Abstract Background: To evaluate the risk factors fo

Muhammad Asad Faruq

Muhammad Danish Khan

Muhammad Junaid

Muhammad Siddiq Qureshi

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Journal of Rawalpindi Medical College Students Supplement; 2015:19(S-1):48-50 
 
 48 
Original Article 
Risk factors for  Hepatitis B 
Muhammad Junaid ,Muhammad Siddiq Qureshi , Muhammad Danish Khan,  Muhammad Asad Faruq 
Medical Students, Rawalpindi Medical College 
 
Abstract 
Background: To evaluate the risk factors for  
Hepatitis B infections  
Methods:  In  this cross sectional descriptive study 
ppatients presenting to medical OPD and 
eemergency room with confirmed diagnosis of 
hepatitis B, were included. Any patient with 
concomitant Hepatitis C and D were excluded. 
Information related to presence of risk factors like 
dental procedures, intravenous drug abuse, 
occupational risk, blood transfusions, multiple 
sexual contact, tattooing and haemodialysis was 
recorded.  
Results: 141 patients presented with Hepatitis B in 
study period. Majority (70%) were males. Out of 
these (33%) were Intravenous drug abusers, (27%) 
had history of dental procedures, (9%) had sexual 
contact history with an infected individual as most 
likely source of infection, 5% had a history of blood 
transfusion, 3% were health workers and  2% were 
barbers.  
Conclusions: Majority (83%) had at least one risk 
factor present for hepatitis B. The most common risk 
factor was IV drug abuse and dental procedure. With 
proper prevention and awareness this can be 
overcome and will significantly reduce the burden of 
disease. 
Key Words: Hepatitis B, Risk factors 
 
Introduction 
   Chronic hepatitis B is defined  as the persistence of 
HBsAg (Hepatitis B surface antigen) in serum for at 
least 6 months.1 Hepatitis B Virus (HBV) infection 
contracted early in life may lead to chronic hepatitis, 
then to cirrhosis, and finally to hepatocellular 
carcinoma (HCC), usually after a period of 30 to 50 
years. HBV occurs worldwide. The highest rates of 
Hepatitis B surface antigen (HBsAg) carrier rates are 
found in developing countries with primitive or 
limited medical facilities. Global estimate put 350 
million people chronically infected with HBV.3 There is 
significant disease burden with estimated 5-8% people 
have Hepatitis B in Pakistan and is termed a shadow 
epidemic.4 A weighted average of hepatitis B antigen 
frequency among healthy adults in Pakistan was 2.4% 
(range 1.4–11.0%). This shows a significant disease 
burden in Pakistan. Given its large population (165 
million) and intermediate to high rates of infection, 
Pakistan is among the worst afflicted nations.4 
Hepatitis B has a spectrum of risk factors; each of them 
includes contact with blood or blood products of an 
infected person. Some of the risk factors include; 
infected pregnant mothers, health care workers, 
intravenous drug use, use of unsterile surgical or 
dental equipment, tattooing, travel to Hepatitis B 
endemic areas, hemodialysis, heterosexuality and HIV 
infection.6  
      Heterosexuality is also a documented risk factor for 
acquiring hepatitis B infection and in 1986 was 
documented to be more prevalent in those with 
increased number of partners by upto four times.7 It 
shows that greater the number of sexual partners, 
greater is the risk for getting the infection. Lack of the 
adequate vaccination among high risk groups like 
doctors, dentists and hospital personnel is a risk 
factor.8 A study in Iran concluded that a history of 
endoscopy, major surgery, and tattooing were major 
risk factors for developing chronic Hepatitis B 
infection8. In Pakistan the important contributors for 
different types of hepatitis were blood transfusion, 
surgical procedures and history of piercing in last six 
months.2 
 
Patients and Methods 
     This cross sectional descriptive study was 
conducted at Holy Family Hospital (HFH) during the 
period of January 2013 to December 2013. Patients 
Presenting to medical OPD, Emergency room with 
confirmed diagnosis of hepatitis B, were included. All 
patients had confirmed diagnosis of Hepatitis B. Any 
patient with concomitant Hepatitis C and D were 
excluded. Information related to presence of risk 
factors like dental procedures, IV drug abuse, 
occupational risk, blood transfusions, multiple sexual 
contact, tattooing and haemodialysis was recorded.  
 
