The seroprevalence of 2 hepatitis B virus markers, Hepatitis B surface antigen, and Hepatitis B core antibody were determined in 731 blood donors, and 1020 pregnant women in 3 hospitals in a rural community in Ghana during August 1991-July 1992 (blood donors) and August-November 1992 (pregnant women) by an Enzyme Immunoassay method. The prevalence of Hepatitis B surface antigen in the 2 groups was 19.5%, and 14% respectively. That hepatitis B virus infection is endemic in the community is borne out by the finding that 90% of the study population had serological evidence of Hepatitis B infection

Adu-Sarkodie Y.

Appiah-Denkyira E.

Matke P.

Tetteh C.

Nagasaki University's Academic Output SITE: NAOSITE

TrOP－Med．，38（3／4），87－90，December，1996　　　　　　　　　　　　　　　　　　　87SEROPREVALENCE OF HEPATITIS B MARKERSIN A RURAL COMMUNITY IN GHANAY. ADU-SARKODIE1, P. MATKE2, C. TETTEH3, and E. APPIAH-DENKYIRA3J励γゆAmo砂β乃ocゐimg月b坤iiαん∬umαsあGゐomα2Gβmom乃cゐmiαiiCo‾坤βniiom4酢mり′，Accn之，Gゐomα甥のomαi月poiiゐA（imimisわⅥiiom，I侮，GゐomαAbstract: The seroprevalence of 2 hepatitis B virus markers, Hepatitis B surface antigen,and Hepatitis B core antibody were determined in 731 blood donors, and 1020 pregnantwomen in 3 hospitals in a rural community in Ghana during August 1991-July 1992 (blooddonors) and August-November 1992 (pregnant women) by an Enzyme Immunoassaymethod. The prevalence of Hepatitis B surface antigen in the 2 groups was 19.5%, and 14%respectively. That hepatitis B virus infection is endemic in the community is borne out bythe finding that 90% of the study population had serological evidence of Hepatitis B infec-tion.勒W0nお：HepatitisB，SerOPreValence，GhanaIMTROI）UCTIOMHepatitisBvirus（HBV）infectionisOneOfthemajOrCauSeSwOr1d－wideOfhepatitis，1iver cirrhOSis，and primary hepatocel1u1ar carcinOma（PHCC）（Beas1ey etaL1981）．Itspreva1enceandmajOrmOdesOftransmissionvaryindifferentpartsOftheW0r1d・InindustriaicOuntries，Where transmissionis main1y throughhOmOSeXua1males andintravenOus drugusers，PreVa1encesof0．1－0．5％havebeenrepOrted（CentersforDiseaseCOntrO1，1990）．InthedevelOp1ngWOr1dwheretransmissiOnisthoughttooccurvertica11yfrOmmOthertOChi1dOrinear1ychi1dhOOdbyhOrizonta1spreadfrOminfectedsiblings OrP1aymates（Daviseta乙1989），PreVa1ences Of6．20％have been repOrted．Other mOdes Of transmissiOninc1udetransfusion Ofinfected b1OOd and heterOseXua1intercOurse．The efficiency Of HBV transmis－sionthrOughb1OOdhasbeenestimatedat30％（CentersfOrDiseaseC0ntrO1，1985）．Itisim－pOrtant therefore tO make a11transfusib1e b1OOd safe from HBVinfection．We repOrt thepreva1ence of Hepatitis B surface antigen（HBsAg）and tOtalHepatitis B cOre antibOdy（HBcAb）in b1OOd dOnOrs and pregnant WOmen rePOrting to the Wa，J阜rapa and MandomHospita1s，a11OfWhicharerura1cOmmunitiesintheUpperWestRegiOnOfGhana．Received fOrPublication，September24，1996．CorrespOndent auth0r，Dr．Y．Adu－SarkOdie，K0mfO AnOkye Teaching HOsPital，P．O・BOX1934Kumasi，Ghana88SuBJECTSAMDMETHODSTheUpperWegtRegionofGhana（Fig．1）hasapopu1ationofabout450，000．Themajorityofthepeop1earecashcropandsubsistencefarmers．Anethnographiccharact。risticOfpeop1einthisregionisuniversa1triba1scarification．