Sero-prevalence of Hepatitis B infection among the Municipal Waste collectors in Aden, Yemen

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M. Gubran, Hana Waleed, Hanan A. A. Mohammed, Aisha Ali Abdullah, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7715119/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Jan, 2026 Read the published version in International Microbiology → Version 1 posted 11 You are reading this latest preprint version Abstract Background the study aimed to determine the prevalence of HBV infection among municipal waste collectors and to identify risk factors associated with this infection among those collectors in Aden, Yemen. Methods An analytical cross-sectional study was carried out on 100 municipal waste collectors. The samples were collected and tested for HBsAg using a Cobas technique. Results The overall prevalence of HBV was 5%, and clustering of infection was 80% in the Khormaksar district. The highest significant rates were 18.2% and 40% among female MWCs and those exposed to biomedical waste (p = 0.033, 0.019), respectively. Significant associations between HBV were revealed among those who were exposed to catheterization (p = 0.002) and needle stick (p = 0.0001). Only 1 (25%) of vaccinated members had HBV infection with a borderline significant association (p = 0.061). Associations were also significant between HBV infection and clinical findings, including fever (p = 0.0001), vomiting (p = 0.0001), nausea (p = 0.001), loss of appetite (p = 0.0001), abdominal pain (p = 0.001), and jaundice (p = 0.005). Conclusion It can be concluded from this study that the prevalence of HBV infection among municipal waste collectors in Aden, Yemen, was relatively low in comparison with most studies globally and lower than the prevalence of HBV infection among the Yemeni population. The highest rates of HBV were among females and those exposed to biomedical waste. Exposure to needle sticks and catheterization may increase the risk of HBV infections. Mandatory screening and vaccination for all for HBV should be implemented at all MWCs to reduce the HBV risks. Further studies are recommended to detect the HBV and other viral infections among informal waste pickers or garbage collectors. Sero-prevalence Hepatitis B infection Municipal Waste collectors Aden Yemen Figures Figure 1 Figure 2 Introduction Hepatitis B infection is a serious viral infection of the liver caused by the hepatitis B virus (HBV) that leads to cirrhosis and liver carcinoma [ 1 ]. It is considered a main public health problem globally [ 2 ]. HBV is one member of a family called Hepadnaviruse [ 3 ]. It is an enveloped virus, and its deoxyribonucleic acid (DNA) genome is surrounded by an icosahedral capsid [ 4 ]. The World Health Organization (WHO) recently reported that more than a quarter people had chronic HBV infection [ 5 ]. HBV is a bloodborne virus that is transmitted to susceptible persons by a variety of ways, including exposure to contaminated blood and body fluids, from infected mothers to their babies, and by sexual contact [ 4 , 6 ]. Exposure to needles and syringes and shaving tools contaminated with blood and other body fluids may also transmit HBV infection [ 7 ]. The barehanded workers, especially municipal waste collectors (MWCs) and waste pickers, are more susceptible to getting HBV infections. This occurs due to incorrect segregation and transportation of waste [ 8 ]. These workers are always exposed to sharp tools from different sources, especially medical center waste that contains infected blood and other secretions [ 9 ]. Even contacts with houses (domestic) wastes may increase the risk of infection due to contaminated tools used for treatment of chronically infected individuals at home, such as diabetic patients [ 10 ]. Socio-economic status, education level, and awareness