Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
J Viral Hepat. 2024 Nov;31(11):645-656. doi: 10.1111/jvh.13986. Epub 2024 Jul 26.
Pakistan harbours a large burden of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. We utilised repeat sero-surveys to assess progress achieved towards hepatitis elimination in Pakistan. Multilevel logistic regression evaluated the change in HBV infection (HBV surface antigen (HBsAg)-positive) prevalence and HCV exposure (HCV antibody (HCV-Ab)-positive) prevalence between two sero-surveys from 2007 and 2019 for Sindh province and associated risk factors. Adjusted odds ratios (aORs) were estimated and population-attributable fractions (PAF) for modifiable risk factors for HCV exposure. The 2007 and 2019 surveys included 8855 and 6672 individuals. HBsAg prevalence decreased from 2.6% (95% confidence intervals (95% CI): 2.2-2.9) in 2007 to 1.1% (95% CI: 0.8-1.3) in 2019, while HCV-Ab prevalence increased from 5.1% (95% CI: 4.6%-5.5%) to 6.2% (95% CI: 5.6%-6.8%). The age and gender-adjusted HBsAg prevalence decreased by 80% (aOR = 0.2, 95% CI: 0.1-0.4) among children and 60% (aOR = 0.4, 95% CI: 0.3-0.6) among adults over 2007-2019, while HCV-Ab prevalence decreased by 60% (aOR = 0.4, 95%CI:0.2-0.7) in children and increased by 40% (aOR = 1.4, 95% CI: 1.2-1.7) in adults. HCV-Ab prevalence was lower in adults with secondary (aOR = 0.6, 95% CI: 0.5-0.8) and higher (aOR = 0.5, 95%CI:0.3-0.8) education compared to illiterates and higher among adults reporting blood transfusion (aOR = 1.7, 95% CI: 1.2-2.4), family history of hepatitis (aOR = 2.5, 95% CI: 1.9-3.3), past year medical injection (aOR = 2.1, 95% CI: 1.6-2.7), being tattooed (aOR = 1.4, 95% CI: 1.0-1.9) and shaved by traditional barber (aOR = 1.2, 95% CI: 1.0-1.5). Modifiable risk factors accounted for 45% of HCV exposure, with medical injection(s) accounting for 38% (95%CI,25.7-48.4%). Overall HCV has increased over 2007-2019 in Sindh province, while HBV prevalence has decreased. Medical injections should be an important focus of prevention activities.
巴基斯坦是乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染的重灾区。我们利用重复血清学调查来评估巴基斯坦在消除肝炎方面取得的进展。多水平逻辑回归评估了 2007 年和 2019 年两次血清学调查之间在信德省乙型肝炎感染（HBsAg 阳性）和丙型肝炎暴露（HCV-Ab 阳性）患病率的变化及其相关危险因素。估计了调整后的优势比（aOR）和丙型肝炎暴露的可改变危险因素的人群归因分数（PAF）。2007 年和 2019 年的调查分别包括 8855 人和 6672 人。HBsAg 患病率从 2007 年的 2.6%（95%置信区间（95%CI）：2.2-2.9）下降到 2019 年的 1.1%（95%CI：0.8-1.3），而 HCV-Ab 患病率从 5.1%（95%CI：4.6%-5.5%）增加到 6.2%（95%CI：5.6%-6.8%）。2007 年至 2019 年期间，儿童的 HBsAg 年龄和性别调整后患病率下降了 80%（aOR=0.2，95%CI：0.1-0.4），成年人下降了 60%（aOR=0.4，95%CI：0.3-0.6），而儿童的 HCV-Ab 患病率下降了 60%（aOR=0.4，95%CI：0.2-0.7），成年人则增加了 40%（aOR=1.4，95%CI：1.2-1.7）。与文盲相比，具有中等（aOR=0.6，95%CI：0.5-0.8）和高等（aOR=0.5，95%CI：0.3-0.8）教育程度的成年人 HCV-Ab 患病率较低，而报告接受过输血（aOR=1.7，95%CI：1.2-2.4）、有肝炎家族史（aOR=2.5，95%CI：1.9-3.3）、过去一年接受过医疗注射（aOR=2.1，95%CI：1.6-2.7）、接受过纹身（aOR=1.4，95%CI：1.0-1.9）和传统理发师刮胡子（aOR=1.2，95%CI：1.0-1.5）的成年人 HCV-Ab 患病率较高。可改变的危险因素占 HCV 暴露的 45%，其中医疗注射占 38%（95%CI，25.7-48.4%）。总的来说，2007 年至 2019 年期间，信德省的 HCV 呈上升趋势，而 HBV 患病率则下降。医疗注射应该是预防活动的重点。
