Viral Hepatitis in Pakistan: Past, Present, and Future

Amna Subhan Butt, Fatima Sharif, Amna Subhan Butt, Fatima Sharif

Abstract

Viral hepatitis is a major cause of morbidity and mortality worldwide and a rising cause for concern in Asian countries. Weather it is blood borne or water/food borne hepatotropic virus, increasing burden is alarming for Asian countries. In this review we have evaluated the existing data to estimate the burden of viral hepatitis in populations of all age groups nationwide, along with an assessment of the risk factors and preventive and management strategies currently employed in Pakistan. The aim of our work is to consolidate and supplement the present knowledge regarding viral hepatitis in light of past and present trends and to provide future direction to the existing health policies.

How to cite this article: Butt AS, Sharif F. Viral Hepatitis in Pakistan: Past, Present, and Future. Euroasian J Hepato-Gastroenterol 2016;6(1):70-81.

Keywords: Hepatitis A; Hepatitis B and C; Hepatitis E; Pakistan; Viral hepatitis..

Conflict of interest statement

Source of support: Nil Conflict of interest: None

References

    1. Lin X, Robinson NJ, Thursz M, Rosenberg DM, Weild A, Pimenta JM, Hall AJ. Chronic hepatitis B virus infection in the Asia-Pacific region and Africa: review of disease progression. J Gastroenterol Hepatol. 2005 Jun;20(6):833–843.
    1. Kmush B, Wierzba T, Krain L, Nelson K, Labrique AB. Epidemiology of hepatitis E in low-and middle-income countries of Asia and Africa. Semin Liv Dis. 2013 Feb;33(1):15–29.
    1. Butt AS. Epidemiology of viral hepatitis and liver diseases in Pakistan. EJOHG. 2015 Jan-Jun;5(1):43–48.
    1. Jacobsen KH, Wiersma ST. Hepatitis A virus seroprevalence by age and world region, 1990 and 2005. Vaccine. 2010 Sep 24;28(41):6653–6657.
    1. Bosan A, Qureshi H, Bile KM, Ahmad I, Hafiz R. A review of hepatitis viral infections in Pakistan. J Pak Med Assoc. 2010 Dec;60(12):1045–1058.
    1. Aziz S, Muzaffar R, Hafiz S, Abbas Z, Zafar MN, Naqvi SA, Rizvi SA. Helicobacter pylori, hepatitis viruses A, C, E, Antibodies and HBsAg-prevalence and associated risk factors in pediatric communities of Karachi. J Coll Physicians Surg Pak. 2007 Apr;17(4):195–198.
    1. Haider Z, Khan AA, Rehman K, Janjua MI, Iqbal J, Chishti MA, Qayyum A, Hasnain S, Shahzad A. Sero-diagnosis for viral hepatitis in 93 patients admitted with acute hepatitis in three different teaching hospitals in Lahore. J Pak Med Assoc. 1994 Aug;44(8):182–184.
    1. Shah U, Habib Z. Liver failure attributable to hepatitis A virus infection in a developing country. Pediatrics. 2000 Feb;105(2):436–438.
    1. Malik R, Ghafoor T, Sarfraz M, Hasan N. Hepatitis A – frequency in children with non-specific abdominal symptoms. J Coll Physicians Surg Pak. 2004 Jun;14(6):348–350.
    1. Hamid SS, Atiq M, Shehzad F, Yasmeen A, Nissa T, Salam A, Siddiqui A, Jafri W. Hepatitis E virus superinfection in patients with chronic liver disease. Hepatology. 2002 Aug;36(2):474–478.
    1. Qureshi H, Hafiz S. Exposure rate of hepatitis A and E (IgG) in children. J Pak Med Assoc. 2000 Aug;50(8):284–285.
