Prevalence of Hcv & Hbv Among Medical Residents Innew Damietta Hospital (Al-Azhar University Hospital)

AAMJ, Vol. 11, N. 2, April, 2013 ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ PREVALENCE OF HCV & HBV AMONG MEDICAL RESIDENTS INNEW DAMIETTA HOSPITAL (AL-AZHAR UNIVERSITY HOSPITAL) Mohamed Amer Afify1*, Mohamed Negm2*, Mekky Abd-Elmonem1***, Ahmed Ali1**, Khaled El Mola1*** and Fareid Fareid Attia1*** Tropical medicine1 and Clinical pathology2 departments - Faculty of Medicine - Al-azhar University (Cairo)*, Alfayom University,Al-azhar University (Damietta)*** ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ ABSTRACT Background: Hepatitis C Virus (HCV) and hepatitis B Virus (HBV) are the most common causes of chronic liver with serious complications. Both viruses are spread mainly through blood transfusion, contaminated blood products and contaminated needles. Health care workers are of high risk for exposure (Fattovich et al., 2011). Objective: The aim of this study is to evaluate prevalence of HCV & HBV among medical residents in New Damietta Hospital Al-Azhar University Hospital to promote the preventive measures of transmission of viral hepatitis. Methods: This study was carried out among medical residents in New Damietta University hospital who are working in different departments between the period from January 2012 to January 2013 in New Damietta University hospital. One hundred medical residents in New Damietta University hospital were planned to participate in our study but 10 of them refusing the participation, only 90 residents (physicians and surgeons) were subjected to provide a written consent for enrollment . Results: Our results showed that prevalence of HBs Ag, HBc Ab, HBs Ab and HCV Ab was 0 %, 45.5%, 22.2% and 0% respectively among residents in New Damietta Hospital (Al-Azhar University). Conclusion: HBV and HCV viral infections are

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Mohamed Amer Afify et al ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ a well-recognized occupational risk for Health care workers. Health care workers in recipient and surgical departments are more exposed to anti-HBc infection among medical residents in New Damietta hospital AlAzhar University hospital.

Key words HBV, HCV, Medical residents and New Damietta hospital.

INTRODUCTION

Chronic viral hepatitis is the most common cause of chronic liver disease. Hepatitis C Virus (HCV) and hepatitis B Virus (HBV) are the most common causes with serious complications. Both viruses are spread mainly through blood transfusion, contaminated blood products and contaminated needles. Health care workers are of high risk for exposure (Fattovich et al., 2011).

One of the problems in recognizing this epidemic is that it is a "silent” epidemic. That is to say, most people who are infected do not know they are infected and have not reached the stage of the disease when clinical symptoms of liver failure begin to show (Wilkins et al., 2010).

Occupational blood-borne infections are associated with significant morbidity and mortality. Health care workers (HCWs) are exposed to hazardous blood-borne pathogens such as hepatitis B virus (HBV) and hepatitis C virus (HCV). HBV and HCV infections are serious public health problems that have consequences in terms of psychological and occupational diseases. HBV and HCV are common causes of occupational diseases transmitted from patients to HCWs and vice versa and also to HCWs' families. Fortunately, most occupational transmissions can be prevented by standard precautions (Bosques et al., 2010).

Post-exposure prophylaxis should be considered. Hepatitis B vaccine has been available since 1981. It is 95% effective in preventing infection and its AAMJ, Vol. 11, N. 2, April, 2013 ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ chronic consequences. It is the first vaccine against a major human cancer. Immunity is predicted to last at least 25 years (Cornberg et al., 2011).

No prophylactic or therapeutic vaccine against hepatitis C is available. The earlier the introduction of interferon, the higher the rate of resolved infection (Pockros et al., 2010).

SUBJECTS AND METHODS

Our study was a cross-sectional study carried out among medical residents in New Damietta University hospital (Al-Azhar University) who are working in different departments.

One hundred medical residents in New Damietta University hospital were planned to participate in our study but 10 of them refusing the participation, only 90 residents (physicians and surgeons) were subjected to provide a written consent for enrollment. The study was carried out from January 2012 to January 2013.

The residents were divided into three groups according to the period of their residence:-

-Group I: Include 17 doctors who have been worked as a residence for one year.