about routes of transmission and prevention of the virus are the main factors that increase infection among MWCs [ 11 ]. Globally, the rate of HBV among MWCs ranges from 1.6% to 57% [ 12 , 13 ]. The studies that demonstrated the HBV rates among Yemeni municipal waste collectors were very rare. A study from Sana'a showed the HBV rate among medical waste handlers was 9.17% [ 14 ]. The waste collectors face a higher risk of viral infections, including HBV, compared to the general population because they are directly exposed to wastes that may be contaminated with fluids from infected patients. This study is considered the first study to deal with this issue in Aden, Yemen, which aimed to determine the prevalence of HBV infection among municipal waste collectors and to identify risk factors associated with this infection among those MWCs in Aden, Yemen. Methodology Study area and design An analytical cross-sectional study design was employed in Aden governorate, Yemen, to determine the prevalence of HBV infection and risk factors associated with this infection among municipal waste collectors in Aden, Yemen, from May 1, 2024, to February 28, 2025. This type of study is observational, in which the collection and analysis of the data from the population are done at a specific time without follow-up. It used to detect both outcomes and exposures at the same time [ 15 ]. Sample size The sample size of municipal waste collectors was calculated after obtaining the prevalence of HBV among medical waste handlers from a study conducted in Sana, Yemen, where the HBV rate was 9.17% (14). The sample size was calculated based on Stephen Thompson's formula: N = expected minimum sample size, Z = standard, corresponding to 95% confidence (1.96), P = the % estimated prevalence at 99% (0.99), and D = maximum likely error taken as 5% [ 16 ]. N \(\:=\frac{{\varvec{Z}}^{2}\varvec{P}(1-\varvec{P})}{{\varvec{d}}^{2}}=\frac{{(1.96)}^{2}\times\:9.17\varvec{\%}(1-9.17\varvec{\%})}{{\left(5\varvec{\%}\right)}^{2}}=\) 135 MWCs. The sample size was 135 MWCs. Among 320 MWCs from all municipal waste centers in Aden governorate during that period of time, only 100 of them were accepted to participate in our study. Data collection The data was collected by a questionnaire that was previously designed with some modifications, which include sociodemographic data, such as sex, age, marital status, economic status, level of education, and accommodation. Risk factors that may contribute to infection include the duration of work with waste, sources of waste, previous exposure to blood transfusion, cupping, acupuncture, dental procedures, tattooing, catheterization, sharp items, needle sticks, and splashes of body fluid to the eye. The presence of clinical findings and complications such as fever, vomiting, nausea, loss of appetite, abdominal pain, jaundice, and liver cirrhosis was also collected from all participants [ 7 , 17 ]. Those males and females MWCs who were in direct contact with waste by collection, separation, and transportation were enrolled in this study. Other workers who do not directly contact waste, such as managers, drivers, etc., were excluded. Laboratory procedures About 5 ml of blood were collected from all municipal waste collectors in plain vacutainer tubes, and they were directly transported to the National Central for Public Health Laboratories, Aden. The sera were separated after clotting of blood using a centrifuge and then directly tested for the presence of hepatitis B antigens (HBsAg) using a commercially available, fully automated cobas® e 411 analyzer (Roche Diagnostics Germany). This system is based on electrochemiluminescence immunoassay (ECLIA), and it was selected for its sensitivity and specificity, which were greater than 97%. According to the manufacturer's instructions, calibration of the