Epidemiology of IntraFamilial Hepatitis B Virus Transmissions: Report from Charmahal O Bakhtiari Province, Iran

AUTHORS

Reza Imani 1 , * , Zahra Parmar 2 , Mohammad Taghi Moradi , Nasser Khosravi 1 , 2 , Saeed Taheri 3

1 Cellular and Molecular Research Center, Shahre-Kord University of Medical Sciences, Shahre-Kord, IR Iran

2 Department of Medicine, Shahre-Kord University of Medical Sciences, Shahre-Kord, IR Iran

3 Dr. Taheri Medical Research Group, Tehran, IR Iran

How to Cite: Imani R, Parmar Z, Taghi Moradi M, Khosravi N, Taheri S. Epidemiology of IntraFamilial Hepatitis B Virus Transmissions: Report from Charmahal O Bakhtiari Province, Iran, Iran Red Crescent Med J. 2013 ; 15(7):-. doi: 10.5812/ircmj.3689.

ARTICLE INFORMATION

Iranian Red Crescent Medical Journal: 15 (7)
Published Online: July 5, 2013
Article Type: Letter
Received: December 3, 2011
Revised: January 6, 2013
Accepted: January 11, 2013
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Keywords

HBV Intrafamilial Transmission Iran Epidemiology

Copyright © 2013, Iranian Red Crescent Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

Dear Editor,

In this study, we aimed to evaluate transmission routes of intrafamilial transmission of hepatitis B virus (HBV) infection in our region. After sample size calculation, we contacted Blood Bank of Charmahal O Bakhtiari Province for the list of all people which have been diagnosed as HBV carriers in any of the Province towns. A cluster sampling was conducted with comparable share of the study population to the percentage of infected people in that region. After randomized selection of the potential families, an educated person was sent to their home for an interview, including description of the study methods and purposes, answering any potential questions by the participants, and taking informed consent from them or their parents (in cases of age < 16 yr). Then they were referred to take the test in a prescheduled laboratory. Laboratories were asked to test participants’ blood samples for potential HBsAg with conventional methods. HBsAg detection was carried out by Diasorin kit with lot no. 0370790/1A through sandwiched ELISA. HBsAb and HBcAb levels were measured by Diasorin kit with lot no. 9230320/A through sandwiched non-competitive ELISA and Diasorin kit with lot no. 8540480/1B through competitive ELISA, respectively.

Table 1 summarizes associations of HBsAg positivity among family members of HBV carriers. Mothers, fathers and spouses had the highest rates of HBsAg positivity among the family members, respectively (P = 0.002). Moreover, lower educational levels were also a significant predictor for a HBsAg positive test (P = 0.004). 282 (64.8%) of the study participants had a history of HBV vaccination, and HBsAg positivity was detected in 35 (12.4%) of them which was significantly lesser than in non-vaccinated patients (25.5%; P = 0.001). Other factors significantly associated with HBsAg positivity included history of injection (frequency: 21 (4.8%); P = 0.015), history of admission to dentistry (freq: 71 (16.3%); P = 0.007), ear piercing (Freq: 97 (22.3%) P = 0.004), and history of Phlebotomy (Freq: 19 (4.4%); P < 0.001). Mothers with 43%, fathers 27% and spouses 25% represented the highest rate of HBsAg positive test followed by siblings (15%) and offspring (12%). Regarding educational levels, illiterates (32%) represented the highest rate of infection followed by individuals with only some preliminary school education (26%). 35% of female spouses of male carriers were positive compared to 15% for their male counterparts (P = 0.025).

Table 1. Epidemiology of Intrafamilial HBV Antigen Prevalence in Charmahal O Bakhtiari Province, Iran
Variable HBsAg positive, No (%)HBsAg negative, No (%)Sig.
Relation type0.002
Offspring33 (12.1)239 (87.9)
Spouse27 (25)81 (75)
Father4 (26.7)11 (73.3)
Mother6 (42.9)8 (57.1)
Sibling4 (15.4)22 (84.6)
Educational levels0.004
Illiterate24 (32.4)80 (76.9)
Preliminary school23 (25.8)66 (74.2)
Guidance school8 (9.8)74 (90.2)
Diploma9 (8.8)93 (91.2)
College10 (17.2)48 (91.2)
Gender male39 (52.7)173 (47.9)0.524
Age, yr36.5 ± 17.432.7 ± 170.081
Rural life44 (59.5)188 (52.1)0.253
Injection8 (10.8)13 (3.6)0.015
Risky sexual contact 11 (14.9)41 (11.4)0.431
Dentistry20 (27%)51 (14)0.007
Tattoo10 (13.5) 35 (9.7)0.302
Ear piercing26 (35.1)71 (19.7)0.004
Jailing5 (6.8)13 (3.6)0.207
Circumcision11 (14.9)62 (17.2)0.734
Phlebotomy10 (13.5)9 (2.5)< 0.001

The prevalence of HBsAg among family members of Iranian HBV carriers from Charmahal O Bakhtiari Province of Iran was 25% which is quite higher than that of the Iranian general population (1, 2). Although previous studies have shown the relevance of horizontal HBV transmission in Iran (3), our study findings, instead suggests vertical transmission as a significant route, especially in our province. In this study, we also found some traditional transmission routes including no-vaccination, ear piercing, phlebotomy, and rural life as players of significant roles in these families; as they have previously been reported as strong risk factors for HBV transmission in Iran (4). Despite the overall decreasing curve for the epidemiology of HBV infection in Iran (5), the significant role for the rural life in intrafamilial HBV transmission also alerts us to pay more attention to improve health measures in these areas. The HBsAg positive rate of 12% for the vaccinated patients is not surprising and can be explained by having the infection before vaccination, or the vaccine inefficiency due to not maintaining the cold chain (6). In conclusion, we found that HBV infection among the family members of carriers is more prevalent than that in the general population and, this can be explained by virus transmission through household contact between family members. The significant role of ear piercing, phlebotomy and rural life in intrafamilial HBsAg prevalence is alarming. Future studies in other Iranian provinces are recommended.

Acknowledgements

Footnotes

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