The Prevalence of Hepatitis E Virus in Al-Sadr City - Baghdad

Abstract

Hepatitis E is an inflammation of the liver caused by hepatitis E virus (HEV) infection. Iraq is one of the Asian countries with high incidence and prevalence of hepatitis. Because of the HEV outbreak that occurred in Al-Sadr city/Baghdad, the present study aimed to determine the prevalence of HEV in this city. A third generation enzyme immunoassay kit was used to test 270 individuals for HEV total Ab (IgM and IgG). Positive HEV (with regards to total Ab sera) were assayed for HEV IgM Ab only. Furthermore, interferon-gamma (IFN-gamma) level and tumor necrosis factor alpha (TNF-alpha) level were assayed in positive HEV specimens by Assay Max Human IFN-gamma and TNF-alpha ELISA Kits, respectively. The positive sera of HEV total Ab also was tested for total serum bilirubin (TSB), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) colorimetrically. Among the 270 analyzed serum specimens, a total of 58 (21.48%) were found to be positive for HEV total Ab. Statistically significant differences (p < 0.01) were observed in the prevalence of HEV total Ab between blood donor and cleaning workers groups in which cleaning workers had higher prevalence. Also significant differences (p < 0.05) were found between males and females, suggesting that exposure to HEV might be more frequent in males than females. Insignificant differences (p > 0.05) were noticed in HEV IgM Ab prevalence between cleaning workers group and blood donor group with recent acute hepatitis. TNF-alpha level was significantly elevated (p < 0.05) in acute hepatitis subjects (HEV IgM Ab positive) when compared to subjects with previous infection (HEV total Ab positive) and healthy control (HEV total Ab negative). IFN-gamma levels were insignificantly (p > 0.05) higher in acute hepatitis in comparison to subjects with previous infection and healthy control. HEV is highly endemic to the Al-sadar city in Baghdad/Iraq and its presents a risk of infection through blood transfusion. Serum levels of Thl cytokines (IFNgamma and TNFalpha) in patients with acute hepatitis E were found to be higher than in subjects of previous HEV infection and healthy control which emphasizes their proinflammatory role in hepatitis E patients.