Endemic hepatitis B virus (HBV) among hospital in-patients in Bangladesh, including evidence of occult infection

Bangladesh is one of the world’s top ten burdened countries for viral hepatitis. We investigated an adult fever cohort (n=201) recruited in Dhaka, to determine the prevalence of hepatitis B virus (HBV) infection and to identify cases of occult hepatitis B infection (OBI). HBV exposure (anti-HBc) was documented in 72/201 (36%), and active HBV infection in 16/201 (8%), among whom 3 were defined as OBI (defined as detectable HBV DNA but negative HBsAg). Applying a target-enrichment sequencing pipeline to samples with HBV DNA >3.0log10 IU/ml, we obtained deep whole genome sequences for four cases, identifying genotypes A, C and D. Polymorphisms in the surface gene of the OBI case may account for the negative HBsAg status. We identified mutations associated with nucleos(t)ide analogue resistance, although the clinical significance in this cohort is not known. The high prevalence of HBV in this setting highlights the benefits of offering screening in hospital patients and the importance of HBV DNA testing of transfusion products to reduce the risk of transmission. In order to work towards international Sustainable Development Goal targets for HBV elimination, increased investment is required for diagnosis, treatment and prevention in Bangladesh. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Commonwealth Scholarship of Dr. Fazle Rabbi Chowdhury (BDCS-2015-44) and by the Wellcome Trust Fellowship awards of Prof Susanna Dunachie (ref WT00174A1A) and Prof Philippa Matthews (ref WT110110). ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The datasets generated during and/or analysed during the current study are available in the following repositories: (1) GenBank accession numbers [MT114170][1] - [MT114173][2] (2) Metadata file of demographic data and HBV screening results in the fever cohort (n=201 subjects) on Figshare - 10.6084/m9.figshare.11973930 (3) A STROBE statement has been submitted as a supplementary file with this manuscript. [DOI:10.6084/m9.figshare.11973930][3] [1]: /lookup/external-ref?link_type=GEN&access_num=MT114170&atom=%2Fmedrxiv%2Fearly%2F2020%2F03%2F20%2F2020.03.17.20037085.atom [2]: /lookup/external-ref?link_type=GEN&access_num=MT114173&atom=%2Fmedrxiv%2Fearly%2F2020%2F03%2F20%2F2020.03.17.20037085.atom [3]: http://doi.org/10.6084/m9.figshare.11973930