ABSTRACT
Hepatitis B virus (HBV) infection remains a major public health problem globally and accounts for about one million deaths worldwide in spite of the use of available vaccine and medications for mitigation of the disease. This study determined the seroprevalence, distribution of HBV infection, factors associated with the infection, and the genotypic patterns amongst patients attending selected hospitals in Niger State, Nigeria.  A total of 500 blood samples were collected from five selected hospitals in Niger state. The samples  were screened  using Hepatitis  B Surface  Antigen  (HBsAg)  test  kit  for qualitative detection of Hepatitis B Surface Antigen in serum. DNAs were extracted from the 65 positive sera. HBV DNA genotyping and sequencing were performed on the HBsAg – positive samples, using Multiplex-PCR. For HBV genotyping, the second amplification products were analyzed using Agarose-Gel electrophoresis. Out of the 32 positive samples genotyped, five (5)  were successfully sequenced and subjected to phylogenic analysis. Prevalence of Hepatitis B infection amongst the studied population was 13.0%. Female participants had a non-significantly higher prevalence (6.8%) of HBsAg infection than their male counterparts (6.2%, p>0.05). Participants within 41- 50 years age group recorded a significantly higher rate of infection (5.2%), compared to patients ≥ 50 years with 2.3% prevalence (p>0.05). The Civil Servants had a higher percentage prevalence of 6.4% followed by house wives (3.2%), while the least prevalence was observed among the students (1.6%). Patients without history of blood transfusion had significantly higher percentage prevalence (7.8%) compared to those with history of blood transfusion (5.2%, p>0.05). The results also revealed that participants with polygamous family type recorded higher prevalence of HBV infection (11.4%) compared to those belonging to the monogamous type (1.6%). Five (5) genotypes were identified amongst the 32 positive samples as follows: genotype A: 14 (34.1%); genotype C: 4 (9.8%); genotype D: 1 (2.4%); genotype E: 19 (46.3%); and genotype F: 3 (7.3%). Fifteen (15) samples accounting for 46.9% had co-infection of multiple genotypes; with A/E accounting for 31.25% (10/32), followed by C/ E, 9.375% (3/32) and the least was A/F, 3.125% (1/32). Most of the co‑infections were a combination of genotype E, the predominant genotype and others.  Sequencing and phylogenic  analysis of  the  five  queried samples  showed that  genotype  E had  a percentage identity ranging from 98-100. The results obtained in this study shows that HBV is hyper-endemic in the study area and the circulation of the five HBV genotypes (A, C, D, E and F) amongst the study population of Niger state was confirmed; with HBV genotype E (HBV-E) predominating amongst the study population, probably due to the in ability of the innate immune response of the host to resist the strain. There is the need for more awareness and sensitization of people on the prevalence of HBV infection in Niger State. People need to be enlightened on the modes of transmission and spread of the virus through different information media outfits.
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background to the Study
Hepatitis is a condition defined by the inflammation of the liver (Thio et al., 2002). It is caused by infectious and noninfectious agents. The former includes hepatotrophic viruses (hepatitis A, B, C, D and E) of which hepatitis B is the most infectious and most virulent, while the latter is induced by an over active immune system, use of drugs, alcoholism, chemicals and environmental toxins (Thio et al., 2002).
Hepatitis B virus (HBV) is a member of the Hepadnavirus family; it is a partially double-stranded DNA virus with a core antigen surrounded by a shell containing hepatitis B surface antigen (HBsAg) (Hollinger and Dienstag, 1990; Thio et al., 2002). HBV has numerous antigenic components such as hepatitis B surface antigen (HBsAg), hepatitis B core antigen (HBcAg), and hepatitis B e antigen (HBeAg) (Chisari et al., 1989). The HBV genome harbors 3200 nucleotides and it can encode four groups of proteins and their regulatory components by shifting the reading frames over the same genetic matter (Chisari et al., 1989).
Hepatitis B virus (HBV) is a public health problem and it is responsible for 60-80% of liver cancer worldwide despite the infection being preventable through vaccination (WHO, 2014). The initial infection after exposure is acute (resolved within six months), with either complete recovery, or progression to chronic disease that lasts more than six months (WHO, 2014).