    1. Rab MA, Bile MK, Mubarik MM, Asghar H, Sami Z, Siddiqi S, Dil AS, Barzgar MA, Chaudhry MA, Burney MI. Water-borne hepatitis E virus epidemic in Islamabad, Pakistan: a common source outbreak traced to the malfunction of a modern water treatment plant. Am J Trop Med Hyg. 1997 Aug;57(2):151–157.
    1. Bryan JP, Tsarev SA, Iqbal M, Ticehurst J, Emerson S, Ahmed A, Duncan J, Rafiqui AR, Malik IA, Purcell RH et al. Epidemic hepatitis E in Pakistan: patterns of serologic response and evidence that antibody to hepatitis E virus protects against disease. J Infect Dis. 1994 Sep;170(3):517–521.
    1. Bashir K, Hussain N, Hasnain S, Elahi S. Seroprevalence of hepatitis E virus immunoglobulin G and M antibodies in adults: a hospital-based study. Indian J Med Microbiol. 2009 Apr-Jun;27(2):139–141.
    1. Jafri W, Yakoob J, Abid S, Awan S, Siddiqui S, Jafri F, Hamid S, Nizami SQ. Seroprevalence of hepatitis E and Helicobacter pylori in a low socioeconomic area of a metropolitan city in a developing country. Br J Biomed Sci. 2013;70(1):27–30.
    1. Yasmeen T, Hashmi HA, Taj A. Fetomaternal outcome with hepatitis e in pregnancy. J Coll Physicians Surg Pak. 2013 Oct;23(10):711–714.
    1. Sultana R, Humayun S. Fetomaternal outcome in acute hepatitis e. J Coll Physicians Surg Pak. 2014 Feb;24(2):127–130.
    1. Kamani L, Hamid SS, Ismail FW, Haider SW, Awan S, Ahmed A, Jafri W. Morbidity and mortality assessment in acute hepatitis-E. J Ayub Med Coll Abbottabad. 2015 Jan-Mar;27(1):64–69.
    1. Siddiqui AR, Jooma RA, Smego RA. Nosocomial outbreak of hepatitis E infection in Pakistan with possible parenteral transmission. Clin Infect Dis. 2005 Mar 15;40(6):908–909.
    1. Khan A, Tanaka Y, Kurbanov F, Elkady A, Abbas Z, Azam Z, Subhan A, Raza S, Hamid S, Jafri W et al. Investigating an outbreak of acute viral hepatitis caused by hepatitis E virus variants in Karachi, South Pakistan. J Med Virol. 2011 Apr;83(4):622–629.
    1. van Cuyck-Gandré H, Zhang HY, Tsarev SA, Warren RL, Caudill JD, Snellings NJ, Bégot L, Innis BL, Longer CF. Short report: phylogenetically distinct hepatitis E viruses in Pakistan. Am J Trop Med Hyg. 2000 Feb;62(2):187–189.
    1. Butt AS. Epidemiology of viral hepatitis and liver diseases in Pakistan. EJOHG. 2015 Jan-Jun;5(1):43–48.
    1. Waheed-uz-Zaman T, Hussain AB, Hussain T, Anwar M, Ghani E. Hepatitis A virus infection – shifting epidemiology. J Coll Physicians Surg Pak. 2006 Jan;16(1):15–18.
    1. Khan W, Irshad M, Rehman G, Hussain A. HAV in fresh vegetables: a hidden health risk in district Mardan, Pakistan. SpringerPlus. 2014 Nov;3(1):675.
    1. Centers for Disease Control and Prevention (CDC). Establishment of a viral hepatitis surveillance system – Pakistan, 2009-2011. MMWR Morb Mortal Wkly Rep. 2011 Oct 14;60(40):1385–1390.
    1. WHO. Hepatitis B: Fact sheet No. 204 WHO 2015 [updated 2015 Jul cited 2015 Feb 3, 2016] Available from: .
    1. CDC. CDC in pakistan: Factsheet 2013 [updated 2013 Nov] Available from: .
    1. Mumtaz K, Hamid SS, Adil S, Afaq A, Islam M, Abid S, Shah HA, Jafri W. Epidemiology and clinical pattern of hepatitis delta virus infection in Pakistan. J Gastroenterol Hepatol. 2005 Oct;20(10):1503–1507.
    1. Jafri W, Jafri N, Yakoob J, Islam M, Tirmizi SF, Jafar T, Akhtar S, Hamid S, Shah HA, Nizami SQ. Hepatitis B and C: prevalence and risk factors associated with seropositivity among children in Karachi, Pakistan. BMC Infect Dis. 2006 Jun 23;6(1):101.
