Hepatitis B and D Virus Co-Infection: A Study of Seroprevalence and IgM Response among Patients in Abakaliki Metropolis, Ebonyi State, Nigeria
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594-611
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Sep 26, 2025
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10.58578/ajmsphr.v2i3.7485
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Authors:
Okosigha Saviour Azibanyam1, Imarenezor Edobor Peter Kenneth2, Anyiam Vivian Ifeoma3 
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Abstract
Hepatitis, an inflammation of the liver commonly caused by viral infections, exists in five primary forms: Hepatitis A, B, C, D, and E. Among these, Hepatitis D virus (HDV) is a defective virus that requires co-infection with Hepatitis B virus (HBV) for replication. Hepatitis may present as acute or chronic, and early diagnosis and treatment are essential to prevent complications. This study investigated the seroprevalence of HBV and HDV co-infection among patients in Abakaliki Metropolis, Ebonyi State, Nigeria. A cross-sectional analytical design was employed, involving 1,000 patients who attended the Federal Teaching Hospital Abakaliki (FETHA) and Mile 4 Hospital Ishieke. Serological testing was conducted using ELISA kits in accordance with the manufacturer’s protocols and standard laboratory procedures. Of the 1,000 participants, 89 (8.9%) tested positive for HBsAg, indicating HBV infection, while 5 (5.6%) of these were also positive for HDV-IgM, confirming co-infection. The prevalence of HBV/HDV co-infection was higher among females (7.7%) compared to males (2.7%) and more pronounced among married individuals (6.9%) than singles (3.2%). These findings indicate a notable burden of HBV and HDV co-infection in the study area. The results underscore the importance of routine HDV screening for all HBsAg-positive patients and the implementation of targeted public health interventions to prevent HDV transmission and reduce the severity of HBV-related disease.
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Abakaliki; Co-Infection; Hepatitis B Virus; Hepatitis D Virus; IgM; Seroprevalence; Public Health Intervention
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Azibanyam, O. S., Kenneth, I. E. P., & Ifeoma, A. V. (2025). Hepatitis B and D Virus Co-Infection: A Study of Seroprevalence and IgM Response among Patients in Abakaliki Metropolis, Ebonyi State, Nigeria. African Journal of Medicine, Surgery and Public Health Research, 2(3), 594-611. https://doi.org/10.58578/ajmsphr.v2i3.7485
References
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Engelke, M., Mills, K., Seitz, S., Simon, P., Gripon, P., Schnölzer, M., and Urban, S. (2006): Characterization of a Hepatitis B and Hepatitis Delta Virus Receptor Binding Site Hepatology. 43 (4): 750–760.
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Imarenezor, E.P.K., N. P. Ofiri, O. E. Yakubu, S. T. C. Brown, F. U. Ebuara and S. Sani (2019). CD4, CD8 T-Lymphocytes and WBC profiles during pregnancy among HIV-seronegative women in Wukari, North East, Nigeria. FUW Trends in Science & Technology Journal, 4 (3): 930 – 933
Imarenezor EPK, Brown STC, Yakubu OE, Soken DC, 2016. Survey of Hepatitis B and C among students of Federal University Wukari, Taraba State, Nigeria. Int Res J Med Med Sci, 4(3): 31-37.
Imarenezor Edobor Peter Kenneth, Anyiam Ifeoma Vivian, Abhadionmhen Abel Onolunosen, Ndubuisi Miracle Nneoma, Ekeh Amarachi Promise (2023). Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV) Co-Infections among Patients attending General Hospital, Wukari, Taraba State, North East, Nigeria. International Journal of Medical and All Body Health Research, 4 (2):36-42
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Imarenezor Edobor Peter Kenneth, Anyiam Vivian Ifeoma, Ofiri Pascal Ngozi, Abhadionmhen Onolunosen Abel (2024). Pervasiveness of Human Immuno-Deficiency Virus (HIV), among Individuals in Wukari, Taraba State, North-East Nigeria. International Journal of Advanced Biological and Biomedical Research, 12(3), 237-247.
