The total number of blood samples received for Hepatitis B and Hepatitis C testing from March 2018 to Feb 2022 was 59,972 samples, with 37,070 samples in pre-pandemic and 22,902 samples in pandemic times. There was a substantial decrease of 23.63% in the number of samples received during the pandemic period demonstrating the impact of COVID-19 on various laboratory testing. The occurrence of late medical diagnosis among individuals with viral hepatitis could be interrelated with travel restriction guidelines during the COVID-19 pandemic. There was also channeling of equipment, infrastructure, and manpower for the sole purpose of the pandemic which led to a lack of attention to other laboratory tests. Similar findings are demonstrated by studies done by Gupta N et al. and Ismail Z et al. where they have discussed the impact of COVID-19 pandemic on viral hepatitis diagnosis and treatment in Africa.^6,7

Out of the total 39,578 samples tested for Hepatitis B surface antigen, 413 were positive with a seroprevalence of 1.04%. Among the 20,394 samples tested for anti-Hepatitis C antibodies, 53 samples were found to be positive showing a seroprevalence of 0.25%. These results are concordant with the results of a similar study done by Baitha B et al. where seroprevalence rates for HIV, HBsAg, and Hepatitis C were calculated in blood donors.⁸

The seroprevalence for Hepatitis B surface antigen in the pre-pandemic era was 1.11% and in the pandemic era, it was found to be 0.91% displaying a decreasing trend. Seroprevalence for anti-HCV antibodies in the pre-pandemic was found to be 0.24% whereas in the pandemic the seroprevalence for Hepatitis C infection showed a small increase to 0.27%.

The overall prevalence of Hepatitis B has decreased during the pandemic time when compared to the pre-pandemic era. The decreased trend in Hepatitis B positive cases was also reported by Baitha B et al., Padmalatha et al. and Ray K et al.^8-10 The prevalence rate of Hepatitis C showed a small increase in the later part of the pandemic in our study. The increased trend in Hepatitis C positive cases has been reported by Arora I et al. and Masood Z et al. during the pre-pandemic times but no studies have reported Hepatitis C trends in the late pandemic era.^{11, 12}

Male predominance was observed for both Hepatitis B (65.37%) and Hepatitis C (56.60%) positivity in this study which is identical to studies done by Padmalatha et al. and Khan et al.^{9, 13} The reason for male predominance could be more chances of exposure to risk factors for Hepatitis B and Hepatitis C infections, like promiscuous sexual practices and needle sharing in drug abuse. The population catered by our tertiary care hospital has a sex ratio of 988 (females per thousand males) according to the Telangana state statistics which might have contributed to the male predominance in this study.

The positivity rate of Hepatitis B was highest in the 61 to 80 years age group (38.25%) with the mean age being 67.6 years±4.90. The reason for the older age group showing Hepatitis B positivity in our study could be that the population seeking services in our hospital belongs to the older age group and surrounding rural areas. Moreover, the majority of samples sent to the Microbiology laboratory for screening of Hepatitis B were from patients who were seeking free services during the Ophthalmology cataract camps held by our tertiary care hospital. The majority of the population requesting such services are from the older age group. Hepatitis B was highest in the fourth (61-80) age group with a mean age of 67.3±4.62 before the pandemic but during the pandemic, Hepatitis B positivity was equally distributed in the third (41 to 60) and fourth (61-80) age groups with a mean age of 52.2±5.34 and 68.3±5.32 respectively. Padmalatha et al. and Khan et al. have reported high Hepatitis B positivity rates in the 41 to 59 years age group and 21 to 40 years age group respectively.^{9, 13}

Hepatitis C positive cases were equally distributed in the third (41 to 60) and fourth (61-80) age groups with a mean age of 52.5±5.86 and 67.6±3.75 years, respectively, whereas during the pandemic, Hepatitis C positivity was highest among the third (41 to 60) age group with a mean age of 51.9±3.91years. The overall positivity rate of Hepatitis C was highest in the 41 to 60 years age group (47.16%) with a mean age of 52.2 years ±5.12 which is concordant with studies done by Padmalatha et al. and Tripathi PC et al.^9,14

Based on the addresses submitted by Hepatitis B and Hepatitis C cases during registration with our tertiary center, they were divided into urban and rural populations. Among the 413 positive cases of Hepatitis B, 315 (76.27%) cases belonged to the rural population and among the 53 Hepatitis C positive cases, 37 (69.81%) cases were from rural areas. Similar findings have been reported by Shanmugam RP et al. and Bhate et al. Both these studies have confirmed that Hepatitis B and Hepatitis C positivity was high among the rural and low socioeconomic status populations.^15,16 Bhate et al. also claim that the practice of tattooing in rural populations has a high risk of Hepatitis B positivity.¹⁶

The Hepatitis B positive with HIV reactive cases were 6 (1.45%) cases out of the total of 413 Hepatitis B positives. Shrestha LB et al. reported 2.95% of HIV and HBV coinfected cases in their study whereas J Sarkar et al. have shown a higher percentage of 8.33% HIV and HBV coinfected cases in their study.^17,18 The COVID statuses of all the Hepatitis B positive cases during the pandemic were negative. Among the 23 Hepatitis C positive cases during the pandemic, one case (4.3%) was found to be COVID positive.

There was a decrease in the number of HBsAg and anti HCV antibodies’ positive samples in the pandemic era which could be attributed to the reduction of samples received during the pandemic, especially in the early pandemic times. Similar findings have been reported by Gupta N et al., Ismail Z et al. and Kaufman HW et al., where they describe the decrease in Hepatitis testing and treatment during the COVID-19 pandemic.^6,7,19