ADVANCED MOLECULAR PROFILING AND SPATIOTEMPORAL EPIDEMIOLOGY OF HEPATITIS B AND C IN LAHORE, PAKISTAN: UNRAVELING TRENDS, TRANSMISSION PATTERNS, AND PUBLIC HEALTH CHALLENGES
Main Article Content
Keywords
HBV, HCV, qPCR, Molecular Epidemiology, Serology, Diagnostic Markers, Public Health, Viral Hepatitis.
Abstract
Hepatitis B virus (HBV) and hepatitis C virus (HCV) remain the escalating public health challenges in Pakistan, particularly in regions with limited healthcare resources. This study uses molecular and serological analysis to investigate the prevalence, transmission routes, and epidemiological trends of HBV and HCV in asymptomatic individuals from Lahore. A total of 533 individuals were screened at Pakistan Mint Hospital Lahore with the coordination of the Health Foundation Lahore, Pakistan. Of 533 screened individuals, 05 persons with HBV were confirmed through serological and molecular diagnostic markers, whereas HCV serological markers were detected in 23 individuals. However, only 10 HCV-positive cases were validated through molecular confirmation, indicating the inconsistencies of antibody-based diagnosis. Phylogenetic analysis identified two main routes of HCV transmission: healthcare-associated spread linked to unsafe medical practices, such as improper sterilization of instruments, and intra-household transmission within densely populated settings, a factor often overlooked in urban disease dynamics. Spatial mapping identified persistent transmission hotspots in district Lahore, primarily associated with informal healthcare providers and high-mobility populations. Over five years, HCV incidence rose by 22%, outpacing HBV infection rates. Systemic challenges included delayed diagnosis, averaging 4.2 years post-infection and low HBV vaccination rates (48%), particularly in high-risk areas with inadequate neonatal immunization programs. These findings underscore the urgency of precision public health strategies tailored to the unique epidemiological landscape of Lahore. Proposed interventions include deploying mobile genomic surveillance units in high-risk clusters, implementing community-led harm reduction programs (e.g., needle-exchange initiatives), and adopting genotype-specific antiviral regimens and stricter infection control measures to mitigate the spread of viral hepatitis in Pakistan.
References
2. Chivero, E. T., Guo, M., Perelson, A. S., & Dahari, H. (2022). The impact of hepatitis B virus genotypes on disease progression and treatment responses. Viruses, 14(3), 582.
3. Lavanchy, D. (2018). Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. Journal of Viral Hepatitis, 25(2), 146-159.
4. Lemoine, M., & Thursz, M. (2019). Battlefield against hepatitis B infection and HCC in Africa. Liver International, 39(1), 38-46.
5. McNaughton, A. L., D'Arienzo, V., Ansari, M. A., Lumley, S. F., Littlejohn, M., Revill, P. A., ... & Matthews, P. C. (2021). Insights from deep sequencing of the HBV genome—unique, tiny, and misunderstood. Gastroenterology, 161(1), 1-14.
6. Nayagam, S., Chan, P., Zhao, K., Sicuri, E., Wang, X., & Kim, J. (2018). Investment case for hepatitis B elimination in low-income and middle-income countries: a modelling study. The Lancet Gastroenterology & Hepatology, 3(7), 545-555.
7. Polaris Observatory HCV Collaborators. (2018). Global prevalence and burden of HCV infection and related mortality in 2017: a modelling study. The Lancet Gastroenterology & Hepatology, 3(6), 371-385.
8. Razavi, H., Robbins, S., Zeuzem, S., Negro, F., Buti, M., Duberg, A. S., ... & Blach, S. (2020). The global impact of hepatitis B virus infection: a modelling study. Journal of Hepatology, 72(5), 893-902.
9. Schreuder, T. C., Rijckborst, V., Sonneveld, M. J., & Hansen, B. E. (2020). Progress in global hepatitis elimination: Barriers and challenges. World Journal of Gastroenterology, 26(34), 5121-5135.
10. Schweitzer, A., Horn, J., Mikolajczyk, R. T., Krause, G., & Ott, J. J. (2015). Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. The Lancet, 386(10003), 1546-1555.
