title: Prevalence of hepatitis d in the eastern mediterranean region: systematic review and meta analysis.
abstract: BACKGROUND
  Hepatitis D Virus (HDV) causes the most threatening form of chronic viral hepatitis. To date, there is no overall estimation of HDV prevalence in the Eastern Mediterranean Region Office of WHO (EMRO) countries.
  
  
  OBJECTIVE
  To provide a clear estimation of HDV prevalence in the aforementioned region.
  
  
  METHODS
  In the current systematic review, databases such as PubMed, Embase, Web of sciences and Google scholar were searched Until December 2010. The summary estimate of HDV prevalence in the EMRO region was calculated as an average of the pooled infection prevalence of each country weighted by the ratio of the country's HBV population to the study's sample size in the survey data analysis.
  
  
  RESULTS
  We included 62 eligible studies. The weighted mean of HDV prevalence in the EMRO region was 14.74% (95% CI: 14.73 - 14.77), 27.8% (95% CI: 27.78 - 27.82), 36.57% (95% CI: 36.55 - 36.59) and 16.44%. (95% CI: 16.42 - 16.46) in asymptomatic HBsAg positive carriers, chronic hepatitis patients, cirrhosis/ hepatocellular carcinoma, and high risk group, respectively. Among the asymptomatic HBsAg positive group, HDV prevalence was increased by years in older patients in Saudi Arabia but its prevalence was decreased in Iran. No specific pattern was seen according to chronological analysis during years among the EMRO countries.
  
  
  CONCLUSIONS
  HDV infection is endemic in the EMRO countries and it is more common among patients with severe forms of hepatitis. Due to the high HDV infection rates in the EMRO countries, we recommend blood screening for HDV infection in this region.
authors.affiliation: Tehran University of Medical Sciences, Students' Scientific Research Centre, Tehran, IR Iran.
authors.forename: Neda
authors.initials: N
authors.lastname: Amini
authors.forename: Seyed Moayed
authors.initials: SM
authors.lastname: Alavian
authors.forename: Ali
authors.initials: A
authors.lastname: Kabir
authors.forename: Seyed Hossein
authors.initials: SH
authors.lastname: Aalaei-Andabili
authors.forename: Seyed Yasser
authors.initials: SY
authors.lastname: Saiedi Hosseini
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
keywords: EMRO; Epidemiology; Hepatitis D; Meta-Analysis; Prevalence
references.citation: J Med Virol. 2011 Jul;83(7):1172-7
references.pmid: 21541950
references.citation: Prog Clin Biol Res. 1991;364:63-8
references.pmid: 2020722
references.citation: J Gastroenterol Hepatol. 1989 Mar-Apr;4(2):151-4
references.pmid: 2518790
references.citation: Saudi Med J. 2005 May;26(5):819-23
references.pmid: 15951876
references.citation: Prog Clin Biol Res. 1987;234:441-2
references.pmid: 3628409
references.citation: Ann Saudi Med. 2004 Sep-Oct;24(5):343-4
references.pmid: 15573844
references.citation: J Coll Physicians Surg Pak. 2007 Jun;17(6):320-2
references.pmid: 17623577
references.citation: J Ayub Med Coll Abbottabad. 2009 Apr-Jun;21(2):1-3
references.pmid: 20524456
references.citation: J Clin Microbiol. 2011 Mar;49(3):1162-4
references.pmid: 21209162
references.citation: J Med Virol. 1993 Aug;40(4):330-3
references.pmid: 8228926
references.citation: Indian J Med Sci. 2007 May;61(5):263-8
references.pmid: 17478956
