Epidemiology and Estimating the Risk Factors for the Transfer of Hepatitis B Virus Using Multivariate Analysis Model: A Retrospective Case-Control Study

Document Type: Original Article

Authors

1 Colorectal Research Center, Iran University of Medical Science, Tehran, Iran

2 Internal Medicine Department, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background and aims: Hepatitis B virus (HBV) is one of the important public health diseases in Iran.
Therefore, to control the prevalence of the disease, knowledge is required regarding the risk factor of
HBV. Accordingly, the aim of this study was to determine the risk factors of HB transmission.
Methods: A retrospective case-control study was conducted on the possible risk factors of HBV
transmission. To this end, a total of 171 patients with HBV infection and 171 controls from Rasoul-e-
Akram hospital were investigated during 2015-2018. All subjects were directly evaluated using a faceto-
face questionnaire about demographic aspects. Finally, HBV infection and its risk factors among the
subjects were detected using hepatitis B surface antigen test.
Results: Overall, 171 HBV patients including 77 (42%) males and 93 (58%) females were evaluated.
The mean age of the participants was 40 ± 13 years. Univariate logistic analysis showed that HBV
infection in these cases was associated with addiction injection (odds ratio [OR] = 4.08, CI:1.3-
9.57), family history (OR = 4.52, CI: 1.27-10.7), and having a history of blood transfusion (OR =
3.16, CI: 1.52-5.37). There were no significant relationships between the liver function tests, alcohol
consumption, the history of dental visits, and HBV participants. In addition, the logistic-regression
model proved that patients with a history of HBV-infected parents (At least one of them) and addiction
injection were severely subject to HB infection. In other words, there was a significant association
between a history of HBV-infected parents and addiction injection and HB infection.
Conclusion: In general, HBV infection was strongly related to having a family member infected with
hepatitis B, suffering from addiction injection, and having blood injection.

