Indian Journal of Medical Microbiology Medknow Publications on behalf of Indian Association of Medical Microbiology ISSN: 0255-0857 EISSN: 1998-3646 Vol. 27, Num. 1, 2009, pp. 80-81

Indian Journal of Medical Microbiology, Vol. 27, No. 1, January-March, 2009, pp. 80-81

Correspondence

Hepatitis B virus and human immunodeficiency virus infections are a public health problem even in rural communities of Vellore district, Tamil Nadu

Balaji N, Nadarajah R, Sankar S, Varadhan C

Sri Narayani Hospital and Research Centre, Sripuram, Thirumalaikodi, Vellore - 632 055, Tamil Nadu
Correspondence Address:Sri Narayani Hospital and Research Centre, Sripuram, Thirumalaikodi, Vellore - 632 055, Tamil Nadu, director@snhrc.org

Date of Submission: 19-May-2008
Date of Acceptance: 23-Aug-2008

Code Number: mb09024

Dear Editor,

Hepatitis B virus (HBV) and Human immunodeficiency virus (HIV) infections have been reported from many parts of India, especially from urban centers. ^[1] There are only a few reports from centers on the problem of these infections in rural communities. ^[2]

We report here data collected over three years starting from 2005 on HBV and HIV prevalence. This study was carried out at a 150-bed tertiary hospital. The hospital serves a large rural and tribal population of about 130,000 in a 50 km radius. The HBsAg screening was carried out by Quick Chek-HBsAg (flow through device, Morepen Laboratories Ltd, New Delhi). HIV antibody was screened by Retroquik HIV (flow through device, Qualpro Diagnostics, Goa), and the antibody status confirmed by a supplementary test ELISCAN HIV (RFCL limited, Haridwar) as per strategy IIB of the NACO guidelines. The presumed HIV positive individuals were referred to the Integrated Counseling and Testing Center, at the Government Vellore Medical College Hospital, Vellore for management. These tests were carried out as part of preoperative screening, antenatal screening, and on patients suspected to have these infections, after their verbal consent.

In our study the frequency was quite high. Of the 6233 individuals screened between 2005 and 2007, 106 (1.7%) were HBsAg positive. Among these, 2493 were from rural areas with HBsAg positive rate being 1.97%. In the periurban population the frequency was 1.52% of 3740 individuals. There was no statistically significant difference between the two groups (Chi square test; P > 0.05). Studies from rural areas on the frequency of HBV infection as measured by detection of HBsAg have shown a high frequency in Tamilnadu, ^[1] Punjab, ^[2] and Maharashtra. ^[3] The percent frequency has been in around 5%. In rural areas, outbreaks of HBV infections have also been reported to be associated with injection practices. ^[4] The reasons for the high frequency of HBV infections in our rural population needs to be investigated. An earlier study reported that poor injection practice, high risk sexual behavior, and transmission in childhood could be important factors. ^[1]

In our hospital between the years 2005 and 2007, 94 (1.85%) of 5085 individuals from rural and periurban communities tested were HIV antibody positive. Among these, 2034 individuals were exclusively from rural communities. The HIV antibody frequency was 1.72%. In the peri group, the frequency was 1.93% of 3051 individuals. There was no statistically significant difference between the two groups (Chi square test; P > 0.05). There are only a few reports on the frequency of HIV in rural communities. ^[5],[6] One particular study from Tamil Nadu, ^[5] carried out in the mid-1990s indicated 7% frequency among rural population. Another study from Tamil Nadu carried out on samples collected in 1999 and 2000, indicated a relatively low frequency of only 0.66% among rural people. The NACO statistics presently indicates a country wide reduction in the frequency and the estimate for the general population is 0.3-0.4%. However, the rates are ten times higher among high risk groups. The rural communities in our service area have high frequency of HIV, suggesting a need to intervene with an AIDS awareness program.

References

1.	Kurien T, Thyagarajan SP, Jeyaseelan L, Peedicayil A, Rajendran P, Sivaram S, et al . Community prevalence of hepatitits B infection and modes of transmission in Tamil Nadu, India. Indian J Med Res 2005;121:670-5.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.	Werner GT, Fronsner GG, Sareen DK. Prevalence of serological markers for viral hepatitis and AIDS in rural Punjab. J Commun Dis 1989;21:139-41.  Back to cited text no. 2
3.	Sonwane BR, Birare SD, Kulkarni PV. Prevalence of seroreactivity among blood donors in rural population. Indian J Med Sci 2003;57:405-7.  Back to cited text no. 3  [PUBMED]
4.	Singh J, Gupta S, Khare S, Bhatia R, Jain DC, Sokhey J. A severe and explosive outbreak of hepatitis B in a rural population in Sirsa district, Haryana, India: Unnecessary therapeutic injections were a major risk factor. Epidemiol Infect 2000;125:693-9.  Back to cited text no. 4  [PUBMED]
5.	Solomon S, Kumarasamy N, Ganesh AK, Amalraj RE. Prevalence and risk factor of HIV - 1 and HIV-2 infection in urban and rural areas in Tamil Nadu, India. Int J STD AIDS 1998;9:98-103.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.	Kang G, Samuel R, Vijayakumar TS, Sridharan G, Brown D, Wanke C. Community prevalence of antibodies to human immunodeficiency virus in rural and urban Vellore, Tamil Nadu. Natl Med J India 2005;18:15-7.  Back to cited text no. 6  [PUBMED]

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