ACİL SERVİSE MÜRACAAT EDEN HASTALARIN HEPATİT A, B VE C SEROPREVALANSININ RETROSPEKTİF ANALİZİ

Yıl 2026, Cilt: 16 Sayı: 1, 13 - 23, 15.03.2026

Ramazan Kıyak , Tuğba Kula Atik , Asli Gamze Şener

https://doi.org/10.16919/bozoktip.1764521

https://izlik.org/JA96FS36WF

Öz

Giriş: Viral hepatitler, dünya genelinde yüksek morbidite ve mortaliteye yol açan önemli enfeksiyonlardır. Dünya Sağlık Örgütü (DSÖ), 2030 yılına kadar hepatit B (HBV) ve hepatit C’yi (HCV) elimine etmeyi hedeflemektedir. Türkiye, HBV açısından orta düzey endemisiteye, HCV açısından ise düşük prevalansa sahiptir. Acil servisler hem akut hepatit vakalarının hem de tanı almamış taşıyıcıların saptanmasında stratejik öneme sahiptir.
Yöntem: Ocak 2020–Aralık 2024 arasında Balıkesir Üniversitesi Tıp Fakültesi Hastanesi Acil Servisi’nde hepatit A, B veya C’ye yönelik en az bir serolojik test yapılan 4.687 hasta retrospektif olarak incelendi. Dahil edilme kriteri, başvuru sırasında hepatit serolojisi istenmiş olmasıydı. Eksik verili veya mükerrer kayıtlar dışlandı. Demografik veriler, başvuru nedenleri ve laboratuvar sonuçları hastane kayıtlarından elde edildi. Testler ELISA yöntemiyle çalışıldı. İstatistiksel analiz SPSS 26.0 ile yapıldı, p<0,05 anlamlı kabul edildi.
Bulgular: Toplam 19.100 test sonucu değerlendirildi. Anti-HAV IgG (%59,9) ve Anti-HBs (%43,9) en yüksek pozitiflik oranlarına sahipti. Aktif enfeksiyon belirteçleri (Anti-HAV IgM, Anti-HBc IgM, Anti-HCV, HBsAg) %1’in altında saptandı. En sık başvuru nedenleri kanama (%48,4), gebelikle ilişkili şikâyetler (%23,9) ve düşme (%13,8) idi. Mevsimsel olarak başvurular en çok sonbaharda gerçekleşti. Hastaların %52,1’i taburcu edildi, %47,9’u ise Kadın Doğum, Ortopedi, Genel Cerrahi ve Gastroenteroloji kliniklerine yatırıldı.
Sonuç: Türkiye’de HAV ve HBV’ye karşı yüksek bağışıklık düzeyi, aşılama programlarının başarısını yansıtmaktadır. Aktif enfeksiyon oranlarının düşük olması olumlu bir tablo sunarken, tespit edilen az sayıdaki taşıyıcı, acil servis tabanlı taramaların önemini ortaya koymaktadır. Acil servislerde yaygın tarama stratejilerinin sürdürülmesi, viral hepatit eliminasyon hedeflerine ulaşmada kritik rol oynayabilir.

