Hepatitis B and C among blood donors in Tartous city, Syria. A Retrospective study


Houssam Hamdane1, Rim M. Harfouch2*

1Department of Laboratory Medicine, Faculty of Medicine, Tartous University, Syria.

2Department of Microbiology and Biochemistry, Faculty of Pharmacy, Al Andalus University, Qadmous, Syria.

*Corresponding Author E-mail:



Aim of study: This study is the first done in the blood bank of Tartus to study the percentage of infected donors with hepatitis B and C. The aim was to determine the serological prevalence of Hepatitis B and C infection among Syrians, and factors that increase the risk of infection. Method of study: The subjects  were blood donors at the Blood Transfusion Center in Tartus city from 02/01/2017 to 31/12/2017, all personal data of donors relating to age, gender, professional status and medical. history were recorded. After collecting blood units, a blood sample of 5 ml was taken in the EDTA tube for testing, using Enzyme -Linked Immunosorbent Assay (Biokit®, Spain), we calculated  the value of CUT-OFF according to the manufacturer's instructions. at any positive result, the tube was retested in duplicate before final interpretation. The statistical comparison was conducted and the p value of <0.05 was considered statistically significant. Results: The study showed a significant decrease in the number of donors with hepatitis B and C in Tartus governorate, which makes this percentage the lowest in Syria and developing countries, and reduce state spending on patient’s treatment. Conclusion: The study emphasizes the importance of spreading the culture of blood donation because, in addition to the fact that blood donation is a humanitarian duty, tests performed free in blood banks, may alert us early to infection with these diseases, and the results are reported to the Ministry of health, which may be remedied in the premiere stages.


KEYWORDS: Hepatitis B Virus (HBV),: Hepatitis C Virus (HCV), Hepatitis B Surface Antigen (HbsAg), blood donors



Hepatitis B and C continue to be an important cause of morbidity and mortality around the world. Several local and international studies have been conducted involving population groups in major cities, leaving knowledge gaps in relation to relatively smaller cities, such as Tartous city. Numerous studies have shown that higher prevalence of hepatitis B virus positive factor in blood donors reflects an increase in infection rates in patients receiving recurrent blood.1,2 There are 2 billion people living with hepatitis B, with an estimated 360 million people having chronic hepatitis B and around 600,000 deaths each year from either HBV-related liver disease or hepatocellular carcinoma worldwide.3



13 million people are infected with chronic hepatitis B virus in the European Union and about 15 million others are chronically infected with hepatitis C4 The World Health Organization's 2017 World Hepatitis Report suggests that the vast majority of these people are unable to access life-saving tests and treatment, and as a result, millions of people are at risk of slow progression of chronic liver disease, cancer and mortality.5


The hepatitis B vaccine was included in the national vaccination program in Syria during the early 1990s based on a three-dose regimen given after birth, in the third and in the seventh month.6 Surface antigen antibodies that protect against the surface antigen in 90% of immunocompetent individuals appear after the three doses.



The is a retrospective cohort study that included all 24,166 blood donors in the blood transfusion center of Tartous city during the year of 2017. Personal data were recorded for all donors related to age, gender, professional status and their medical history. After a clinical examination to ensure the ability to donate, donor was directed to the blood-picking room where a blood unit was harvested, and a blood sample of 5 ml was taken in an EDTA tube for laboratory tests, using the ELISA method, and kits from BIOKIT company, Spain. The cut-off value was calculated based on the manufacturer’s instructions, and at any positive result, the tube was re-examined doubly, before the final interpretation of the results.


Blood donors were considered a random sample representing the entire community of Tartous city, because the donation includes all population groups from the age of 18 to 60, and most of them donate their blood voluntarily, in addition to other categories (blood donors for a specific person, youth at the age of recruitment, young university graduates, and citizens who want to obtain driving licenses). We excluded phlebotomy patients, as their blood is drained and not utilized, and no studies are conducted for blood safety checks for them, we also excluded the destroyed blood units due to poor manufacturing, excess weight or hemolysis.



Screening of hepatitis B virus:

Among the 24,166 donors, the serological HbsAg tests were negative for 24030 subjects, which constitutes the vast majority of the studied donors group (99.4%), while the number of patients who had positive HbsAg tests reached 136, or 0.56% of the donors.


