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 Health & You:
Aug 15, 2013
By: Eze Nkeiruka Perpetua

Nigeria: -

   EZE, N. P1., AKINOSUN, O. M2 and EMELIKE, O. F3.

1. Med.Lab.Scienist, Haematology/Blood Transfusion Medicine, University College Hospital Ibadan, Oyo State.

2. Consultant Chemical Pathologist, University College Hospital Ibadan, Oyo State

3. Senior Lecturer, Medical Laboratory Science Department, Ambrose Alli University, Ekpoma, Edo State.


  Hepatitis B virus (HBV) infection is a major public health problem worldwide despite availability of an effective vaccine since 1982 with Nigeria being described as an endemic zone.

  This Study is aimed at determining the Seroprevalence of Hepatitis B infection among unvaccinated blood donors who attended the blood bank of OLA Catholic Hospital, Oluyoro,  Ibadan, Oyo state.

The  seropositivity of Hepatitis B virus among a total of 3446 donors who were screened for Hepatitis B virus for a period of 5 years  between January 2007 to December 2011 using Hepatitis B surface antigen (HBsAg) ELISA to determine the prevalence of HBsAg  at this hospital. The seropositivity of Hepatitis B virus infection was found to be 8.56%. It is concluded that the Seroprevalence of Hepatitis B in this region is high according to the global patterns of transmission.

Key Words:  HBsAg, Seroprevalence, Hepatitis B Virus, Seropositivity.


The recognition of a form of hepatitis that was transmitted by direct inoculation of blood products was first documented by Lurman in Breman, Germany in 1883, during a small pox campaign1.

Hepatitis B virus (HBV) is a blood borne pathogen approximately 75-200 times more infectious than the human immunodeficiency virus (HIV) 2. Hepatitis B virus (HBV) is the most common cause of serious liver infection in the world and is estimated that worldwide more than two billion people have been infected by HBV and 350 million people have chronic infection3. About 75% of the Nigerian population is reportedly likely to have been exposed to HBV at one time or the other in their life4 because of high level of occurrence of blood demanding health conditions in many parts of sub-Saharan Africa.

HBV is transmitted by percutaneous or mucosal exposure to infected blood or other body fluids. The highest concentration of infectious HBV are found in blood and serum, other serum derived body fluid, such as semen and saliva are also infectious.5.

In developing countries, exposure to contaminated therapeutic injection equipment are common in many settings because of lack of awareness of infection control practices, lack of resources for sterilization and purchase of new disposable equipment, economic incentives and cultural preferences favouring overuse of injections.6

Blood Transfusion is an important intervention to save many lives. Blood Transfusion may itself result in complication - which includes transmitting several infections like HIV, Hepatitis B, Hepatitis C, Syphilis and malaria.

A proper screening of the Donor is important and mandatory to prevent these infections so that the blood transfusion does not harm the patient. The risk of transmitting these infections can be effectively reduced by accurately screening the Donors for these infections and hence this studies to determine the Sero prevalence of Hepatitis B infection among blood Donors at the Catholic Hospital, Oluyoro, Ibadan, Nigeria.




SAMPLE COLLECTION: The study was conducted at the department of Haematology, Catholic Hospital, Oluyoro, and Ibadan. The blood donors for this study were within the age range of 18- 45years and were apparently healthy voluntary donors.

A total of 3446 voluntary donors attending the blood bank of the Catholic Hospital for a period of 5 years from January 2007 to December 2011 were screened for Hepatitis B surface antigen. The donor’s samples were screened for HBsAg, HIV, Hepatitis C and VDRL.

Only HBsAg seropositivity was taken into consideration for this study. About 5 ml of venous blood was obtained from each subject, serum separated and stored at —20ºC until assayed after all the patients were informed verbally and their consent duly obtained


METHOD: Serum samples from the donors were assayed for HBsAg by commercially available enzyme—linked immuosorbent assay kit (Murex Diagnostics Ltd., Dart ford, UK) following the manufacturer's instruction strictly to determine the HBsAg seropositivity or otherwise of each serum sample.


 A Total of 3446 donors were screened for Hepatitis B infection of which 295 were found to be seropositive for HBsAg – an incidence of 8.56% (Table I)

 The Seropositivity samples for HBsAg are shown below:



Number of Samples

Number of negative samples

Number of positive samples

































From the study, HBV infection among blood donors was 8.56% positive to HBsAg. This figure is lower than 15.0% by Ayoola and Adelaja , 1998 and 13.2% by Fasola et al., 2009.


 The classification of high endemicity for HBV has been defined as HBsAg greater than 7% in an adult population7. The HBsAg seropositivity of 8.56% among blood donors confirmed that Ibadan, Nigeria is still endemic for HBV infection. Our results were in conformity with earlier reports from community and hospital based studies in some parts of Nigeria, which showed high prevalence of HBsAg ranging from 7.4-26% 8, 9, 10.

 The Studies in Ibadan have shown that the risk of transmission of HBsAg has decreased through the prevention of the virus from entering the blood supplied by screening of donors. The increased risk of transmission of Hepatitis B virus could be further minimised by introduction of a few more screening tests of Donors’ sample .such as Anti- Hepatitis B core antigen (HBcAg) and IgM for hepatitis B infection which are recommended to detect the infection during the window period.11, 12.


The prevalence of HBsAg in this region is still high though has decreased compared to other similar researches done in Ibadan, but donors should always be properly screened for hepatitis B virus. Community health education programme should be promoted, by Nigerian Government on HBV and vaccination programme should be extended to adult population and not just limited to national childhood immunization programme.


