Parallel and Overlapping Prevalence of Hepatitis B and C Viruses in Apparently Healthy Individuals in a Northern Nigerian Population Pennap, GRI and Chuga, F J Microbiology Unit Nasarawa State University, Keffi, Nigeria

Introduction  HBV and HCV are hepatotrophic viruses that cause acute and chronic hepatitis as well as latent hepatic infection.  Account for a substantial portion of Liver diseases worldwide – emerging global public health problems.  Both are endemic in Sub-Saharan Africa– highest prevalence of HCV is in Africa  Nigeria—35M people live with HBV and/or HCV  Infected persons can remain asymptomatic for decades but after years chronic carriers develop liver related ailments e.g. Liver failure, Liver cirrhosis and HCC.  Lethal duo – Coinfection results in more severe disease than either infection. Risk factors associated with HIV and HHV-8 infection

Introduction contd Transmission: Overlap-- parenterally( transfusion), sexually and vertically. In Africa – cultural practices(sexual rituals, scarification, piercing, contact sports, circumcision). Chronic HBV and HCV infections are defined by the detection of HBsAg and anti- HCV antibodies respectively. Good progress on antiviral therapy BUT as infections are largely ASYMPTOMATIC, patients who might benefit from treatment remain undetected. It is therefore very important to detect such carriers so as to: Reduce burden of illness and healthcare cost Reduce transmission through reduction of infected pool— reduction in viral load Vaccinate susceptible contacts of identified HBV carriers

Aims Numerous transfusion requiring ailments abound ---- depletion in donors Gains of ART -- hampered by coinfection with the duo It is important to sustain the gains of HAART and also have readily available blood donors. This study was therefore mooted to:  Determine the prevalence of HBV and HCV infections among apparently healthy people.  Determine the risk factors associated with infection. It is hoped that the findings will contribute to information required to make clinical decisions and set proactive health policies.

Materials and Methods Cross-sectional study Study population Ethical clearance Health talk and informed consent Sociodemographic information – questionnaire Sample collection Venipuncture – Serum ◦ storage (-4 0 C)  thawing (room temperature)  Screening procedure--- HBsAg and anti-HCV Rapid Test strips ( according to the Manufacturer’s instructions).

Results and Discussion  Population – 200 participants (48% males, 52% females)  General prevalence of hepatitis– 15%  Prevalence of HBV – 11.5%  Prevalence of HCV – 3.0%  Prevalence of coinfection – 0.5%  HBV in Nigeria – 16.5%(Pregnant women) 13.2%(General population) 7.9%(HIV population)  HCV in Nigeria -2.3%(HIV population) 4.5%(General population) 0.8%(Pregnant population)

Result and Discussion contd. Probable reasons for differences in prevalence Type of population studied Geographic region Socoieconomic status Cultural practices Method of viral detection HBsAg negative (in cases of occult infection i.e –ve HBsAg but detectable HBV DNA)

Figure 1: Prevalence of Hepatitis B and C virus infections among apparently healthy individuals in relation to age

Figure 2: Prevalence of Hepatitis B and C virus infections among apparently healthy individuals in relation to gender

Figure 3: Prevalence of Hepatitis B and C virus infections among apparently healthy individuals in relation to marital status

Figure 4: Prevalence of Hepatitis B and C virus infections among apparently healthy individuals in relation to history of blood transfusion

Figure 6: Prevalence of Hepatitis B and C virus infections among apparently healthy individuals in relation to Educational background

Figure 7: Prevalence of Hepatitis B and C virus infections among apparently healthy individuals in relation to occupation

Figure 8: Prevalence of Hepatitis B and C virus infections among apparently healthy individuals in relation to Facial marks

Conclusion This study reported infection with HBV (11.5%), HCV(3.0%) and HBV-HCV coinfection(0.5%) in apparently healthy participants. Study confirms the endemicity of these viruses in the study area. High prevalence in apparently healthy people is a cause for alarm. No identifiable risk factors Not identifying risk factors has drawn attention to the probability of obscured risk factors or locality specific risk factors.

Recommendation These findings underscore the importance of screening apparently healthy people for these viruses. Screening should be available and affordable Evaluate salient social and cultural practices that may facilitate transmission Institute proactive strategies for prevention and control

Future Work Larger studies Longitudinal studies Inclusion of more probable risk factors( viz-a-viz sociocultural practices of the study area) Molecular study of circulating strains

Acknowledgement We wish to sincerely thank:  All the study participants  Staff of Innovative Biotechnology Laboratory for technical support  Dr DS Nyabam for statistical analysis..

References Udeze et al. (2011). Hepatitis C virus antibody detection among first year students of University of Ilorin, Nigeria. World Journal of Medical Science 6(3) Kolawale et al.(2012).Hepatitis B antigenemia and its effects on hematological parameters in pregnant women in Osogbo. Journal of Virology 9:317 Tremeau-Bravard et al.(2012). Seroprevalence of Hepatitis B and C infection among HIV positive population in Auja, Nigeria. African Health Science. 12(3) Dawurung et al. (2012). Archives of Applied Science Research. 4(4)

Screening asymptomatic persons is an IMPORTANT instrument in disease detection especially in silent killers like HBV and HCV infections. T H A N K YOU