Prevalence of hepatitis B and C in blood transfusion center, Oujda Morocco (2013-2015)

Viral hepatitis is a serious public health problem. Its epidemiology is not precisely known in Morocco. Our objective was to assess the prevalence of HBV and HCV in a particular population of “blood donors” at the Regional Blood Transfusion Centre in Oujda. A retrospective study was conducted from May 1, 2013 to May 31, 2015. Thirty-one thousand nine hundred and fifty-two blood donors were tested. Antigen detection was made according to ELISA technique (MonolisaTMHBs Ag ULTRA). HCV research was performed by ELISA using the kit « Monolisa HCV Ag-Ab ULTRA ». 177 blood donors included, they are divided into 155 male (87.6%) and 22 female (12.4%) subjects with a ratio of 7. The average age was 37.64 ± 12 years. Six cases were positive for HCV with an overall prevalence of 0.02%. The population study by sex shows a prevalence of 0.004% for 23177 male sera and 0.057% for 8775 female sera. Six donors were HCV positive, of which 05 were female (83.33%) and one was male (16.66%). The average age was 43 ± 14 years. Co-infection with HCV HBV-HCV and HCV-Syphilis and HCV-HIV are absent. Co-infection with HBV and HIV was found in one case. HBV-syphilis co-infection was found in 04 cases. Chronic viral hepatitis is a real global health problem. Its prevalence is currently estimated at 0.55% for HBV and 0.02% for HCV, reclassifying Morocco as a low endemic area. The prevention remains the most effective method to successfully control HBV and HCV infection.


Introduction
Hepatitis Virus B (HBV) and C (HCV) Viruses are a major public health problem worldwide. The World Health Organization (WHO) has estimated that 2 billion people have been infected with HBV and that approximately 350-400 million of them are chronic carries of HBV surface antigen (HBs Ag) [1,2]. One hundred seventy (170 million) chronic HCV cases or 3% of the general population with a large geographical variation, have high risk of progression to cirrhosis and hepato-cellular carcinoma (HCC) [3]. It is estimated that more than 300,000 new cases of HCC are observed annually [3].
One million people die each year from this disease because of the complications of chronic hepatitis and its consequences. The epidemiology of HBV and HCV infection in Morocco was studied.
Through a recent Moroccan study on the general population, the WHO has estimated that 3 million of people are chronically infected with hepatitis B or C. This figure is an alarming sign and reclasses Morocco among the countries where these diseases are endemic in the world [2,3]. Before the introduction of the hepatitis B vaccination into the immunization program, the WHO concluded that Morocco has an intermediate prevalence of hepatitis B. Currently, the epidemiology of hepatitis B is not precisely known in our country [1,2]. The main objective of this study was to assess the prevalence of HBV and HCV in a particular population of "Blood Donors" at the Regional Blood Transfusion Center of Oujda.

Methods
This is a retrospective descriptive study conducted at the Regional  (Figure 1).

Discussion
Hepatitis C: the HCV identification uses the following targets: Serological markers: anti-HCV antibodies and HCV Ag; the viral nucleic acid: HCV RNA. In Morocco, only serology for hepatitis C is mandatory in blood donors [3]. In France, in addition the serology, the research for HCV RNA is obligatory for any blood donations [5].
In our study, hepatitis C was identified by the research of antigen and hepatitis C antibodies. Kit "Monolisa HCV Ag-Ab ULTRA "has been used for screening and Kit" INNO -LIA HCV " for confirmation of HCV [5,9].

Sample: the population of blood donors
In our study, there was a significant increase in the number of blood donors at the Regional Blood  [15].
However, the prevalence of HBs Ag in our series is lower than that observed in Tunisia (3.6%) [16] and Mauritania (20.3%) [17]. There was also a significant decrease in the prevalence of HBs Ag among blood donors at the Regional Blood Transfusion Centre compared of  [11].

HCV prevalence
The WHO estimated that in 1999, 2.9% of the world's population was living with HCV infection [18], knowing that no data were available in 57 countries. In Morocco, the exact prevalence of HCV infection is not well known. The WHO classifies Morocco in an area of average HCV prevalence, with a prevalence ranging from 1 to 2.49% [19]. In our study, the prevalence of HCV infection is 0.02%, which places the Oujda region in the low prevalence area, these results show a significant decrease in HCV prevalence compared to Dr Moussi´s study conducted at the same centre between 1996 and 2000 which indicated a prevalence of 0.42% [11], we also note a low prevalence compared to studies on blood donors in different transfusion centers in Morocco with a maximum prevalence (1.1%) in Casablanca [19].
Compared to the Maghreb countries, the prevalence of HCV positive serum in our series is lower than that observed in Tunisia (0.56%) [20], Algeria (0.2%) [21] and Mauritania (1.1%) [17]. The figures in our series are in addition to those recorded in France with a prevalence of 0.03%, in an interesting study of 383,000 blood donors in 2012 [5]. In Africa, there is a very high heterogeneity of prevalence rates observed, ranging from 0% in Zambia to 26.6% in Egypt [22]. In our study, we found a higher prevalence of anti-HCV among female blood donors (83.33%), this Page number not for citation purposes 4 predominance of women can be explained by some of the more common social risk practices among women (blood transfusion during delivery, tattooing). There is also a prevalence of 50% in the > 45 age group, which is also found in Dr. Moussi's study at the Regional Blood Transfusion Centre in Oujda (1996-2000) [11].

Dosing of ALT
When the hepatitis C screening test is introduced, the search for increased ALT levels is not identifiable in terms of improving transfusion safety according to the WHO and for this reason, routine ALT testing of blood donors is not recommended [8]. In Morocco, the systematic determination of ALT in blood donors is obligatory [23].

Co-infection
In Dr MOUSSI's study conducted at the Regional Blood Transfusion study at the regional blood transfusion centre in Oujda. In our study, no cases of HBV/HCV co-infection were noted. This can be explained by the low prevalence of HCV in our series. In Morocco, the study found 0.13% co-infection with HBV and HCV [25], compared to 0.03% co-infection in the study by Zouhdi et al. [26].

Competing interests
The authors declare no competing interests.

Authors' contributions
All authors contributed to the development of this work, read and approved the final version of the manuscript.