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Kuo, M. Y., Chao, M., and Taylor, J .(1989). Initiation of Replication of the Human Hepatitis Delta virus Genome from cloned DNA: Role of Delta antigen. Journal of Virology, 63: 1945–1950.
Lehmann, E., Brueckner, F., and Cramer, P .(2007). Molecular basis of RNA-dependent RNA Polymerase II Activity. Nature, (7168): 445–449.
Nisini, R., Paroli, M., Accapezzato, D., Bonino, F., Rosina, F., Santantonio, T., Sallusto, F., Amoroso, A., Houghton, M., and Barnaba, V .(1997). Human CD4+ T-cell response to hepatitis Delta virus: Identification of multiple epitopes and characterization of T-helper cytokine profiles. Journal of Virology, 71: 2241–2251.
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Poisson, F., Roingeard, P., Baillou, A., Dubois, F., Bonelli, F., Calogero, R.A. and Goudeau, A. (1993): Characterization of RNA-binding Domains of Hepatitis Delta Antigen. Journal of General Virology, 74 (11): 2473–2478.
Rizzetto, M., Canese, M. G., Purcell, R. H., London, W. T., Sly, L. D., and Gerin, J. L. (1981). Experimental HBV and delta infections of chimpanzees: occurrence and significance of intrahepatic immune complexes of HBcAg and delta antigen. Hepatology. 1 (6): 567–574.
Schulze, A., Schieck, A., Ni, Y., Mier, W., and Urban, S .(2010). Fine Mapping of Pre-S Sequence Requirements for Hepatitis B Virus Large Envelope Protein-Mediated Receptor Interaction. Journal of Virology. 84 (4): 1989–2000.
Schulze, A., Schieck, A., Ni, Y., Mier, W., and Urban, S. (2010): Fine Mapping of Pre-S Sequence Requirements for Hepatitis B Virus Large Envelope Protein-Mediated Receptor Interaction. Journal of Virology, 84 (4): 1989–2000.
Tahaei, S. M. E., Mohebbi, S. R., Azimzadeh, P., Behelgardi, A., Sanati, A., and Mohammadi, P (2014): Prevalence of Hepatitis D Virus in Hepatitis B Virus Infected Patients Referred to Taleghani Hospital Tehran, Iran. Journal of Gastroenterology and Hepatology, 7 (3):144-150.
Taylor, J. M. ( 2006): Hepatitis Delta Virus. Virology. 344 (1): 71–76.
Wang, K (1986): ”Capture” Enzyme Immuno-Assay (ELISA) for the Determination of IgM antibodies to Hepatitis Delta Virus in Human Plasma and Sera. Nature, (323):508-514.
Wang, K. S., Choo, Q. L., Weiner, A. J., Ou, J. H., Najarian, R. C., Thayer, R. M., Mullenbach, G. T., Denniston, K. J., Gerin, J. L., and Houghton, M .(1986). Structure, sequence and expression of the hepatitis delta (delta) viral genome. Nature, 323 (6088): 508–514.
Wu, H. N., Lin, Y. J., Lin, F. P., Makino, S., Chang, M. F., and Lai, M. M .(1989). Human hepatitis delta Virus RNA Subfragments contain an Autocleavage Activity. Proceedings of the National Academy of Sciences of the United States of America. 86 (6): 1831–1835.
Casey, J. L., Brown, T. L., Colan, E. J., Wignall, F. S. and Gerin, J. L. (1993). A Genotype of Hepatitis D Virus that occurs in Northern South America. Procreate of the National Academy of Science, 90: 9016–9020.
Casey, J. L., Tennant, B. C. and Gerin, J. L. (2006). Genetic Changes in Hepatitis Delta Virus from Acutely and Chronically Infected Woodchucks. Journal of Virology 80: 6469–6477.
Engelke, M., Mills, K., Seitz, S., Simon, P., Gripon, P., Schnölzer, M., and Urban, S. (2006): Characterization of a Hepatitis B and Hepatitis Delta Virus Receptor Binding Site Hepatology. 43 (4): 750–760.
Fattovich, G., Bortolotti, F., and Donato, F. (2008): Natural History of Chronic Hepatitis B: Special Emphasis on Disease Progression and Prognostic Factors. Journal of Hepatology. 48: 335–352.
