Transmission of Hepatitis B Virus among Prison Inmates in Ghana

Abstract

Background: Data on the transmission of hepatitis B virus (HBV) within correctional facilities is limited in Ghana, even though the prevalence suggests intra-prison transmission. Aim: This study determined the level of transmissibility, new infections, and intra-prison transmission of HBV among inmates in Ghana Methodology: Immunoglobulin M antibodies to hepatitis B core antigen (anti-HBc IgM) and Hepatitis B e antigen (HBeAg) were determined for 323 archived plasma samples obtained from a nationwide prison survey. Risk factors for high HBV transmissibility and recent infections were determined using Pearson‟s chi square test, t test and a binary logistic regression analysis. The Surface (S) gene was sequenced for 17 plasma samples, 9 of which were from one prison and 8 with recent infections from other prisons. Phylogenetic analysis and sequence identity matrix were used to establish possible transmission within a selected prison. Results: Out of the 323 HBsAg positive samples screened, 91(28.2%) were HBeAg positive and 16 (5.0%) were anti-HBc IgM positive. HBeAg was found to be strongly associated with the type of prison (p< 0.001) and the length of stay within the prison (p= 0.033). Fever, genital pain and discharge were also found to be significantly associated with recent infections (p=0.040) and transmissibility (p= 0.005, p=0.010), respectively. Majority (62.5%) of the anti-HBc IgM positive inmates had been

incarcerated for more than one year. Although there was no specific intra-prison clustering of sequences, an identity matrix revealed a narrower similarity range for intra-prison sequences than for inter-prison sequences. All sequences clustered with HBV genotype E with the exception of two which clustered with subgenotypeA3/genotype E recombinant. Conclusion: Recent infections suggest that there is on-going transmission within the prisons. The high HBeAg prevalence may be attributed to lack of adequate nutrition and poor healthcare due to long duration of stay.