Saudi Journal of Gastroenterology
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ORIGINAL ARTICLE Table of Contents   
Year : 2008  |  Volume : 14  |  Issue : 2  |  Page : 70-72
Hepatitis B virus sero-prevalence among pregnant females in Saudi Arabia


1 King Fahad National Guard Hospital, NGHA, Riyadh, Saudi Arabia
2 Biobanking Section, Research Center, King Abdulaziz Medical City, NGHA, Riyadh, Saudi Arabia

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Date of Submission29-Sep-2007
Date of Acceptance27-Jan-2008
 

   Abstract 

Background/Aim : Since selective screening for Hepatitis B virus (HBV) in pregnant women has failed to identify a high proportion of HBV-infected mothers, pre-natal HBsAg testing of all pregnant women is now recommended. We aimed to determine the prevalence of HBV infection among pregnant women at the ante-natal clinic of a tertiary care center in Saudi Arabia and to identify the target group for postpartum immunization. Materials and Methods : A total of 755 pregnant females who attended the antenatal clinic from June 2005 to June 2006 for the first time - before 38 weeks of gestation - constituted the target of the present study. Blood samples 30-39 were drawn from all subjects and sera were tested for HBV serologic markers including Hepatitis B surface antigen, anti-HBs, and anti-HBc using ELISA technique (third generation). Results : The overall prevalence of sero-positive HBsAg among pregnant women was 1.6%. As age increased, the prevalence of sero-positive HBsAg significantly increased (χ2 = 116.43, P < 0.001), 30-39 were women aged ≥40 were five times more likely to be positive for HBsAg as compared to those <30 years (OR = 4.78). On the other hand, women aged 40 and over were five times more likely to be susceptible to infection with hepatitis as compared to young women aged <20 (OR = 5.15). Women susceptible to HBV infection constituted about 80% of all pregnant females. Conclusion : These findings reflect that the full impact of the Hepatitis B vaccination program that was conducted in 1989 for all Saudi children has not yet reached all pregnant women, with the majority (79.9%) being nonimmune and thus liable to HBV infection. Postpartum HB immunization should be recommended in such cases.

Keywords: Antenatal screening, Hepatitis B, postpartum Hepatitis B vaccine

How to cite this article:
Alrowaily MA, Abolfotouh MA, Ferwanah MS. Hepatitis B virus sero-prevalence among pregnant females in Saudi Arabia. Saudi J Gastroenterol 2008;14:70-2

How to cite this URL:
Alrowaily MA, Abolfotouh MA, Ferwanah MS. Hepatitis B virus sero-prevalence among pregnant females in Saudi Arabia. Saudi J Gastroenterol [serial online] 2008 [cited 2019 Aug 21];14:70-2. Available from: http://www.saudijgastro.com/text.asp?2008/14/2/70/39621


Hepatitis B virus (HBV) infection is a major public health problem in the Middle East. The majority of the countries in the region have intermediate (2 to <5%) or high (>5%) endemicity of HBV infection. [1] Studies in Saudi Arabia showed prevalence of Hepatitis B surface antigen (HBsAg) that ranges from 7.4 to 17% denoting high endemicity. [2]

The HBV is a major cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. It ranks as an important pathogen throughout the world. [3] Transmission occurs mainly from a mother to child at time of parturition, as well as person-to-person (horizontal) transmission among children <5 years of age. [4] Even when not infected during the perinatal period, children of HBV-infected mothers remain at a high risk of acquiring HBV infection by horizontal transmission during the first 5 years of life. [5]

Since selective screening of pregnant women for HBV has failed to identify a high proportion of HBV-infected mothers, [6] pre-natal HBsAg testing of all pregnant women is now recommended. [7] Universal HBsAg screening of pregnant women to prevent perinatal HBV infection has been shown to be cost saving. [8] Previous studies showed that the prevalence of HBsAg among Saudi pregnant females ranged from 3.9 to 12.7%. [9],[10],[11]

A study conducted to investigate the acceptance and efficacy of Hepatitis B immunization in United States women during the postpartum period revealed its feasibility and effectiveness. [12] Thus, the aim of the present study was to determine the prevalence of HBV infection among pregnant women at the ante-natal clinic of a tertiary care center in Saudi Arabia and to identify the target group for postpartum immunization.


   Materials and Methods Top


At the antenatal clinic of King Fahad Hospital at Riyadh National Guard Health Affairs, every pregnant woman was routinely tested in each pregnancy. Serology screening for HBsAg, Hepatitis B core antigen (HBcAb), and Hepatitis B antibody (HBsAb) is requested in every first booking visit. All pregnant females who attended the antenatal clinic from June 2005 to June 2006 for the first time - before 38 weeks of gestation - constituted the subjects of the present study.

Age and parity status were recorded. A total of 755 women were screened for HBsAg, HBsAb, and HBcAb. Blood samples were drawn from all subjects and sera were tested for HBV serologic markers including HBsAg, and HBsAb, and HBcAb were detected by using chemiluminescent microparticle immunoassay using commercial kits from Abbott Laboratories Diagnostics Division, Abbott Park, USA (ABBOTT).

SPSS software program version 10 was used for all statistical analyses.


   Results Top


[Table - 1] shows an overall prevalence of sero-positive HBsAg of 1.6%. However, as age increased, the prevalence of sero-positive HBsAg significantly increased (χ2 = 116.43, P < 0.001). Sero-positivity among those aged 40 years and over was seven times as it was among people <30 (OR = 7.07). Meanwhile, people aged 30 to <40 are five times more likely to be positive for HBsAg as compared to those <30 years (OR = 4.78).