analyzer is performed using provided standards and controls before testing the patients' sera [ 18 ]. Statistical analysis Statistical Package for the Social Sciences (SPSS) (Version 26) was used for analysis of the data. The quantitative data was normally distributed, so it was presented as mean and standard deviations (SD), while qualitative data was presented as percentages, and the chi-square (χ2) test was used to determine the association between two qualitative variables. p-value (< 0.05) was statistically significant. Results Among 100 municipal waste collectors, the majority were males (89%), in the age groups 25–35 and 36–45 years (30% and 31%, respectively), married (83%), illiterate (94%), of low economic status (62%), and living with their families as accommodation 89% (Table 1 ). The total mean age of collectors was 36.74 ± 10.98 years. The range of ages was 16 and 60 years. The overall prevalence of HBV among MWCs was 5 (5%) (Fig. 1 ). Clustering of HBV among MWCs was high (80%) in Khormaksar district compared to other districts in Aden governorate (Fig. 2 ). The highest rates were 3 (10%) in the age group 25–35 years, 2 (18.2%) females, and 1 (5.9%) unmarried. Those MWCs whose economic status was medium, who had an illiterate education, who lived alone, whose duration of work as waste collectors was > 20 years, and who were exposed to biomedical waste had the highest HBV rates, which were 2 (5.3%), 4 (43%), 1 (9.1%), 2 (8.0%), and 2 (40%), respectively. The statistically significant associations between HBV positive and sex and exposure to biomedical waste (p = 0.033 and 0.019), respectively (Table 2 ). Significant associations between HBV were revealed among those exposed to catheterization (p = 0.002) and needle stick (p = 0.0001). Only 1 (25%) of vaccinated members had HBV infection with borderline significant association (p = 0.061) (Table 3 ). The associations were also significant between HBV infection and the presence of clinical findings, including fever (p = 0.0001), vomiting (p = 0.0001), nausea (p = 0.001), loss of appetite (p = 0.0001), abdominal pain (p = 0.001), and jaundice (p = 0.005) (Table 4 ). Table 1 Socio-demographic characteristics of municipal waste collectors in Aden-Yemen Variables Frequency Percentage (%) Variables Frequency Percentage(%) Sex Education level Male 89 89.0 Illiterate 94 94.0 Female 11 11.0 Secondary school 5 5.0 Age University 1 1.0 < 25 17 17.0 Economical status 25–35 30 30.0 Low 62 62.0 36–45 31 31.0 Medium 38 38.0 ≥ 45 22 22.0 Accommodation Marital status Alone 11 11.0 Unmarried 17 17.0 Not alone 89 89.0 Married 83 83.0 Table 2 Variables associated with HBV infection among municipal waste collectors in Aden-Yemen Variables HBV + ve p Variables HBV + ve p No % No % Age group Economical status < 25 ( n = 17 ) 0 0.0 Low (n = 62) 3 4.8 0.632 25–35 ( n = 30 ) 3 10.0 0.158 Medium (n = 38) 2 5.3 36–45 ( n = 31 ) 1 3.2 0.505 Accommodation ≥ 45 ( n = 22 ) 1 4.5 0.697 Alone (n = 11) 1 9.1 0.449 Sex Not alone (n = 89) 4 4.5 Male (n = 89) 3 3.4 0.033 Duration of work as waste Female (n = 11) 2 18.2 > 10 (n = 34) 0 0.0 ---- Marital status 10–20 (n = 41) 3 7.3 0.332 Unmarried (n = 17) 1 5.9 0.614 < 20 (n = 25) 2 8.0 0.367 Married (n = 83) 4 4.8 Sources of waste Education level Houses (n = 35) 0 0.0 ---- Illiterate (n = 94) 4 43.0 0.309 Biomedical (n = 3) 2 40.0 0.019 Secondary school (n = 5) 1 20.0 0.116 Mixed (n = 62) 3 4.8 0.632 University (n = 1) 0 0.0 ---- Table 3 Association between risk factors and HBV infections and vaccination status against HBV among municipal waste collectors in Aden-Yemen. Risk factors HBV + ve p Risk factors HBV + ve p No. % No. % Blood transfusion ( n = 8) 1 12.5 0.303 Catheterization ( n = 6 ) 2 33.3 0.002 Cupping ( n = 12 ) 0 0.0 ----- Exposed to sharp items ( n = 35 ) 2 5.7 0.576 Acupuncture (n = 9 ) 0 0.0 ----- Exposed