-Group II: Include 44 doctors who have been worked as a residence for two years.

-Group III: Include 29 doctors who have been worked as a residence for three years. Methodology

After taking an informed consent from each individual accept to participate in the study; all participants were subjected to, full personal history taking, past 309

Mohamed Amer Afify et al ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ history of HCV infection, HBV infection, HBV vaccination, blood transfusion, surgical operation, dental procedures, acupuncture, schistsomiasis, sharp exposure (needle stick and sharp injuries) during interventions (surgical operations, GIT endoscopic unit, hemodialysis unit.., etc.,), splashes to eye and sharing personal items such as toothbrushes and razors, family history to HCV infection and or HBV infection, complete clinical examination as jaundice and hepatosplenomegaly and laboratory investigations, CBC, SGPT, SGOT, GGT, s.bilirubin, s.albumin, prothrombin time, INR, blood urea, s.creatinine, hepatitis B viral markers including hepatitis B surface antigen (HBs Ag), hepatitis B core antibody (HBc Ab) and hepatitis B surface antibody (HBs Ab) by ELISA technique,Hepatitis C virus antibody (HCV Ab) by ELISA technique.It was done by COBAS CORE auto analyzer; the kits were supplied by (Roche, USA). AAMJ, Vol. 11, N. 2, April, 2013 ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ RESULTS Table (1) Basic data of the participants

I (n=17) II (n=44) III (n=29) Total t No % No % No % (Non=9 0)% P value test Age (mean ± SD) 25± 2 27± 2 29± 2 -- 0.68 0.65(NS)

Married 6 35.3 26 59.1 26 89.7 --58 64.4 Marital 14.89 0.001* status Not 11 64.7 18 40.9 3 10.3 32 35.6 Rural 7 41.2 20 45.5 8 27.6 35 38.9 0.30(Ns) Residence Urban 10 58.8 24 54.5 21 72.4 55 61.1 2.39 Past history HBV Positive 2 11.8 8 18.2 5 20.8 15 16.7 0.37 Vaccination Negative 15 88.2 36 81.8 24 79.2 75 83.3 blood Positive 0 0 0 0 0 0 0 0 a

transfusion Negative 17 100 44 100 29 100 90 100 surgical Positive 0 0 2 4.5 0 0 2 2.2 2.13 34(NS) operations Negative 17 100 42 95.4 29 100 88 97.8 Positive 0 0 0 0 0 0 0 0 schistsomiasis a Negative 17 100 44 100 29 100 90 100 dental Positive 6 35.3 21 47.7 12 41.4 39 43.3 0.83 0.65(NS) procedures Negative 11 64.7 23 52.3 17 58.6 51 56.7 Positive 0 0 0 0 1 3.4 1 1.1 acupuncture 2.12 0.34(NS) Negative 17 100 44 100 28 96.6 89 98.9 splashes to Positive 0 0 6 13.6 1 3.4 7 7.8 4.29 0.11(NS) eye Negative 17 100 38 86.4 28 96.6 83 92.2 Sharing Positive 4 23.5 9 20.5 7 24.1 20 22.2 personal 0.92(NS) 0.15 items Negative 13 76.5 35 79.5 22 75.9 70 77.8 Sharp Positive 3 17.6 18 41 9 31 30 33.3 0.21(NS) exposure Negative 14 82.4 26 59 20 69 60 66.7 3.08 other Positive 0 0 1 2.3 2 6.9 3 3.3 0.39(NS) diseases Negative 17 100 43 97.7 27 93.1 87 96.7 1.88 Table (2) Prevalence of viral markers among residents in New Damietta Hospital Total participants (n=90) + ve - ve Subjects No % No % HBs Ag 0 0 90 100 HBc Ab 41 45.5 49 54.5 Viral markers HBs Ab 20 22.2 70 77.8 HCV Ab 0 0 90 100

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I II III Total Total (n=17) (n=44) (n=29) (n=90) P detected X2 No % No % No % No % % value Negative 8 47.1 24 54.5 17 58.6 49 54.5 - Positive 9 52.9 20 45.5 12 41.4 41 45.5 100 +ve with – 0.74 veHBsAb and-ve 6 66.7 12 60 10 83.3 28 31.1 68.3 0.57 (NS) HBsAg

