Seroprevalence and risk factors of hepatitis A virus infection in Zakho City, Kurdistan region, Iraq: A population-based study

Nawfal Hussein; Ibrahim Naqid; Halder J  Abozait; Shakir Jamal; Delovan Albrifkani; Mateen Ahmed; Passar Abdullah; Amed Sharif; Sarbast Yasin; Siaband Miho; Awin Saeed; Yousif Yousif; Rozhgar Ali; Naji Mohammed; Ahmed Muhammad; Morad Adam; Dildar Musa; Nashwan Ibrahim; Zana Saleem

doi:10.23750/abm.v96i6.17336

Seroprevalence and risk factors of hepatitis A virus infection in Zakho City, Kurdistan region, Iraq: A population-based study

Authors

Nawfal R Hussein Department of Biomedical Sciences, College of Medicine, University of Zakho, Zakho independent administration, Kurdistan Region, Iraq https://orcid.org/0000-0002-7813-9198
Ibrahim A Naqid Department of Biomedical Sciences, College of Medicine, University of Zakho, Zakho independent administration, Kurdistan Region, Iraq https://orcid.org/0000-0002-7223-2690
Halder J Abozait Department of Biomedical Sciences, College of Medicine, University of Zakho, Zakho independent administration, Kurdistan Region, Iraq https://orcid.org/0009-0003-8035-2443
Shakir A Jamal Department of Biomedical Sciences, College of Medicine, University of Zakho, Zakho independent administration, Kurdistan Region, Iraq
Delovan Albrifkani Department of Medicine, College of Medicine, University of Duhok, Duhok, Kurdistan Region, Iraq
Mateen Dilsher Ahmed Department of Medical Education Development, College of Medicine, University of Zakho, Zakho independent administration, Kurdistan Region, Iraq
Passar Sulaiman Abdullah Department of Medical Education Development, College of Medicine, University of Zakho, Zakho independent administration, Kurdistan Region, Iraq
Amed Mesoud Sharif Department of Medical Education Development, College of Medicine, University of Zakho, Zakho independent administration, Kurdistan Region, Iraq
Sarbast Ibrahim Yasin Department of Medical Education Development, College of Medicine, University of Zakho, Zakho independent administration, Kurdistan Region, Iraq
Siaband Sabri Miho Department of Medical Education Development, College of Medicine, University of Zakho, Zakho independent administration, Kurdistan Region, Iraq
Awin Hussein Saeed Department of Medical Education Development, College of Medicine, University of Zakho, Zakho independent administration, Kurdistan Region, Iraq
Yousif Salah Yousif Department of Medical Education Development, College of Medicine, University of Zakho, Zakho independent administration, Kurdistan Region, Iraq
Rozhgar Salah Ali Department of Medical Education Development, College of Medicine, University of Zakho, Zakho independent administration, Kurdistan Region, Iraq
Naji Muhsen Mohammed Department of Medical Education Development, College of Medicine, University of Zakho, Zakho independent administration, Kurdistan Region, Iraq
Ahmed Islam Muhammad Department of Medical Education Development, College of Medicine, University of Zakho, Zakho independent administration, Kurdistan Region, Iraq
Morad Rayan Adam Department of Medical Education Development, College of Medicine, University of Zakho, Zakho independent administration, Kurdistan Region, Iraq
Dildar H Musa Department of Surgery, College of Medicine, University of Duhok, Duhok, Kurdistan Region, Iraq
Nashwan MR Ibrahim Department of Surgery, College of Medicine, University of Duhok, Duhok, Kurdistan Region, Iraq
Zana SM Saleem Department of Medicine, College of Medicine, University of Duhok, Duhok, Kurdistan Region, Iraq

Keywords:

hepatitis A virus (HAV), seroprevalence, risk factors, Iraq, population-based study

Abstract

Background and aim: Hepatitis A virus (HAV) is a major cause of acute hepatitis globally, with higher burden in low- and middle-income countries. Iraq is considered hyperendemic, yet limited regional data are available, particularly from Zakho city. This study aimed to evaluate the seroprevalence of HAV and identify associated risk factors in the general population of Zakho.

Methods: A cross-sectional study was conducted in Zakho from February 1 to March 1, 2025. A multistage random sampling approach was used to select 391 participants. Information was collected through structured self-administered questionnaires, and blood samples were tested for HAV IgG.

Results: The average age of participants was 33.53 ±13.34 years; 65% were male, and 93.9% lived in urban areas. The overall HAV seroprevalence was 34.5%, with the highest rates found in individuals aged 20–29. No significant associations were found concerning gender (p = 0.772), age (p = 0.095), or water source (p = 0.295). However, handwashing habits were significantly related to HAV status (p = 0.026).

Conclusions: The lower HAV prevalence in Zakho compared to national statistics indicates improvements in sanitation and hygiene. Nevertheless, proper hand hygiene remains critical, underscoring the importance of targeted public health education.

References

1. Mohajan HK. Liver diseases: Epidemiology, prevention, and management strategy. J Innov Med Res. 2025;4(2):19–25.

2. Kurra P, Sravani D, S D. Hepatitis-A: Review on current and future scenario. J In Silico In Vitro Pharmacol. 2018;3(1):e15. doi:10.21767/2469-6692.100015.