Classification of HBV patients according to gender:

Results show that 92% of the infected donors are male, while the percentage of infected females is about 8% of the donors, and this may be due to the fact that males are more susceptible to infection than females because of the nature of life and wrong habits such as the use of non-sterile shaving tools.  When comparing the numbers of infected donors, 4264 women were HbsAg negative among all 4275 female blood donors, and the number of infected women was 11, while the number of infected males who had HbsAg positive tests was 125 among all 19891 male blood donors. As it is demonstrated in the following table:


Table (1): Classification of HBV patients according to gender



HbsAg positive



HbsAg negative







Classification of HBV patients according to age:

When HBV infected subjects were divided into two age groups, the first for those born before 1993, and the second for those born later on, we observe the following table:

Table (2): Classification of HBV patients according to age

Groups according to age



Born before 1993



Born before 1993







This table is important to illustrate the effectiveness of the national vaccination program against hepatitis B that was implemented in Syria starting in 1993. 83.1% of total infected subjects were born before 1993, this high percentage is related to the fact that they did not receive the vaccination against HBV, with a significant correlation (P <0.0001). The table shows a significant decrease in the number of infections for ages 24 and below, 16.9% (23 out of 136 infected people), which may be attributed to failure to complete the vaccination program by the parents (three doses) or that this strain carry mutations on the gene of epitope regions of surface antigen5, or have impaired immune response mainly among these people for different reasons.


Screening of hepatitis C virus:

The data of blood transfusion center in Tartous city show that among 24,166 donors, tests were negative for anti-HCV antibodies for 99.52% of total donors, while the percentage of infected individuals who had positive antibodies reached 0.48%.


Table (3): Screening of hepatitis C virus


HCV positive

HCV negative











Classification of HCV patients according to gender:

The table shows that 92% of infected subjects are male, and this result is similar to hepatitis B data. The difference in ratios is statistically significant (P <0.05).


Table (4): Classification of HCV patients according to gender



HCV positive



HCV negative








Our study included 24,166 blood donors at Tartous Blood Transfusion Center during year of 2017, to shed light on the spread of hepatitis B, C infection. Donors’ blood safety tests were performed and HBsAg surface antigen was investigated, of whom 19891 (82.3%) were males and 4275 (17.7%) were females.


We found that 24030 (99.44%) citizens were HbsAg negative and 136 (0.56%) cases were HbsAg positive, divided into 125 (0.56%) infected males and 11 (8%) infected females. This result may be explained by the fact of wrong habits and life style of males such as the use of non-sterile shaving tools as well as tattoo tools in some centers and beauty salons, where these centers are not subject to health control standards.

When the donors were divided into two age groups, the first was born before 1993 (who did not receive the national vaccination against hepatitis B) and the second category was born after 1993 and they are all supposed to have undergone this program. Hepatitis B there were 113 people (83.1%) who were born before 1993, and 23 people (16.9%) were born after 1993, (P <0.0001), which may be attributed either to neglect by the family and health authorities in the Ministry Health that does not have a mandatory mechanism for imposing vaccines and punishing those left behind for the fact that infection with these diseases is an economic burden and Large community, or it may be due to missing one of the three required doses of the vaccine against the surface antigen of the virus, or that immunization was not effective.6


The fact that 23 infected persons born after 1993 out of 24,166 people (0.01%) are relatively small, and confirm that these cases are individual cases that may be easily explained by the responsible authorities in the Ministry of Health, which is supposed to be entrusted with the task of communicating with patients and interrogating them medically, and not only Inform them of the results of laboratory tests - as is currently done - in order to draw conclusions and take lessons and avoid them in the future.


A study carried out by the Ministry of Health in the governorates of Damascus and Aleppo in 2004 showed 3168 individuals that the prevalence of infection in Damascus is about 5.6% for hepatitis B and 2.8% for hepatitis C and there was a clear geographical difference with a greater prevalence in Aleppo, where It reached 10.14% for hepatitis C and 10.5% for hepatitis B, and Al-Jazeera by more than 10% for hepatitis B, while in our study the percentage did not exceed 0.56% for HBV and 0.48% for HCV.7


In a study conducted in Iran8, the prevalence of hepatitis B was 3%, the distribution of which showed that hepatitis C virus prevalence varied in different governorates from 0.87% to 8.86%. The hepatitis B virus rate was higher in Golestan (8.86%) and lower in the Kurdistan Region (0.87%).