ThisisatraditionalpracticeinwhichdifferentsizesofscarsaremadeOnthefaceorOtherpartsofthebodyofindividua1sOftenwithunsteri1esharpkniveS・Thereg10nisservedby3hospita1swithatOta10f250－300bedsbetWeenthem．TheRegiona1Pub1icHea1th1ab0ratOryhashadassistancefromtheGermanTechnica1CO＿OperationAgency（GTZ）intheroutinescreeningofb10OdfOrantibodiestoHIV，Hepatitis Bvirus and物0nemaPallidum．B100dWas CO11ectedfroma11firsttimebl。。ddonors（August1991－Ju1y1992）andpregnantw0men（August．Movember1992）．Afterseparation，seraweresCreenedforHBsAgandHBcAbbyanEnzymeimmunoassay（Behring，Germany）RESULTSSevenhundredandthirtyone（731）b10Od donorsandl020pregnantwomenwerescreened．Ofthistotaifigure of1751，On1y164（9．45％）werenegativefOra11markers0fIIBV．TheserOPreVa1enceofHBsAginthe731b100ddonorswas19．5％，and14％inthePregnantwOmenrespeCtive1y．MoneofthepatientshadHBsAga10neasamarker．75％ofthesubjectshadHBcAba1One，and16．5％werefoundtohavebothHBsAgandHBcAb．Inbothgroups，thepreva1enceofHBcAbwashigh（71・3％inblooddonorsand76．4％inpreg＿nant women），Tab1el．Tab1elSeroprevalenceOfHepatitisBmarkersinb100ddOnOrsandpregnantwOmenHBsAg HbcAb HbsAgand Megativef0r Tota10n1y（％〉On1y（％）　HBcAb（％〉　　markerS（％〉Blooddonors　　　0　　　　521（71．3〉　143（19．5〉　　　　67（9．1〉　　　　731Pregnantwomen　0　　　780（76．4）　143（14）　　　　97（9．5〉　　1020T0tal　　　　　0　　1301（75〉　　　286（16．5〉　　　164（9．45）　　1751DISCUSSIOMThehighseropreva1enceof19．5％OfHBsAgfoundinb100ddonorsinthisreg10nishigherthanstudiesfromotherpartsofthecountry（Acheampong，1991andAcquaye1991）andmaybeaccountedforbythea1mostuniversa1traditiona1scarificati0ninpeop1eofthisreg10n aS eXp1ained previous1y・Chronic carr1age Of HBsAg from horizonta1transmissioninChi1drenfrom1argefami1iesp1ayingands1eepingtogetherinsma1iroomSduetOpOOrsO－89cioeconomic conditions, with probable dissemination of saliva could be another factor. It isdifficult to estimate the relative contribution of these two factors. Perez et al (1989) studyingblood donors in Maputo, reported a prevalence of 18.6%perinatal transmission of HBV from carrier mothers is important in determining theprevalence of infection in some regions of the world. 14% of pregnant women had bothHBsAg and HBcAb serology in this study. These women together with the 143 blood donors,even though not acutely ill or jaundiced, could potentially infect their babies･The endemicity of HBV in this rural community is shown by the finding that out of thetotal of 1751 subjects studied, 90% had serological evidence of present and/or past HBV in…fection. A figure of 78.4% has been reported from Yaounde, Cameroun (Ndumbe and Njie,1989).Tropical Africa together with East and South East Asia and the Pacific Islands havebeen designated high endemic areas of HBV infection (Centers for Disease Control, 1989).These geographic areas have high incidences of PHCC, and patients with PHCC tend to beHBsAg positive or have high titres of HBcAb (Zuckerman et al, 1990). Sixty per cent ofAcheampong's patients with PHCC were HBsAg positive (Acheampong, 1991). The contri-bution of HBV to the development of PHCC can not be underestimated.Hepatitis B is now a vaccine