Meet the Team

Prevalence of Otalgia in
Patients with Temporo-mandibular Disorders

Patient Satisfaction 18 months After a Two-day Quadruple Therapy for Helicobacter Pylori

The Prevalence of Hepatitis B Carrier State

Total Quality Management for Turkish Primary Care Current Status and Suggestions

Vaccination Practice in Saudi Arabia: Is it Safe?

Change in Medical Students’ Opinions and Attitudes Towards Mental Illness

First Annual International Primary Care Conference-Abu Dhabi-UAE

Announcement of the Second Course of the MEAMA

Launch of 'World CME'

Antibiotic Sensitivity Profile of Common Bacterial Pathogens in Dubai
– A study of 107 cases

Women's Health Week in Rawalpindi, Pakistan

Middle East Academey for Medicine of Aging First Course

Pan Arab Congress for Evidence Based Medicine

Childhood Emergencies


Dr Abdulrazak Abyad
Editorial office:
Abyad Medical Center & Middle East Longevity Institute
Azmi Street, Abdo Center,
PO BOX 618
Tripoli, Lebanon

Phone: (961) 6-443684
Fax:     (961) 6-443685


Lesley Pocock
medi+WORLD International
572 Burwood Road,
Hawthorn 3122
: lesleypocock


The Prevalence of Hepatitis B Carrier status Before and After Hepatitis B Vaccination


D Hussein Azzam Al-Bataineh, MD
Department of Paediatrics
Prince Hashem Ben Alhussin Hospital
PO BOX 260
Aidoun 21166


Aim: To measure the prevalence of hepatitis B carrier status in the pediatric population before and after the era of hepatitis B vaccination.

Method: A prospective study done in two cities of Jordan Tafeleh and Zarqa, a random screening for HBs Ag by ELISA method for 247 children who were not vaccinated during the year of 1997, and also done for the same number of children who were vaccinated for the same age group during the year of 2004.

Results: 8 (3.3) persons are HBs-Ag positive and only one child (0.4)is positive from the vaccinated group .

Conclusion: Hepatitis B is a common disease, and vaccination is effective in reducing the carrier status, and we concentrated on routine screening for all pregnant mothers as a part of prenatal care.


It is evident that HBV infection is a serious public health problem in the middle east area. The majority of countries in the region have an intermediate or high indemicity of HBV infection.(1)

The chronic carrier of hepatitis B is an important risk factor in the development of serious diseases, such as chronic persistent hepatitis , chronic active hepatitis, and liver cirrhosis and hepatocelluler carcinoma.(2)

The World Health Organization (WHO) has considered it a disease of public health importance. So it has recommended universal immunization against it by including a vaccine into Expanded Program for Immunization (EPI) schedule for children.(3)

The first Middle East countries to introduce hepatitis B vaccination into their EPI, were Saudi Arabia and Qatar in 1989. These were followed by Oman in 1990, Bahrain, Iraq, Syrian Arabic Republic, UAE in 1991, Egypt in 1992, Palestine in 1993, Jordan and Tunisia in 1995, and the Republic of Yemen in 1998.(4)


Our aim is to measure the prevalence of HB carrier status in children before and after the period of hepatitis vaccine, and to find the most effective way of protection .


A random selection of children who are below the age of 10 years was done after taking the consent of the parents. Blood samples were taken and tested for HBs Ag using the ELISA method , 247 children were included in the study during the year of 1997 . The same numbers of children were screened during the year of 2004 for the same age group who received the three doses of vaccine via the national vaccination program during the first year of their life.

A complete evaluation for the patients who were found to be HBs-positive , included liver function test , prothrombin time, partial thromboplastin time, HBs-Ab ,HBe-Ag and Ab, HBc-Ab, HAV-Ab , HCV-Ab. Family screening was done for all the family members.


During the year of 1997 a total number of 247 children were screened; 106 (43%) were females and 141 (57%) were males; a total of 8 patients were found to be HBs Ag-positive.

The same number of patients was screened for HBs Ag, for the group of children who received INGERIX vaccine via the national vaccination program. It consisted of three doses. The first dose is given at the age of two months, and the second dose is given at three months and the third dose at the fifth or the six month. The age group ranged from the first year of life to ten years of age.

  Only one child was found to be HBs -Ag positive. This child is an eight month old and he was admitted with fever and was found to have acute viral meningitis. Liver function tests showed mild elevated liver enzymes, hepatitis screen showed HBs Ag positive, HBs Ab was negative, Anticore Ab was positive for IgG. The family screening showed a HBs positive mother, and she was not aware of her status.


According to the percentage of HBV chronic carriers among the adults in the general population , the countries were classified into three categories as low endemicity (<2%) , intermediate endemicity (2%-5%), and high endemicity (>5%).(5)

Here in Jordan the prevalence of HBS Ag positive ranges from 2.6-10%.(6)

Hepatitis B virus is one of the world's most important causes of disease and death. More than one third of the world population have serologic evidence of past or present infection, with over ???? being chronic carriers of the virus. (7,8)

There are many modes of transmission, including vertical transmission and horizontal transmission.

Vertical transmission: the virus does not cross the placenta but is transmitted from the pregnant carrier through invasive procedures such as amniocenteses, and when the newborn comes into contact with the mothers infected blood, during delivery. The infant can be protected by vaccination.

The proportion of infected newborns depend on levels of infectivity; if the mother is HBS Ag positive and HBe Ag positive, 90% of infants will become infected without appropriate prophylaxis, but if the mother is only HBs positive the risk of transmission is about 20 %.