+ve with detected HBsAb 3 33.3 8 40 2 16.7 13 14.4 31.7 +ve with HBsAb titre >10 3 100 5 62.5 0 0 8 8.9 61.5 IU/ml 0.038* 5.07 +ve with HBsAb titre <10 0 0 3 37.5 2 100 5 5.6 38.5 IU/ml Table (4) HBc Ab in relation to personal data among studied groups HBc Ab in studied participants (n= 90) X2 P value Studied variables + ve - ve No % No % < 27 years 9 22 8 16.3

27 – 29 years 20 48.8 24 49 0.57 0.74(NS) Age groups > 29 years 12 29.2 17 34.7 Married 30 73.2 33 67.3 0.36 0.54(NS) Marital status Not married 11 26.8 16 32.7 Rural 15 36.6 20 40.8 0.16 0.68(NS) Residence Urban 26 63.4 29 59.2 Elgharbia 8 19.5 7 14.3 Elsharkia 3 7.3 2 4.1 Eldakahlia 14 34.2 13 26.5 Elmenofiya 3 7.3 5 10.2 Damietta 5 12.3 10 20.4 0.92(NS) Kafr-Elshikh 3 7.3 6 12.2 4.46

Elgiza 1 2.4 1 2 Cairo 1 2.4 2 4.1 Residence according Elkalyobia 1 2.4 1 2 to governorates Elbehira 2 4.9 1 2 Alfayom 0 0 1 2

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Figure (1) Distribution of HBc Ab in different departments Table (6) Prevalence of HBc Ab in different departments X2 P value Studied variables

Total number inside 27 11 7 5 3 6 5 26 departments n=90) HBc Ab +ve No 19 6 4 4 3 3 2 0 <0.001* among (n=41) % 70.4 4.5 57.1 80 100 50 40 0 studied 35.28 participants -ve No 8 5 3 1 0 3 3 26 (n= 90) (n=49) % 29.6 45.5 42.9 20 0 50 60 100

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Total HBcAb +ve in HBc Ab +ve participants among studied groups (n= 41) 45.5% different I (n=9) III n=(12) X2 P value Total departments II (n=20) 41.4% (n=90) (n= 41) 52.9% 45.5% Studied variables No % No % No % No % Surgical 27 19 70.4 6 66.7 9 45 4 33.3 departments Departments ICU 11 6 54.5 1 11.1 3 15 2 16.7

Internal 7 4 57.1 0 0 4 20 0 0 Cardiology 5 4 80 2 22.2 1 5 1 8.3

Rheumatology 3 3 100 0 0 1 5 2 16.7 12.96 0.05* Gynecology 6 3 50 0 0 1 5 2 16.7 Departments Clinical path. 5 2 40 0 0 1 5 1 8.3 Others 26 0 0 0 0 0 0 0 0 Others: include (4) radiology, (5) pediatric, (4) neurology, (3) tropical, (3) dermatology, (2) psychiatric, (3) ENT, (1) ophthalmology and (1) toxicology departments. Our study showed that HBs Ab was detected among (20/90) 22.2% from the participants. Table (8) Prevalence of HBs Ab among studied groups

I II III Total Total (n=17) (n=44) (n=29) (n=90) P detect X2 No % No % No % No % % value Not detected 13 76.5 33 75 24 82.8 70 77.8 _ Detected 4 23.5 11 25 5 17.2 20 22.2 100 Detected with titre <10 IU/ml 0 0 3 27.3 2 40 5 5.6 25 0.6 0.73 Detected with (NS) titre>10 IU/ml 4 100 8 72.7 3 60 15 16.7 75

Positive with 53.3 3 75 5 62.5 0 0 8 8.9 HBcAb +ve 0.45 Positive with 1.57 (NS) HBcAb -ve 1 25 3 37.5 3 100 7 7.8 46.7 AAMJ, Vol. 11, N. 2, April, 2013 ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ

Figure (2) HBs Ab among studied groups

Discussion Chronic viral hepatitis is the most common cause of chronic liver disease. Hepatitis C Virus (HCV) and hepatitis B Virus (HBV) are the most common causes with serious complications. Both viruses are spread mainly through blood transfusion, contaminated blood products and contaminated needles. Health care workers are of high risk for exposure (Fattovich et al., 2011).