Fattovich, G., Giustina, G., and Christensen, E. (2000): Influence of Hepatitis Delta Virus Infection on Morbidity and Mortality in Compensated Cirrhosis Type B. Journal of General Virology. 46 (3): 420–426.
Fattovich, G., Giustina, G., Christensen, E., Pantalena, M., Zagni, I., Realdi, G., and Schalm, S. W. (2000): Influence of Hepatitis Delta Virus Infection on Morbidity and Mortality in Compensated Cirrhosis type B. The European Concerted Action on Viral Hepatitis. 46: 420–426.
Francois, M., and Roggendorf, M. (2005): Immunology of HDV Infection. Current Top Microbiology and Immunology. 307: 187–209.
Govindarajan, S., De Cock, K. M., and Redeker, A. G. (1986): Natural Course of Delta Super Infection in Chronic Hepatitis B virus-infected Patients: Histopathologic Study with Multiple Liver Biopsies. Hepatology 6: 640–644.
Govindarajan, S., Fields, H. A., Humphrey, C. D., and Margolis, H. S. (1986): Pathologic and Ultrastructural changes of Acute and Chronic Delta Hepatitis in an Experimentally infected Chimpanzee. American Journal of Pathology. 122: 315–322.
Greco-Stewart, V. S., Schissel, E., and Pelchat, M. (2009): The Hepatitis Delta Virus RNA Genome Interacts with the Human RNA Polymerases I And III. Journal of Virology. 386 (1): 12–15.
Imarenezor, E.P.K., N. P. Ofiri, O. E. Yakubu, S. T. C. Brown, F. U. Ebuara and S. Sani (2019). CD4, CD8 T-Lymphocytes and WBC profiles during pregnancy among HIV-seronegative women in Wukari, North East, Nigeria. FUW Trends in Science & Technology Journal, 4 (3): 930 – 933
Imarenezor EPK, Brown STC, Yakubu OE, Soken DC, 2016. Survey of Hepatitis B and C among students of Federal University Wukari, Taraba State, Nigeria. Int Res J Med Med Sci, 4(3): 31-37.
Imarenezor Edobor Peter Kenneth, Anyiam Ifeoma Vivian, Abhadionmhen Abel Onolunosen, Ndubuisi Miracle Nneoma, Ekeh Amarachi Promise (2023). Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV) Co-Infections among Patients attending General Hospital, Wukari, Taraba State, North East, Nigeria. International Journal of Medical and All Body Health Research, 4 (2):36-42
Imarenezor Edobor Peter Kenneth and Benjamin Nanisi Daniel (2024). Unveiling Co-Infections: Hepatitis C Virus and Malaria Sero Prevalence among Outpatients Attending General Hospital Wukari in Taraba State, Nigeria. Int. J. Adv. Biol. Biomed. Res., 12(2), 192-205
Imarenezor Edobor Peter Kenneth, Anyiam Ifeoma Vivian, Abhadionmhen Abel Onolunosen, Iduku Husseni (2023). The immunological evaluate of Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) co-infection with plasmodium in Wukari, Taraba State, North East, Nigeria. International Journal of Medical and All Body Health Research, 4(2): 43-47
Imarenezor Edobor Peter Kenneth, Anyiam Vivian Ifeoma, Ofiri Pascal Ngozi, Abhadionmhen Onolunosen Abel (2024). Pervasiveness of Human Immuno-Deficiency Virus (HIV), among Individuals in Wukari, Taraba State, North-East Nigeria. International Journal of Advanced Biological and Biomedical Research, 12(3), 237-247.
Kamimura, T., Ponzetto, A., Bonino, F., Feinstone, S. M., Gerin, J. L., and Purcell, R. H .(1983). Cytoplasmic tubular structures in Liver of HBsAg carrier Chimpanzees infected with Delta agent and comparison with cytoplasmic structures in non-A, non-B hepatitis. Hepatology, 3: 631–637.
Kuo, M. Y., Chao, M., and Taylor, J .(1989). Initiation of Replication of the Human Hepatitis Delta virus Genome from cloned DNA: Role of Delta antigen. Journal of Virology, 63: 1945–1950.
