Molecular Prevalence and Causes of Hepatitis B Virus Infection in District Bannu Khyber Pakhtunkhwa, Pakistan

Viral Hepatitis is a diseases of liver in which infl ammation of liver cells occur. The word Hepatitis is the combination of two words, according to the Greek word hepar means the “liver” and the Latin word means the “infl ammation” so the liver have an effect on and hinder its ability to renew. Liver is a soft and elastic organ that complete different function such as blood fi ltration (break down of harmful substance, remove bacteria and injure Red blood cells) and production of bile that is store in a gall bladder and then release in small intestine for fat digestion. Hepatitis caused liver cells failure and then infl ammation of the liver also. Hepatitis B virus (HBV) is a hepadnavirus. Hepatitis B is a viral disease that causes liver infl ammation [1,2]. Hepatitis B is caused by the hepatitis B virus (HBV), the HBV make attacks the liver cells and causing acute as well as chronic hepatitis. Acute hepatitis produces simple sign and symptoms from which people get well soon, while chronic hepatitis symptom are more subtle and treatment is focused on to check long term liver injure and spread of the disease. When infection is appeared, it may be acute or chronic (long-term) [3]. Acute hepatitis B (affecting approximately 20% of people infected) is usually a low grade sickness from which people totally recover. The chronic form of hepatitis B (affecting approximately 20% of people infected) is more serious and mainly lead to complications if not treated at proper time, such as liver cirrhosis (scarring of the liver), liver malfunction and liver cancer [4]. Hepatitis B infection is the main health problem all over the world About 2 billion people are infected with Hepatitis B Virus (HBV) worldwide of which 350 million are chronic HBV transporter. Each year approximately 1 to 2 million people die from HBV related complications such as chronic hepatitis, cirrhosis and hepatocellular carcinoma [5,6].


Introduction
Viral Hepatitis is a diseases of liver in which infl ammation of liver cells occur. The word Hepatitis is the combination of two words, according to the Greek word hepar means the "liver" and the Latin word means the "infl ammation" so the liver have an effect on and hinder its ability to renew. Liver is a soft and elastic organ that complete different function such as blood fi ltration (break down of harmful substance, remove bacteria and injure Red blood cells) and production of bile that is store in a gall bladder and then release in small intestine for fat digestion. Hepatitis caused liver cells failure and then infl ammation of the liver also. Hepatitis B virus (HBV) is a hepadnavirus. Hepatitis B is a viral disease that causes liver infl ammation [1,2]. Hepatitis B is caused by the hepatitis B virus (HBV), the HBV make attacks the liver cells and causing acute as well as chronic hepatitis. Acute hepatitis produces simple sign and symptoms from which people get well soon, while chronic hepatitis symptom are more subtle and treatment is focused on to check long term liver injure and spread of the disease. When infection is appeared, it may be acute or chronic (long-term) [3]. Acute hepatitis B (affecting approximately 20% of people infected) is usually a low grade sickness from which people totally recover. The chronic form of hepatitis B (affecting approximately 20% of people infected) is more serious and mainly lead to complications if not treated at proper time, such as liver cirrhosis (scarring of the liver), liver malfunction and liver cancer [4]. Hepatitis B infection is the main health problem all over the world About 2 billion people are infected with Hepatitis B Virus (HBV) worldwide of which 350 million are chronic HBV transporter. Each year approximately 1 to 2 million people die from HBV related complications such as chronic hepatitis, cirrhosis and hepatocellular carcinoma [5,6].
Citation: Tawab  nose and ear stabbing/shrill, reuse of non-refundable syringes and distribution needles with drugs abusers, sharing personal things such as razors, toothbrushes, and sexual and delayed close up personal contact with infected person are also the widespread ways of HBV transmission [7].
Pakistan is highly endemic (9 million people infections across the country), with 3% chronic HBV carriers, its transmission and the speed of this disease is increasing day to passing day [8].
High frequency of HBV was observed in ecological areas of low fi nancial group, which underscores the importance in controlling this disease because approximately, 67.5% of the Pakistani population belongs to rural areas of low fi nancial group. This study was planned with the main aim to determine the causes and molecular prevalence of HBV infection in district Bannu Khyber Pakhtunkhwa Pakistan, as limited data is available about the HBV infection in this province of the country.