to broken glass ( n = 44 ) 4 8.7 0.135 Dental procedures ( n = 13 ) 1 7.1 0.537 Splash of body fluid to eye ( n = 40 ) 2 5.0 0.686 Tattooing ( n = 5 ) 0 0.0 ----- Exposed to needle stick ( n = 8 ) 4 50.0 0.0001 Vaccination against HBV ( n = 4 ) 1 25.0 0.061 Table 4 Distribution of clinical findings and complications of HBV infection among municipal waste collectors in Aden-Yemen. Symptoms HBV + ve p Symptoms HBV + ve p No. % No. % Fever ( n = 22) 5 22.7 0.0001 Loss of appetite ( n = 21 ) 5 23.8 0.0001 Vomiting ( n = 22 ) 5 22.7 0.0001 Abdominal pain ( n = 25 ) 5 20.0 0.001 Nausea (n = 24 ) 5 20.8 0.001 Jaundice ( n = 36 ) 5 33.3 0.005 Liver cirrhosis ( n = 6 ) 1 16.7 0.188 Discussion According to this study, the prevalent rate of HBV infections among municipal waste collectors was 5.0%. Three studies conducted in Bangladesh and Ethiopia found that HBsAg were 6.3%, 6.04%, and 6.0% [ 19 , 20 , 21 , 22 ]. A study done in Greece detected 7% of MWCs had HBV [ 23 ]. Lower percentages than ours were recorded in Afghanistan (4%), [ 24 ] Iran (3.06%) [ 25 ], Malaysia (1.6%) [ 13 ], and Egypt and Iran (1.5%) [ 26 , 27 ]. In contrast, higher results than our findings were shown in different countries globally, such as Thailand (57% and 42%) [ 12 ], Egypt (36.1%) [ 26 ], Italy (32.4%) [ 28 ], Greece (23%) [ 29 ], Eastern Ethiopia (20.4%) [ 30 ], Pakistan ( 18.8%) [ 31 ], Nigeria (17.4%) [ 32 ], Greece (15%) [ 33 ], and Brazil (12.8% and 14%) [ 34 , 35 ]. Corrao and colleagues and Mol et al. showed (11% and 9.8%) of MWCs had had positive antibodies to hepatitis B core antigen (anti-HBc) [ 36 , 37 ]. A study conducted among Yemeni medical waste handlers showed 9.17% of them were HBV positive [ 14 ]. These variations may be attributed to the education of workers, economic status, vaccination status of WMCs, type of waste, and availability of personal protective equipment such as gloves, masks, and glasses [ 35 ]. The prevalence of HBV among MWCs in our study is lower than the general population [ 2 , 17 , 38 , 39 , 40 ]. According to the clustering of HBV infection in the Aden districts, 80% of those who were HBV positive were from the Khormaksar district. There was no literature that was in agreement or disagreement with ours. This result was also recorded as the first finding among MWCs. Regarding the age group in the current study, the highest rate was 10.0% in the 25–35-year-old age group. In agreement with our findings, Mussa et al. reported that MWCs in the age group 20–30 years had a high HBV rate [ 22 ].Shiferaw et al. observed that the highest anti-HBcAg was in the age group between 20 and 29 years [ 19 ].Sarvari et al. revealed that the highest rate was among the mean age of 38 years [ 27 ].Anagaw et al. noticed that HBV infection is high among those collectors in the age group < 35 [ 20 ].Two studies carried out in Bangladesh and Yemen revealed that workers in the 30-39-year and ≥ 41 age groups had the highest HBV rates [ 14 , 21 ].Other studies demonstrated the highest HBV infection among those MWCs over age 50 [ 26 , 34 ].HBV infection decreases among new generation children and young adults by effectively using the type and doses of HBV vaccines [ 34 ]. In this study, the significant high prevalent rates of HBV infection among MWCs were found among females (18.2%, p = 0.033). Our results were in line with the results obtained from similar studies conducted in Ethiopia and Egypt [ 20 , 22 , 26 ]. Other studies showed the highest HBV rates were among males [ 14 , 19 , 29 , 33 , 34 ]. The prevalence of HBV infection among patients according to their sex may be attributed to variations in the physiology and hormones, immunity, and genes [ 41 ]. The obtained result detected that unmarried people had the highest prevalent rate of HBV infection (5.9%). Shiferaw et al. reported a similar finding [ 19 ]. Opposite results were reported in Ethiopia, Bangladesh, Iran, and Yemen [ 14 , 20 , 21 , 25 ]. El-Wahab et al. reported that divorced MWCs had the highest HBV rate [ 26 ]. As regards the economic status of municipal waste collectors, those members whose economic status was medium had the highest HBV rate (5.3%). Anagaw et al. and El-Wahab et al. found different results [ 20 , 26 ]. Despite the lack of significant results, in Yemen, there are no differences between those members whose economic status is either low or medium due to the consequences of war, where the costs of necessary requirements are continuously rising. According to the education levels in our results, the illiterate MWCs had the highest HBV rate (43%), but this result was not statistically significant. Ansari-Moghaddam et al. and Edrees found similar results [ 14 , 25 ]. El-Wahab et al. detected that primary education MWCs had the highest prevalence of HBV [ 26 ]. Three studies carried out in Ethiopia and Bangladesh showed that those waste collectors who had secondary and above education levels had the highest HBV rates [ 20 , 21 , 22 ]. Increasing education levels may increase the awareness of individuals about the risk of virus and preventive measures, thereby decreasing the rate of viral infection [ 9 ]. Regarding accommodation, 9.1% of members who live alone had HBV infection. There was no literature that either agreed or disagreed with our findings. In contrast, Gubran et al. revealed that HBV infection among Yemeni family members was common [ 17 ]. According to the duration of work as waste collectors, the highest HBV infection rate, 8.0%, was among those who worked for more than 20 years. A similar result was demonstrated in Iran [ 25 ]. Data from Northwest Ethiopia reported that HBV infection was high among those whose duration of work was less than 20 [ 20 ]. Lower than our finding was reported in Ethiopia > 15 [ 19 ], Brazil > 10 [ 34 ], Yemen 5-10years [ 14 ] and Northeast Ethiopia and Iran ≤ 5 years [ 22 ]. Increasing the duration of work means increasing exposure to the infected waste tools, thus increasing the risk of infectious diseases (25). Related to sources of waste, there was a statistically significant association between being HBV positive and being exposed to biomedical waste (p = 0.019). No previous studies supported this finding. Biomedical waste from hospitals and other medical service centers may contain more harmful and serious infectious pathogens [ 22 ]. Regarding risk factors, statistically significant associations between HBV were noted among those who were exposed to catheterization and needle sticks (p = 0.002 and 0.0001, respectively). Different results were recorded by Shiferaw et al., where those MWCs who were exposed to tattooing and dental procedures had significant associations [ 19 ]. Mussa et al. found that the history of surgical procedures and family history of hepatitis infection were significantly associated factors (P < 0.05) [ 20 ]. Edrees showed an association between HBV infection and receiving a blood transfusion [ 14 ]. Poor immunization status and contact with harmful waste containing blood and body secretions contaminated with HBV without any personal protective measures may be risk factors for transmission of infection [ 25 ]. Related to vaccination status against HBV, there was only one of 4 MWCs, comprising 25%, who was previously vaccinated against HBV and had an infection. A study performed in Brazil showed 12.3% of the vaccinated MWCs had HBV infection [ 34 ]. Three studies from Yemen noticed that HBV rates among vaccinated individuals were 0%, 4.4%, and 14.3% [ 2 , 7 , 17 ]. The vaccination status of persons may depend on the effectivity, type, and doses of HBV vaccines, as well as the time of administration [ 34 ]. According to clinical findings, there were