11. Smith, D. B., Bukh, J., & Kuiken, C. (2020). Hepatitis virus genetic diversity and molecular epidemiology. Hepatology, 72(1), 15-30.
12. Spearman, C. W., Afihene, M., Ally, R., Apica, B., Awuku, Y., Cunha, L., ... & Sonderup, M. W. (2019). Hepatitis B in sub-Saharan Africa: Strategies to achieve the 2030 elimination targets. The Lancet Gastroenterology & Hepatology, 4(7), 542-550.
13. Thomas, D. L. (2019). Global elimination of chronic hepatitis. New England Journal of Medicine, 380(21), 2041-2050.
14. World Health Organization (WHO). (2021). Global progress report on accelerating access to hepatitis C diagnostics and treatment. WHO Publications.
15. Zou, H., Nelson, K. E., Tan, Y., Hu, J., Fang, Y., & He, Y. (2020). Spatiotemporal dynamics of hepatitis B virus infection in China. Clinical Infectious Diseases, 71(11), 2853-2861.
16. Blach, S., Zeuzem, S., Manns, M., Altraif, I., Duberg, A. S., Muljono, D. H., & Razavi, H. (2017). Global prevalence and genotype distribution of hepatitis C virus infection in 2015: A modelling study. The Lancet Gastroenterology & Hepatology, 2(3), 161-176. https://doi.org/10.1016/S2468-1253(16)30181-9
17. Blach, S., Razavi, H., Batrla-Utermann, R., Waked, I., Esmat, G., Gomaa, A., & Cooke, G. S. (2022). Impact of hepatitis C virus elimination on global mortality and incidence rates. Journal of Hepatology, 77(2), 310-318. https://doi.org/10.1016/j.jhep.2022.04.013
18. Chivero, E. T., Murakami, J., Trippler, M., Mittelstädt, J., & Pietschmann, T. (2022). The role of hepatitis B virus genotypes in infection and disease progression. Frontiers in Microbiology, 13, 1026371. https://doi.org/10.3389/fmicb.2022.1026371
19. Gower, E., Estes, C., Blach, S., Razavi-Shearer, D., & Razavi, H. (2014). Global epidemiology and genotype distribution of the hepatitis C virus infection. Journal of Hepatology, 61(1), S45-S57. https://doi.org/10.1016/j.jhep.2014.07.027
20. Hajarizadeh, B., Grebely, J., & Dore, G. J. (2013). Epidemiology and natural history of HCV infection. Nature Reviews Gastroenterology & Hepatology, 10(9), 553-562. https://doi.org/10.1038/nrgastro.2013.107
21. Hajarizadeh, B., Marathe, S., & Dore, G. J. (2020). Transmission of hepatitis C virus: via healthcare and beyond. Journal of Hepatology, 73(3), 663-677. https://doi.org/10.1016/j.jhep.2020.05.046
22. Lazarus, J. V., Picchio, C. A., Dillon, J. F., Rockstroh, J. K., Weis, N., Buti, M., ... & Wiktor, S. (2021). Too many people with viral hepatitis are diagnosed late – with dire consequences. Nature Reviews Gastroenterology & Hepatology, 18(6), 337-338. https://doi.org/10.1038/s41575-021-00440-9
23. McNaughton, A. L., Lemoine, M., van Rensburg, C. J., Matthews, P. C., & Lourenco, J. (2021). Hepatitis B virus seroepidemiology data for Africa: Modelling intervention strategies. The Lancet Gastroenterology & Hepatology, 6(12), 906-917. https://doi.org/10.1016/S2468-1253(21)00189-9
24. Messina, J. P., Humphreys, I., Flaxman, A., Brown, A., Cooke, G. S., Pybus, O. G., & Barnes, E. (2015). Global distribution and prevalence of hepatitis C virus genotypes. Hepatology, 61(1), 77-87. https://doi.org/10.1002/hep.27259
25. Mansha, S., Imran, M., Shah, A. M. U. H., Jamal, M., Ahmed, F., Atif, M., ... & Bilal Waqar, A. (2017). Hepatitis B and C virus infections among human immunodeficiency virus-infected people who inject drugs in Lahore, Pakistan. Viral immunology, 30(5), 366-370.
