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Review
. 2009 Jan;13(1):9-19.
doi: 10.1016/j.ijid.2008.06.019. Epub 2008 Oct 2.

Hepatitis B and hepatitis C in Pakistan: prevalence and risk factors

Syed Asad Ali  1 , Rafe M J Donahue, Huma Qureshi, Sten H Vermund
Affiliations
Review

Hepatitis B and hepatitis C in Pakistan: prevalence and risk factors

Syed Asad Ali et al. Int J Infect Dis. 2009 Jan.

Abstract

Background: Pakistan carries one of the world's highest burdens of chronic hepatitis and mortality due to liver failure and hepatocellular carcinomas. However, national level estimates of the prevalence of and risk factors for hepatitis B and hepatitis C are currently not available.

Methods: We reviewed the medical and public health literature over a 13-year period (January 1994-September 2007) to estimate the prevalence of active hepatitis B and chronic hepatitis C in Pakistan, analyzing data separately for the general and high-risk populations and for each of the four provinces. We included 84 publications with 139 studies (42 studies had two or more sub-studies).

Results: Methodological differences in studies made it inappropriate to conduct a formal meta-analysis to determine accurate national prevalence estimates, but we estimated the likely range of prevalence in different population sub-groups. A weighted average of hepatitis B antigen prevalence in pediatric populations was 2.4% (range 1.7-5.5%) and for hepatitis C antibody was 2.1% (range 0.4-5.4%). A weighted average of hepatitis B antigen prevalence among healthy adults (blood donors and non-donors) was 2.4% (range 1.4-11.0%) and for hepatitis C antibody was 3.0% (range 0.3-31.9%). Rates in the high-risk subgroups were far higher.

Conclusions: Data suggest a moderate to high prevalence of hepatitis B and hepatitis C in different areas of Pakistan. The published literature on the modes of transmission of hepatitis B and hepatitis C in Pakistan implicate contaminated needle use in medical care and drug abuse and unsafe blood and blood product transfusion as the major causal factors.

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Conflict of interest statement

Conflict of interest: No conflict of interest to declare.

Figures

FIGURE 1
FIGURE 1. Summary of studies reporting HBV prevalence in the general population of Pakistan
Each study is represented horizontally. From L-R: reference number, first author, city in which study conducted, year in which study published; Dot and bar represent the point prevalence of HBV with calculated 95% confidence interval; lab technique used to detect HBsAg; and sample size of the study. The vertical line represents the calculated weighted average prevalence of HBV based on all the studies in the particular group. ELISA (#) =Enzyme linked immunosorbent assay (# represents generation of test); RPHA=Reverse particle hemagglutination assay; ICT=Immuno-chromatographic test; LPA=Latex particle agglutination; MEIA (#)=Micro enzyme immunoassay (# represents generation of test); RIBA=Recombinant immunoblot assay; ??=unknown
FIGURE 2
FIGURE 2. Summary of studies reporting HCV prevalence in the general population of Pakistan
Each study is represented horizontally. From L-R: reference number, first author, city in which study conducted, year in which study published; Cross and bar represent the point prevalence of HCV with calculated 95% confidence interval; lab technique used to detect HCVAb; and sample size of the study. The vertical line represents the calculated weighted average prevalence of HCV based on all the studies in the particular group. ELISA (#) =Enzyme linked immunosorbent assay (# represents generation of test); RPHA=Reverse particle hemagglutination assay; ICT=Immuno-chromatographic test; LPA=Latex particle agglutination; MEIA (#)=Micro enzyme immunoassay (# represents generation of test); RIBA=Recombinant immunoblot assay; ??=unknown
FIGURE 3
FIGURE 3. Summary of studies reporting HBV and HCV prevalence in the high risk population of Pakistan
Each study is represented horizontally. From L-R: reference number, first author, city in which study conducted, year in which study published; Dot and bar represent the point prevalence of HBV with calculated 95% confidence interval while cross and bar represent point prevalence of HCV with calculated 95% confidence interval; lab technique used to detect HBsAg or HCVAb; and sample size of the study. The vertical line represents the calculated weighted average prevalence of HBV or HCV based on all the studies in the particular group. ELISA (#) =Enzyme linked immunosorbent assay (# represents generation of test); RPHA=Reverse particle hemagglutination assay; ICT=Immuno-chromatographic test; LPA=Latex particle agglutination; MEIA (#)=Micro enzyme immunoassay (# represents generation of test); RIBA=Recombinant immunoblot assay
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