Despite many publications about programs and strategies to prevent transmission, HBV and HCV infections remain major public health issue. This study looks at aspects of epidemiology, prevention, risk factors, economy, knowledge, attitudes, practice and ethics of HBV and HCV management that affect HCWs. HBV infection is a well-recognized occupational risk for HCWs (Thomas et al., 2012).

The present study aimed to study the prevalence of hepatitis B virus and hepatitis C virus among medical residents in New Damietta hospital Al-Azhar University hospital.

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Mohamed Amer Afify et al ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ This study was carried out among 90 participants of medical residents who are working in different departments in New Damietta University hospital. Statistical analysis revealed that there was no significant difference between studied groups as regard as mean age distribution. Mean age in group III (29 ± 2) was higher than that of group II (27 ± 2) and group I (25 ± 2) and age in group II was higher than that of group I. This result comes in agreement with Ola et al., (2012) who studied prevalence of HBV markers among 88 participants of Nigerian health care workers and found no significant difference between studied groups as regard as mean age distribution. On the other hand this result disagrees with that reported by (Zaghloul et al., 2013) who study prevalence of HCV Ab and HBs Ag among health care workers of Zagazig faculty of medicine and its hospitals and found that the age in health care workers (HCWs) groups was statically significant in-between them.

In our study prevalence of HBs Ag among medical residents in New Damietta hospital Al-Azhar University hospital by ELISA technique was 0 % among all studied groups. This result comes in agreement with (Roushdy., 2005) who reported that, the overall prevalence of HBs Ag among health care personnel (100 subjects) in Menoufiya governorate was 0%. .But this result disagrees with that reported by (El Fouly., 2005) who found the prevalence of HBs Ag in health care workers (563 personnel) in Ain Shams University hospitals was 21.5%.

prevalence of HBc Ab among medical residents in New Damietta hospital Al-Azhar University hospital by ELISA technique was (41/90) 45.5% among all studied groups in our study. This result comes in agreement with (Sherif et al., 1985) who studied hepatitis B virus infection among 1,866 apparently healthy residents of two Egyptian provinces representing Upper and Lower Egypt populations and found high infection rate as shown by the prevalence of anti- HBc was found in both populations (88 %). On the other hand this result AAMJ, Vol. 11, N. 2, April, 2013 ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ disagrees with (El Kadey et al., 2009) who found that prevalence of HBc Ab among health care workers in fever hospital of Banha was (53/204) 25.9 %.

In our study participants with HBc Ab positive alone, HBs Ab negative, who were lost serum HBs Ag represent (28/90) 31.1% of total participants in which interpretation is unclear which undergo four possibilities; resolved infection in an undefined time frame (most common), false positive anti-HBc (susceptible), “low level” chronic infection (occult HBV if HBV DNA detected in serum or tissue) or resolving acute infection (window phase) (CDC., 2012). In which this high prevalence rate not coincides with another study. Our result disagrees with Mirza et al (2010) who found HBc Ab alone positive among (1/346) 0.28 % of total participants of health care workers in Iran.

In our study HBc Ab positive participants with HBs Ab positive with their titre > 10 IU/ml represent (8/90) 8.9 % from total participants which denoting that they were achieving immunity post HBV infection (naturally acquired immunity).. This result comes in agreement with Mirza et al (2010) who found HBc Ab positive participants with HBs Ab positive represent (20/346) 5.8 % from total participants of health care workers in Iran. On the other hand this result disagrees with Slusarczyk et al (2012) who found HBc Ab positive participants with HBs Ab positive represent (149/961) 15.5 % from total participants of health care workers in Poland.