26. Ott, J. J., Stevens, G. A., Groeger, J., & Wiersma, S. T. (2017). Global epidemiology of hepatitis B virus infection: New estimates of age-specific HBsAg seroprevalence. Hepatology, 57(4), 1333-1342. https://doi.org/10.1002/hep.26141
27. Polaris Observatory HCV Collaborators. (2018). Global prevalence and treatment of hepatitis C virus infection in 2018: Modelling study. The Lancet Gastroenterology & Hepatology, 3(6), 371-385. https://doi.org/10.1016/S2468-1253(18)30083-9
28. Pourkarim, M. R., Lemey, P., Amini-Bavil-Olyaee, S., Maes, P., Van Ranst, M., & Nevens, F. (2014). Molecular epidemiology of hepatitis B virus and hepatitis C virus co-infection among injecting drug users in Europe. Journal of Clinical Virology, 60(3), 200-206. https://doi.org/10.1016/j.jcv.2014.03.012
29. Razavi, H., Robbins, S., Zeuzem, S., Negro, F., Buti, M., Duberg, A. S., & Blach, S. (2020). Challenges in achieving the WHO goals for hepatitis C elimination. Journal of Hepatology, 72(1), 31-37. https://doi.org/10.1016/j.jhep.2019.08.027
30. Schweitzer, A., Horn, J., Mikolajczyk, R. T., Krause, G., & Ott, J. J. (2015). Estimations of worldwide prevalence of chronic hepatitis B virus infection: A systematic review of data published between 1965 and 2013. The Lancet, 386(10003), 1546-1555. https://doi. org/10.1016/S0140-6736(15)61412-X
31. Smith, D. B., Izopet, J., Simmonds, P., & Members of the International Committee on Taxonomy of Viruses. (2020). Expansion of HCV subtypes and its implications for HCV treatment and elimination. Clinical Infectious Diseases, 71(12), 3075-3083. https://doi. org / 10.1093/cid/ciaa170
32. Spearman, C. W., Afihene, M., Ally, R., Apica, B., Awuku, Y., Cunha, L., & Sonderup, M. W. (2019). Hepatitis B in sub-Saharan Africa: Strategies to achieve the 2030 elimination targets. The Lancet Gastroenterology & Hepatology, 2(12), 900-909. https://doi.org/10.1016/S2468-1253(19)30336-6
33. Vasylyeva, T. I., Smyth, B. P., Hope, V., & O'Sullivan, M. (2016). Patterns of hepatitis C virus transmission in people who inject drugs in Europe. The Journal of Infectious Diseases, 213(5), 753-761. https://doi.org/10.1093/infdis/jiv111
34. WHO. (2021). Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. World Health Organization. https://www.who.int/publications/i/item/9789240027077
35. Zou, X., Zhang, X., Wu, L., Huang, X., Liu, S., Liu, F., & Zhang, J. (2020). Spatiotemporal epidemiology of hepatitis C virus infection in China: A modelling study. The Lancet Regional Health – Western Pacific, 3, 100035. https://doi.org/10.1016/j.lanwpc.2020.100035
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Farkhanda Bismil
Pakistan Mint Hospital Lahore, Pakistan
Hamna Tariq
Department of Molecular Biology, University of Okara, Pakistan
Ghulam Murtaza
Department of Molecular Biology, University of Okara, Pakistan
Nosheen Majeed
Department of Molecular Biology, University of Okara, Pakistan
Iqra Laiqat
Department of Molecular Biology, University of Okara, Pakistan
Tayyaba Bibi
Department of Molecular Biology, University of Okara, Pakistan
Muhammad Masood Ahmed
Pharmacy College Nishtar Medical University Multan, Pakistan
Khawar Ali
Department of Molecular Biology Virtual University of Pakistan
Moeen Zulfiqar
Department of Molecular Biology, University of Okara, Pakistan
Muhammad Saleem
Department of Molecular Biology, University of Okara, Pakistan