Study/ Experimental area
The research study was conducted in the District Bannu Khyber Pakhtunkhwa province, Pakistan, as all the research's experimental work was conducted in Hematology lab and PCR section in Khalifa Gulnawaz Teaching hospital Bannu. Blood samples and investigational data were collected from patients attending the Institute of Khalifa Gull Nawaz. Patients belonging to different areas of Bannu were included in this study.

Study sample
For the diagnosis of anti HBV antibodies a total of 500 blood sample were collected from gender patients, (300 males and 200 females) were examined, directed by clinicians of HBV in the Khalifa Gull Nawaz Teaching Hospital Bannu. All the persons were aged between 01-60 years arranged into three groups including aged, adults and children. Informed permission was collected from all the people included in this study and the most considerable and specifi c was the permission from children parents for permit us to do experiments and collect data for completion of our work without taking any risk. Out of which 78 (26%) males and 48(24%) females were reported positive for anti HBV antibodies and then these were additional processes for the fi nding of HBV DNA. Individuals including 75 (25%) males and 47 (23.5%) females were found positive for HBV DNA while the lasting 4patients including 2 males and 2 female result were negative. Took blood from patient and then centrifuged at 10,000 RPM for 15 mints to separate serum. Testing performed directly after the sample has been collected. Sample may stored at 2-8 ºC for up to 3 days. For long term storage, specimens should be kept below -20ºC.

HBV screening
HBV screening was carried out with ICT (Immunochromatographic Technique) for fi nding anti HBsAg and other such as HBsAb, HBeAb, and HBc AB.

HBs Ab
It is also called as Hepatitis B surface. "Positive" or "reactive"

HBe Ab
Is one of the antibodies formed by the body when it defend itself against hepatitis B.These antibodies are aimed at against the "soluble" or extractable piece of the "core" antigen of the Hepatitis B Virus (HBV).

HBc Ab
It is also known as the Hepatitis B core antibody. The

Micro-well based ELISA (Enzyme linked Immunosorbent
Assay) for detection of Antibodies to HBV in human serum.

HBV PCR
PCR (polymerase chain reaction) are used to identify HBV in the serum of patient blood. PCR is a test on molecular stage to identify presence of HBV and Viral load.

Results
The epidemiological study of Hepatitis B was conducted in district Bannu from January, 2018 to April, 2018. Total 500samples of males (n=300) and females (n=200) were studied in a Khalifa Gull Nawaz Teaching Hospital of Bannu. The Data was collected Gender-wise and Age-wise. For detection of HBV all the Samples were examined by ELISA, ICT and PCR Tests.

Sex-wise distribution of HBV in general population of district Bannu
For the identifi cation of anti HBV antibodies total 500 population 47 (23.5%) male population was more infected 75 (25%) (Figure 1).

Age-wise distribution of HBV in general population of Bannu
The patients of 01-60 years of age were categorized into three groups Aged, Adults and Children's. After demonstration, it was found that the rate of HBV infection was directly related to age i.e. higher the age higher was the rate of HBV infection ( Figure 2).The highest HBV infection was found in the agegroup of 41-60 years (32%) categorized as Aged, lowest in the age-group of 01-20 years (10%) as the Children and moderate in the age-group of 21-40 years which is the Adults is (13.33 %) ( Table 2).
The above graph shows the sex-wise distribution of HBv +ve in the general population of District Bannu KP Pakistan.
The green color cone shape strip shows the total samples, the blue color cone shape strip shows the males and the red color In the above graph there shown the age-wise distribution of HBv +ve in total sample with a percentage in general population of district Bannu KP Pakistan. The patients of 01-60 years of age were categorized into three groups. After demonstration, it was found that the rate of HBV infection was directly related to age i.e. higher the age higher was the rate of HBV +ve infection, as shown by the above mentioned graph.
The highest HBV infection was found in the age-group of 41-60 years which was 64 and is 32%, shown by red colour cone shape strip as compare to other age-groups. There shown a moderate percentage found in the age-group of 21-40 years

Discussion
The word Hepatitis is the combination of two words, according to the Greek word hepar stand for the "liver" and the Latin word stand for the "infl ammation" so liver is affected and stop its capacity to reform Hepatitis B is a viral infection that causes the liver infection [1,2]

Conclusion
HBV is a major health trouble internationally affects more than a few people all over the world and increase gradually with the increase in age i-e direct proportional to the age factor.
Similarly the percentage and amount of Hepatitis B was highest in male as comparison to female population which may be due to the fact that male has dominancy in the society, performs different activities The HBV has a high prevalence rate in Bannu