Abstract
The United Nations considers the situation in Yemen to be the worst humanitarian crisis in the world. In the midst of this, the fastest-spreading viral infection among HD patients was recorded. Therefore, this cohort study based in HD unit was conducted in Dhamar Hospital to estimate the outbreak of hepatitis B and C viruses among dialysis patients during the dialysis crisis in Yemen. All the patients who continuous go through hemodialysis from January 2018 to December 2018 and they were free from HBV/HCV infections at the start of the study (January 2018) were included. Patients who were discontinued from dialysis before the end of the year due to death or relocation were excluded from the study. Patients were tested for anti-HCV antibodies and hepatitis B surface antigen (HBsAg) at study start (January 2018) then at the end of the follow up (December 2018). The individual’s data were collected in a pre-designed questionnaire including; demographic data of HD frequency, and laboratory results. The study included 202 patients, 20 (9.9%), 18 (8.9%) and 6 (2.97%) were found to be infected with HCV, HBV and Co-HBV/HCV infection respectively. There was significant association between rise of HCV rate and younger patient age, and high frequency of dialysis. In conclusion, the prevalence of HBV and HCV infection and HBV / HCV infection in hemodialysis patients in our surroundings one year after HD was extremely common and lead to disaster for HD patients. This catastrophe is due to the lack or limited availability of materials and tools for dialysis and laboratory materials for virus tests due to the unfair siege on Yemen from Saudi Arabia and the United Arab Emirates and the closure of Sana'a airport, which is the only entrance to medicines.
 Peer Review History: 
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 Received file 
 
 Average Peer review marks at initial stage: 5.5/10
 Average Peer review marks at publication stage: 8.5/10
 Reviewer(s) detail:
 Name: Dr. Mohammed Sadeg Abdullah Al-Awar
 Affiliation: Physiology & Histopathology Queen Arwa University and Amran University, Yemen
 E-mail: momed.sadeg@gmail.com
 
 Name: Dr. Heba-Tallah Ahmed Mohamed Moustafa 
 Affiliation: Heliopolis University Cairo, Egypt
 E-mail: anasweety2003@yahoo.com
 Comments of reviewer(s): 
Highlights
In the midst of this, the fastest-spreading viral infection among HD patients was recorded. This cohort study based in HD unit was conducted in Dhamar Hospital, Dhamar City, Yemen to estimate the outbreak of hepatitis B and C viruses among dialysis patients during the dialysis crisis in Yemen
There was an increase in the HCV rate in the age group below 30 years where the rate was 27.8% with Odds ratios (OR) equal to 3.0, confidence intervals (CI)=1.0-9.2, and P=0.04; followed by 20.3% with OR equal to 2.5, CI =1.1-5.6, and P=0.03 in the age group 50-59 years; while there was a decrease in the rate of hepatitis C infection in the age group ≥60 years (4.5%) but differences between rates in the sexual groups and most age groups were not statistically significant
There was an increase in HCV rate in dialysis frequency 8 times where the rate was 15.7% with OR equal to 1.9, while lower rates occurred in other frequency groups; differences between rates in dialysis frequency groups were not statistically significant
Summary
Viral infections of hepatitis B (HBV) and hepatitis C (HCV) are major causes of morbidity and mortality in dialysis patients and pose problems in the management of these patients in renal dialysis units[1]. In the midst of this, the fastest-spreading viral infection among HD patients was recorded This cohort study based in HD unit was conducted in Dhamar Hospital, Dhamar City, Yemen to estimate the outbreak of hepatitis B and C viruses among dialysis patients during the dialysis crisis in Yemen. All patients consistently undergoing dialysis from January 2018 to December 2018 and were free of HBV / HCV infection at the beginning of the study (January 2018). Patients were tested for anti-HCV antibodies hepatitis B surface antigen (HBsAg) at study start (January 2018) at the end of the follow up (December 2018). Values (OR, CI, χ2) were estimated using 2x2 tables to identify possible odds ratio on occurrence of HBV and HCV and their significance.
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