HBc Ab was higher in group I (52.9%) than group II (45.5%) and group III (41.4%) but not reach the statistically significance. This difference may be explained by residents of group I are newly employed with more tasks and more exposure to patients suffering from viral hepatitis especially in recipient department. These study results are consistent with that of El Kadey (2009) and Roushdy (2005) in which there was no significant difference between studied groups regarding the seroprevalence of HBc Ab among them. But this result 317

Mohamed Amer Afify et al ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ disagrees with El foully (2005) who found that there was significant difference between studied groups regarding the seroprevalence of HBc Ab among them. There is no significant association had been found between medical participants and seroprevalence of anti-HBc as regard as residence in rural and urban areas and also their residence according to governorates. This result comes in agreement with that of El Kadey A (2009) and Roushdy (2005) who found no significant association between health care personnel and seroprevalence of anti-HBc as regard as residence in rural and urban areas. But this result disagrees with Berbesh (2000) who studied prevalence of hepatitis B and C viral markers among health care personnel in Damanhur fever hospital and found significant difference between positive and negative antiHBc regarding residence in rural areas. This may be due to more health hygiene in urban areas and schistosomiasis treatment (tarter emetic injection) is more in rural areas which is risk factor of HBV virus infection.

Our study showed a statically significant association between history of sharp exposure (needle stick and sharp injuries) during interventions and seroprevalence of anti-HBc in the studied groups (25/41) 61% of positive antiHBc. Needle stick injuries among participants occurred mainly in recipient department in number between 5 to 30 sticks in-between residents. 70 % of sticks from unknown source while 20 % from hepatitis C infected patients and 10 % also from hepatitis B infected patients. Sharp injuries during interventions occurred mainly in operation rooms, recipient and surgical departments in number between 2 to 20 injuries inbetween residents. 55 % of injuries from unknown source while 25 % from hepatitis C infected patients and 20 % from hepatitis B infected patients. This result comes in agreement with that of El Kadey., (2009), Roushdy(2005) and El foully (2005) whom stated that the most common route of transmission of hepatitis B virus as an occupational risk is needle stick injuries. On the other hand this result disagrees with AAMJ, Vol. 11, N. 2, April, 2013 ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ Berbesh(2000) who studied prevalence of hepatitis B and C viral markers among health care personnel in Damanhur fever hospital and found no significant difference between history of sharp exposure (needle stick and sharp injuries) and seroprevalence of anti-HBc in the studied groups.

In our study no significant association had been found between history of dental procedures and the seroprevalence of anti-HBc in the studied groups (HCWs). This result comes in agreement with that of Daw M et al (2000) who found no significant association between history of dental procedures and the seroprevalence of anti-HBc in the studied groups (HCWs), but this result disagrees with that of El Kadey (2009) and Roushdy(2005) who found a significant association between history of dental procedures and the seroprevalence of anti-HBc in the studied groups.

The distribution of HBc Ab in different departments showed statistically significant associations with HBc Ab infection ( 41/90 was HBc Ab positive) among residents as follows; 19 subjects (19/41) 46.3% working in surgical departments, 6 subjects (6/41) 14.6% in ICU, 4 subjects (4/41) 9.8% in internal medicine department, 4 subjects (4/41) 9.8% in cardiology department, 3 subjects (3/41) 7.3% in gynecology department, 3 subjects (3/41) 7.3% in rheumatology department and 2 subjects (2/41) 4.9% in clinical pathology department. This may be due to residents working in surgical departments are more exposed to sharp injuries during interventions and needle stick injuries as a risk factor of HBV virus infection than others. This study comes in agreement with El foully (2005) who found significant difference between departments of work of the studied groups and seroprevalence of anti-HBc among them which more among surgeons. On the other hand this result disagrees with that of El Kadey (2009) who found there is no significant difference between departments of work of the studied groups and seroprevalence of anti-HBc among them. 319

Mohamed Amer Afify et al ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ Prevalence of HBc Ab in-between residents of the same department related to other departments showed statistically significant association as follows; 3 subjects (3/3) 100% in rheumatology department, 4 subjects (4/5) 80% in cardiology department, 19 subjects (19/27) 70.4% in surgical departments, 4 subjects (4/7) 57.1% in internal medicine department, 6 subjects (6/11) 54.5% in ICU department, 3 subjects (3/6) 50% in gynecology department and 2 subjects (2/5) 40% in clinical pathology department. This may be due to residents of rheumatology and cardiology departments were exposed to needle stick injuries in recipient department and there was no history of HBV vaccination in these departments compared to others as preventive measure for HBV infection and also number of residents of these departments (small sample) is lower than others.

