Background: Very few studies have been reported on hepatitis B in the State of Azad Jammu and Kashmir, Pakistan, and none of them are specific to the prevalence and causes of hepatitis B spread among educational institutes. This study aimed to estimate the prevalence of hepatitis B infection and its associated risk factors among the University of AJ and K population. Methods: An observational, cross-sectional, and analytical study was conducted with 7015 students and employees. Hepatitis B was detected by rapid immunochromatographic tests (ICTs), enzyme-linked immunosorbent assay (ELISA), and real-time quantitative PCR. A questionnaire and interview method was used to assess the disease knowledge and associated risk factors with hepatitis B through Chi-square, Fisher’s exact test, and paired t-test. Results: Of the participants, 150 (2.13%) were found positive for the hepatitis B surface antigen (57.3% male and 42.7% female). Only 0.3% participants were found fully vaccinated against the hepatitis B virus. Among ethnic groups, the Syed tribe was found more prevalent for hepatitis B infection (40.6%), while use of contaminated mourning blades (95% CI: p = 0.0001) was found as an overlooked risk factor. Hepatitis preventive awareness sessions were found to be very significant (p = 0.0001). Conclusions: The study showed that an overlooked risk factor is playing a key role in the spread of HBV in a tribe living worldwide, which must be addressed globally to eradicate hepatitis B. In Pakistan, a country-wide annual HBV vaccination program should be launched to control hepatitis B.

OBJECTIVE: To determine the seroprevalence of hepatitis B and C among immigrants residing refugee camps in Muzaffarabad, Azad Kashmir, Pakistan, and to identify possible risk factors for HBV and HCV transmission. METHODS: Around 1,225 individuals inhabiting Muzaffarabad refugee camps, participated in the study. A qualitative Immuno-Chromatographic Technique was used for initial screening and PCR test was used for detection of HBV and HCV in participants. The major risk factors for HBV and HCV transmission were assessed using a questionnaire approach. RESULTS: Around 86 (7.0%) individuals were observed for HBsAg presence, and 215 (17.5%) individuals were found positive for Anti-HCV. Only 32 (2.6%) individuals were confirmed for HBV DNA and 126 (10.3%) individuals were positive for HCV RNA after PCR. Demographically, both HBsAg and Anti-HCV were found more prevalent in female (4.4% HBsAg and 10.8% Anti-HCV) population as compared to male (2.6% HBsAg and 6.7% Anti-HCV) population. Surprisingly, the HBsAg (23.5%) and Anti-HCV (41.1%) appeared to be more frequent in the age group 62–75 years. Previous history of hepatitis in the family (p < 0.0001), blood transfusion (p = 0.0197) dental treatment (p < 0.0001) and tattooing or piercing on any part of the body (p = 0.0028) were assessed as significant risk factors in HBV and HCV transmission. CONCLUSIONS: Presence of 7.0% HBsAg and 17.5% Anti-HCV in a small fragment of the migrant population cannot be overlooked. Lack of awareness among people and negligence of health department could escalate the situation.

Background: As the prevalence of hepatitis B continues to rise in Pakistan, our study focused on educational institutions in the state of Azad Kashmir due to the complete absence of data on this scenario concerning college populations. We aimed to assess the prevalence of hepatitis B and identify associated risk factors among the population of postgraduate colleges in Muzaffarabad city, situated in Pakistan-administered Kashmir. Methods: In this cross-sectional study, rapid immuno-chromatographic tests and real-time quantitative PCR methods were used to identify hepatitis B infection, while serum ALT levels were tested to assess their diagnostic associations with the infection level. The evaluation of risk factors was conducted through interviews using a questionnaire, and the obtained data were subjected to statistical analysis. Results: The study revealed 1.3% of participants positive for HBsAg, 0.6% tested positive for HBV, and 0.1% tested positive for HBeAg. Male participants were found to be more likely to test positive for HBsAg (odds ratio of 4.026, p=0.0074), and participants aged 30 years and above exhibited a higher prevalence (p<0.0001) for hepatitis B. The average ALT level in the HBsAg positive participants was significantly higher (p<0.0001). A significant association between HBsAg positivity and various factors including married status (p=0.0005), doing jobs (p=0.0004), getting cuts at hair salons or parlours (p<0.0001), hospitalization history (p<0.0001), blood transfusion (p<0.0001), and residence in hostels (p=0.0015) was observed. Only 0.4% participants were vaccinated against hepatitis B virus. Conclusions: Our study revealed a significant prevalence of hepatitis B among postgraduate colleges in Muzaffarabad city, emphasizing the need for targeted awareness and prevention efforts. Identifying key risk factors such as blood transfusion, hospitalization, and residence in hostels underscores the importance of tailored initiatives. Considering the low vaccination rate, comprehensive actions, including routine screening, prioritized vaccination campaigns, and the implementation of multi-marker-based testing, are essential to mitigate the impact of hepatitis B.

Chronic hepatitis B virus (HBV) infection poses a significant global health challenge, impacting millions of individuals and elevating the risk of morbidity and mortality. Antiviral therapies are the primary treatment for chronic HBV infection, but treatment resistance can occur, leading to poor clinical outcomes and an increased risk of liver complications. This case report presents the clinical trajectory of a 28-year-old male diagnosed with asymptomatic HBV infection in 2016 under the auspices of the Hepatitis Control Program, Government of Azad Jammu and Kashmir, Pakistan. Over 6 years, persistent HBsAg, HBV, and HBeAg were observed, with absent acute markers and co-infections. Initial HBV DNA viral load was 1 × 10⁴ copies/mL in 2016, escalating despite entecavir and pegylated interferons therapy, indicating multi-drug resistance. Tenofovir therapy initially reduced viral load but later exacerbated it, reaching 1.86 × 10⁶ copies/mL in 2022. Liver function abnormalities and lipid profile irregularities persisted. Urine examination consistently showed abnormalities. Pending HBV DNA sequencing results may offer insights into treatment resistance. This case underscores the need for an adaptive approach in managing chronic HBV infections within public health programs. Continuous monitoring, integration of virological and biochemical data, and a tailored treatment strategy are essential for optimizing outcomes in similar cases, stressing the importance of refining therapeutic approaches against chronic HBV infection.