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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM THE ARAB WORLD Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 2  |  Page : 300-306
The epidemiology of viral hepatitis in Qatar


1 Departments of Medical Statistics and Epidemiology, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar; Department Evidence for Population Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester, UK
2 Departments of Gastroenterology, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
3 Departments of Immunology, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
4 Laboratory Medicine and Pathology Department, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar

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   Abstract 

Viral hepatitis is a major public health problem in many countries all over the world and especially in Middle East, Asia, East-Europe, and Africa. The aim of our study was to assess the incidence of viral hepatitis A, B and C in Qatar and compare it with other countries. This is a retrospective cohort study, which was conducted at Hamad General Hospital, State of Qatar from 2002-2006. Patients who were screened and diagnosed with viral hepatitis were included in this study. The diagnostic classification of definite viral hepatitis was made in accordance with criteria based on the International Classification of Disease tenth revision (ICD-10). A total of 527 cases of hepatitis C, 396 cases of hepatitis B, 162 cases of hepatitis A and 108 cases of unspecified were reported during the year 2006. Reported incidence rate per 10,000 populations during the year 2006 for hepatitis A was 1.9, hepatitis B 4.7, and Hepatitis C 6.3. The proportion of hepatitis B and C was significantly higher in male population than females across the years (2002-2006). Hepatitis A was more prevalent in children below 15 years (72.3%), hepatitis B in adults aged above 15 years, and hepatitis C in the population above 35 years of age. The incidence of hepatitis A has been declining in Qataris and increasing in expatriates. There was a significant relationship in gender and age group of the patients with hepatitis A, B and C. We conclude that hepatitis has become a national health issue in Qatar. The incidence rate of hepatitis in Qatar is comparable to its neighboring countries, United Arab Emirates and Saudi Arabia. There is a need for further research on hepatitis and the associated risk factors.

Keywords: Epidemiology, Trends, Gender, Ethnicity, Viral hepatitis A, B, C, Population, Qatar

How to cite this article:
Bener A, Al-Kaabi S, Derbala M, Al-Marri A, Rikabi A. The epidemiology of viral hepatitis in Qatar. Saudi J Kidney Dis Transpl 2009;20:300-6

How to cite this URL:
Bener A, Al-Kaabi S, Derbala M, Al-Marri A, Rikabi A. The epidemiology of viral hepatitis in Qatar. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2019 Dec 7];20:300-6. Available from: http://www.sjkdt.org/text.asp?2009/20/2/300/45587

   Introduction Top


Viral Hepatitis is a major global public health concern. It is a source of substantial morbidity and mortality, both in the USA and around the world. Viral Hepatitis is caused by at least five distinct viruses A, B, C, D, or E. Each belongs to an entirely different family of viruses, and they have very little in common except the target organ, they affect the liver and a certain degree of shared epidemiology. [1] The medical impact of these viruses on society has been strongly influenced by changes in human ecology.

According to the data from the Center for Di­sease Control and prevention, [2] 20,000 to 70,000 new cases of acute viral hepatitis occur in the USA each year. Of these, 32% are caused by hepatitis A virus (HAV), 43% by hepatitis B virus (HBV), 21% by hepatitis C virus (HCV) and 4% are classified as hepatitis type non A, B, C, D and E.

In general, the original incidence rates for each virus are lowest in the western hemis­phere and northern regions and highest in the eastern hemisphere and tropical regions. [1] He­patitis A has a worldwide distribution like other enteric infectious diseases. It is classically an infection of childhood and is highly influenced by personal and public hygiene. [3] HBV and HCV infections are among the devastating health problems in the world. The World Health Or­ganization (WHO) estimates that 350 million people are carriers of the HBV, and that 0.5­0.9 million people die from it annually. [4]

HCV is a leading cause of chronic liver dis­ease, cirrhosis and carcinoma as well as the most common indication for liver transplan­tation. Approximately 170 million people are affected with HCV worldwide out of the glo­bal population. HCV is the most common chronic infection in the US and is involved in 40% of chronic liver disease. [5]

The aim of this study was to assess the incidence of viral hepatitis A, B and C in Qatar and compare it with other countries.