Keywords

Main Subjects


1. Xia Y, Protzer U. Control of hepatitis B virus by cytokines.
Viruses. 2017;9(1). doi: 10.3390/v9010018.
2. Zibbell JE, Asher AK, Patel RC, Kupronis B, Iqbal K, Ward JW,
et al. Increases in Acute Hepatitis C Virus Infection Related
to a Growing Opioid Epidemic and Associated Injection
Drug Use, United States, 2004 to 2014. Am J Public Health.
2018;108(2):175-81. doi: 10.2105/ajph.2017.304132.
3. Alexander J, Kowdley KV. Epidemiology of hepatitis B--clinical
implications. MedGenMed. 2006;8(2):13.
4. Niederau C. Chronic hepatitis B in 2014: great therapeutic
progress, large diagnostic deficit. World J Gastroenterol.
2014;20(33):11595-617. doi: 10.3748/wjg.v20.i33.11595.
5. Lavanchy D, Kane M. Global epidemiology of hepatitis B
virus infection. In: Liaw YF, Zoulim F, eds. Hepatitis B Virus in
Human Diseases. Cham: Springer; 2016:187-203.
6. Andre F. Hepatitis B epidemiology in Asia, the Middle East and
Africa. Vaccine. 2000;18 Suppl 1:S20-2.
7. Merat S, Malekzadeh R, Rezvan H, Khatibian M. Hepatitis B in
Iran. Arch Iran Med. 2000;3(4):192-201.
8. Ghavanini AA, Sabri MR. Hepatitis B surface antigen and
anti-hepatitis C antibodies among blood donors in the Islamic
Republic of Iran. East Mediterr Health J. 2000;6(5-6):1114-6.
9. Shepard CW, Simard EP, Finelli L, Fiore AE, Bell BP. Hepatitis B
virus infection: epidemiology and vaccination. Epidemiol Rev.
2006;28:112-25. doi: 10.1093/epirev/mxj009.
10. Sadi S, Farrohi K, McCollum RW, Le Bouvier GL.
Hepatitis-B antigen in Iran: frequency and subtype. Lancet.
1972;2(7791):1377-8. doi: 10.1016/s0140-6736(72)92833-4.
11. Te HS, Jensen DM. Epidemiology of hepatitis B and C viruses:
a global overview. Clin Liver Dis. 2010;14(1):1-21, vii. doi:
10.1016/j.cld.2009.11.009.
12. Adibi P, Ghassemian R, Alavian SM, Ranjbar M,
Mohammadalizadeh AH, Nematizadeh F, et al. Effectiveness
of hepatitis B vaccination in children of chronic hepatitis B
mothers. Saudi Med J. 2004;25(10):1414-8.
13. Al Mahtab M, Akbar SMF, Aguilar JC, Guillen G, Penton E,
Tuero A, et al. Treatment of chronic hepatitis B naive patients
with a therapeutic vaccine containing HBs and HBc antigens
(a randomized, open and treatment controlled phase III
clinical trial). PLoS One. 2018;13(8):e0201236. doi: 10.1371/
journal.pone.0201236.
14. Morelos RR, Ramirez PM, Sanchez DG, Chavarin RC,
Melendez-Herrada E. Healthcare providers and the risk
of acquired infectious diseases. Standard and biosafety
precautions. Rev Fac Med Univ Nac Auton Mex.
2014;57(4):34-42.
15. Rieumont ER, Lugo Rosa MG, Gonzalez Griego AM, Martinez
Martinez TG. Evaluación inmunológica. Hepatitis viral tipo B.
Pre y post refuerzo en trabajadores de la salud. Policlínico 5
de septiembre. Año 2003-2004. [Immunological assessment.
Viral type-B hepatitis: pre and post-reinforcement to the health
workers. “5 de septiembre” Outpatient Clinic-2003-2004].
Rev Cienc Med Pinar Rio. 2005;9(2):72-81.
16. Sorrell MF, Belongia EA, Costa J, Gareen IF, Grem JL, Inadomi
JM, et al. National Institutes of Health consensus development
conference statement: management of hepatitis B. Hepatology.
2009;49(5 Suppl):S4-s12. doi: 10.1002/hep.22946.
17. Wu B, Shen J, Cheng H. Cost-effectiveness analysis of different
rescue therapies in patients with lamivudine-resistant chronic
hepatitis B in China. BMC Health Serv Res. 2012;12:385. doi:
10.1186/1472-6963-12-385.
18. Sali S, Bashtar R, Alavian SM. Risk factors in chronic hepatitis
B infection: a case-control study. Hepat Mon. 2005;5(4):109-
15.
19. Mohammadi Z, Keshtkar A, Eghtesad S, Jeddian A, Pourfatholah
AA, Maghsudlu M, et al. Epidemiological profile of hepatitis B
virus infection in Iran in the past 25 years; a systematic review
and meta-analysis of general population studies. Middle East J
Dig Dis. 2016;8(1):5-18. doi: 10.15171/mejdd.2016.01.
20. Mohaghegh Shelmani H, Karayiannis P, Ashtari S, Mahmanzar
MA, Khanabadi B, Modami N, et al. Demographic changes
of hepatitis B virus infection in Iran for the last two decades.
Gastroenterol Hepatol Bed Bench. 2017;10(Suppl1):S38-s43.
21. Talaat M, Radwan E, El-Sayed N, Ismael T, Hajjeh R, Mahoney
FJ. Case-control study to evaluate risk factors for acute
hepatitis B virus infection in Egypt. East Mediterr Health J.
2010;16(1):4-9.
22. Tran TT, Martin P. Hepatitis B: epidemiology and natural
history. Clin Liver Dis. 2004;8(2):255-66.
23. Noubiap JJ, Nansseu JR, Ndoula ST, Bigna JJ, Jingi AM, Fokom-
Domgue J. Prevalence, infectivity and correlates of hepatitis
B virus infection among pregnant women in a rural district
of the Far North Region of Cameroon. BMC Public Health.
2015;15:454. doi: 10.1186/s12889-015-1806-2.
24. Hahne S, Ramsay M, Balogun K, Edmunds WJ, Mortimer
P. Incidence and routes of transmission of hepatitis B
virus in England and Wales, 1995-2000: implications for
immunisation policy. J Clin Virol. 2004;29(4):211-20. doi:
10.1016/j.jcv.2003.09.016.
25. Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ.
Estimations of worldwide prevalence of chronic hepatitis B
virus infection: a systematic review of data published between
1965 and 2013. Lancet. 2015;386(10003):1546-55. doi:
10.1016/s0140-6736(15)61412-x.
26. Candan F, Alagozlu H, Poyraz O, Sumer H. Prevalence of
hepatitis B and C virus infection in barbers in the Sivas region
of Turkey. Occup Med (Lond). 2002;52(1):31-4. doi: 10.1093/
occmed/52.1.31.
27. Akhtar S, Younus M, Adil S, Hassan F, Jafri SH. Epidemiologic
study of chronic hepatitis B virus infection in male volunteer
blood donors in Karachi, Pakistan. BMC Gastroenterol.
2005;5:26. doi: 10.1186/1471-230x-5-26.
28. Khan F, Shams S, Qureshi ID, Israr M, Khan H, Sarwar MT, et al.
Hepatitis B virus infection among different sex and age groups
in Pakistani Punjab. Virol J. 2011;8:225. doi: 10.1186/1743-
422x-8-225.
29. Zago AM, Machado TF, Cazarim FL, Miranda AE. Prevalence
and risk factors for chronic hepatitis B in HIV patients attended
at a sexually-transmitted disease clinic in Vitoria, Brazil. Braz
J Infect Dis. 2007;11(5):475-8.
30. He N, Chen L, Lin HJ, Zhang M, Wei J, Yang JH, et al. Multiple
viral coinfections among HIV/AIDS patients in China. Biosci
Trends. 2011;5(1):1-9. 

31. Nasir A, Todd CS, Stanekzai MR, Bautista CT, Botros BA, Scott
PT, et al. Prevalence of HIV, hepatitis B and hepatitis C and
associated risk behaviours amongst injecting drug users in
three Afghan cities. Int J Drug Policy. 2011;22(2):145-52. doi:
10.1016/j.drugpo.2010.10.006.
32. Bani IA, Mahfouz MS, Maki E, Gaffar A, Elhassan IM,
Yassin AO, et al. Prevalence and risk factors of hepatitis B
virus among pregnant women in Jazan Region-Kingdom
of Saudi Arabia. Journal of Biology, Agriculture and
Healthcare.2012;2(7):39-43.
33. Hayajneh WA, Masaadeh HA, Hayajneh YA. A case-control
study of risk factors for hepatitis B virus infection in North
Jordan. J Med Virol. 2010;82(2):220-3. doi: 10.1002/
jmv.21603.
34. Nazzal Z, Sobuh I. Risk factors of hepatitis B transmission in
northern Palestine: a case - control study. BMC Res Notes.
2014;7:190. doi: 10.1186/1756-0500-7-190.