Egypt is considered by WHO as intermediate area as regards epidemiology of HBV [16]. Between 1980 and 2007, studies detected that HBV prevalence in Egypt was 6.7% generally, 11.7% in Upper Egypt, 4.6 in Lower Egypt, and 4% in pregnant women [17]. In a cross sectional study performed in 2015, 1.4% of general Egyptian populations were positive for HBV with 1.9% prevalence in males, and 1.1% prevalence in females [18].
Our study showed that HBsAg prevalence was 1.54% in pregnant women. In Egypt, many studies were made to identify prevalence of hepatitis B in different states. Similar study in 2016–2017 in Alexandria showed that HBsAg prevalence in pregnant females was 3.39% [19]. However, sample size in each study and different socioeconomic status could result in some variability in results of studies in different Egyptian states and differences throughout the countries. In Ismailia, 18.3% of women were HBcAb positive, and 5% were HBsAg positive [20]. HBsAg seropositivity was found to be 1.56% in Benha in agreement with our study [21]. In Upper Egypt, sero-prevalence of HBsAg was 4.8% in Assiut [22].Findings of the present study were similar to findings in Libya and Algeria. Both had low prevalence rates (1.5% and 1.6%) respectively [23]. However, Differences were detected in Saudi Arabia (4.1%) [24], Pakistan (4.6%) [25], Sudanese antenatal clinics (10.2%) [26], and Nepal (17%) [27].This study showed that rural areas had HBV cases more than urban areas but the difference was not statistically significant. However; in another study in Minia, rural areas were significantly higher in prevalence than urban areas, which could be explained by different educational level, and presence of home delivery in rural areas [28]. As regards age, HBV was more prevalent in those ≥ 27 years with significant statistical difference. However, no significant difference detected as regards gestational age in the present study. Similar findings were reported in Ethiopia, Saudi Arabia [29, 30]. Yohanes et al; agreed with our study that gestational age was not significantly related to hepatitis B infection [31]. However; in Alexandria, no significant association was detected between age or gestational age and HBV [19].
In our study, multigravidae and primigravidae did not differ significantly. This was in agreement with previous study made in Benha [21], and in Nigeria [32]. However, Azhar et al; stated that multigravidae had higher percentage of infection because of multigravidae exposure to many risk factors as multiple pregnancies, blood transfusion, and hospital admission [33].Occupation is a risk factor for HBV infection. People who work as physician or medical staff have chance to catch the infection many times than general population [34]. Our study showed that working in health care fields was a significant risk factor for HBV acquisition. This was in agreement with Eke et al; who reported that about 25% of health care workers were HBsAg positive [35]. However, results of studies made by Taseer et al; and Sharifi-Mood et al; were not significant as regards the occupation [25, 36]. Our study also detected significant prevalence of HBsAg positivity in those with family history of HBV. This might be due to presence of contaminated infected surfaces with HBV in living areas of chronic infected ones. This was in agreement with other studies also [11].
Although blood transfusion is a risk factor for hepatitis B transmission, it was not that in this study and other studies in Egypt, Mexico, and Saudi Arabia [11, 37, and 38]. This could be due to application of screening of blood donors. However; in other countries, blood transfusion was an important risk factor [25].In our study many cases of HBV did not take vaccine before (p = 0.045). Many Egyptian studies had similar findings because many pregnant women were born before of the introduction of vaccine [33, 35]. There were some risk factors which were not significantly associated with HBV prevalence in this study (IV drug or syringe use, hospital admission, history of endoscopic procedures, history of Shistosomiasis, and tattooing), and these findings were in agreement of some studies and in disagreement with others. Taseer et al; reported the association between hepatitis B infection and multiple injection therapy [25]; also, addiction of patient's husband was found to be a significant risk factor in another study [21]. Previous studies reported non significant difference between HBsAg positive and negative ones as regards history of hospital admission [11, 39]. However, many other studies found the significant role of hospitalization in presence of HBV infection [40].
Our study detected a significant association between HBsAg positivity and history of surgery and as well as history of dental procedures. Another study was similar to our study in which 80% of HBsAg positive cases were set for surgeries [11]. However, previous surgery was not significant risk factor in some other studies [19, 21]. Also, other studies detected that dental procedures were no longer significant risk factor for HBV. This might be attributed that large number of patients in our sample underwent dental procedures [11, 24].Our study detected that 2 (6.67%) of 30 cases were immunotolerant with HBeAg positive and high viral load. They needed follow up and introduction of therapy in the last trimester to prevent fetal acquisition. The remaining 28 cases were carriers with HBeAg negative and low viral load. This percentage was similar to an Egyptian study made by Elsabaawy et al; in 2020. This study detected (82.4%) HBeAg negative and 33(17.6%) HBeAg positive [41]. However; in studies in Ismailia and Benha, all cases were HBeAg negative and HBeAb positive [20, 21]. Reduction of HBeAg positivity in HBV infected ones in Egypt might be attributed to improve vaccination coverage [42].
A Saudi Arabian study estimated that prevalence of HBeAg positivity was < 5%. [43]. HBeAg was negative in more than 98% and 96% of cases in Iran and Oman respectively [44, 45]. Similar pattern of prevalence of HBeAg negativity was detected in France, Greece, Italy, Portugal, and Spain [46–51].