The risk of chronic infection is related to age, approximately 90% of infected infants become chronically infected, compared with 2%–6% of adults (WHO, 2014).
Transmission of this disease is commonly through blood transfusion, blood products, body fluids (Urine, semen, sweat, saliva and tears), use of contaminated needles and mother-to-child transmission through infected birth canal (Brooks et al., 2007). Approximately 70–140 million of the chronic HBV infections and 250,000 of the 1.3 million HBV-related deaths recorded each year around the world occur in Africa (Hubschen et al., 2008).
There have been previous studies on sero-prevalence of HBV amongst some target groups like pregnant women attending ante-natal care clinics (Thio et al., 2002; Kuta et al., 2014; Adabara et al., 2012, Olayinka et al., 2016; Berinyuy et al., 2019) with different percentage prevalence reported. The present study was designed to determine sero-prevalence of HBV taking into consideration the following risk factors: sharing of utensils, gender, marital status, blood transfusion, family type, age, and occupation; attending different hospitals located in three zones of Niger state, Nigeria. This is the first study designed to cover this scope.
1.2 Statement of the Research Problem
Hepatitis B virus (HBV) is a public health challenge worldwide (WHO, 2017). Many people are harboring the virus unknowingly due to reluctance of people to undergo routine screening. Lack of awareness by the larger population on some remote modes of transmission of the disease such as the use of contaminated utensils, needles, clippers, shavers, mother to child transmission through infected birth canal and contaminated body fluids (urine, sweat, semen, saliva and tears) (Brooks et al., 2007).
The prevalence of hepatitis B virus infection in sub Saharan Africa, including Nigeria has been reported to be high (WHO, 2017). About 75% of its population likely to have been exposed to the virus at one time or the other in their lives. HBV may persist in the liver for lifetime (Jia and Zhuang, 2007). Which not only causes severe HBV related sequalae such as cirrhosis and hepatocellular carcinoma but also constitutes the reservoir of the virus (Zou et al., 2001).
Prevalence rate of 4.3 % was reported from Port Harcourt (Akani at al., 2005). 5.7% from Ilorin (Agbede et al., 2007). 11.6% from Maiduguri (Harry et al., 1994). 8.3% from Zaria (Jatau and Yabaya, 2009). 23.3% from patients attending all clinics at the Aminu Kano Teaching Hospital (Nwokedi et al., 2006). Adabara et al. (2012) reported 6.5% Prevalence of Hepatitis B Virus among Women Attending Antenatal Clinic in the General Hospital, Minna, Niger State.
In Niger State, the current picture of the circulating genotypes of the virus has not been established. Therefore, this study is an attempt to identify the circulating genotypes of the virus in the study areas.
1.3 Justification for the Study
The need for continuous surveillance and monitoring of the prevalence of HBV infection in endemic regions cannot be over-emphasized. About 18 million Nigerians were infected with HBV (Olayinka et al., 2016). Expectedly, the number keeps growing largely because of the chronic nature of the infection. There is a gap of study on current molecular characteristics of the HBV in Niger state, Nigeria. The present study was therefore designed to provide information on HBV sero-prevalence, and identification of the circulating HBV strains in Niger State.
Such information would assist in planning and strategizing the management of this fatal health challenge. It is envisaged that information obtained from the strains isolated will form the basis for future development of target specific Hepatitis B virus vaccines.
1.4 Aim and Objectives of the Study
1.4.1 Aim
The aim of this study was to determine the Sero-prevalence and Identification of circulating genotypes of Hepatitis B Virus (HBV) from patients attending some Hospitals in Niger State.
1.4.2 Objectives
The objectives of this study are to:
i. determine the prevalence of HBsAg infection amongst patients attending some hospitals in Niger State.
ii. identify the socioeconomic/risk factors associated with the rate of HBV infection.
iii. identify the circulating genotypes of hepatitis B virus amongst patients attending some hospitals in the study area.
iv. examine the degree of divergence of HBV genotypes from the different study sites using phylogenic analysis.
This material content is developed to serve as a GUIDE for students to conduct academic research
SERO-PREVALENCE AND IDENTIFICATION OF CIRCULATING GENOTYPES OF HEPATITIS B VIRUS AMONGST PATIENTS ATTENDING SOME HOSPITALS IN NIGER STATE
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