references.citation: J Microbiol Immunol Infect. 2008 Jun;41(3):227-30
references.pmid: 18629418
references.citation: Scand J Infect Dis. 1993;25(5):559-64
references.pmid: 7506842
references.citation: Virol J. 2010 Oct 26;7:283
references.pmid: 20977704
references.citation: Transplant Proc. 1992 Oct;24(5):1913-4
references.pmid: 1412910
references.citation: Trans R Soc Trop Med Hyg. 1988;82(3):469-71
references.pmid: 3232188
references.citation: Trans R Soc Trop Med Hyg. 1989 May-Jun;83(3):399-400
references.pmid: 2617589
references.citation: Rev Epidemiol Sante Publique. 2006 Sep;54(4):377-80
references.pmid: 17088701
references.citation: New Microbiol. 2009 Apr;32(2):193-8
references.pmid: 19579699
references.citation: Liver Int. 2011 Jan;31(1):7-21
references.pmid: 20880077
references.citation: Am J Trop Med Hyg. 1989 Feb;40(2):200-6
references.pmid: 2919728
references.citation: J Hepatol. 1987 Dec;5(3):274-81
references.pmid: 3429834
references.citation: J Egypt Soc Parasitol. 1989 Dec;19(2 Suppl):869-78
references.pmid: 2794575
references.citation: J Med Virol. 2008 Dec;80(12):2092-9
references.pmid: 19040284
references.citation: East Afr Med J. 1998 Jun;75(6):327-8
references.pmid: 9803612
references.citation: Hepatology. 1985 Mar-Apr;5(2):188-91
references.pmid: 3979950
references.citation: Trans R Soc Trop Med Hyg. 1991 Jan-Feb;85(1):104-8
references.pmid: 1712517
references.citation: J Hepatol. 1996 Oct;25(4):439-44
references.pmid: 8912142
references.citation: J Gastroenterol Hepatol. 2005 Oct;20(10):1503-7
references.pmid: 16174065
references.citation: Med Mal Infect. 2004 Apr;34(4):181-2
references.pmid: 15619891
references.citation: Clin Infect Dis. 1996 Jul;23(1):195-6
references.pmid: 8816162
references.citation: J Egypt Public Health Assoc. 1989;64(1-2):155-68
references.pmid: 2520146
references.citation: Scand J Infect Dis. 1988;20(1):15-9
references.pmid: 3363303
references.citation: Clin Infect Dis. 2006 Mar 1;42(5):628-33
references.pmid: 16447107
references.citation: Vox Sang. 1986;50(4):216-9
references.pmid: 3487881
references.citation: Intervirology. 2007;50(6):387-93
references.pmid: 17975319
references.citation: Panminerva Med. 2000 Jun;42(2):97-100
references.pmid: 10965769
references.citation: J Egypt Public Health Assoc. 1991;66(3-4):427-39
references.pmid: 1791415
references.citation: Histol Histopathol. 1988 Jan;3(1):57-62
references.pmid: 2980208
references.citation: World J Gastroenterol. 2007 May 14;13(18):2604-7
references.pmid: 17552010
references.citation: Clin Microbiol Rev. 1999 Apr;12(2):351-66
references.pmid: 10194463
references.citation: APMIS Suppl. 1988;3:30-4
references.pmid: 2846019
references.citation: Ann Inst Pasteur Virol. 1988 Jul-Sep;139(3):285-90
references.pmid: 3207507
references.citation: East Mediterr Health J. 2001 Jul-Sep;7(4-5):771-8
references.pmid: 15332778
references.citation: J Med Virol. 1985 Dec;17(4):371-5
references.pmid: 3935751
references.citation: J Microbiol Immunol Infect. 2010 Dec;43(6):519-23
references.pmid: 21195980
references.citation: J Egypt Public Health Assoc. 1992;67(1-2):147-61
references.pmid: 1295943
references.citation: J Med Virol. 1997 Jan;51(1):64-6
references.pmid: 8986951
references.citation: Am J Trop Med Hyg. 1993 Mar;48(3):372-6
references.pmid: 8385885
references.citation: Am J Epidemiol. 1992 Dec 15;136(12):1507-16
