Hepatitis B and C among Multi-Transfused Pediatric Thalassemic Patients in Sana'a City, Yemen: A Single-Center Retrospective Study

Abstract

Objective: To determine the prevalence of hepatitis B and C infections and their association with repeated blood transfusions among thalassemic children attending the Yemen Society for Thalassemia and Genetic Blood Disorders (YSTGBD) in Sana’a city, Yemen.
Methods: This retrospective cross-sectional study analyzed the medical records of 195 thalassemic children aged <18 years taken who were attending the YSTGBD from January 2008 to December 2018. Data about the gender and age of the child, time of thalas- semia diagnosis, frequency of monthly blood transfusions, hepatitis B virus (HBV) vaccination status, hepatitis B infection and hepatitis C virus (HCV) seropositivity were retrieved from the records into a data collection sheet. Data were then analyzed and summarized as frequencies and proportions. The association between the independent variables and infection with hepatitis B and/or hepatitis C was tested using the chi-square test.
Results: The majority of thalassemic children attending the YSTGBD were males (58.5%), aged 8 years or older (81.0%), diag- nosed with thalassemia at 6 months of age or older (71.8%, were receiving ≤500 ml of transfused blood per month (88.7%) and had been vaccinated against HBV (72.8%). Regarding the serostatus for viral hepatitis, 15.4% (30/195) of children were seroposi- tive for the antibodies against HCV, 13.3% (26/195) were infected with hepatitis B as confirmed by HBsAg seropositivity, and 4.1% (8/195) were concomitantly seropositive for HBsAg and anti-HCV. Not getting vaccinated against HBV was significantly associated with infection with HBV (P <0.001), where 45.3% of unvaccinated children were seropositive compared to 1.4% of vaccinated children. In contrast, gender, age, age at thalassemia diagnosis and the quantity of monthly transfused blood were not significantly associated with infection with hepatitis B, anti-HCV seropositivity, or concomitant seropositivity for HBsAg and anti- HCV among thalassemic children.
Conclusions: Viral hepatitis is a major problem for thalassemic children seeking healthcare in institutions of concern in Yemen, but it is rather difficult to assess the status of hepatitis C infection because of the lack of confirmatory tests. On the other hand, vaccination against HBV is significantly associated with a lower prevalence of hepatitis B among thalassemic children, highlighting the need for vaccinating all thalassemic children before enrollment in specialized centers of care. Thalassemic children should be screened for blood-borne viruses, including hepatitis viruses, before the establishment of regular blood transfusions.