Analysis of Acute Viral Hepatitis (A and E) in Iraq

Abstract

Hepatitis, an inflammation of the liver, has a number of infectious and non-infectious causes. Two of the virusesthat cause hepatitis (hepatitis A and E) can be transmitted through water and food; hygiene is therefore importantin their control. First, to assess the importance of HAV and HEV as a possible diagnosis for clinically diagnosedpatients with acute viral hepatitis. Second, to assess the prevalence of hepatitis A and E in all provinces of Iraqand study its association with age, gender. This study consisted of two groups: The first group consisted of 2975patients with a clinical diagnosis of acute viral hepatitis. The second group consisted of a total of 9610 persons,which were recruited by surveying a nationally representative random sample of households. A stratified randomsample proportional to size of each of the 18 Iraqi governorates, both urban and rural areas was employed. Bloodsamples were taken from study subjects. The relative frequency of positive anti-HAV IgM antibodies was 41.0%,while anti- HEV IgM represented 19.4 % of patients with a clinical suspicion of acute viral hepatitis. Theprevalence of hepatitis A-IgG antibodies in Iraqi population is 96.4% (95% confidence interval is 96-96.8%),while that of Hepatitis E-IgG antibodies was 20.3 % (95% confidence interval is 19.4-21.2%). Thesero-prevalence showed a steady and significant increase with age for hepatitis E, while it showed an obviousincrease between the first and second decade of life for HAV. No significant sex variation was observed forHAV, while males had a higher risk (by 15%) for HEV. The after war situation in Iraq is disastrous, due to thedamage to water supply infrastructure and its contamination with sewage, Hepatitis A is hyper endemic in Iraq,while hepatitis E is endemic. Among patients with a clinical diagnosis of acute viral hepatitis, two fifths hadserologic evidence of type A and another one fifth had type E viral hepatitis.