preventable disease. It is recommended that in areas ofintermediate to high endemicity and where transmission is primarily perinatal or child tochild, all infants should receive hepatitis B vaccine as pre-exposure prophylaxis (World Healthorganisation, 1989). Where it can be afforded, maternal screening should be carried outduring pregnancy with the administration of hepatitis B vaccine and/or immunoglobulm toinfants of HBsAg mothers. In the Gambia, Hepatitis B vaccine has been integrated into theNational Expanded Programme on lmmunisation without major changes to the schedule ofimmunisation or the mechanism of delivery (The Gambian Hepatitis Group, 1989). Serologicalstudy of some of the vaccinated children has shown the strategy to be effective in reducingthe prevalence of persistently infected children (Whittle et al, 1995).We have shown the endemicity of HBV infection in this rural community in Ghana.Ghana, like some other developing countries has not introduced Hepatitis B vaccine as aroutine in the expanded programme on immunisation, due mostly to its cost. A closer lookneeds to be taken at this.RE FERENCE S1) Acheampong, J. W. (1991): The prevalence of Hepatitis B surface antigen (HBsAg) among blooddonors and jaundiced patients at Komfo Anokye Teaching Hospital. Ghana Med… J., 25 (1&2),313-317.2) Acquaye, J. K. (1991): Hepatitis B surface antigen among Ghanaian blood donors. Ghana Med. J., 25(3&4), 366-369.3) Beasley, R. P., Hwang, L. Y., Lin, C. C., Chien, S. (1981): Hepatocellular carcinoma and Hepatitis Bvirus: a prospective study of 22707 men in Taiwan. Lancet ii , 1129-1133./904）CentersforDiseaseControl（1989）：Hepatitissurveii1ance，RepOrt52．5）CentersforDiseaseCOntr0l（1990）：Preventionagainstvira1hepatitis．RecOmmendati0nsOftheIm－munisatiOnpraCticeSC0mmittee．MOrtalityandMorbidityweek1yReport，39，5－22．6）CentersfOrDiseaseC0ntrOl（1985）：Rec0mmendationfOrprOteCtiOnagainstvira1hepatitis．M0rta1ityandMorbidityweeklyRepOrtS，34，312－313・7）Davis，L．G．，weber，D．J．，LemOn，S．M・（1989）：Horizonta1transmisSionOfHepatitisBvirus．LancetI，889．893．鼠0Mdumbe，P．M．，Njie，T．K．（1989）：HepatitisAandBinfectionsinYaounde，Cameroun．Res．VirO1．，140（3），253－261．9）Perez，0・，Lastre，M．，Miyar，R．（1989）：Preva1enceOfHepatitisBSurfaceantigeninbiOOddOnOrsandpatientSattheCentralHOsPita1OfMaputo，M0zambique．Rev．Cubana・Med．TrOp．，41（3），355．361．10）TheGambianHepatitisGr0up（1989）：HepatitisBvaccineintheExpandedPrOgrammeOfImmuni－satiOn：theGambianexperience．LancetI，1057－1059．11）whittle，H・C・，Maine，M．，Piikingt0n，J．，MendyM．（1995）：LOngtermefficacyofcontinuinghepa－titisBvaccinati0nin2Gambianvil1ages．Lancet345，1089－1092．12）wOrldHea1thOrganisatiOn（1989）：Imp1ementationoftheprOgrammetOC0ntrOlvira1hepatitisB．Bul1．wHO，67，585．13）Zuckerman，A．J．，andHarrisOn，T．J．（1990）：HepatitisViruses．p135－157．hZuckermaneta1（et）．Princip1esandPracticeofC1inica1VirO10gy．JOhnwileyandSOn

SEROPREVALENCE OF HEPATITIS B MARKERS IN A RURAL COMMUNITY IN GHANA

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SEROPREVALENCE OF HEPATITIS B MARKERS IN A RURAL COMMUNITY IN GHANA

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