Carried hepatitis B among Libyan patients who attended the Al Zawia street hospital

Hepatitis B (HBV) is a significant liver disease that affects roughly 400 million individuals globally with chronic infection, leading to liver cirrhosis or carcinoma. The virus can spread through blood transfusion, sexual contact, or the use of contaminated needles. HBV is more prevalent in developing countries than developed ones. However, it is estimated that 5% to 10% of the global population carry the virus, whereas, in North America and western Europe, only 1% of the people have a chronic infection. Our objective is to determine the prevalence of HBV and identify the disease’s risk factors. We conducted a statistical study, and data were collected through the Al Zzawia street hospital from November 1, 2010, to January 1, 2011. Our results concluded that the prevalence of HbsAg was higher in 2005 than in 2010. HBV was also found to be more prevalent in males than in females. As a result, more attention and guidance, especially for young people, could reduce the spread drastically.


Introduction
Hepatitis B virus (HBV) is a common viral disease that is a considerable health problem worldwide (1). The World Health Organization (WHO) estimated that about 2 billion people are exposed to the virus, 3.3% from the Eastern Mediterranean Region (2) chronically infected with HBV, and 350 million subjects. HBV leads to acute and chronic liver disease worldwide (3), including liver cirrhosis (LC) and hepatocellular carcinoma (HCC), accounting for 0.5 million to 1.2 million deaths per year (4). HBV can spread through risk blood transfusion, sexual intercourse, intravenous drug abuse (5), contact with infected bodily fluids, and the use of improper injection techniques (6). HBV remains viable on surfaces for at least a week. Persons with chronic infection (presence of HbsAg in the serum more than six months following acute infection) (7). More than one million infected people are killed by complications due to the virus annually worldwide, which is 2.7% of total deaths (8). People who were infected early in life are at high risk of developing cirrhosis or liver carcinoma 15% to 30%, leading to premature death (9). HBV or the "Australia antigen" was discovered in 1965 by Baruch Blumberg (10) and later identified as the hepatitis B virus surface antigen (10). HBV is a small double-stranded DNA genome (11), approximately 3.2 kb in size (12); it belongs to the Hepadnaviridae family (7,12). The severe type of hepatitis is known as hepatitis B or HBV. The surface antigen of the virus (HBsAg) is one of the earliest serums present in HBV infection, and because it persists, HBsAg is vital to the diagnosis of HBV infection. Other serum markers of HBV infection include the HBV envelope antigen (HBeAg) and the HBV core antigen (HBcAg) (13). Some individuals can develop acute HBV infections and then achieve complete immune clearance, yielding lifelong immunity. In contrast, others can develop chronic HBV infections depending on the host's immune response (14). Many studies estimated that about 10% of patients with acute hepatitis B virus (HBV) would progress to chronic disease (15).
Hepatitis B is a particularly major health problem in on the continent of Africa (16). The prevalence of HBV is roughly 12.1% in Sudan, which is similar to other African countries such as Burundi (15.6%), and the Central African Republic (14%), and higher than Nigeria (5%) and Ethiopia (7%) (17). However, in Tunisia, the prevalence of HbsAg ranges from 4 to 7% (18), while in Libya, the overall incidence of hepatitis B was 2.2% (11,19) and higher among males than females (1.4:1.0) (19). Surveillance is needed to guide public health policy and control of viral hepatitis spread in Libya efficiently, which requires reliable epidemiological data. Therefore, we determined the prevalence of hepatitis B viruses among the Libyan population and analyzed the risk factors.

Objective
To estimate the prevalence of HBV within the Libyan population.

Methods
The survey was started in November 2010 and completed in January 2011. The incidence data were based on the analysis of files (official records) from January 1, 2005, to December 31, 2010; the prevalence of HBV was calculated based on the total number of regular other patients who attended the Al Zawia Street Hospital in Tripoli, the capital city of Libya. A hundred (100) patients diagnosed with HBV participated in the survey to determine the risk factors for infection. A structural questionnaire and face-to-face interviews were carried out to collect information regarding the age, education, blood receipt, and surgery history of patients, etc. We entered the data into Microsoft Excel 2016 for analysis.   Total 100

Results
In this study, men were more numerous than women, as shown in Table 1 (69%vs31%), with a ratio of 1:2.22. Total 30

Discussion
The incidence of HBV cases averages about 2% in developed countries; the majority is low. However, the incidence reaches about 8% in developing countries, due to sex, age, and economic status being essential risk factors (20). Countries were classified according to low (<2%), intermediate (2-8%), or high (>8%) endemic rates of those infected with HBsAg (19). The estimated number of chronic HBsAg carriers in Libya lies between 120.000 and 150.000 (18). Many studies in Libya concluded that the prevalence of HBsAg within the Libyan population was about 2.2%. (11). As a result, Libya is considered in the middle zone of the HBV epidemic, as classified by the WHO (21). The incidence of HBV is different from one area to another. However, the highest rate was in Sirt, located in the north-central region of the county (6.6%). In contrast, the lowest incidence was in Benghazi (1.0%) (19). In our statistical study, which depended on available data, we found that 13548 cases carried HbsAg recorded from 2005 to 2010, and the rates were very high in 2005 compared to 2010 (3203vs1153). However, the number of cases decreased by 23.64%, 13.8%, 20.77%, 18.09%, and 8.51% from 2005 to 2010, respectively, as shown in Figure 1. Suggested this could be due to the efforts made to control the infection. Therefore, in our study, interview with a hundred (100) carried HbsAg, (31%vs 69%) women and men, respectively, with a ratio of 1:2.2, provided information about the disease. In Libya, Daw and Elbouzedi mentioned (19) out of 107,848 infected people, 39.2% were females versus 61.8% males. A nother study in Libya carried out on more than 65000 individuals infected with HBV and HCV showed that the overall seroprevalence of HbsAg 2.2% and was lower in females (42.3%) than males (58.7%) (22). A similar study in 2015 on 125 persons showed that about 2/3 of the infected were males (23). Our study revealed that the rate of HBV infections decreased from 42% for youth aged15 to 25 years to 10% for adults aged 48 to 58 years. This viaration between youth and adulthood ages suggests that transmission differences between age groups could be due to personal behaviours. The risk of transmission through sexual intercourse, means that youth may be more susceptible to other high risk behaviours, such as sharing needles among addicted individuals. Only 30 patients provided full information regarding the transmission of the virus; 6.66% were addicts, 43.3% had been infected through exposure to surgical operation, and 50% had unknown causes. Conversely, out of 100 hepatitis B carriers, 55% were not married, and 45% were married, with their partner also being infected 4.4%. There was also an association between literacy and the disease. However, 57% of patients were low or not educated. Even though, the prevalence of HBsAg (2.2%) in Libya (24) is still in the low limit, as recognized by the World Health Organization (WHO), but more attention should be taken to minimize the prevalence of the virus.

Conclusion
In addition to the viral screening of blood donors, hospital admissions, and mandatory vaccinations of neonatal babies against HbsAg to prevent the spread of the virus from an infected mother to her child, more awareness and guidance regarding disease transmission could reduce the spread of the infection to the lowest limit.