  1. Lurman. A. (1855) Eine icterus Epidemic Berlin  Klin. Wochenschr 22:20-23
  2. Bowyer S.M, Sim JGM., Webber L.M (2011): Current Laboratory Diagnosis of Hepatitis B Virus infection CME may 2011 vol 29 No 5.
  3. Drosten C, Nippraschk T, Manegold C, et al., (2004). Prevalence of Hepatitis B Virus DNA in anti- HBC-positive/HBsAg negative sera correlates with HCV but not HIV serostatus.J Clin Virol 29: 59-68.
  4. Sirisena ND, Njoku MO, Idoko JA, et al.,(2002). Carriage rate of hepatitis B surface antigen (HBsAg) in an urban community in Jos, Plateau State, Nigeria.Nig Post grad Med J 9:7-10.
  5. Chisari, F., and C. Ferrari (1995): Hepatitis B Virus immunopathogenesis.Annu Rev Immunol 13: 29-60.
  6. Gibas, A.E. Watkins. Hinkle, and J.I Dienstag.(1998).Long term persistence of protective antibody after hepatitis B Vaccination of healthy adults. Alan R. Liss, New York,N.Y.
  7. Hodges M, Sanders E, Aitken C (1998). Seroprevalence of hepatitis markers: HAV, HBV, HCV and HBV amongst primary school children in Freetown sierra Leone.W Afr J Med 17:3-7.
  8. Ekpo M, sasegbon H, Oyewole F (1995). HIVand HBV Serostatus of non-intravenous drug users in Lagos, Nigeria.Nig Med J 29:35-36.
  9. Ayoola, E.A and Adelaja, A.B (1998). Sub Determinants and incidence of Hepatitis B antigen in carriers of Hepatitis B surface Antigen. Nigerian Journal of Medical Practitioners 11:133-136.
  10. Fasola F.A, Kotila T.R, and Joshua O.A: Trends in Transfusion transmitted viral infections from 2001-2006 in Ibadan, Nigeria.intervirology 2008:51:427-431.
  11. N. Sawke, G.K Sawke et al. People journal of scientific research 2010, 3.1.
  12. David. (2007). Evaluation of new recombinant DNA Hepatitis B Vaccine (shawac-B) vaccine 17:1125-1130.




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Tak said:
Because you are HBsAg+ and you are pregnant, I would egorucane you to see a liver specialist so he can quickly look into your HBV and your liver health. Be sure to let them know you are pregnant. it is likely you had hepatitis B before you were vaccinated. The vaccine does not help those that already have an HBV infection. People are not usually tested for HBV prior to vaccination. If you test HBsAg positive for longer than 6 months then you are considered chronically infected. You can also ask your doctor to run an anti-HBc IgM test which if positive would indicate that you have an acute, new infection. Regardless, proper followup is important. I don\'t know if you will require medication or not. This is more dependent on the HBV DNV viral load. It is very important to talk to your doctor to be sure your baby receives the first shot of the HBV vaccine series and a shot of HBIG within 12 hours of birth. I don\'t know where you live, but if you live outside of the US, you may need to arrange to get the HBIG shot and the vaccine to be given at the hospital. This is a very effective prophylaxis for babies of HBV positive moms and prevents transmission from HBV+ moms to their little ones at birth 90-95% of the time. There would only be concern if you have a very high viral load. Please try not to panic, but please contact your doctor, and contact a liver specialist to learn more about your HBV and your liver health. Making sure your baby is able to receive the first shot of the HBV vaccine series and a shot of HBIG is essential before you deliver your baby. Best of luck to you!

Alfredo said:
Do you know if you have an acute (new) or chronic inictefon? A person is considered chronically infected if they test HBsAg+ for more than 6 months. It appears that you may in the process of serconversion of HBe, where you will lose the HBeAg antigen and gain the antibody. If you have an acute inictefon, you would likely serconvert and eventually lose surface antigen and gaining the antibody since 90% of healthy adults newly infected will resolve the inictefon. (Eventual results of a resolved inictefon: HBsAg neg, HBsAb pos, HBcAb pos, HBeAg neg, HBeAb pos, undetectable viral load). Keep in mind that HBe serconversion is also part of the natural progression of the virus. Those that are chronically infected will eventually seroconvert and lose HBe, but they rarely serconvert and lose the surface antigen (HBsAg) and gain the antibody (HBsAb). So, if you are chronically infected, but serconverting losing HBe, your results may look like the following: HBsAg pos, HBsAb neg, HBeAg neg, HBeAb pos, very low or undetectable HBV DNA (quantitative). You will need to check back with your doctor if you have not confirmed if this is an acute or chronic inictefon to look at some of your results.

Denise said:
It is very possible that you have a choinrc HBV infection. Children are very susceptible to HBV and tend to remain choinrc after they are infected. 90% of healthy adults are able to clear a new or acute case of HBV. HBV is very prevalent throughout most of Africa. It is possible that your partner was previously infected, which would show up if a hepatitis B panel is run (HBcAb+ notes previous infection, HBsAb+ notes generation of antibodies to HBV). It is possible you are currently in the inactive phase, and may have been for years, so you may have a low viral load, making transmission less likely. Be sure you partner has an hepatitis B panel run to determine whether or not there was a previous infection. If your partner resolved a prior infection, there is no need for vaccination. If your partner is HBsAg neg, HBcAb neg, and HBsAb neg then your partner should be vaccinated. Be sure your little ones get a booster and follow up with an anti-HBs titre test 1-2 months following the booster shot. If they have a titre greater than 10IU/mL, then they have generated adequate immunity. http://bdyhtbf.com [url=http://asfopqjb.com]asfopqjb[/url] [link=http://czzhnsdz.com]czzhnsdz[/link]

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