A landmark study reveals crisis-level HBV/HCV infections in Pakistan's heartland
In Pakistan's heartland, a silent epidemic rages. Hepatitis B and C viruses (HBV/HCV) have infected millions in Punjab—home to 110 million people—with prevalence rates dwarfing global averages. A landmark 2017–18 study screened over 140,000 Punjabis, revealing crisis-level infections: 8.4% HBV and a staggering 42.7% HCV positivity 1 4 . By comparison, Egypt—previously considered the world's HCV epicenter—has a 7% HCV prevalence. This article unpacks the science behind Punjab's epidemic and the urgent roadmap to elimination.
The multicenter study identified alarming clusters across Punjab's 24 districts:
| District | HBV Prevalence | HCV Prevalence |
|---|---|---|
| Muzaffargarh | 26.0% | 65.2% |
| Rajanpur | 20.3% | 58.1% |
| Shujabad | 18.9% | 66.4% |
| Khanewal | – | 45.0% |
58.8% HCV prevalence—highest of any group 1
40% HCV positivity due to occupational injuries and limited protective gear 5
29.8% HCV infection from frequent blood transfusions 6
The Pakistan Kidney and Liver Institute (PKLI) led this massive cross-sectional study:
141,705 participants tested at 24 clinics via ELISA (HBsAg for HBV, anti-HCV for HCV) 1
12,427 high-risk subjects completed detailed questionnaires on medical/social practices 3
Multivariable regression identified drivers of infection (OR >1; p<0.05) 4
| Research Tool | Function | Study Role |
|---|---|---|
| ELISA Kits | Detects viral antibodies/antigens in blood | Initial screening of all subjects |
| PCR Systems | Quantifies viral load via RNA/DNA amplification | Confirmed active infection |
| Structured Questionnaires | Captures risk behavior data | Mapped exposure pathways |
Accounted for 34% of transmissions (OR=3.1) 7
28% of infections linked to unsterilized instruments 1
Thalassemia patients faced 30× higher HCV risk 6
Contributed to 19% of cases (shared razors) 1
Used contaminated blades (OR=2.8) 4
Only 11.3% of women were ever tested for hepatitis
Pakistan's 2030 hepatitis elimination goal requires:
Only 12% of Punjab's women know HBV is vaccine-preventable
Target youth via universities—IUB's model vaccinated 12,912 students/employees 7
| Knowledge Factor | Women with Awareness | Impact on Behavior |
|---|---|---|
| Heard of HBV/HCV | 88.3% | – |
| Knew prevention methods | 34.8% | 4× higher testing uptake |
| >10 Years of schooling | 41.2% | 75% lower infection risk |
Source:
Punjab's hepatitis epidemic is treatable but demands unified action. The 2017–18 study proved that targeting high-risk groups and reforming medical practices can slash infections. With cost-effective diagnostics and generic antivirals now available, elimination is feasible. As researchers warn: "Sustainable funding and policy enforcement are non-negotiable" 1 4 . The silent epidemic need not remain silent.