on ARCHITECT of Abbott

12. Results Positivity of HBV serological markers among study population

13. Frequency of HBV serological markers in different age groups Age (Y)n (%) HBV Serological markers HBsAbHBsAgHBeAg (n)(%)(n)(%)(n)(%) (15-25)98(35.37)1313.261111.22Nil (26-35)143(51.62)2114.68149.79Nil (36-45)36(30.01)0411.110513.88038.33 Total277(100)3813.713010.83031.08

14. Distribution of HBV serological markers among selected rural and urban clusters of District Islamab

15. Demographical variables among study population. S.No.Demographical variablesYesNo 1.Prior knowledge of HBV vaccine 5620.21%22180.01% 2. Ever been tested for HBV during any of the pregnancy 12143.61%15656.31% 3. HBV positive house hold contact 2910.46%24889.53% 4. History of blood transfusion196.85%25893.14%

16. Conclusion: Overall HBsAg seroprevalence among married women of District Islamabad is 10.83%, which is alarmingly high as compared to the general population i.e. 5.6%. About 10% cases from HBsAg positive group were also HBeAg positive showing presence of active replicating virus (Highly infective stage) and if women were pregnant at that time than there would be 90% chances to transmit virus to their newborn.

17. Recommendations: Vaccination program should be implemented not only in infants and children but also in adults. Further, the routine maternal HBsAg screening should be promoted and strengthened so as to prevent mother-to-child transmission of HBV.

18. Thank you