references.pmid: 1288280
references.citation: Ann Trop Med Parasitol. 1990 Aug;84(4):349-53
references.pmid: 2260899
references.citation: Hepat Mon. 2010 Spring;10(2):110-5
references.pmid: 22312383
references.citation: J Trop Med Hyg. 1989 Feb;92(1):1-5
references.pmid: 2918572
references.citation: Ann Trop Paediatr. 1990;10(2):139-43
references.pmid: 1699476
references.citation: J Egypt Public Health Assoc. 1992;67(1-2):181-93
references.pmid: 1295945
references.citation: Liver. 1986 Apr;6(2):73-7
references.pmid: 3461233
references.citation: J Med Virol. 2005 Dec;77(4):491-9
references.pmid: 16254981
references.citation: Indian J Med Res. 2005 Sep;122(3):254-7
references.pmid: 16251784
references.citation: J Pak Med Assoc. 1988 Nov;38(11):283
references.pmid: 3148748
references.citation: Scand J Infect Dis. 1987;19(6):611-6
references.pmid: 3126547
references.citation: Ann Trop Med Parasitol. 1988 Dec;82(6):555-9
references.pmid: 3151428
references.citation: Trop Doct. 2009 Jul;39(3):154-6
references.pmid: 19535751
references.citation: Scand J Immunol. 1993 Feb;37(2):265-70
references.pmid: 8434238
references.citation: World J Gastroenterol. 2010 Feb 7;16(5):554-62
references.pmid: 20128022
references.citation: Vox Sang. 1992;62(2):94-7
references.pmid: 1325714
references.citation: Hepat Mon. 2010 Spring;10(2):77-9
references.pmid: 22312377
references.citation: Hepatology. 2000 Oct;32(4 Pt 1):824-7
references.pmid: 11003629
references.citation: Int J Antimicrob Agents. 2003 Feb;21(2):143-52
references.pmid: 12615378
references.citation: J Infect Dis. 1983 Oct;148(4):768
references.pmid: 6631068
references.citation: Acta Virol. 2005;49(4):219-25
references.pmid: 16402678
references.citation: J Med Virol. 2009 Aug;81(8):1343-7
references.pmid: 19551834
references.citation: J Pak Med Assoc. 2009 Jul;59(7):434-7
references.pmid: 19579728
references.citation: Trans R Soc Trop Med Hyg. 1997 Jan-Feb;91(1):11-4
references.pmid: 9093616
references.citation: Hepatology. 1987 Nov-Dec;7(6):1340-5
references.pmid: 2824316
references.citation: Eur J Epidemiol. 1988 Jun;4(2):185-8
references.pmid: 3402577
references.citation: Infection. 1986 Sep-Oct;14(5):250-1
references.pmid: 3025102
references.citation: J Pak Med Assoc. 1988 May;38(5):126-8
references.pmid: 3146653
references.citation: Trans R Soc Trop Med Hyg. 1990 Mar-Apr;84(2):288-91
references.pmid: 2389323
references.citation: Niger J Clin Pract. 2009 Dec;12(4):439-42
references.pmid: 20329688
references.citation: Prog Clin Biol Res. 1987;234:471-5
references.pmid: 2819896
references.citation: J Coll Physicians Surg Pak. 2006 Sep;16(9):581-4
references.pmid: 16945230
references.citation: J Clin Microbiol. 1996 Dec;34(12):3023-30
references.pmid: 8940442
references.citation: Gut. 2000 Mar;46(3):420-6
references.pmid: 10673308
references.citation: Liver Int. 2008 Apr;28(4):494-8
references.pmid: 18339076
references.citation: J Hepatol. 1997 Feb;26(2):236-43
references.pmid: 9059941
references.citation: Clin Infect Dis. 2002 Jun 15;34(Suppl 5):S171-207
references.pmid: 12019465
references.citation: Virus Genes. 2005 May;30(3):383-93
references.pmid: 15830157
references.citation: J Med Virol. 1987 Mar;21(3):217-22
references.pmid: 3104532
references.citation: Prog Clin Biol Res. 1993;382:277-85