A European study showed that the prevalence of hepatitis B virus and hepatitis C virus is low to moderate in most of the European Union / EEA countries, but the situation is diverse and dynamic, due to the arrival of immigrants, national estimates of seroprevalence in the general population vary from 0.1% to 4.4% for HBV, and from 0.1% to 5.9% for HCV. 9



Applying surveillance for infection cases to direct public health policies is very important to control the spread of viral hepatitis and this requires the availability of epidemiological data, which confirms the urgent need for credible data from serological surveys on a large scale which is present in the current study.


Improvisation sterilizes medical tools used in circumcision, tattoo and ear piercing, as well as cupping in addition to the dangers of digging containers - the fact that garbage in our country is not subject to scientific standards regarding medical waste - including needles from pharmacy waste and others, to a great risk in the transmission of infection, and must In addition to avoiding these matters, it is necessary to require dentists to investigate the accuracy required to sterilize their tools, as well as hairdressers and popular cleansers.


The HBV vaccine is considered one of the best means to protect society from hepatitis B, especially in areas with medium and high epidemiology and is given in three doses. The level of response and the formation of high protective antibodies in children reach more than 95% and about 90% at the middle age, which indicates the necessity of vaccinating all the newborns with the hepatitis B vaccine in the first 24 hours of the child’s age and adherence to the three doses, as well as spreading awareness in the community about prevention methods, especially among high-risk groups, and the necessity of remedial vaccinations for those who missed the vaccination program in Syria.



The authors declare no conflict of interest



1.         Ansari SH, Shamsi TS, Khan MT, Perveen K, Farzana T, Erum S. Seropositivity of hepatitis C, hepatitis B and HIV in chronically transfused B-thalassaemia major patient. Jcoll Physicians Surg Pak. 2012;22 (9): 610-1

2.         Al-Sheyyab M, Batieha A, El-Khateeb M. The prevalence of hepatitis B, hepatitis C and human immune deficiency virus markers in multi-transfused patients. J Trop Pediatr. 2001; 47(4):239-42

3.         Zeng F, Guo P, Huang Y, et al. Epidemiology of hepatitis B virus infection: results from a community-based study of 0.15 million residents in South China. Sci Rep. 2016; 6:36186. Published 2016 Nov 7.

4.         Yacoub R, Al Ali R, Moukeh G, Lahdo A, Mouhammad Y, Nasser M. Hepatitis B vaccination status and needlestick injuries among healthcare workers in syria. J Glob Infect Dis. 2010;2(1):28–34

5.         H. Bashour and G. Muhjazi , Hepatitis B and C in the Syrian  Arab Republic: a review. Eastern Mediterranean Health Journal,  2016. 22(4): 267-73

6.         Sharifi Z, Milani S, Shooshtari MM. Study on efficacy of hepatitis B immunization in vaccinated beta thalassemia children in Tehran. Iran J Pediatr. 2010; 20(2):211-5.

7.         Karim M, Laham H. Prevalence of viral hepatitis B and C in Syria. Syrian Epidemiol Bull. 2008; 3:10-11

8.         Mohammadi Z., Keshtkar A., Eghtesad S., Jeddian A., Pourfatholah AA., Maghsudlu M., Zadsar M., Mahmoudi Z., Shayanrad A., Poustchi H., Malekzadeh R. Epidemiological Profile of Hepatitis B Virus Infection in Iran in the Past 25 years; A Systematic Review and Meta-analysis of General Population Studies. Middle East J Dig Dis. 2016 Jan;8(1):5-18.

9.         Tavoschi L., Duffell E., de Carvalho Gomes H., Amato-Gauci A. European Centre for Disease Prevention and Control. Systematic review on hepatitis B and C prevalence in the EU/EEA. Stockholm: ECDC; 2016. Catalogue number TQ-02-16-837-EN-N. https://www.ecdc.europa.eu/sites/default/ files/media/en/publications/Publications/systematic-review-hepatitis-B-C-prevalence.pdf







Received on 29.02.2020           Modified on 01.04.2020

Accepted on 15.05.2020         © RJPT All right reserved

Research J. Pharm. and Tech. 2021; 14(1):442-444.

DOI: 10.5958/0974-360X.2021.00080.9