   Patients and Methods Top


This is a retrospective, cohort hospital-based study, which was conducted during the period in the State of Qatar from 2002 to 2006. According to the ICD-10 viral hepatitis is classified into acute hepatitis A (B15), acute hepatitis B (B16), Other acute viral hepatitis (B17), chronic viral hepatitis (B-18), unspecified viral hepatitis (B-19). [6] There was a total of 527 cases of hepatitis C, 396 cases of hepa­titis B, 162 cases of hepatitis A, and 108 cases of unspecified hepatitis were reported during the year 2006. There is a national hepatitis dis­ease registry in the preventive health care de­partment of the National Health Authority re­gistering all the reported cases in Qatar. Any patient who visits primary health centers or private clinics with any doubt of hepatitis would be reported to the "Communicable Dis­eases Control Section" and blood specimen would be sent to the Hamad Medical Corpo­ration Central Lab for diagnostic laboratory tests. All the positive cases of hepatitis A, B, and C are confirmed through serological tests with different markers would have liver func­tion tests performed. This study did not in­clude the asymptomatic patients particularly in childhood.

Statistical analysis

Data are expressed as mean and standard de­viation (SD) unless otherwise stated. Student's "t" test was used to ascertain the significance of differences between mean values of two continuous variables. The Fisher exact and Chi­square test were used to compare frequencies between two or more than two categories. The level p< 0.05 was considered as the cut-off value for significance.


   Results Top


[Table 1] shows the demographic characteristics of the hepatitis A, B, and C during the year 2006. Majority of the patients with hepatitis A, B and C were males. Children below 15 years of age were the victims of hepatitis A (72.3%), while Hepatitis B was more frequent in the population above 15 years of age (99.0%) and hepatitis C in the population above 35 years of age (94.0%). There was a significant relation­ship of gender and age group of the patients with viral hepatitis A,B, and C.

[Table 2] presents the number of viral hepatitis reported according to nationality during the period from 2002 to 2006. The proportion of hepatitis A among Qataris has been declining from 33.9% in the year 2002 to 18.5% in 2006, while there was a sharp increase among non­Qatari's 49.2% to 81.5% in 2006 (p< 0.001). Even in hepatitis B, there was a slight decrease among Qataris 35.1% in 2002 to 23.8% in 2006 (p= 0.004).

[Table 3] shows the incidence of hepatitis re­ported according gender during the period from 2002 to 2006. Over the years, more males were the victims of hepatitis A, B and C than females. A significant difference was found in the gender of patients across the years for he­patitis B (p< 0.001) and hepatitis C (p= 0.008), but not for hepatitis A.

[Table 4] shows the prevalence of hepatitis C among blood donors of different countries. Of the total blood donors, 1.1% had hepatitis C, which is comparable with other Gulf countries, New York and Japan, but lower than the rate in Egypt and Pakistan.

[Table 5] compares the incidence rate of hepa­titis A, B and C per 10,000 population between Qatar and the other gulf countries. The overall incidence rate of reported hepatitis A in Qatar was 1.9/10,000 population. The hepatitis A rates have been similar for Qatar (1.9), Oman (2.4) and Bahrain (3.1), but higher than U.A.E (0.9) and Saudi Arabia (1.1). The incidence rates of hepatitis B (4.7) and C (6.3) are re­markably higher in Qatar, compared to other gulf countries.

[Figure 1] shows the incidence rate of viral he­patitis A, B, and C per 10,000 population du­ring the period from 2002 to 2006. The inci­dence rate of hepatitis A, B, and C shows a tendency to decrease in rate in the recent years. Hepatitis C was most common in the general population, followed by hepatitis B.


   Discussion Top


Although brief reports on the prevalence of hepatitis infection are available, no compre­hensive epidemiological data has yet been published in the Middle East region. In the State of Qatar, so far no study has been con­ducted on the incidence of viral hepatitis and its trend. Hepatitis A, B and C are more im­portant viral hepatitis infections in the popu­lation of the State of Qatar.