    1. Qureshi H, Bile KM, Jooma R, Alam SE, Afrid HU. Prevalence of hepatitis B and C viral infections in Pakistan: findings of a national survey appealing for effective prevention and control measures. East Mediterr Health J. 2010;(Suppl 16):S15–S23.
    1. Janjua NZ, Hamza HB, Islam M, Tirmizi SFA, Siddiqui A, Jafri W, Hamid S. Health care risk factors among women and personal behaviours among men explain the high prevalence of hepatitis C virus infection in Karachi, Pakistan. J Viral Hepat. 2010 May;17(5):317–326.
    1. Fayyaz M, Ghous SM, Ullah F, Abbas I, Ahmed N, Ahmed A. Frequency of hepatitis B and C in patients seeking treatment at the dental section of a tertiary care hospital. J Ayub Med Coll Abbottabad. 2015 Apr-Jun;27(2):395–397.
    1. Hakim ST, Kazmi SU, Bagasra O. Seroprevalence of hepatitis B and C genotypes among young apparently healthy females of Karachi-Pakistan. Libyan J Med. 2008 Jun 1;3(2):66–70.
    1. Khan A, Tanaka Y, Azam Z, Abbas Z, Kurbanov F, Saleem U, Hamid S, Jafri W, Mizokami M. Epidemic spread of hepatitis C virus genotype 3a and relation to high incidence of hepatocellular carcinoma in Pakistan. J Med Virol. 2009 Jul;81(7):1189–1197.
    1. Khokhar N, Gill ML, Yawar A. Interspousal transmission of hepatitis C virus. J Coll Physicians Surg Pak. 2005 Oct;15(10):587–589.
    1. Sarwar J, Gul N, Idris M, Anis-ur-Rehman, Farid J, Adeel MY. Seroprevalence of hepatitis B and hepatitis C in health care workers in Abbottabad. J Ayub Med Coll Abbottabad. 2008 Jul-Sep;20(3):27–29.
    1. Gorar ZA, Butt ZA, Aziz I. Risk factors for bloodborne viral hepatitis in Health care workers of Pakistan: a population based case “control study”. BMJ Open. 2014 Jul 24;4(7):e004767.
    1. Hyder O, Ijaz M, Arshad MA, Zahira T. Age-specific frequency of screen-detected hepatitis C virus seropositivity in men from the Punjab province of Pakistan. J Med Screen. 2010;17(4):214–216.
    1. Alam MM, Zaidi SZ, Malik SA, Naeem A, Shaukat S, Sharif S, Angez M, Khan A, Butt JA. Serology based disease status of Pakistani population infected with Hepatitis B virus. BMC Infect Dis. 2007 Jun 27;7(1):64.
    1. Aslam M, Mumtaz N, Majid A, Tahir M, Obaidullah A. Magnitude of HCV burden in plastic surgery patients. Pak J Med Res. 2003;42:112–115.
    1. Naeem SS, Siddiqui EU, Kazi AN, Khan S, Abdullah FE, Adhi I. Prevalence of Hepatitis ‘B’ and Hepatitis ‘C’ among preoperative cataract patients in Karachi. BMC Res Notes. 2012 Sep 6;5(1):492.
    1. Choudhary I, Khan S. Should we do hepatitis-B and C screening on each patient before surgery. Pak J Med Sci. 2005 Jul-Sep;21(3):278–280.
    1. Khan TS, Rizvi F, Rashid A. Hepatitis C seropositivity among chronic liver disease patients in Hazara, Pakistan. J Ayub Med Coll Abbottabad. 2003 Apr-Jun;15(2):53–55.
    1. Khokhar N, Gill ML, Malik GJ. General seroprevalence of hepatitis C and hepatitis B virus infections in population. J Coll Physicians Surg Pak. 2004 Sep;14(9):534–536.
    1. Khan TM, Naheed T. Comparison of frequency of hepatitis B and hepatitis C in pregnant women in urban and rural area of district Swat. J Ayub Med Coll Abbottabad. 2009 Apr-Jun;21(2):12–15.