In our study distribution of HBc Ab positive participants among studied groups in different departments is more in group III than group II and group I in ICU, rheumatology, clinical pathology and gynecology departments and it is more in group I than others in surgical and cardiology department and more in group II than others in internal medicine department. This may be due to residents who are more infected in group III (ICU, rheumatology, clinical pathology and gynecology departments) and group II (internal medicine department) show more exposure with long period of employment than others. While residents who are more infected in group I (surgical and cardiology department) may be due to their more tasks and more exposure in recipient department or during pre-employment training period.

In our study prevalence of HBs Ab which was detected among medical residents in New Damietta hospital Al-Azhar University by ELISA technique was (20/90) 22.2% among all studied groups. This result comes in agreement with Belo (2000) who found that prevalence of HBs Ab among 167 surgeons in Nigeria was (37/167) 22.2 %. On the other hand this result disagrees with AAMJ, Vol. 11, N. 2, April, 2013 ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ Slusarczyk et al (2012) who found high prevalence value of HBs Ab among health care workers in Poland which represent (943/961) 98.1 % from total participants of health care workers. This difference may be due to high vaccination programs among health care workers in Poland, Iran and Korea that makes HBs Ab with high prevalence value among them and low rate of vaccination programs in our hospital.

In our study prevalence of HBs Ab with their titre >10 IU/ml was (15/20) 75 % of total positive HBs Ab and represent (15/90) 16.7 % of total

participants.This result comes in agreement with Chiarakul et al (2007) who found participants with protective levels of anti-HBs represent (105/548) 19.2 % from total participants among health care workers at the Institute of Neurology in Thailand. On the other hand this result disagrees with Rybacki et al (2013) who found high prevalence value of HBs Ab with their titre >10 IU/ml among health care workers in Poland with percentage of 90 % of total participants (520) health care workers.

In the present study 15 participants with positive HBs Ab with their titre >10 IU/ml. Seven of them (7/15) were HBc Ab negative which represent (7/90) 7.8 % of total participants denoting immunity post HBV vaccination with past history of HBV vaccination 2-3 doses In which this low prevalence rate not coincides with another study. This result disagrees with (Slusarczyk et al., 2012) who found high prevalence value of detected HBs Ab with anti-HBc negative among health care workers in Poland which represent (794/961) 82.6 % from total participants of health care workers.

In our study 15 participants with positive HBs Ab with their titre >10 IU/ml. Eight of them (8/15) were HBc Ab positive which represent (8/90) 8.9 % of total participants denoting immunity post HBV infection (naturally acquired immunity) which discussed before. 321

Mohamed Amer Afify et al ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ In our study prevalence of HCV Ab among medical residents in New Damietta Hospital Al-Azhar University by ELISA technique was (0/90) 0 % among all studied groups. This result comes in agreement with that of Vijaya et al (2013) who studied seroprevalence of hepatitis B virus and hepatitis C virus in health care workers in India and found that prevalence of HCV Ab among studied groups of health care workers was (0/405) 0 .On the other hand this result disagrees with Zaghloul (2013) who studied prevalence of HCV antibodies and HBV surface antigen among workers of Zagazig faculty of medicine and its hospitals and found that prevalence of HCV Ab among studied groups of health care workers was (39/200) 19.5%. Also this result disagrees with El Kadey(2009) who found that prevalence of HCV Ab among studied groups of health care workers in Banha was (27/204) 13.2% .

The problem in this study is no pre-employment checkup about viral markers among residents in which pre-employment checkup does not include checkup about viral marker

CONCLUSION HBV viral infection is a well-recognized occupational risk for Health care workers. The most common route of transmission of hepatitis B virus as an occupational risk is sharp exposure (needle stick and sharp injuries) during interventions Health care workers in recipient and surgical departments are more exposed to anti-HBc infection among medical residents in New Damietta hospital Al-Azhar University hospital. Seroprevalence of anti HBc is significantly higher in this cohort of hospital employees than in the general population. High rate of close contact with patients suffering from viral hepatitis in our hospital and low rate of HBV vaccination was independ ently associated with HBV infection. AAMJ, Vol. 11, N. 2, April, 2013 ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ REFERENCES

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