This study revealed that the prevalence of hepatitis A was very high in children below 15 years (72.3%), but low in people older than 25 years. This is comparable with the studies con­ducted on the American Indians and Alaskan Natives who composed about 8.9% of the total American Hepatitis A population, and the highest incidence was in the children below 14 years of age. [7] The importance of hepatitis A infection in children is that they act as a reservoir of infection for the adult population, thus by eliminating the infection in children by immunization it may decrease the overall incidence in the general population. [8] The decline of HAV prevalence has been a well known epidemiological feature in developing coun­tries that underwent socioeconomic and hy­gienic improvements. [9] The data show a stri­king decrease in hepatitis A among Qataris during the period (2002-2006) and this decline may be attributable to continued improvements in hygiene and standards of living. Despite this success among Qataris, the proportion of hepa­titis A has been increasing in non-Qataris em­phasizing the need for better strategies to pre­vent hepatitis A among this high risk group. A similar finding was reported in a comparative sero-epidemiological study on hepatitis A in Saudi Arabia. It showed that there was a marked decline in hepatitis A virus infection in Saudi children below 12 years of age, 8 years after the first study. [10]

A study conducted by the Wayne State University revealed that African-Americans are more likely to have antibodies to HAV and HBV (65% and 75% respectively) compared to Whites (27% and 20%). [11] The highest prevalence of HBV antibodies was found in patients between the 40-60 years of age. A similar pattern has been observed in our study; most of the patients with hepatitis B were adults above 25 years of age. Southeast Asians have higher rate of liver cancer than any other racial ethnic group in the US. Chronic carriage of hepatitis B virus (HBV) is the most co­mmon underlying cause of liver cancer in the majority of Asian populations. [12] Globally, most developed countries have a low prevalence of chronic hepatitis B infections, usually due to routine vaccination. Most of the infection is either through unprotected sex or via the use of shared needles in drug abusers. [13] Most south Asian countries display socio-economic condi­tions that favor the occurrence of hepatitis B (HBV) and other related infections. The over­all carriage rate for HBsAg from different parts of South Asia is between 4 and 7%, ren­dering HBV infection a major public health problem in this area. [14] In Qatar, a major pro­portion of the foreign labor force is from the Asian countries. Despite the vaccination pro­gram available in Qatar, the incidence rate of hepatitis B (4.7/10,000 population) has been quite high since the year 2002. This is due to the active surveillance program started in the year 2002 by the Preventive Medicine De­partment.

African Americans and Asians with HCV have a 2-fold to 4-fold increased risk of deve­loping hepatocellular carcinoma (HCC) when compared to Caucasians with HCV. [15] In Qatar, the incidence pattern of hepatitis C remains same over the years (2002-2006). The inci­dence rate of hepatitis C per 10,000 population was 8.4 in the year 2002, 8.0 in 2004 and declined slightly to 6.3 in 2006. The rate of he­patitis C is remarkably higher in Qatar (6.3/ 10,000 population) compared to other gulf countries [Table 5]. The WHO estimates that about 170 million people, 3% of the world's population, are infected with HCV and are at risk of developing liver cirrhosis and liver cancer. It is reported that the prevalence of HCV infection in Africa (5.3%), the Eastern Mediterranean (4.6%), South East Asia (2.2%) and the Western Pacific (3.9%) is high compared to some countries in North America (1.7%) and Europe (1.03%). [16] Anti-HCV sero­conversions occurred at a very high rate in the community-based population in Japan in which this infection is endemic. [17]

The most common cause of HCV transmi­ssion by transfusion is the occurrence of new infections in donors. In Qatar, 1.1% of the blood donors had hepatitis C, which is comparable with other Gulf countries, New York, and Japan, but significantly lower than the rate in Egypt Pakistan, [11] and Lebanon. [18] Further­more, the prevalence of HCV among blood donors in the State of Qatar is consistent with the other neighboring countries [8] such as that in Lebanon, [18] Yemen, [8] and KSA. [10]

We conclude that hepatitis has become a national health issue in Qatar. The incidence rate of hepatitis in the general population re­mains nearly the same even though the Com­municable Disease Control Section has im­proved the surveillance system and increased the vaccination coverage. In order to limit the spread of hepatitis, efforts must be directed at minimizing exposure to sources of infection. It is essential to evaluate the socio-demographic and associated risk factors involved.[23]


   Acknowledgement Top


The authors would like to thank Mr. G. Antony, Mrs. S. Samson and Mr. M. A. Farooq for their assistance in preparing and typing the manuscript.