3. World Health Organization. The global prevalence of hepatitis A virus infection and susceptibility: a systematic review. Geneva: World Health Organization; 2010.

4. World Health Organization. Hepatitis A [Internet]. Geneva: World Health Organization; 2025 [cited 2025 Nov 6]. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-a.

5. Itani T, Jacobsen KH, Nguyen T, Wiktor SZ. A new method for imputing country-level estimates of hepatitis A virus endemicity levels in the Eastern Mediterranean region. Vaccine. 2014;32(46):6067–74. doi:10.1016/j.vaccine.2014.09.006.

6. Hussein NR, Abozait HJ, Naqid IA, et al. Risk factors of hepatitis B virus infection in the Kurdistan region of Iraq: A cross-sectional study. Mediterr J Hematol Infect Dis. 2025;17(1):e2025018.

7. Hussein NR. Prevalence of HBV, HCV and HIV and anti-HBs antibodies positivity in healthcare workers in departments of surgery in Duhok City, Kurdistan Region, Iraq. Int J Pure Appl Sci Technol. 2015;26(2):70–6.

8. Hussein NR. Risk factors of hepatitis B virus infection among blood donors in Duhok City, Kurdistan Region, Iraq. Caspian J Intern Med. 2018;9(1):22–6.

9. Hussein NR, Saleem ZSM. Successful treatment of hepatitis C virus genotype 4 in renal transplant recipients with direct-acting antiviral agents. Am J Transplant. 2016;16(7):2237–8.

10. Khalil AS, Hussein NR, Shamdeen MY. Impact of maternal HBsAg carrier status on pregnancy outcomes in Duhok City, Iraq. Asian Pac J Trop Biomed. 2017;7(11):1010–3.

11. Merzah MA, Mohammed AAAG, Hassan Al-Aaragi AN, Salim M. Epidemiology of viral hepatitis from 2007 to 2016 in Karbala Governorate, Iraq. J Res Health Sci. 2019;19(2):e00445.

12. Abdullah I, Goreal A. Seroprevalence of anti-hepatitis A virus antibody in Iraq. East Mediterr Health J. 2022;28(11):829–34. doi:10.26719/emhj.22.087.

13. Turky AM, Akram W, Al-Naaimi AS, Omer AR, Al-Rawi JR. Analysis of acute viral hepatitis (A and E) in Iraq. Glob Health Sci. 2011;3(1):70–6. doi:10.5539/gjhs.v3n1p70.

14. Darwish LAA, Nasrallah HAA, Al Mousaw A. Hepatitis A in Kerbala: Eight-year epidemiological study, Karbala J. Med. 2018; 11(1):3873–83.

15. United Nations. Our work on the Sustainable Development Goals in Iraq [Internet]. 2024 [cited 2025 Nov 6]. Available from: https://iraq.un.org/en/sdgs/.

16. Bizri AR, Fares J, Musharrafieh U. Infectious diseases in the era of refugees: Hepatitis A outbreak in Lebanon. Avicenna J Med. 2018;8(4):147–52. doi:10.4103/ajm.AJM_130_18.

17. Yilmaz A. Hepatitis A seroprevalence in Erzurum, Turkey. Ann Agric Environ Med. 2020;27(3):481–4. doi:10.26444/aaem/125394.

18. Karimi A, Imani-Rastabi R, Moezzi M, Moradi M-T. Hepatitis A seroprevalence and associated risk factors: A community-based cross-sectional study in Shahrekord, Iran. Arch Clin Infect Dis. 2016;11(1):e32288. doi:10.5812/archcid.32288.

19. Kareem N, Al-Salahat K, Bakri FG, Rayyan Y, Mahafzah A, Sallam M. Tracking the epidemiologic shifts in hepatitis A sero-prevalence using age stratification: A cross-sectional study at Jordan University Hospital. Pathogens. 2021;10(9):1081. doi:10.3390/pathogens10091081.

20. Theajeal RF, Al Hadeethi BM, Jasim AZS, Abdullah BK. Hepatitis A profile: Epidemiological, clinical and outcomes in Children’s Welfare Teaching Hospital and the need for hepatitis A vaccine programme setting. J Fac Med Baghdad. 2025;67(1):10–8. doi:10.32007/jfacmedbaghdad2410.

21. Buckley CE 3rd, Dorsey FC. The effect of aging on human serum immunoglobulin concentrations. J Immunol. 1970;105(4):964–72. doi:10.4049/jimmunol.105.4.964.

22. Karasahin EF, Karasahin O. Hepatitis A seroprevalence and demographic risk factors in the susceptible population: A cross-sectional study. Eur Rev Med Pharmacol Sci. 2023;27(11):4936–41. doi:10.26355/eurrev_202306_32610.

23. Merat S, Rezvan H, Nouraei M, et al. Seroprevalence and risk factors of hepatitis A virus infection in Iran: A population-based study. 2010 Mar;13(2):99–104. PMID: 20187662.

24. Cahyono YH, Azizah R, Martini S, Sulistyorini L. Risk factor analysis of the incidence of hepatitis A in Indonesia: A meta-analysis. Poltekita J Ilmu Kesehat. 2023;17(3):1074–82. doi:10.33860/jik.v17i3.2614.