On the other hand, the number of sero-negative cases to Hepatitis B was significantly higher among the elderly compared with the youth. It increased from 48% among those below 20 years to 82.6% among those aged 40 years and more (χ2 = 59.34, P < 0.001). People 30-39 were women aged ≥40 were five times more likely to be susceptible to infection with hepatitis as compared to young people aged <20 (OR = 5.15). Moreover, those aged 20-40 are about 4.5 times more vulnerable to hepatitis as compared to their counterparts aged <20 (OR = 4.5).


   Discussion Top


The present study shows that the sero-prevalence of HBsAg was 1.6%, which is comparable to the <2.6% reported by Al-Mazrou and colleagues [13] and far less than that reported by Al-Shamahy in the study conducted in Yemen [14] and by El-Hazmi. [15] It also shows that 20.1% had HBsAb titer >10 (immunity). This finding was significantly higher among mothers below 20 years of age (52%) who perhaps were exposed to the mass HBV vaccination that took place in 1989 for all Saudi children. [16]

The study also shows that 79.9% of the pregnant females have a nonimmune status making them liable to HBV infection. This suggests that the full impact of the Hepatitis B vaccination program has not yet reached all women during their maternity period, as also reported by a previous study. [13]

Jurema et al. [12] have previously shown that Hepatitis B immunization in the postpartum period is feasible and effective. The availability of a safe and effective hepatitis vaccine [16] encourages us to accelerate viral elimination, and additional intervention such as Hepatitis B immunization in postpartum women can thereon be undertaken. Thus, Hepatitis B immunization can be recommended, giving the first dose immediately on the first postpartum day before the mother gets discharged from the hospital; and the second dose to coincide with her child's first vaccination dose at the age of 2 months, and a third dose to be given to the mother when her child gets vaccinated at the age 6 months. However, further studies to assess the feasibility as well as effectiveness of such a program are necessary.


   Acknowledgement Top


The authors would like to extend their gratitude and thanks to the staff members of King Abdullah International Medical Research Center ( KAIMRC), King Abdulaziz Medical City (KAMC) for their support till the submission of manuscript for publication.

 
   References Top

1.Qirbi N, Hall AJ. Epidemiology of hepatitis B virus infection in the Middle East. East Mediterr Health J 2001;7:1034-45.  Back to cited text no. 1  [PUBMED]  
2.Toukan A. Control of hepatitis B in the Middle East. In : Rizzetto M, editor. Proceedings of IX Triennial International Symposium on Viral Hapatitis and Liver Disease. Edizioni Minerva Medica: Turin; 1997. p. 678-9.  Back to cited text no. 2    
3.Ocama P, Opio CK, Lee WM. Hepatitis B virus infection: Current status. Am J Med 2005;118:1413.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Kumar ML, Dawson NV, McCullough AJ, Radivoyevitch M, King KC, Hertz R, et al . Should all pregnant women be screened for hepatitis B? Ann Intern Med 1987;107:273-7  Back to cited text no. 4  [PUBMED]  
5.Beasly RP, Hwang LY. Postnatal infectivity of hepatitis B surface antigen-carrier mothers. J Infect Dis 1983;147:185-90.  Back to cited text no. 5    
6.Jonas MM, Schill ER, O'Sullivan MJ, de Medina M, Reddy KR, Jeffers LJ, et al . Failure of the centers for disease control criteria to identify hepatitis B Infection in a large municipal obstetrical population. Ann Intern Med 1987;107:335-7.  Back to cited text no. 6    
7.CDC. Protection against viral hepatitis: Recommendations of the immunization practices advisory committee (ACIP). MMWR Recomm Rep 1990;39:1-26.  Back to cited text no. 7    
8.Arevalo JA, Washington E. Cost-effectiveness of prenatal screening and immunization for hepatitis B virus. JAMA 1988;259:365-9.  Back to cited text no. 8    
9.Arya SC. Hepatitis B virus in Gizan, Saudi Arabia. J Med Virol 1985;17:267-74.  Back to cited text no. 9    
10.Ramia S, Hossain A, Bakir TM, Waller DK, Vivian PA. Prevalence and subtype of hepatitis B surface antigen (HbsAg) in the Saudi population. Trop Geogr Med 1986;38:63-9.  Back to cited text no. 10  [PUBMED]  
11.Ramia S, Abdul-Jabbar F, Bakir TM, Hossain A. Vertical transmission of hepatitis B surface antigen in Saudi Arabia. Ann Trop Pediatr 1984;4:213-6.  Back to cited text no. 11    
12.Jurema MW, Polaneczky M, Ledger WJ. Hepatitis B immunization in postpartum women. Am J Obstet Gynecol 2001;185:355-8.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]
13.Al-Mazrou YY, Al-Jeffri M, Khalili MK, Al Ghamdi YS, Mishkhas A, Bakhsh M, et al . Screening of pregnant Saudi women for hepatitis B surface antigen. Ann Saudi Med 2004;24:265-9.   Back to cited text no. 13    
14.Al-Shamahy H. Prevalence of hepatitis B surface antigen and risk factors of HBV infection in a sample of health mothers and their infants in Sana'a, Yemen. Ann Saudi Med 2000;20:5-6.  Back to cited text no. 14    
15.El-Hazmi MA. Hepatitis B virus in Saudi Arabia. J Trop Med Hyg 1989;92:65.   Back to cited text no. 15    
16.Al Faleh FZ, Ayoola EA, Arif M, Ramia S, Al-Rashed R, Al-Jeffry M, et al . Seroepidemiology of hepatitis B virus infection in Saudi Arabian children: A baseline survey for mass vaccination against hepatitis B. J Infect 1992;24:197-206.  Back to cited text no. 16    

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Correspondence Address:
Mohammed A Alrowaily
King Fahad National Guard Hospital, NGHA, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.39621

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