Arch Iran Med. 2018;21(10):436-442.
PMID: 30415551
Scopus id: 85056356294
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Original Article

Intra-familial Transmission of Chronic Hepatitis B Infection: A Large Population-Based Cohort Study in Northern Iran 

Aezam Katoonizadeh 1, Nazgol Motamed-Gorji 1, Maryam Sharafkhah 1, Mohammadreza Ostovaneh 1,2, Saeed Esmaili 1,3, Layli Eslami 1, Abdolsamad Gharravi 1, Masoud Khoshnia 1, Amaneh Shayanrad 1, Fatemeh Shakki Katouli 4, Abolfazl Shiravi Khuzani 5, Sedigheh Amini Kafi-Abad 6, Mahtab Maghsudlu 6, Jacob George 3, Hossein Poustchi 1 * , Reza Malekzadeh 1

1 Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran university of Medical Sciences, Tehran, Iran
2 Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, USA
3 Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Westmead, NSW, Australia
4 Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
5 Department of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
6 Iranian Blood Transfusion Organization Research Center, Department of Pathology, Tehran, Iran
*Corresponding Authors: Hossein Poustchi, MD, PhD; Associate Professor, Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Tehran university of Medical Sciences, Shariati Hospital, N. Kargar St., Tehran 14117, Iran. Tel: +98-21-82415141 Fax: +98-21- 8241 5400; Email: Email: h.poustchi@gmail.com

Abstract

Aim: The aim of this study was to investigate the intra-familial transmission of chronic hepatitis B (CHB) in Golestan province, that has the highest prevalence of CHB in Iran.

Methods: The Golestan Cohort Study (GCS) is a population-based prospective study of 50045 individuals, 40 years or older, initially set-up to study upper GI cancers in Northern Iran. In 2008, a baseline measurement of hepatitis B surface antigen (HBsAg) on the stored serum of all GCS participants identified 3505 HBsAg+ individuals. In 2011, we assessed HBV serological markers in 2590 initially HBsAg+ individuals and their first-degree relatives including spouses (1454) and children (3934).

Results: The median (IQR) age of spouses and children were 52 (12) and 25 (12) years respectively. Out of 5388 family members, 2393 (44.5%) had no HBV markers, indicating susceptibility to infection. Of these, 378 (15.8%) were fully-vaccinated children with no apparent response to primary immunization. HBsAg was positive in 2.2% (n = 33) of spouses and 8.2% (n = 325) of children (overall rate of 6.6%). HBcAb was positive in 761 (52.3%) and 914 (23%) spouses and children, respectively. The rate of spontaneous loss of HBsAg (HBsAg-, HBsAb+ and HbcAb+) was 41.3% and 13.9% in spouses and children, respectively. A higher rate of HBsAg+ children (10.2%) was found in families in which the mother was positive for HBsAg compared with families where the father was positive for HBsAg (6.3%) (P < 0.001). When both parents were positive for HBsAg, the rate of HBsAg positivity was high (23.5%, P < 0.001). Despite high virus exposure rates between spouses (52.6 %), the prevalence of HBsAg positivity among them was very low (2.3 %).

Conclusion: Sexual and parent-to-child transmission are important routes of CHB spread in this population from northern Iran despite the fact that 24 years have passed since the beginning of hepatitis B vaccination in infants. Low percentage of HBsAg positivity in spouses is related to high HBsAg clearance rate among them.

Cite this article as: Katoonizadeh A, Motamed-Gorji N, Sharafkhah M, Ostovaneh M, Esmaili S, Eslami L, et al. Intrafamilial transmission of chronic hepatitis B infection: a large population-based cohort study in Northern Iran. Arch Iran Med. 2018;21(10):436–442.
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Submitted: 12 Jun 2018
Accepted: 02 Aug 2018
First published online: 01 Oct 2018
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