Trends of Reported Cases of Hepatitis B Virus Infection, Kingdom of Saudi Arabia, 2009 - 2013 Open Access

Abstract

ABSTRACT

PURPOSE: Hepatitis B virus (HBV) infection is widespread globally and a serious public health threat. Understanding the distribution of HBV is important to policymakers to evaluate public health surveillance and develop prevention and control policies. Therefore, we studied the trends of reported HBV infection in the Kingdom of Saudi Arabia (KSA) during the 5-year period from 2009 - 2013.

METHODS: Laboratory-confirmed HBV cases reported to the KSA Ministry of Health (MoH) National Hepatitis Program (NHP) were analyzed by year, gender, nationality, region, and age group.

RESULTS: There were 23,236 cases of HBV infection reported to the KSA MoH during the 5-year period 2009 - 2013. In 2009, the incidence rate (IR) of HBV infection was 19.3 (95% CI = 18.8, 19.9) per 100,000 population. The IR significantly decreased to 14.7 (95% CI = 14.2, 15.1) in 2013. The IR was consistently greater among males than females (in 2013, 16.7 versus 12.2). Over the study period, Saudi citizens had a 2- to 3-fold greater IR than non-Saudis (in 2013, 18.7 versus 5.9). There was a large variation among HBV infection IRs across regions, with Tabouk having the highest. The greatest number of cases was found among those aged 15 to 44 years, followed by those > 45 years of age.

CONCLUSION: Despite the significant decrease in the IRs over the 5-year period from 2009 - 2013, HBV infection remains a major public health problem in KSA. Therefore, there is a need for continuous monitoring and evaluation of the disease's observation protocols and prevention strategies. Various strategies and preventive measures should be implemented to control HBV infection, and well-designed research programs should be carried out in different regions of KSA to improve planning and define the priorities in tackling this health issue.

Table of Contents

Table of Contents

Chapter I: INTRODUCTION..................................................................................................... 1

Background............................................................................................................................................................................................... 2

Statement of the problem............................................................................................................................................................. 3

Rationale..................................................................................................................................................................................................... 4

Objectives...................................................................................................................................................................................................... 4

Chapter II: LITERATURE REVIEW........................................................................................... 5

Epidemiology of HBV Infection and Scope of Study............................................................................................ 6

HBV Infection in KSA.......................................................................................................................................................................... 7

Literature on the Regional Distribution of HBV Infection in KSA........................................................ 7

Hepatitis B Studies Comparing Saudis and Non-Saudis...................................................................................... 9

HBV Infection, by Age.................................................................................................................................................................... 10

HBV Infection, by Gender........................................................................................................................................................... 11

Pregnancy as a Determinant in Hepatitis B Infection.................................................................................... 12

The Role of Genetics in HBV Epidemiology............................................................................................................... 14

Other Factors in HBV Epidemiology................................................................................................................................ 14

Chapter III: MANUSCRIPT..................................................................................................... 18

INTRODUCTION................................................................................................................................................................................... 20

METHODS................................................................................................................................................................................................... 21

Data Sources......................................................................................................................................................................................... 21

Case Definition of Hepatitis B Virus Infection................................................................................................................. 22

Study Variables.................................................................................................................................................................................... 22

Statistical Analyses............................................................................................................................................................................ 22

Ethics.......................................................................................................................................................................................................... 23

RESULTS...................................................................................................................................................................................................... 23

DISCUSSION............................................................................................................................................................................................... 26

Chapter IV: CONCLUSION AND RECOMMENDATIONS.................................................. 30

Vaccination............................................................................................................................................................................................. 30

Maternal Screening....................................................................................................................................................................... 30

Other Preventive Measures..................................................................................................................................................... 31

References............................................................................................................................... 33

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	KSA Kingdom of Saudi Arabia Hepatitis B infection Trends HBV
Committee Chair / Thesis Advisor	McNabb, Scott JN, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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