    1. Bibi S, Dars S, Ashfaq S, Qazi RA, Akhund S. Seroprevalence and risk factors for hepatitis C virus (HCV) infection in pregnant women attending public sector tertiary care hospital in Hyderabad Sindh. Pak J Med Sci. 2013 Apr;29(2):505–508.
    1. Jaffery T, Tariq N, Ayub R, Yawar A. Frequency of hepatitis C in pregnancy and pregnancy outcome. J Coll Physicians Surg Pak. 2005 Nov;15(11):716–719.
    1. Batool A, Bano K, Hussain R. Antenatal screening of women for hepatitis B and C in an out-patient department. J Dow Univ Health Sci. 2008;2(1):32–35.
    1. Qureshi H, Javaid N, Alam SE, Bile KM. The evidence of mother to child transmission of hepatitis B virus infection in Pakistan and the need for hepatitis B immunization policy change. J Pak Med Assoc. 2014 Apr;64(4):403–408.
    1. Ahmed B, Ali T, Qureshi H, Hamid S. Population-attributable estimates for risk factors associated with hepatitis B and C: policy implications for Pakistan and other South Asian countries. Hepatol Int. 2013 Jun;7(2):500–507.
    1. Butt AS, Abbas Z, Jafri W. Hepatocellular carcinoma in pakistan: where do we stand? Hepat Mon. 2012 Oct;12(10 HCC):e6023.
    1. Malik IA, Anwar CM, Luqman M, Ahmed A, Sarfraz T, Qamar MA. The pattern of acute viral hepatitis in children. A study based on seroepidemiology and biochemical profile. J Pak Med Assoc. 1987 Dec;37(12):314–317.
    1. Agboatwalla M, Isomura S, Miyake K, Yamashita T, Morishita T, Akram DS. Hepatitis A, B and C seroprevalence in Pakistan. Indian J Pediatr. 1994 Sep-Oct;61(5):545–549.
    1. Bryan JP, Iqbal M, Tsarev S, Malik IA, Duncan JF, Ahmed A, Khan A, Khan A, Rafiqui AR, Purcell RH et al. Epidemic of hepatitis E in a military unit in Abbotrabad, Pakistan. Am J Trop Med Hyg. 2002 Dec;67(6):662–668.
    1. Khadim MI. Prevalence of hepatitis-B antigen in various population groups of NWFP. J Pak Med Assoc. 1982 May;32(5):122–123.
    1. Kakepoto GN, Bhally HS, Khaliq G, Kayani N, Burney IA, Siddiqui T, Khurshid M. Epidemiology of blood-borne viruses: a study of healthy blood donors in Southern Pakistan. Southeast Asian J Trop Med Public Health. 1996 Dec;27(4):703–706.
    1. Ahmad N, Asgher M, Shafique M, Qureshi A. An evidence of high prevalence of Hepatitis C virus in Faisalabad, Pakistan. Saudi Med J. 2007 Mar;28(3):390–395.
    1. Khan A, Tareen AM, Ikram A, Rahman H, Wadood A, Qasim M, Khan K. Prevalence of HCV among the young male blood donors of Quetta region of Balochistan, Pakistan. Virol J. 2013 Mar 13;(10):83.
    1. Malik IA, Legters LJ, Luqman M, Ahmed A, Qamar MA, Akhtar KA, Quraishi MS, Duncan F, Redfield RR. The serological markers of hepatitis A and B in healthy population in Northern Pakistan. J Pak Med Assoc. 1988 Mar;38(3):69–72.
    1. Khan S, Rai MA, Khan A, Farooqui A, Kazmi SU, Ali SH. Prevalence of HCV and HIV infections in 2005-Earthquake-affected areas of Pakistan. BMC Infect Dis. 2008 Oct;8(1):147.
    1. Noorali S, Hakim ST, McLean D, Kazmi SU, Bagasra O. Prevalence of Hepatitis B virus genotype D in females in Karachi, Pakistan. J Infect Dev Ctries. 2008 Oct 1;2(5):373–378.
    1. Shaikh FH, Abro HA, Chhutto MA, Abbasi PA, Shaikh AW, Buriro SA. Hepatitis C: frequency and risk factors associated with sero-positivity among adults in Larkana City. J Ayub Med Coll Abbottabad. 2009 Apr-Jun;21(2):107–109.
