Letter to editor

Pismo uredniku

ARCH GASTREONTEROHEPATOL 2001; 20 ( No 1 – 2 ):

 

The prevalence of Hepatitis B virus and Hepatitic C virus infections in elderly persons in Afyon, Turkey

 

Prevalencija Hepatitis B i Hepatitis C virusnih infekcija u starijih osoba u gradu Afijon, Turska

 

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To the Editor: Hepatitis B virus ( HBV ) infection is worldwide distributed causing variety of liver diseases such as chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. Hepatitis B and Hepatitis C ( HCV ) viral infections are mainly parenterally spread. About 5% of world population ( 400 millions ) is infected with HBV and one million eventualy die of HBV related liver disease every year ( 1,2 ). In Turkey HBV-carrier state incidence is varying depending on area, and range between 4.4-12.9% ( 3 ). Hepatitis C virus infection is trasmitted via blood and its derivates and 300 millions people is HCV infected worldwide ( 4 ). According to literature data HCV seropositivity rate in Turkey is between 0.3-4% ( 5,6 ).  This figures are matter of high public health concern due to high rate of HCV infection chronicity and ongoing cirhhosis and hepatocellular carcinoma. In Turkey HBs antigen and anti-HCV seropositivity among healthy population varies greatly depending on the region of the country. Therefore we performed the study at Kocetepe University Hospital investigating the prevalence of HBV and HCV infections in unimmunised elderly persons attending this hospital due to other reasons than hepatitis.

 

This study enrolled 97 patients ( male 45, female 42; mean age 53.2+21.3 years ). HBs antigen, anti-HBs and anti-HBc IgG antibodies, and anti-HCV  antitbodies were tested by ELISA Diasorin commercial kits. HBs antigen was positive in 6.2% of cases, anti-HBV seropositivity in 29.9%. Anti-HCV antibodies were positive in 1.03% of the total population.

HBs antigen positivity and anti-HBV seropositivity were: in males 7.3% and 32.7%, and in females 4.76% and 26.2% respectively. This difference was no statistically significant ( p>0.05 ). In the age group 40-55 yrs HBs positivity was 8.9%, anti-HBV seropositivity 33.3%. In the age group 56-70 yrs HBs positivity was 7.4%, anti-HBV seropositivity 33.3%.  In elderly persons over 71 yrs 31.2% in total was either HBs or anti-HBV positive.

 

HBV hepatitis is a major public health problem in developing countries ( 8 ). HBs carrier state varies between 0.2% in UK to 45% in Alaskian Eskimos ( 8 ). In metanalysis study reported from Turkey HBs seropositivity among soldiers was 7.4% ( population examined: 91 136 ), and 5.1% in civilians ( population examined: 612 221 ). In healthy elderly people ( population examined: 20 267 ) this figures were 5.1% and 34.6% respectively ( 9 ).  On the contrary to these figures Kilic and Akblut reported HBs positivity of 13.9% ( 12-14 ).  Our results further support the observation of high HBV carrier state in the region of Afyon ( HBs positivity 6.2% ) with high rate of anti-HBV seropositivity indicating the neccesity for nationwide HBV screen and immunisation programe.

 

There are two national reports from Turkey about anti-HCV seropositivity rate ( 11,12 ). Hafta and his co-workers reported the following figures: 2.7% of doctors, 0.5% of dentists, 2.1% of nurses, 14.4% of haemodialysis patients, 5.7% of prostitutes, 12.5% of blood samples ( from blood donors ) tested, 12.5% of kidney transplanted, 4.2% of relatives of anti-HCV positive cases, and 2.5% tattoo were anti-HCV seropositive. In the other metanalysis study from Turkey anti-HCV seropositivity was as follow: 0.52% of blood donors ( population tested 226 288 ), 0.27% of 457 240 blood units tested, 41% of haemodialyisis patients, 0.9% of health-care personel, 4.8% of prostitutes, and 52.7% of kidney transplanted. Our study indicates that in elderly persons without overt clinical liver disease 1.03% is anti-HCV seropositive.  In summary, our data further proofs the epidemiological and public health importance of high rates of HBV and HCV in Afyion, Turkey and the need for more stringent public health measures to control these liver viral diseases.    

 

 

Address correspondence to: Professor Dr Musfata Altinidis, PhD.

                                               Dumulpinar mah. Karagozoglu sok           

                                               Alimoglu  apt. No 25

 

 

Table 1. Distribution of hepatitis markers  in  elderly population

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Age         HBs +       Anti-HBs +    Anti-HBc+      Contacts        Anti-HCV

in yrs                                                                          with HBV*

 

40-55      4       8.8    7       15.5      8      17.8           15    33.3       1     2.2

( No 45 )

 

56-70       2      7.4    4       14.8      5      18.5             9    33.3       -        -

( No 27 )

 

Total:     6       6.2    13     133.4    16    16.5           29     29.9       1     1.03

97

·        p>0.05

 

 

 

Table 2. Distribution of hepatitis markers in elderly population by gender

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Hepatitis markers     Woman ( No 42 )     Man ( No 55 )     Total ( No 97 )

 

HBs+                           2        4.8                  4        7.3              6        6.2

 

Anti-HBs+                 5         11.9                8       14.5            13      13.4

 

Anti-HBc IgG           6         14.3              10      18.2             16      16.5

 

Contact with HBV  11        26.2               18      32.7             29      29.9

 

Anti-HCV                  -           -                    1        1.8               1       1.03

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3.Balik I. Epidemiology of Hepatitis B. Viral Hepatitis 94. Kilcturgay K, ed. 1994, Istambul.

 

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5.Cakaloglu Y. Hepatitis C virus infection: epidemiology, pathogenesis,

clinical findings, therapy. Viral Hepatitis 94. Kilicturgay K, ed. 1994, Istambul.

 

6.Gerberding JL. Incidence and prevalence of Human immunodeficiency  virus, Hepaitis B virus, Hepatitis C virus, and CMV among health personel at risk for blood exposure: Final report from a longitudinal study. J Infect Dis 1994; 170: 1410-7.

 

7.Krawit EL. Chronic hepatitis. Principles and practice of infective diseases, 4^th ed. Mandell GL, Bennett JE, Dolin R, eds. New York: Churchill-Livingstone, 1995; 1153-64.

 

8.Hoofnagale JH. Acute viral hepatitis.In: Principles and practice of infective diseases,4^th ed. Mandell GL, Bennett JE, Dolin R, eds. New York: Churchill-Livingstone, 1995; 1001-7.

 

9.Mistik R, Balik I. Epidemiology of viral hepatitis in Turkey. Viral Hepatitis 98. Kilicturay K, ed. 1998; 10-39.

 

10.Kilic SS, Akblut A, Felek S, Kalkan A, Ocak S. An investigation og hepatitis B seroprevalence in Elazig. Firat Univ J Health Sci 1996; 10: 49-55.

 

11.Sahin Y, Yarkin F, Kocabas E, Likit M, Akan E. HAV, HBV, and HCV markers in healthy and acute hepatitis children. 4^th Viral Hepatitis Symposium Abstract Book, 1998; 125.

 

12.Hafta A, Colakoglu S, Akiz E et al. The seroprevalence of anti-HCV in various risk group in Cukova region. J Viral Hepatitis 1996; 1: 46-9.