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Letter
Hepatitis B Infection, Eastern
India
Kamalesh Sarkar,*
Dwijendra N. Ganguly,† Baisali Bal,* Malay K. Saha,* and Sujit K. Bhattacharya*
*National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal,
India; and †Kolkata National Medical College, Kolkata, West Bengal, India
Suggested citation
for this article:
Sarkar K, Ganguly DN, Bal B, Saha MK, Bhattacharya MK, Bhattacharya
SK. Hepatitis B infection, eastern India [letter]. Emerg Infect Dis
[serial on the Internet]. 2004 Jul [date cited]. Available from:
http://www.cdc.gov/ncidod/EID/vol10no7/03-0766.htm
To the Editor: The National Institute of Cholera and Enteric Diseases
(ICMR), Kolkata, India, conducted a serologic study in July 2003 to determine
the rate of hepatitis B virus (HBV) infection of brothel-based commercial
sex workers. These study participants worked in the South-24 Parganas
district of West Bengal, one of the eastern states of India. Routine immunization
to prevent HBV infection is not a practice in India, and chronic HBV infection
is endemic (1). The nature of their work makes commercial
sex workers more vulnerable to HBV infection, which could accelerate the
infection’s spread into the general community, particularly in areas with
low literacy rates and socioeconomic status.
The study participants were 167 commercial sex workers from three prominent
brothels, which were located in small towns and along the national highway
of the district. Blood samples from the participants were tested by using
the HBsAg unlinked anonymous method. The results showed that 23.3% (unpub.
data, National Institute of Cholera and Enteric Diseases) of the commercial
sex workers were infected with HBV. The Figure shows
the distribution of commercial sex workers and prevalence of HBV infection
by age group.
To ascertain a possible route of transmission other than sexual activity,
all study participants were questioned about their medical history, including
jaundice, injury requiring blood transfusion, surgical events, and tattooing.
The evidence indicated that HBV infection in the study participants was
not acquired by any route other than sexual activity. Since the carrier
rate of chronic HBV in the general population is approximately 5% in eastern
India (2), this increase in chronic HBV infection can
be attributed to sexual transmission.
The Figure indicates that HBV infection is not
correlated to age or duration of commercial sex work; the rate of infection
is distributed almost equally in all age groups except the 26- to 30-year-old
group in which it was slightly lower. Most of the HBV-infected commercial
sex workers likely were infected early in their profession and remained
infected throughout their lives, which led to higher rate of chronic infection
as compared with the general population.
This higher rate of chronic HBV infection among commercial sex workers
(23.3%) is of concern, particularly in a country with an estimated 4.58
million persons infected with HIV. In India, >80% of HIV infection
is transmitted sexually (3). HIV infection can affect
the natural course of HBV; sexual activity between HIV- and HBV-infected
persons could prolong the infected status of those infected with HBV,
as was shown in a previous study (4). This sexual activity
could facilitate HBV transmission, particularly in areas that have few
resources or where the rate of condom use is low or questionable.
After this study concluded, all study participants were notified of their
infection status and advised to use condoms when engaging in sexual activity.
The commercial sex workers and their family members were advised that
they should be tested for HBV infection and receive HBV vaccination if
test results were negative. Local health authorities were advised that
commercial sex workers and their clients should be vaccinated to prevent
HBV infection.
References
- World Health Organization. World health report 1998,
life in 21st century—a vision for all. Geneva: The Organization; 1998.
- World Health Organization. Health Situation in SEAR. Geneva: The Organization;
1999.
- Report of National AIDS Control Organisation (2001), New Delhi: Government
of India: 2001.
- Gilson RJ, Hawkins AE, Beecham MR, Ross E, Waite J, Briggs M, et al.
Interactions
between HIV and hepatitis B virus in homosexual men; effects on the
natural history of infection. AIDS. 1997;11:597–606.
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