Anahtar Kelimeler

viral hepatit , seroprevelans , acil servis , hepatit taraması

RETROSPECTİVE ANALYSİS OF HEPATİTİS A, B, AND C SEROPREVALENCE AMONG PATİENTS PRESENTİNG TO THE EMERGENCY DEPARTMENT

https://izlik.org/JA96FS36WF

Öz

Introduction: Viral hepatitis is a significant infection that causes high morbidity and mortality worldwide. The World Health Organization (WHO) aims to eliminate hepatitis B (HBV) and hepatitis C (HCV) by 2030. Turkey has moderate endemicity for HBV and low prevalence for HCV. Emergency departments play a strategic role in identifying both acute hepatitis cases and undiagnosed carriers.
Method: Between January 2020 and December 2024, 4,687 patients who underwent at least one serological test for hepatitis A, B, or C at the Emergency Department of Balıkesir University Faculty of Medicine Hospital were retrospectively reviewed. The inclusion criterion was that hepatitis serology was requested at the time of presentation. Incomplete or duplicate records were excluded. Demographic data, reasons for presentation, and laboratory results were obtained from hospital records. Tests were performed using the ELISA method. Statistical analysis was performed using SPSS 26.0, with p < 0.05 considered statistically significant.
Results: A total of 19,100 test results were evaluated. Anti-HAV IgG (59.9%) and Anti-HBs (43.9%) had the highest positivity rates. Active infection markers (Anti-HAV IgM, Anti-HBc IgM, Anti-HCV, HBsAg) were detected in less than 1% of cases. The most common reasons for presentation were bleeding (48.4%), pregnancy-related complaints (23.9%), and falls (13.8%). Seasonally, the highest number of presentations occurred in the fall. 52.1% of patients were discharged, while 47.9% were admitted to Obstetrics, Orthopedics, General Surgery, and Gastroenterology clinics.
Conclusion: The high level of immunity against HAV and HBV in Turkey reflects the success of vaccination programs. While the low rates of active infection present a positive picture, the small number of carriers detected highlights the importance of emergency department-based screening. Continuing widespread screening strategies in emergency departments may play a critical role in achieving viral hepatitis elimination goals.