    1. Rauf A, Nadeem MS, Ali A, Iqbal M, Mustafa M, Latif MM, Latif MZ, Ahmed N, Shakoori AR. Prevalence of hepatitis B and C in internally displaced persons of war against terrorism in Swat, Pakistan. Eur J Pub Health. 2011 Oct;21(5):638–642.
    1. Sheikh NS, Sheikh AS, Sheikh AA, Yahya S. Sero-prevalence of hepatitis B virus infection in Balochistan Province of Pakistan. Saudi J Gastroenterol. 2011 May-Jun;17(3):180.
    1. Zafar A, Khan E, Khan MS, Moiz B, Jafri W. Changing trends of Hepatitis B seromarkers amongst Pakistani population: a laboratory-based review. J Pak Med Assoc. 2013 Jul;63(7):826–830.
    1. Siddiqui TS, Lahrasab W, Sharif MA. Prevalence of hepatitis B and C in healthy adult males of paramilitary personnel in Punjab. J Ayub Med Coll Abbottabad. 2012 Jul-Dec;24(3-4):138–140.
    1. Khan F, Akbar H, Idrees M, Khan H, Shahzad K, Kayani MA. The prevalence of HBV infection in the cohort of IDPs of war against terrorism in Malakand Division of Northern Pakistan. BMC Infect Dis. 2011 Jun 20;11(1):176.
    1. Aziz S, Khanani R, Noorulain W, Rajper J. Frequency of hepatitis B and C in rural and periurban Sindh. J Pak Med Assoc. 2010 Oct;60(10):853–857.
    1. Memon MR, Shaikh AA, Soomro AA, Arshad S, Shah QA. Frequency of hepatitis B and C in patients undergoing elective surgery. J Ayub Med Coll Abbottabad. 2010 Apr-Jun;22(2):167–170.
    1. Ahmad W, Ijaz B, Javed FT, Jahan S, Shahid I, Khan FM, Hassan S. HCV genotype distribution and possible transmission risks in Lahore, Pakistan. World J Gastroenterol. 2010 Sep 14;16(34):4321–4328.
    1. Ali A, Nisar M, Idrees M, Ahmad H, Hussain A, Rafique S, Sabri S, Rehman HU, Ali L, Wazir S et al. Prevalence of HBV infection in suspected population of conflict-affected area of war against terrorism in North Waziristan FATA Pakistan. Infect Genet Evol. 2012 Dec;12(8):1865–1869.
    1. Khan J, Shafiq M, Mushtaq S, Ayaz S, Ullah R, AbdEI-Salam NM, Fouad H, Wasim MA. Seropositivity and coinfection of hepatitis B and C among patients seeking hospital care in Islamabad, Pakistan. Biomed Res Int. 2014;2014:516859.
    1. Qureshi H, Ahsan T, Mujeeb SA, Jawad F, Mehdi I, Ahmed W, Alam SE. Diabetes mellitus is equally frequent in chronic HCV and HBV infection. J Pak Med Assoc. 2002 Jul;52(7):280–283.
    1. Bukhtiari N, Hussain T, Iqbal M, Malik AM, Qureshi AH, Hussain A. Hepatitis B and C single and co-infection in chronic liver disease and their effect on the disease pattern. J Pak Med Assoc. 2003 Apr;53(4):136–139.
    1. Zuberi BF, Quraishy MS, Afsar S, Kazi LA, Memon AR, Qadeer R, Kumar A, Akhtar N. Frequency and comparative analysis of hepatitis D in patients seeking treatment for hepatitis B. J Coll Physicians Surg Pak. 2006 Sep;16(9):581–584.
    1. Shaikh MA, Shaikh WM, Solangi GA, Shaikh BA, Soomro MA. Frequency of hepatitis D virus infection in hepatitis B surface antigen-positive liver diseases. J Coll Physicians Surg Pak. 2011 Jan;21(1):23–25.
    1. Majid A, Khan MS, Ullah S. Rising prevalence of Hepatitis B and C and risk factors at District Head Quarter Teaching Hospital Bannu. Khyber-Pakhtunkhwa. J Coll Physicians Surg Pak. 2010 Jul;20(7):492–493.
    1. Baig S, Siddiqui AA, Ahmed WU, Qureshi H, Arif A. Frequency of hepatitis C and D super infection in patients with hepatitis B related complex liver disorders. J Coll Physicians Surg Pak. 2009 Nov;19(11):699–703.