Lehmann, E., Brueckner, F., and Cramer, P .(2007). Molecular basis of RNA-dependent RNA Polymerase II Activity. Nature, (7168): 445–449.
Nisini, R., Paroli, M., Accapezzato, D., Bonino, F., Rosina, F., Santantonio, T., Sallusto, F., Amoroso, A., Houghton, M., and Barnaba, V .(1997). Human CD4+ T-cell response to hepatitis Delta virus: Identification of multiple epitopes and characterization of T-helper cytokine profiles. Journal of Virology, 71: 2241–2251.
Onwuakor, C. E., Eze, V. C., Nwankwo, I. U. and Iwu, J.O. (2014). Sero-prevalence of Hepatitis B Surface Antigen (HBsAg) amongst Pregnant Women Attending Antenatal Clinic at the Federal Medical Centre Umuahia, Abia State, Nigeria. American Journal of Public Health Research, 6;255-259
Opaleye, O. O., Tijani, B. A., Zakariyahu, T. O and Taiwo, S. S (2016). Prevalence of HBsAg and HIV among blood donors in Osogbo, Osun State, Nigeria. International Resource Journal of Medical Science, (1):68-71.
Ottobrelli, A., Marzano, A., Smedile, A., Recchia, S., Salizzoni, M., Cornu, C., Lamy, M. E., Otte, J. B., De Hemptinne, B., and Geubel, A .(1991). Patterns of Hepatitis Delta virus Reinfection and Disease in Liver Transplantation. Gastroenterology, 101: 1649–1655.
Poisson, F., Roingeard, P., Baillou, A., Dubois, F., Bonelli, F., Calogero, R.A. and Goudeau, A. (1993): Characterization of RNA-binding Domains of Hepatitis Delta Antigen. Journal of General Virology, 74 (11): 2473–2478.
Rizzetto, M., Canese, M. G., Purcell, R. H., London, W. T., Sly, L. D., and Gerin, J. L. (1981). Experimental HBV and delta infections of chimpanzees: occurrence and significance of intrahepatic immune complexes of HBcAg and delta antigen. Hepatology. 1 (6): 567–574.
Schulze, A., Schieck, A., Ni, Y., Mier, W., and Urban, S .(2010). Fine Mapping of Pre-S Sequence Requirements for Hepatitis B Virus Large Envelope Protein-Mediated Receptor Interaction. Journal of Virology. 84 (4): 1989–2000.
Schulze, A., Schieck, A., Ni, Y., Mier, W., and Urban, S. (2010): Fine Mapping of Pre-S Sequence Requirements for Hepatitis B Virus Large Envelope Protein-Mediated Receptor Interaction. Journal of Virology, 84 (4): 1989–2000.
Tahaei, S. M. E., Mohebbi, S. R., Azimzadeh, P., Behelgardi, A., Sanati, A., and Mohammadi, P (2014): Prevalence of Hepatitis D Virus in Hepatitis B Virus Infected Patients Referred to Taleghani Hospital Tehran, Iran. Journal of Gastroenterology and Hepatology, 7 (3):144-150.
Taylor, J. M. ( 2006): Hepatitis Delta Virus. Virology. 344 (1): 71–76.
Wang, K (1986): ”Capture” Enzyme Immuno-Assay (ELISA) for the Determination of IgM antibodies to Hepatitis Delta Virus in Human Plasma and Sera. Nature, (323):508-514.
Wang, K. S., Choo, Q. L., Weiner, A. J., Ou, J. H., Najarian, R. C., Thayer, R. M., Mullenbach, G. T., Denniston, K. J., Gerin, J. L., and Houghton, M .(1986). Structure, sequence and expression of the hepatitis delta (delta) viral genome. Nature, 323 (6088): 508–514.
Wu, H. N., Lin, Y. J., Lin, F. P., Makino, S., Chang, M. F., and Lai, M. M .(1989). Human hepatitis delta Virus RNA Subfragments contain an Autocleavage Activity. Proceedings of the National Academy of Sciences of the United States of America. 86 (6): 1831–1835.