A Review of Hepatitis B Virus Infection in Sri Lanka

Abstract

Hepatitis B virus (HBV) infection is a major public health concern in many Southeast Asian, South Asian and African countries. HBV infection is transmitted sexually or by other parenteral routes. HBV causes an acute viral hepatitis or chronic infection, largely based on the age at which the infection is acquired. In the majority of infected infants, HBV causes a chronic protracted infection for decades without symptoms. After several decades, the infection might flare up to give rise to an active hepatitis followed by sero-conversion to anti-HBs. However, the vast majority of patients with chronic HBV (CHB) infection will have chronic liver disease. Some with CHB infection develop a primary liver cancer, hepatocellular carcinoma (HCC) later in life. Approximately 25 percent of chronically infected individuals die prematurely of cirrhosis or HCC. The prevalence of HBV infection in Sri Lanka is estimated to be less than 2%. Sri Lanka is therefore considered a country of low endemicity. This prevalence rate of HBV in Sri Lanka is very different to that in many other South Asian countries such as India and Bangladesh. Diagnosis of HBV infection in Sri Lanka is carried out in many private and state laboratories using immunochromatography based rapid assays or ELISAs for HBV surface antigen (HBsAg) detection. Those with latter stages of CHB are treated with currently available nucleotide / nucleoside analogues in some private sector hospitals where testing facilities for virus load during different stages of treatment is available. Sri Lanka has a policy of immunizing healthcare workers (HCW) who are at risk of acquiring HBV occupationally. Sri Lanka included HBV immunization in the Expanded Program of Immunization (EPI) with effect from 2003. In all HBsAg immunization programmes for HCW, testing for the protective anti-HBs response is mandatory in those who receive a complete course of immunization in order to ensure immunity in responders and to re-vaccinate non-responders.

Seroconversion following Hepatitis B immunization in National Immunization Programme in a selected Medical Officer of Health area in Galle District

“…In the year 2015, the average admission to government hospitals due to viral hepatitis was 12.9 per 100,000 population with the case fatality rate of 0.2 and mainly affecting the age group 25 -50 years (2). The commonest type of viral hepatitis reported in the country was hepatitis A. Sri Lanka has an intermediate prevalence for HBV infection with a prevalence of HBsAg positivity not more Seroconversion following Hepatitis B immunization in National Immunization Programme in a selected Medical Officer of Health area in Galle District than 2.5% in different selected communities, although it is located in the high endemic region (3). However, a large number of clinically defined hepatitis cases remain unreported as most of them do not seek hospital admission or go to the private sector or visit other allopathic and ayurvedic practitioners.…”

Sharp injuries during clinical training among medical students in the University of Peradeniya, Sri Lanka

“…1 Prevalence of Hepatitis B is less than 2% and Hepatitis C has an intermediate level prevalence in Sri Lanka. [2][3][4] But this recent change in social structure and proximity to India makes Sri Lanka very vulnerable to blood-borne infections. 5 The health system in Sri Lanka is free for all and it caters ever-increasing number of patients with various medical conditions.…”

Immunity against hepatitis B in a selected child population in Gampaha district, Sri Lanka, ten years after vaccination at two, four and six months of age

“…4 Although located in a hyper-endemic region, Sri Lanka remains a low endemic country for Hepatitis B, with an estimated prevalence of less than 2%. 5 Transmission of HB virus (HBV) mainly occurs through direct contact with blood or body fluids of an infected person, unprotected sexual contacts and vertical transmission from mother to child. Since HBV is capable of remaining infective outside the body for at least seven days, horizontal transmission through close interpersonal contact is possible.…”