Anahtar Kelimeler

viral hepatitis , seroprevalence , emergency department , hepatitis screening

Destekleyen Kurum

YOKTUR

Kaynakça

• 1. World Health Organization. Global health sector strategies on HIV, viral hepatitis and sexually transmitted infections, 2022–2030. Geneva: WHO; 2022.
• 2. Farbod Y, Kankouni H, Moini M, Fung S. Hepatitis B-induced hepatocellular carcinoma: understanding viral carcinogenesis and disease management. J Clin Med. 2025;14(7):2505
• 3. Badell ML, Prabhu M, Dionne J, Tita AT, Silverman NS, Society for Maternal-Fetal Medicine (SMFM) Publications Committee, et al. Society for maternal-fetal medicine consult series #69: hepatitis B in pregnancy—updated guidelines. Am J Obstet Gynecol. 2024;230(4):B2–11.
• 4. Aygen B, Gurbuz Y, Cetinkaya RA, Cinar G, Kayabas U, Ormen B, et al. Management of chronic hepatitis C virus infection: a consensus report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases – 2023 update. Klimik J. 2023;36(S1):43–76
• 5. Elbahrawy A, Atalla H, Alboraie M, Alwassief A, Madian A, El Fayoumie M, et al. Recent advances in protective vaccines against hepatitis viruses: a narrative review. Viruses. 2023;15(1):214.
• 6. Marrapu S, Kumar R. Chronic hepatitis B: prevent, diagnose, and treat before the point of no return. World J Hepatol. 2024;16(10):1151–7.
• 7. Razavi-Shearer D, Gamkrelidze I, Nguyen MH, Chen DS, Van Damme P, Abbas Z, et al. Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modeling study. Lancet Gastroenterol Hepatol. 2018;3(6):383–403
• 8. Razavi-Shearer D, Gamkrelidze I, Pan C, Jia J, Berg T, Gray R, et al. Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modeling study. Lancet Gastroenterol Hepatol. 2023;8(10):879–907
• 9. Shin EC, Jeong SH. Natural history, clinical manifestations, and pathogenesis of hepatitis A. Cold Spring Harb Perspect Med. 2018;8(9):a031708
• 10. Dandekar, PD. Journey with jaundice: a narrative review on the global health perspective of hepatitis A virus and its impact on the modern world. Emerging Human Viral Diseases, Volume II: Encephalitic, Gastroenteric, and Immunodeficiency Viral Infections, 2024. p. 493–507.
• 11. Lemon SM, Ott JJ, Van Damme P, Shouval D. Type A viral hepatitis: a summary and update on the molecular virology, epidemiology, pathogenesis and prevention. J Hepatol. 2018;68(1):167–84
• 12. Doğan HD, Baştarcan Ç. The mystery of hepatitis B prevalence: hepatitis B and pregnancy. Izmir Democracy Univ Health Sci J. 2021;4(1):118–35.
• 13. Yılmaz S, Yılmaz S, Çetinkaya RA, Türker T, Avcı İY, Beşirbellioğlu BA, et al. An epidemiological overview of anti-HBc total test positivity in blood banking practice. Gulhane Med J. 2016;58(2):174–6.
• 14. World Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections 2021: accountability dashboard. Geneva: WHO; 2022.
• 15. Bhamidimarri KR, Satapathy SK, Martin P. Hepatitis C virus and liver transplantation. Gastroenterol Hepatol (N Y). 2017;13(4):214–20.
• 16. Çaşkurlu H, Vural H, Gündüz R, Uludağ MB. Evaluation of acute hepatitis B patients epidemiologically and clinically. Viral Hepat J. 2025;31(1):8–12.
• 17. Montrief T, Koyfman A, Long B. Acute liver failure: a review for emergency physicians. Am J Emerg Med. 2019;37(2):329–37.
• 18. Ciftci IH, Koroglu M, Demiray T, Terzi HA, Kahraman Kilbas EP. Age-specific seroprevalence of hepatitis A virus in Turkey between 2000 and 2023: systematic review and meta-analysis. Diagnostics. 2024;14(22):2464.
• 19. Akman AÖ, Burhan BY, Uzun AK, Taş D. Hepatitis A virus age-specific seroprevalence after implementation of a toddlers' vaccination program in Turkey: shifting susceptibility to adolescents. Turk Arch Pediatr. 2020;55(4):370-5
• 20. Tosun S, Deveci S, Kasırga E. Effect of a nationwide universal HBV vaccination program and catch-up vaccination campaign on HBV prevalence in children. Viral Hepat J. 2021.
• 21. Tozun N, Ozdogan O, Cakaloglu Y, Idilman R, Karasu Z, Akarca U, et al. Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a TURHEP fieldwork study. Clin Microbiol Infect. 2015;21(11):1020–6.
• 22. Karaca, C., Cakaloğlu, Y., Demir, K., Ozdil, S., Kaymakoğlu, S., Badur, S., et al. Risk factors for the transmission of hepatitis C virus infection in the Turkish population. Dig Dis Sci 2006;51(2), 365-9.
• 23. Polaris Observatory Collaborators. Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modeling study. Lancet Gastroenterol Hepatol. 2018;3(6):383–403.
• 24. Galbraith JW, Franco RA, Donnelly JP, Rodgers JB, Morgan JM, Viles AF, et al. Unrecognized chronic hepatitis C virus infection among baby boomers in the emergency department. Hepatology. 2015;61(3):776–82.
• 25. Fujii H, Enomoto M, Murakami Y, Hagihara A, Kawada N, Saito S. Last crusade against HCV: direct-acting antiviral treatment for marginalized populations. J Viral Hepat. 2019;26(12):1501.
• 26. Galbraith JW, Anderson ES, Hsieh YH, Franco RA, Donnelly JP, Rodgers JB,et al. High Prevalence of Hepatitis C Infection Among Adult Patients at Four Urban Emergency Departments - Birmingham, Oakland, Baltimore, and Boston, 2015-2017. MMWR Morb Mortal Wkly Rep. 2020;69(19):569-74.
• 27. Beckwith CG, Kurth AE, Bazerman LB, Patry EJ, Cates A, Tran L, et al. A pilot study of rapid hepatitis C virus testing in the Rhode Island Department of Corrections. J Public Health. 2016;38(1):130–7.
• 28. Sert ET, Mutlu H, Kokulu K, Yeşildağ K, Sarıtas A. Five-year analysis of patients presenting to our emergency department. Mugla Sitki Kocman Univ Med J. 2021;8(1):1–4.
• 29. Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, Caughey AB, et al. Screening for hepatitis B virus infection in pregnant women: US Preventive Services Task Force reaffirmation recommendation statement. JAMA. 2019;322(4):349–54.
• 30. Erdoğan MS, Otkun M, Tatman-Otkun M, Akata F, Türe M. The epidemiology of hepatitis A virus infection in children in Edirne, Turkey. Eur J Epidemiol. 2004;19(3):267–73.
• 31. World Health Organization. Guidelines on hepatitis B and C testing. Geneva: WHO; 2020. License: CC BY-NC-SA 3.0.
• 32. Llaneras J, Ruiz-Cobo JC, Rando-Segura A, Barreira-Díaz A, Domínguez-Hernández R, Rodríguez-Frías F, et al. Integrating viral hepatitis management into the emergency department: a further step towards viral hepatitis elimination. JHEP Rep. 2023;6(1):100932.