references.pmid: 8502692
references.citation: Arch Inst Pasteur Tunis. 1994 Jul-Oct;71(3-4):403-6
references.pmid: 8801835
references.citation: Trans R Soc Trop Med Hyg. 1989 Jan-Feb;83(1):107-8
references.pmid: 2603184
references.citation: J Clin Microbiol. 2011 Mar;49(3):1083-9
references.pmid: 21191061
references.citation: Trans R Soc Trop Med Hyg. 1987;81(2):317-8
references.pmid: 3617196
references.citation: J Egypt Soc Parasitol. 1991 Aug;21(2):561-5
references.pmid: 1875081
references.citation: Digestion. 1989;42(2):110-5
references.pmid: 2767341
references.citation: J Med Virol. 1986 May;19(1):41-6
references.pmid: 3009704
references.citation: Trans R Soc Trop Med Hyg. 1991 Jul-Aug;85(4):541-2
references.pmid: 1755067
references.citation: Epidemiol Infect. 2007 Aug;135(6):959-62
references.pmid: 17176498
references.citation: Trop Doct. 2005 Apr;35(2):121
references.pmid: 15970048
references.citation: Pathol Biol (Paris). 2009 Nov-Dec;57(7-8):518-23
references.pmid: 19038509
references.citation: Clin Infect Dis. 1995 Sep;21(3):621-7
references.pmid: 8527554
references.citation: J Pak Med Assoc. 1994 Aug;44(8):182-4
references.pmid: 7996663
references.citation: J Med Virol. 2003 Aug;70(4):529-36
references.pmid: 12794714
references.citation: J Ayub Med Coll Abbottabad. 2008 Apr-Jun;20(2):39-42
references.pmid: 19385455
references.citation: J Commun Dis. 1991 Dec;23(4):270-5
references.pmid: 1668818
references.citation: J Hepatol. 1987 Apr;4(2):224-8
references.pmid: 3584931
references.citation: Microbes Infect. 2002 Sep;4(11):1169-75
references.pmid: 12361917
references.citation: J Infect Dis. 1986 Nov;154(5):912-3
references.pmid: 3772169
references.citation: Gut. 1977 Dec;18(12):997-1003
references.pmid: 75123
references.citation: Am J Trop Med Hyg. 1986 Sep;35(5):1040-4
references.pmid: 3094392
references.citation: Arch Iran Med. 2009 May;12(3):238-43
references.pmid: 19400600
references.citation: Hepatogastroenterology. 1988 Dec;35(6):313-5
references.pmid: 3265126
references.citation: Infection. 1990 Jan-Feb;18(1):26-8
references.pmid: 2155876
references.citation: J Public Health Med. 1994 Mar;16(1):71-8
references.pmid: 8037956
references.citation: Bull Soc Pathol Exot Filiales. 1987;80(5):741-4
references.pmid: 3450437
references.citation: J Egypt Soc Parasitol. 1993 Apr;23(1):151-60
references.pmid: 8482861
references.citation: Ann Saudi Med. 1996 Mar;16(2):184-92
references.pmid: 17372446
references.citation: Zhonghua Liu Xing Bing Xue Za Zhi. 1998 Jun;19(3):138-40
references.pmid: 10322728
references.citation: J Egypt Public Health Assoc. 1992;67(5-6):549-63
references.pmid: 1294681
references.citation: J Coll Physicians Surg Pak. 2009 Nov;19(11):699-703
references.pmid: 19889265
references.citation: J Med Virol. 1994 Aug;43(4):397-403
references.pmid: 7964650
references.citation: J Microbiol Immunol Infect. 2008 Jun;41(3):254-8
references.pmid: 18629421
references.citation: Intervirology. 2009;52(3):123-31
references.pmid: 19468235
references.citation: Trans R Soc Trop Med Hyg. 1988;82(5):761-6
references.pmid: 2855284
references.citation: Pak J Biol Sci. 2007 May 15;10(10):1751-4
references.pmid: 19086531
references.citation: J Trop Med Hyg. 1993 Oct;96(5):277-87
references.pmid: 8411302
references.citation: Ann Saudi Med. 1994 Nov;14(6):503-6
references.pmid: 17587959