Frequency of Hepatitis - B & C in Patients Undergoing Ocular Surgery in Rawalpindi (Difficulties in controlling potential carriers)

Objective: To analyze the frequency of hepatitis C virus (HCV) and hepatitis B virus (HBV) in patients with different ocular
procedures in a tertiary care centre in Rawalpindi. It was a retrospective descriptive study in Department of Ophthalmology,
Fauji Foundation Hospital, Rawalpindi.
Method: The study was conducted from Nov 2015 to Nov 2017. A total of 3143 patients who underwent different ocular
procedures were included in our study. HBV and HCV screening was done in all patients.
Results: Out of these patients, 7.2% were males and 92.8% females, 9% patients were hepatitis positive, with 8.3% of the
total infected with HCV while 0.70% had HBV.
CONCLUSION:
There should be uniform policy in all hospitals to do routine screening test for hepatitis B and C to avoid the spread of hepatitis viruses.

INTRODUCTION 

Hepatitis B (HBV) and Hepatitis C (HCV) are viral types leading to inflammation and swelling of the liver1. Worldwide 2 billion people have been infected with HBV and 5-15% of the total cases are carriers of the virus2.WHO estimated that HCV prevalence is at 3% of world population, 50% of all cases become chronic carriers, which may lead to liver cirrhosis and malignancy3. The annual death toll from hepatitis is around 1.5 million. 4 HBV is transmitted through the blood, semen, vaginal fluids, and other body fluids of an infected individual having hepatitis B infection. HCV, is a bloodborne viral infection whose primary mode of transmission is via direct percutaneous exposure to blood such as blood transfusions, sharing of needles, accidental percutaneous occupational exposures and vertical transmission from infected mothers .5,6,7.For instance, studies have suggested that annual percutaneous exposure among US hospital staff is around half a million per annum.8. In Pakistan, the incidence of hepatitis B and C is rising. According to Khan et al up to 38% of our population is infected with HCV and 2.5% with HBV9.The prevalence of transmissible blood-borne viral infections is quite high in Pakistan.Various studies have reported an incidence of 4%-20% of hepatitis infection in the general population in Pakistan 10.


1,4.P.G.Trainees 2. Assistant Professor 3.Professor,


Correspondence: Dr Amna Rizwan, Ophthalmology Department Fauji
Foundation Hospital, Rawalpindi
E.Mail> aamnarizwan@hotmail.com Cell: 03234183663
House:1 Street: 35 Sector C, (Orchard)
DHA Phase: 1, Islamabad 03365619966


Received: April 2019 Accepted: May’2019


There should be a uniform policy in all hospitals to do screening test before procedures in order to avoid the spread of these transmissible diseases from patients to doctors, paramedical staff and to other non-infected patients. The battle against the spread of hepatitis requires holistic approach using print, electronic media and the society at large to educate the general public on prevention and culminating the spread of viral epidemics.



Both HCV and HBV infections are highly prevalent. Health care workers (HCW) who are constantly in contact with human blood products, infected individuals, and laboratory equipment are at high risk of acquiring these infections. Once HCW get in contact with human blood products or infected individuals or infected laboratory equipment, they remain asymp-tomatic in the initial phase of infection8. Most of the public and private sector hospitals are not routinely screening for HCV, HBV before doing routine surgeries or procedures. Thus carriers of HCV or HBV pose a serious threat of infection to surgeon, paramedical staff and other patients11. The primary reason for not doing proper screening is perhaps a desire to cut procedural costs but comes at a much greater cost in terms of affliction and the greater risk of transmission 12. In Fauji Foundation Hospital (FFH), Rawalpindi we do routine screening tests at the time of admission before all elective surgeries, but not in minor procedures. The study was in patients in view of recommending stricter screening protocols that are in-line with international best practices.

MATERIAL AND METHODS

This retrospective study was conducted in Ophthalmology Department, Fauji Foundation Hospital, Rawalpindi. Duration of study was from Nov 2015 to Nov 2017. Hospital ethical committee has approved this study. The study data was collected from hospital records. All patients included in the study were admitted in eye ward for different ocular surgeries. All such patients were excluded from the study that underwent minor ocular surgeries in which screening tests were not performed.

