HEPATITIS B AND C IN CHAKAR, DISTRICT MUZAFARABAD,

DUE TO POST EARTHQUAKE EVENTS

ABSTRACT

Background: Earthquake of year 2005, played havoc in many northern Districts of Pakistan. Emergent measures to manage the injured and displaced people resulted rise in many diseases. Hepatitis B & C were among more serious outcomes which were considered to be studied.

Aims: The study was conducted to see the positivity of Hepatitis B & C as a  result of post-disaster activities and to identify possible  risk factors which could have contributed in their transmission. .

Setting: Union Council Chakar of District Muzafarabad was selected and subjects of all ages were interviewed for having undergone various high-risk procedures in the post-disaster period.

Methods: It was a case control study in which 220 cases were selected because they had suffered some injury in the earthquake, and had undergone some emergency surgical procedure or had been transfused with blood. These cases were matched with 1295 controls from the same area who had not been physically affected by the earthquake.

All the 1515 subjects were interviewed through a questionnaire and a blood sample of 5 ml was taken for assessing Hepatitis B & C positively. Rapid method was used in the field while ELISA was used later to confirm the results.

Results: A total of 1515 cases were studied of which 220 (14.5%) were injured (group 1) and 1295 (85.5%) non injured (group 2). There were 89 males and 131 females in group 1 and 579 males and 716 females in groups 2.

On rapid dry chemistry test in group-1 HBsAg was positive in 19 cases (8.6%) ( 12 males ( 13.4%) and 7 females (5.3%)) and anti  HCV  was positive in  6 (2.7%) cases  (3 males (3%) and 3 females (2.2%) respectively. In group-2 HBsAg was positive in 6 cases (0.4%)  (4 males (0.6%) and 2 females (0.2%) and anti HCV was positive in 3 cases (0.2%) (2 males (0.3%) and 1 female (0.1%) respectively.

Using ELISA in group-1, the HBsAg was found positive in 29 cases (13.1%) (18 males (20.2%) and 11 females (8.3%) and anti HCV in 7 cases (3%) (4 males (4.4%) and 3 females (3.3%).  In group-2, HBsAg  was  found  positive in 13 cases (1%) (7 males and 6 females) and for anti HCV among 4 cases (0.3% ( 2 males and 2 females ) respectively. The hepatitis B positivity in the injured group (group-1) was 3 times higher than the controls (group-2) who did not receive any invasive treatment.  

Conclusions: Using ELISA as the standard diagnostic method for HBV and HCV detection, the injured group showed a very high positivity (13%) for hepatitis B surface antigen, indicating the possible transmission of the virus during disaster management. HCV takes a longer time (over 6 months) to become positive and there is a chance that its figures might also go high after few years.

Disaster planning should include the proper implementation of preventive strategies against hepatitis B and C and Active vaccination against Hepatitis B.

Key Words: Hepatitis B, Hepatitis C, Disaster Management.