Bosan Altaf, Qureshi Huma, Bile Khalif Mohamud, Ahmad Irtaza, Hafiz Rehan
National Institute of Health.
J Pak Med Assoc. 2010 Dec;60(12):1045-58.
A review of published literature on viral hepatitis infections in Pakistan is presented. A total of 220 abstracts available in the Pakmedinet and Medline have been searched. All relevant articles were reviewed to determine the prevalence of hepatitis viral infections in Pakistan. Two hundred and three (203) relevant articles/abstracts including twenty nine supporting references are included in this review. Of the articles on prevalence of hepatitis infection, seven were related to Hepatitis A, fifteen to Hepatitis E while the remaining articles were on frequency of hepatitis B and C in different disease and healthy population groups. These included eight studies on healthy children, three on vertical transmission, nineteen on pregnant women, fifteen on healthy individuals, six on army recruits, thirty one on blood donors, thirteen on health care workers, five on unsafe injections, seventeen on high risk groups, five on patients with provisional diagnosis of hepatitis, thirty three on patients with chronic liver disease, four on genotypes of HBV and five on genotypes of HCV. This review highlights the lack of community-based epidemiological work as the number of subjects studied were predominantly patients, high risk groups and healthy blood donors. High level of Hepatitis A seroconversion was found in children and this viral infection accounts for almost 50%-60% of all cases of acute viral hepatitis in children in Pakistan. Hepatitis E is endemic in the country affecting mostly the adult population and epidemic situations have been reported from many parts of the country. The mean results of HBsAg and Anti-HCV prevalence on the basis of data aggregated from several studies was calculated which shows 2.3% and 2.5% prevalence of HBsAg and Anti-HCV in children, 2.5% and 5.2% among pregnant women, 2.6% and 5.3% in general population, 3.5% and 3.1% in army recruits, 2.4% and 3.6% in blood donors, 6.0% and 5.4% in health care workers, 13.0% and 10.3% in high risk groups, 12.3% and 12.0% in patients with provisional diagnosis of hepatitis and 25.7% and 54% in patients with chronic liver disease respectively. This review has illustrated the high endemicity of hepatitis viral infections in Pakistan where hepatitis B and C potentially account for a serious burden of the disease. This review has triggered the launching of a network intervention for the control of hepatitis viral infectious. This review was used as the basis for the launch of hepatitis programme, but putting it into a formal review took time and the hepatitis program was initiated.
本文对巴基斯坦已发表的有关病毒性肝炎感染的文献进行了综述。我们检索了巴基斯坦医学网（Pakmedinet）和医学在线（Medline）上共220篇摘要。对所有相关文章进行了综述，以确定巴基斯坦病毒性肝炎感染的流行情况。本综述纳入了203篇相关文章/摘要，其中包括29篇参考文献。在关于肝炎感染流行情况的文章中，7篇与甲型肝炎有关，15篇与戊型肝炎有关，其余文章则是关于不同疾病和健康人群中乙型和丙型肝炎的发病频率。这些研究包括8项关于健康儿童的研究、3项关于垂直传播的研究、19项关于孕妇的研究、15项关于健康个体的研究、6项关于新兵的研究、31项关于献血者的研究、13项关于医护人员的研究、5项关于不安全注射的研究、17项关于高危人群的研究、5项关于初步诊断为肝炎患者的研究、33项关于慢性肝病患者的研究、4项关于乙肝病毒基因型的研究以及5项关于丙肝病毒基因型的研究。本综述强调了基于社区的流行病学研究工作的匮乏，因为所研究的对象主要是患者、高危人群和健康献血者。在儿童中发现了高水平的甲型肝炎血清转化，这种病毒感染占巴基斯坦儿童急性病毒性肝炎病例的近50%-60%。戊型肝炎在该国呈地方性流行，主要影响成年人群，该国许多地区都报告过疫情。根据多项研究汇总的数据计算了乙肝表面抗原（HBsAg）和抗丙肝病毒（Anti-HCV）流行率的平均结果，结果显示儿童中HBsAg和Anti-HCV的流行率分别为2.3%和2.5%，孕妇中为2.5%和5.2%，普通人群中为2.6%和5.3%，新兵中为3.5%和3.1%，献血者中为2.4%和3.6%，医护人员中为6.0%和5.4%，高危人群中为13.0%和10.3%，初步诊断为肝炎患者中为12.3%和12.0%，慢性肝病患者中为25.7%和54%。本综述表明巴基斯坦病毒性肝炎感染的高地方性流行，其中乙型和丙型肝炎可能构成严重的疾病负担。本综述促使启动了一项控制病毒性肝炎感染的网络干预措施。本综述被用作启动肝炎项目的依据，但将其纳入正式综述需要时间，肝炎项目随后启动。