90% of infected infants will become HBV carriers and 25% will ultimately develop a good morbidity rate from hepatitis B related disease.(9)

Horizontal transmission occurs to the family, friends and close contacts. The mechanism is not fully understood, but the vehicle is a small amount of infected saliva or blood contacting an open wound which may be a small abrasion.(10)

Also hepatitis B is considered to be a sexually transmitted disease (STD). Blood from minor lesions, semen and vaginal secretions are considered to likely be positive. The number of sexual partners, the number of years of sexual activity and a history of other sexual transmitted diseases have an increased risk of HBV infection.(11)

Another way of horizontal transmission is via HBV-contaminated blood and blood products, contaminated surgical instruments and other hazards.

The large majority of HBs-Ag carriers have normal function tests (75-90%), 1-5% develop chronic active hepatitis and the remaining had chronic persistent hepatitis.(13)

About 20% of individuals with chronic active hepatitis B progress to cirrhosis. (14)

In patients with cirrhosis, the annual incidence of hepatocelluler carcinoma ranges from 2% to 7%.

So as we can see from our study before the era of vaccination Jordan (Tafelah and Zarqa) have an intermediate endemicity rate of chronic hepatitis B carrier status. This chronic asymptomatic carriage can be prevented or decreased by vaccination. The vaccine is highly immunogenic, the sero-protection rates are greater than 95% after a 3-dose vaccine course, and the protection lasts for at least 8-10 years, even though the presence of antibodies would continue to provide protection against HBV infection.(15)

The most important aspect is the protection of newborn babies by giving the vaccine and the immunoglobulin as soon as possible after birth, and this can be achieved only by detecting the carrier mother before delivery as our patient's mother was neither screened nor vaccinated for hepatitis B.


It is apparent that vaccination of children under one year of age would be the most effective way of decreasing the prevalence of Hepatitis in accordance with the Expanded Program on Immunization (EPI).

Also we recommend a routine screening for the pregnant women as a part of antenatal care, and vaccination for HBs-Ag negative mothers ,and immediate vaccination for newborns of carrier mothers as soon as possible after birth. (12)

Table 1. Clinical Diagnosis of Patients in whom Helicobacter could be eradicated
no age sex history LFT Hepatitis profile Family screening
1 8year male History of surgery to scrotal cyst 3 years ago normal HBs-Ag positive negative
2 9year male History of dental extraction normal HBs-Ag HBe-Ab (IgM) positive negative
3 13 female History of hospital admission for 15 days due to F.U.O normal HBs-Ag HBe-Ab (IgM) positive  
4 12year female No history of illness normal HBs-Ag positive negative
5 8year male Negative for himself, his mother has a history of blood transfusion normal HBs-Ag positive Mother and one sister is positive, the father, brother and one sister are negative
6 10 years female She had a history of blood transfusion normal HBs-Ag positive , and CMV positive negative
7 7 year male No relevant history discovered accidentally during investigation to anemia Mild elevation of ALT and AST HBs-Ag positive only negative
8 5 year female History of acute hepatitis b infection 6 months ago LFT back to normal HBs-Ag positive The mother is positive one sister and one brother are positive, one sister and the father are negative


1. N.Qirbi and A.J.Hall, Epidemiology of hepatitis b virus infection in the midle east , Eastern Mediterranean Health Journal. Volume 7 ,No. 6, November 2001,1034-1045.
2. Dragosics B ,Ferenci P , Hitchman E , Denk H , Long term follow up study of asymptomatic HBs Ag -positive voluntary blood donors in Austria: a clinical and histologic evaluation of 242 cases .Hepatology 1987; 7:302-306.
3. WHO Expanded Program on Immunization. Hepatitis B control through immunization. Global program for vaccines and immunization sub-committee meeting of the scientific advisory group of expert. Geneva, 12-16 June, 1995.
4. Annual Report on the activities of the Hepatitis B Virus Prevention Program Sana'a , Republic of Yemen, Ministry of Public Health, 1999.
5. Hall AJ. Control of hepatitis by children vaccination. Reviews in medical microbiology,1994,5(2):123-30
6. AU Toukan, ZK Sharaiha, OA Abu-el-Rub, MK Hmoud, SS Dahbour, H Abu-Hassan, SM Yacoub, SC Hadler, HS Margolis and PJ Coleman. The epidemiology of hepatitis B virus among family members in the Middle East. American Journal of Epidemiology, Vol 132, Issue 220-232.
7. World Health Organization. Vaccines, immunization and biological: hepatitis B.www.who.int/vaccines/en/hepatitisb.shtml.
8. Altermj. epidemiology and prevention of hepatitis B.semin Liver dis2003;23;39-46.

9. Center for Disease Control and Prevention. Hepatitis B.In: Epidemiology and Prevention Preventable Disease 7th ed.2003.
10. Davis LG , et al .Horizontal transmission of Hepatitis B viral.Lancet1989 ;1 :889-93
11. Alter MJ. Epidemiology and prevention of Hepatitis B. Semin Liver Dis 2003,23:39-46.
12. Batayneh N, Bdour Srisk of perinatal transmission of hepatitis B virus in Jordan.Infect Dis Obstet Gynecol.2002;10(3):127-32
13. Dragosics B, Ferenci P, Hitchman E,Denk H. Long term follow up study of asymptomatic HBs-Ag positive voluntary blood donors in Austria :a clinical and histologic evaluation of 242 cases hepatology 1987;7:302-306.
14. Lo Kj, Tong Mj Chien Ml, Liaw Yf, Yang Kc, Chian H, et al. The natural course of hepatitis B surface antigen positive chronic active hepatitis in Taiwan. J Infect Dis 1982;146:205-210.
15. Chadha MS, Arankalle VA. Ten year serological follow up of hepatitis B vaccine recipient. Indian j gastroenterol 2000; 19:168.