MOLECULAR EPIDEMIOLOGY AND PREVALENCE OF HEPATITIS C AND B VIRUS INFECTIONS IN SOUTH PUNJAB, PAKISTAN: MULTICENTER PCR-BASED STUDY

Abstract

Objective: To establish the prevalence and geospatial mapping of Polymerase Chain Reaction (PCR) confirmed Hepatitis C (HCV) and Hepatitis B (HBV) infections and to identify the possible demographic and occupational risk factors in South Punjab, Pakistan. A multi-centric cross-sectional study was carried out at different collection sites in South Punjab. Method: Active viral infections were confirmed using real-time PCR (COBAS 5800 system, detection limit 2.7 IU/ml) in 1,000 subjects for both viruses, who were suspected based on clinical presentation. A questionnaire was used to gather information about age, sex, profession and risk factors, which were analyzed with Chi-square tests and Odds Ratios (OR). Result: The overall positivity rate for active infection was 34% (340/1000) for HCV and 53% (530/1000) for HBV. Maps revealed hyper-endemic hotspots, mostly in rural areas, including Jalalpur Peerwala (85% HBV), Alipur (82% HBV), and Mian Channu (70% HCV).There was a clear generational shift: HCV was highest in the age group 40-60 years (67%), whereas HBV was the highest in young adults, 15-39 years (57%).In terms of occupations, the highest prevalence was among laborers (81% HBV) and farmers (70% HBV).Key risk factors included ignorance (74% HCV; 50% HBV), history of surgery (45% HBV; 8% HCV), and blood transfusion (50% HBV). Significantly, there was a 100% association between drug abuse and HBV. Family history was a significant predictor for HBV (46%) but not for HCV (3%, p < 0.001). Conclusion: The viral hepatitis burden in South Punjab is a serious one, with a "legacy" HCV epidemic in middle-aged people and an emergency of HBV in rural youth and the labor force. The concentrated infection in rural "exposure points" highlights the need for micro-level public health strategies, vaccination in high-risk workplaces, and improved clinical infection control practices