significant associations between HBV infection and fever, vomiting, nausea, loss of appetite, abdominal pain, and jaundice (p = 0.0001, 0.0001, 0.001, 0.0001, 0.001, and 0.005), respectively. There was no literature among MWCs that agreed or disagreed with these results. These results were recorded as the first findings among MWCs. Small sample size of studied workers and molecular techniques, as real-time polymerase chain reaction (RT-PCR) was not used to detect viral genome and viral load, were the most common limitations of our study. Conclusions and recommendations It can be concluded from this study that the prevalence of HBV infection among municipal waste collectors in Aden, Yemen, was relatively low in comparison with most studies globally and lower than the prevalence of HBV infection among the Yemeni population. The highest rates of HBV were among females and those exposed to biomedical waste. Exposure to needle sticks and catheterization may increase the risk of HBV infections. Mandatory screening and vaccination for all for HBV should be implemented at all MWCs to reduce the HBV risks. Further studies are recommended to detect the HBV and other viral infections among informal waste pickers or garbage collectors. Abbreviations HBV Hepatitis B virus HBsAg hepatitis B surface antigen DNA deoxyribonucleic acid WHO World Health Organization MWCs municipal waste collectors ECLIA Electrochemiluminescence immunoassay SPSS Statistical Package for the Social Sciences SD standard deviations χ2 chi-square RT-PCR Real time polymerase chain reaction Declarations Acknowledgments The authors wish to thank the municipal waste collectors who agreed to participate in their study. They would also like to express their gratitude to the team who collected the data and perform serological tests procedures . Ethics declarations Competing interests The authors declare that there is no conflict of interest Ethics approval and consent form Ethical approval: The ethical approval of this study was obtained from the Ethics Committee of College of Medicine and Health Science at University of Science and Technology; MEC No. (MEC /AD043). Ethical approval was based on standards of Helsinki Declaration. The written consent form was obtained from each woman before performing any research procedure. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Availability of data and materials All data was presented in the manuscript, no further data available and it will be available from corresponding author upon request. Authors' contributions ANMG supervision and revision and final editing of manuscript. HW, AAA and NHA collected of data and samples from all municipal waste collectors and tested of samples for the presence of HBsAg. HAAM, FMSM, BMS, NAO and AGA wrote of introduction and methodology and analyzed, prepared of tables and figures and discussed of results. All authors arranged referencing style, read and made final revision of manuscript. References Rug gieri A, Gagliardi MC, Anticoli S (2018). Sex-dependent outcome of hepatitis B and C viruses infections: synergy of sex hormones and immune responses?. Frontiers in Immunology.;8;9:2302. Gubran ANM, Qassim DH, Abdullah AK, Al Kaf FA, Abdullah AF, Moqlam AA, Thabet NJ, Ali HH, Mohammed BM (2024). Intra-Familial Transmission of Hepatitis B Virus In Aden-Yemen. EJUA-BA.5(2):210–6. You CR, Lee SW, Jang JW, Yoon SK (2014). Update on hepatitis B virus infection. World journal of gastroenterology: WJG.20(37):13293. Levinson W, Chin-Hong P, Joyce E, Nussbaum J, Schwartz B (2018). Review of Medical Microbiology and Immunology: A Guide to Clinical Infectious Diseases. 