 
   References Top

1.Purcell RH. Hepatitis viruses: Changing patterns of human disease. Proc Natl Acad Sci USA 1994;91:2401-6.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Ahmed A, Keeffe EB, Cost-effective evalua­tion of acute viral Hepatitis. West J Med 2000; 172:29-32  Back to cited text no. 2    
3.Feinstone S. Hepatitis A: epidemiology and prevention. Eur J Gastroenterol Hepatol 1996; 8:300-5.  Back to cited text no. 3    
4.Beutels P, Shkedy Z, Mukomolov S, et al. Hepatitis B in St. Petersburg, Russia 1994­1999: incidence, prevalence and force of infec­tion. J Viral Hepatitis 2003;10(2):141-9.  Back to cited text no. 4    
5.National Institute of Health Consensus Deve­lopment Conference Statement Management. Gastroenterology 2002;123(6):2082-99.  Back to cited text no. 5    
6.Bramer GR. International Statistical Classifica­tion of Diseases and Related Health Problems - Tenth Revision. World Health Stat Q 1988; 41:32-6.  Back to cited text no. 6    
7.Stephanie R, Bialek, Douglas A, et al. Hepatitis A incidence and hepatitis A vaccination among American Indians and Alaska natives 1990­2001. Am J Public Health 2004;94:996-1001.  Back to cited text no. 7    
8.Bener A. The epidemiology and trend in viral hepatitis A, B, C among Qatari population: Compared to regional and western countries. 1 st International Qatari Hepatitis Symposium December 16-17, 2005, Doha, The State of Qatar.  Back to cited text no. 8    
9.Hurwitz ES, Deseda CC, Shapiro CN, Nalin DR, Freitgkoontz MJ, Hayashi J. Hepatitis infections in the day care setting. Pediatrics 1994;94:1023-4.  Back to cited text no. 9    
10.Al-Faleh ZA, Al-Jeffri MH, Ramia ST, et al. Hepatitis A in Saudi Arabia. Saudi Med J 1999;20(9):678-81.  Back to cited text no. 10    
11.Siddiqui F, Muthnick M, Kinizie J, Peleman R, Naylor P, Ehrinpreis M. Prevalence of Hepatitis A virus and hepatitis B virus immunity in patients with polymerase chain reaction con­firmed hepatitis C: Implication for vaccination strategy. Am J Gastroenterol 2001;96(3):858-63.  Back to cited text no. 11    
12.Taylor VM, Choe JM, Yasui Y, Li L, Burke N, Jackson C. Hepatitis B awareness, testing, and knowledge among Vietnamese American men and women. J Com Health 2005;30:477-89.  Back to cited text no. 12    
13.Lavanchy D. Hepatitis B Virus Epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat 2004;11:97-107.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]
14.Mumtaz K, Hamid SS, Adil S, et al. Epide­miology and clinical pattern of hepatitis delta virus infection in Pakistan. J Gastroenterol Hepatol 2005;20:1503-7.  Back to cited text no. 14  [PUBMED]  [FULLTEXT]
15.Nguyen MH, Whittemore AS, Garcia RT, et al. Role of ethnicity in risk for hepatocellular carcinoma in patients with cirrhois. Clin Gastroenterol 2000;119(5):1385-96.  Back to cited text no. 15    
16.Weekly Epidemiological Record No.49, 10 December 1999, World Health Organization.  Back to cited text no. 16    
17.Okayama A, Stuver SO, Rabor E, et al. Incident hepatitis C virus infection in a community based population in Japan. J Viral Hepatol 2002;9:43-51.  Back to cited text no. 17    
18.Irani-Hakme N, Tamim H, Samaha H, Almawi WY. Prevalence of antibodies hepatitis C virus among blood donors in Lebanon 1997 - 2000. Clin Lab Haemetol 2001;23:317-23.  Back to cited text no. 18    
19.Annual Health Report for the year 2006, Hamad Medical Corporation, State of Qatar.  Back to cited text no. 19    
20.Annual Health Report for the year 2005, Sultanate of Oman.  Back to cited text no. 20    
21.Annual Statistical Report, 2004, United Arab Emirates.  Back to cited text no. 21    
22.Annual Report, 2002, Bahrain  Back to cited text no. 22    
23.Annual Statistical Report, 2001, Kingdom of Saudi Arabia.  Back to cited text no. 23    

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Correspondence Address:
Abdulbari Bener
Department of Epidemiology and Medical Statistics, Hamad Medical Corporation, Weill Cornell Medical College in Qatar, P.O. Box 3050, Doha - State of Qatar

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    Abstract
    Introduction
    Patients and Methods
    Results
    Discussion
    Acknowledgement
    References
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