Results 
     One hundred and forty one patients presented with 
Hepatitis B in Holy family hospital. Majority (70%) 
were males and 30% were females. Amongst these 141 
Journal of Rawalpindi Medical College Students Supplement; 2015:19(S-1):48-50 
 
 49 
patients at least one risk factor was found to be 
positive in 83% .IV drug abusers and dental work done 
with unsterilized equipment were  the most commonly 
prevalent risk factors (Table 1). When intra-familiar risk of 
Hepatitis B was assessed it was found out the 38% had a 
intra-familial risk factor (Table 2). 
 
Table 1: Hepatitis B- Risk Factors (n=141) 
Risk Factors No Percentage 
IV drug abuse 51 36 
Dental Procedures 39 28 
Sexual contact 13 9 
Blood transfusions 7 5 
Barbers 3 2 
Health Care workers 4 3 
None 24 17 
 
Table 2: Hepatitis B and Intra-familial risks 
Intra-familial risk Percentage 
Mother 25 
Spouse 20 
Brother 16 
Sister 11 
Father 2 
Children 2 
Other relatives 24 
 
Discussion 
    Review of Pakistani literature verifies liver pathology as a 
frequent cause of admission in our local hospitals. A study 
in Morocco showed the frequency of HbsAg was 2.29% 
and 0.93% in male and female subjects respectively in 
general population of Morocco showing a higher 
occurrence in males as compared to females which is 
agreement with our study9. The same study in 
Morocco revealed dental extraction procedure as the 
leading cause of Hepatitis B whereas our study 
showed IV drug users as the most common risk factor 
of Hepatitis B followed by dental procedures. In 
Pakistan syringes are reused and sterility of injections 
is often not maintained due to financial restrictions 
and lack of awareness among the healthcare providers 
and the population in general. These injections appear 
to be the single most significant factor in the spread of 
HBV and HCV in the general population of Pakistan. 5 
     There are about 1.5 million units of blood products 
transfused each year in Pakistan4. Our research shows 
that at least 5% of the presenting population had a 
blood transfusion as cause of Hepatitis B. Data on the 
proper processing and safety of blood transfusion is 
not available4. Poor management in this regards 
contributes significantly to the disease burden. 
     Certain professions like healthcare workers, sex 
workers, and barbers may be at increased risk of 
getting HBV and HCV. The best studied amongst them 
in Pakistan are healthcare workers, showing a 
relatively higher frequency (weighted average 6% and 
5.5% for HBV and HCV, respectively) than in general 
population4. Our study showed 3% were Health care 
workers and 2% were barbers. 
     Some studies have shown a relatively higher 
frequency in the household members of patients with 
HBV and HCV, other studies in the spouses of index 
cases have shown rates similar to controls.10 Pasha et 
al. showed the frequency of HCV in household 
members of HCV patients to be 2.5 times that of the 
general population, but no routes of transmission 
within the household were associated. The 
international literature suggests that the sexual 
transmission of HCV is very low11. It is likely that the 
high frequency reported in household contacts in 
Pakistan may be due to the fact that they are exposed 
to the same community risk factors as the index 
patient, rather than intra-household transmission per 
se. In contrast, HBV intra-familial transmission is well 
documented outside of Pakistan, and HBV is far more 
infectious as compared to HCV or HIV11. 
It is estimated that approximately 2 billion 
people have serological evidence of past or current 
HBV infection. And more than 350 million are chronic 
carriers of HBV12. Among them around 75% of chronic 
carriers live in Asia and western pacific13.It was 
reported that 15-40% of HBV infected patients would 
develop cirrhosis, liver failure or HCC 14 and 500,000 
to 1.2 million people die of HBV infection annually14-16 
 
Conclusion 
1.The frequency of risk factors was found to be very 
high (83%). High prevalence of Hepatitis B patients 
suggests that the disease burden is substantial 
globally,and steps must be taken for its prevention and 
control. 
2.Hepatitis B vaccination strategy must be prioritized 
for its prevention  
 
 
Acknowledgements 
We would like to show our immense gratitude to 
Principal and Chief Rawalpindi Medical College 
(RMC) and Allied Hospitals Professor Dr. Muhammad 
Journal of Rawalpindi Medical College Students Supplement; 2015:19(S-1):48-50 
 
 50 
Umar and Dr. Faiza Aslam Research Co-ordinator, 
RMC for their guidance and support. 
 
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Risk factors for Hepatitis B

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Risk factors for Hepatitis B

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