RESULT

A total of 3143 patients participated in our study of which 7.2% were males and 92.8% females. In the total population under study 9% patients were hepatitis positive, 8.3% of the total having HCV+ while 0.70% had HBV. 4% of the males exhibited HCV+ while 8.6% females were diagnosed with the same. The incidence of HBV in males and females was 0.44% and 0.72%, respectively. Only 1 female patient presented with combined HCV and HBV infection.Mean age among hepatitis patients was 62.34 ± SD 10.99.



DISCUSSION:

The incidence and prevalence of chronic liver disease due to HBV and HCV is gradually increasing in Pakistan. This is in congruence with the trend in other developing countries where lack of financial resources coupled with illiteracy to blame.13 The World Health Organization (WHO) puts the percentages of population suffering from Hepatitis B between 2 and 5 % in the Indian subcontinent, with a figure of 4-5% Pakistanis infected with Hepatitis C. These are recognized as some of the highest global infection rates. In Pakistan, in addition to the high-risk populations, Hepatitis B and C are also found in the wider population at alarming rates.14 A large number (estimated 50-80%) of Hepatitis B and C positive individuals are unaware of their infection status as these conditions remain asymptomatic. This results in a large number of potential carriers and adds to the difficulty in battling the spread of these chronic liver diseases.15 An appreciation of the local epidemiology of Hepatitis B and C is essential in coming up with prevention strategies and meeting world wide goals of disease control.16 There is, of course, a need to institute nation-wide screening programs in this regard. 17 In this retrospective study, we have analyzed clinical records of patients who underwent ocular surgeries at the Fauji Foundation Hospital from the point of view of prevalence of Hepatitis B and C. The results of our study show that 8.3% of the 3143 patients suffered from Hepatitis C, whereas 0.70% were HBV positive bringing the total incidence of Hepatitis infectionto 9%. In Ahmed et al, a similar study was done on a smaller group of patients (215) found prevalence rates of 7.44% and 2.8% for HCV and HBV, respectively.10Riazet al, report a higher incidence of 14.29% in their study of 315 patients but, interestingly, do not find any of them infected with HBV.18 Tahir et al found an incidence for Hepatitis B and C of 2.62% and 6.17% in their study of 648 patients which is more or less consistent with our findings.8Finally, Lohanoet al, report a combined Hepatitis B and C prevalence of 15.36% in their study of 2200 patients in Hyderabad, India.11 The distinguishing feature of our study is the large sample size that we have managed to analyze. As shown earlier smaller studies conducted in Pakistan. Our study had a large sample of females, because in FFH families of ex-servicemen are entitled, the number of male patients are rather small (female : male ratio of 12.96:1). This means that we are unable to meaningfully comment on the gender disparity in the prevalence of Hepatitis. Butt et al have reviewed various studies and in almost all studies males are affected more than females both for hepatitis B and C.14 Also, since the patients that we have analyzed were mostly cataract patients, our sample has an average age of 62.34 years. We were therefore, unable to study the incidence of Hepatitis wise as a function of age. Fattahi et al conducted study on 6095 patients (age 7-95years) and showed that maximum prevalence of HCV was present in age 12 years or less.19 Akhtar et alhave showed prevalence of HCV according to age. In their study, maximum prevalencewas present in age group of 41-50 years, and 20-30 years of minimum prevalence was found in patients above 70 years.20 Another drawback of our study is that we have not assessed the risk factors. Various risk factors are the previous surgery or blood transfusion history of any dental treatment or barbershop.21

CONCLUSION

Most of the hospitals are not doing routine screening test to rule out Hepatitis B and C before major and minor surgeries. There should be a uniform policy in all hospitals to do screening test to avoid thespread of these transmissible diseases from patients to doctors, paramedical staff and to othernon-infected patients. Thus, the prevalence of blood born infection will decrease subsequently. The battle against these chronic infections requires a holistic approach using print, electronic media and the society at large to educate the general public on prevention and culminating the spread of viral epidemics.

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