    1. Das K, Ali H, Mahmood T, Munir SM, Ahmed T, Farooq MU. Comparative analysis of disease activity in patients of chronic hepatitis B virus, with and without superinfection with hepatitis D virus; an experience at tertiary care centre. J Ayub Med Coll Abbottabad. 2008 Apr-Jun;20(2):39–42.
    1. Zaidi G, Idrees M, Malik FA, Amin I, Shahid M, Younas S, Hussain R, Awan Z, Tariq A, Parveen K. Prevalence of hepatitis delta virus infection among hepatitis B virus surface antigen positive patients circulating in the largest province of Pakistan. Virol J. 2010 Oct 26;7(1):283.
    1. Mumtaz K, Hamid S, Ahmed S, Moatter T, Mushtaq S, Khan A, Mizokami M, Jafri W. A study of genotypes, mutants and nucleotide sequence of hepatitis B virus in Pakistan: HBV genotypes in pakistan. Hepat Mon. 2011 Jan;11(1):14–18.
    1. Baig S. Gender disparity in infections of Hepatitis B virus. J Coll Physicians Surg Pak. 2009 Sep;19(9):598–600.
    1. Sarwar J, Gul N, Idris M, Anis-ur R, Farid J, Adeel MY. Seroprevalence of hepatitis B and hepatitis C in health care workers in Abbottabad. J Ayub Med Coll Abbottabad. 2008 Jul-Sep;20(3):27–29.
    1. Gorar ZA, Butt ZA, Aziz I. Risk factors for bloodborne viral hepatitis in Health care workers of Pakistan: a population based case-control study. BMJ Open. 2014 Jul 24;4(7):e004767.
    1. Gul N, Sarwar J, Idris M, Farid J, Rizvi F, Suleman M, Shah SH. Seroprevalence of hepatitis C in pregnant females of Hazara division. J Ayub Med Coll Abbottabad. 2009 Oct-Dec;21(4):83–86.
    1. Khattak ST, Ali Marwat M, Khattak Iu, Khan TM, Naheed T. Comparison of frequency of hepatitis B and hepatitis C in pregnant women in urban and rural area of district Swat. J Ayub Med Coll Abbotabad. 2009 Apr-Jun;21(2):12–15.
    1. Kumari K, Seetlani NK, Akhter R. The emergent concern of seropositive status of hepatitis-B virus and hepatitis-C virus in the pregnant females attending a tertiary care hospital. J Ayub Med Coll Abbottabad. 2015 Jan-Mar;27(1):155–157.
    1. Rauf MU, Saleem MD, Anwer MO, Ahmed G, Aziz S, Memon MA. HIV, Hepatitis B and Hepatitis C in garbage scavengers of Karachi. J Pak Med Assoc. 2013 Jun;63(6):798–802.
    1. Maan MA, Fatma H, Muhammad J. Epidemiology of hepatitis C viral infection in Faisalabad, Pakistan: a retrospective study (2010-2012). Afr Health Sci. 2014 Dec;14(4):810–814.
    1. Khan S, Attaullah S, Ali I, Ayaz S, Naseemullah, Khan SN, Siraj S, Khan J. Rising burden of Hepatitis C Virus in hemodialysis patients. Virol J. 2011;8(1):438.
    1. Ali I, Siddique L, Rehman LU, Khan NU, Iqbal A, Munir I, Rashid F, Khan SU, Attache S, Swati ZA et al. Prevalence of HCV among the high risk groups in Khyber Pakhtunkhwa. Virol J. 2011 Jun 11;8:296.
    1. Achakzai M, Kassi M, Kasi PM. Seroprevalences and co-infections of HIV, hepatitis C virus and hepatitis B virus in injecting drug users in Quetta, Pakistan. Trop Doct. 2007 Jan;37(1):43–45.
    1. ur Rehman L, Ullah I, Ali I, Khan IA, Iqbal A, Khan S, Khan SH, Zaman KU, ullah Khan N, Swati ZA et al. Active hepatitis C infection and HCV genotypes prevalent among the IDUs of Khyber Pakhtunkhwa. Virol J. 2011 Jun 28;8:327.

Source: PubMed

3
Suscribir