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KWAME NKRUMAH UNIVERISTY OF SCIENCE AND TECHNOLOGY, KUMASI DEPARTMENT OF MOLECULAR MEDICNE SEROPREVALENCE OF HEPATITIS B AMONG RECIPIENTS OF THE WHO- EPI VACCINE 10 YEARS AFTER THE INTEGRATION OF THE HEPTITIS B VACCINE IN TO THE EPI OF WA MUNICIPALITY, GHANA. THESIS SUBMITTED TO THE DEPARTMENT OF MOLECULAR MEDICINE IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF A MASTER OF SCIENCE IN CHEMICAL PATHOLOGY By ISSAKA KORAY NUHAILA OCTOBER, 2016 i DECLARATION We hereby declare that the work presented, except for references to the other people’s which have been duly acknowledged is entirely the product of our own effort carried out in the Department of Molecular Medicine under the supervision of Prof. Mrs. M. Frempong. This is an original research work which have neither in a whole nor part been submitted anywhere for any other degree. ISSAKA KORAY NUHAILA Signature:…………………………………. (PG6034111) Date: …………………………………… PROF. (MRS) M. FREMPONG Signature:……………………………….. (Supervisor) Date:……………………………………. PROF. F. A YEBOAH Signature:………………………………. (Head of Department) Date: …………………………………. DEPT. OF MOLECULAR MEDICINE ii DEDICATION I dedicate this work to my dear mother, Mrs Salamatu Koray, whose love and support has brought me this far, to all my guardians and mentors and to all the children who participated in this study. iii ACKNOWLEDGMENT To God Almighty who knows our end from the beginning, who is able to do just what He says He will do and has made all things beautiful in our lives be praise now and forever- Amen. My profound gratitude and sincere thanks goes to my Lecturer and project supervisor, Professor Mrs Margaret Frempong and the entire staff of the department of molecular medicine for the tremendous support, advice and guidance which enabled me to produce this report. My utmost thanks goes to the Wa Municipal director of Health service, Mrs Beatrice Kunfaah, the Wa Municipal Director of Education, Mr Alhassan Sulemana, the teachers and staff of all the primary schools within the Wa Municipality, the Medical director and staff of the Upper West Regional Hospital and Laboratory, the Director and staff of Navrongo Research centre , Navrongo, for their technical support. I am also grateful to my entire family and all my loved ones for the encouragements and support especially to the staff of Kaara Diagnostic Services, the entire staff of the Biochemistry Department KNUST and the Regional Hospital Laboratory, Wa, for their tremendous support. I am truly grateful and indebted to you all and May God richly bless you. iv TABLE OF CONTENTS DECLARATION ................................................................................................................ ii DEDICATION ................................................................................................................... iii ACKNOWLEDGMENT.................................................................................................... iv LIST OF TABLES ............................................................................................................. ix LIST OF FIGURE............................................................................................................... x ABBREVIATIONS ........................................................................................................... xi ACRONYMS & ABBREVIATIONS................................................................................ xi ABSTRACT ..................................................................................................................... xiii CHAPTER ONE ............................................................................................................... 1 INTRODUCTION............................................................................................................. 1 1.0 BACKGROUND ....................................................................................................... 1 1.2 STATEMENT OF PROBLEM ................................................................................. 4 1.3 JUSTIFICATION .................................................................................................... 5 1.4 AIM ........................................................................................................................... 6 1.4.1 SPECIFIC OBJECTIVES ................................................................................... 6 CHAPTER TWO .............................................................................................................. 7 LITERATURE REVIEW ................................................................................................ 7 2.1 HEPATITIS B VIRUS .............................................................................................. 8 2.2 NATURAL HISTORY AND CLINICAL MANIFESTATIONS OF HBV INFECTION .................................................................................................................... 8 2.3 ACUTE HEPATITIS B ............................................................................................. 9 2.4 CHRONIC HBV INFECTION ............................................................................... 11 v 2.5 TRANSMISSION ................................................................................................... 13 2.6 GLOBAL PATTERNS OF TRANSMISSION ....................................................... 16 2.7 PREVENTION ........................................................................................................ 20 2.8. THE INVENTION OF THE HEPATITIS B VACCINE....................................... 20 2.8.1 Hepatitis B Vaccine .............................................................................................. 21 2.8.2 Response To Vaccination ..................................................................................... 22 2.8.3 Vaccine Safety...................................................................................................... 24 2.8.4 Duration Of Immunity .......................................................................................... 26 2.9 HEPATITIS B VIRUS VARIANTS ...................................................................... 27 2.9.1 Hepatitis B Vaccine Recommendations And Program Implementation .............. 28 2.9.2 Impact Of Hepatitis B Vaccination ...................................................................... 32 2.9.3 Countries With High Endemicity ......................................................................... 32 2.9.4 Challenges To Hepatitis B Prevention ................................................................. 34 2.9.5 Perinatal Transmission ......................................................................................... 35 CHAPTER THREE ........................................................................................................ 37 METHODOLOGY ......................................................................................................... 37 3.1 STUDY AREA ...................................................................................................... 37 3.2 STUDY DESIGN .................................................................................................... 38 3.3 SAMPLE SIZE ........................................................................................................ 38 3.4. ETHICAL APPROVAL ......................................................................................... 39 3.5 STUDY POPULATION ......................................................................................... 39 3.5.1. Vaccinated children ............................................................................................. 39 3.5.2. Non vaccinated Children ..................................................................................... 40 3.6 ASSAYS FOR SEROLOGICAL TESTING .......................................................... 41 vi 3.6.1 Qualitative Analysis of HBV serological markers: HBsAg, HBsAb, HBeAg, HBeAb and HBcAb. .................................................................................................. 42 3.6.2. Quantitative Determination Of Anti-Hbs (ELISA). ............................................ 43 PRINCIPLE ................................................................................................................... 44 PROCEDURE ............................................................................................................... 45 CHAPTER FOUR ........................................................................................................... 47 RESULTS ........................................................................................................................ 47 4.0 Prevalence of HBV infection among children in the Wa municipality................... 48 4.1 HBV infection markers among non-vaccinated children in the Wa Municipality. 48 4.1.2. Distribution of HBV infection markers among vaccinated children................... 49 4.2 DISTRIBUTION OF HBV INFECTION MARKER ACROSS AGE GROUPS AMONGST VACCINATED CHILDREN....................................................................... 53 4.3.0 Distribution of anti – HBs among vaccinated children. ....................................... 54 4.3.1 Sero protection rates across gender ...................................................................... 56 4.3.2. Seroprotection rates across age groups ............................................................... 57 4.3.3 Compliance with the vaccine dosages .................................................................
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