13th ed. New York: McGraw-Hill Education.. World Health Organization (2024),"publishes new guidelines on hepatitis B". Available at: https://www.who.int/news/item/29-03-2024-who-publishes-updated-guidelines-on-hepatitis-b . Than TT, Jo E, Todt D, Nguyen PH, Steinmann J, Steinmann E, Windisch MP (2019). High environmental stability of hepatitis B virus and inactivation requirements for chemical biocides. J Infect Dis. 219(7):1044–8. Gubran ANM, AL-Ariqi AA, Hashem AR, Garadah EM, AL-Yafaee FN, Ba-Wazer SS, Mohame'd A BN, Tanbash MM (2024). Hepatitis B virus infection among hemodialysis patients in Aden-Yemen. YJMS.18(1):1–8. Rajasekar, R., Chinnakali, P., Kumar, S., Mohan, P., Dhodapkar, R., & Roy, G (2024). Seroprevalence of hepatitis B infection among municipal waste collectors in Puducherry, South India.. El-Gilany AH, Abou-ElWafa HS, El-Bestar SF, El-Sayed Zaki M (2013). Prevalence of hepatitis C virus antibodies among municipal solid waste collectors in Mansoura, Egypt. Occup Med Health Aff.1(133):2. Majumdar A, Sahoo J, Roy G, Kamalanathan S (2015). Improper sharp disposal practices among diabetes patients in home care settings: need for concern?. Indian J Endocrinol Metab.19(3):420–5. Abdulrahman SA, Maideen SF, Rahim FF, Rashid A. Seroprevalence, knowledge, attitude and practice regarding prevention of Hepatitis C among municipal waste collectors in Penang Island, Malaysia. J. Clin. Health. 2019; 4(1): 47–57 Luksamijarulkul P., Sujirarat D., Charupoonphol P. (2008) Risk Behaviors, Occupational Risk And Seroprevalence Of Hepatitis B And A Infections Among Public Cleansing Workers Of Bangkok Metropolis. Hepatitis Monthly[Internet].8(1):35–40. Kader Maideen SF, Rahim FF, Rashid A, Abdulrahman S (2020). Seroprevalence of Hepatitis B Among Municipal Waste Collectors in Penang Island, Malaysia and Their Knowledge, Attitude and Practice Towards the Prevention of Hepatitis B. Glob. J. Health Sci.12(7):20. Edrees WH (2022). Hepatitis B. Hepatitis C, and HIV Infection: Prevalence, Knowledge, Practice,and Attitude among Medical Waste Handlers Working in some Hospitals at Sana’a City-Yemen;. Wang X, Cheng Z (2020). Cross-sectional studies: strengths, weaknesses, and recommendations. Chest.1;158(1):S65-71. Daniel W, Wiley J (1999). Biostatistics: a foundation for analysis in the health sciences. Gubran ANM, Al-Moyed KA, Al-Haddad AM, Ageel AA (2023). Intra-Household Transmission of Hepatitis B Virus in Rasd, Abyan-Yemen. LJMAS.5:50–8. Wadood M, Usman M (2019). Comparative analysis of electrochemiluminescence assay and chemiluminescent microparticle immunoassay for the screening of hepatitis C. Indian Journal of Hematology and Blood Transfusion.25;35(1):131–6. Shiferaw Y, Abebe T, Mihret A (2011). Hepatitis B virus infection among medical waste handlers in Addis Ababa, Ethiopia. BMC Res. Note.4:1–7. Anagaw B, Shiferaw Y, Anagaw B, Belyhun Y, Erku W, Biadgelegn F, Moges B, Alemu A, Moges F, Mulu A (2012). Seroprevalence of hepatitis B and C viruses among medical waste handlers at Gondar town Health institutions, Northwest Ethiopia. BMC Res. Note.5:1–10. Uddin MS, Islam MN, Khan ME, Yeasmin S, Ahmed F, Amiruzzaman M (2017). Frequency of hepatitis B and C viral infection among the medical waste handlers. Bangladesh J Infect Dis.4(1):3. Mussa S, Kasew D, Wondimeneh Y (2022). Seroprevalence of Hepatitis B and C viruses and associated factors among medical waste handlers, Northeast Ethiopia. EJHBS.12(2). Dounias G, Kypraiou E, Rachiotis G, Tsovili E, Kostopoulos S (2005). Prevalence of hepatitis B virus markers in municipal solid waste workers in Keratsini (Greece). Occup Med.55(1):60–3. Hosseini SM, Ranjbar R, Sarshar M, Ebrahimi E (2013). Prevalence of HB-sAg positive among Afghan sweepers in Tehran 2009. Iran J Infect Dis.18:9–53. Ansari-Moghaddam A, Ansari H, Khosravi S, Sanei-Moghaddam E, Mohammadi M, Alavian SM, Poustchi H (2016). The prevalence of hepatitis B virus among municipal solid waste workers: necessity for immunization of at-risk groups. Hepatitis Monthly.16(3). El-Wahab EW, Eassa SM, Lotfi SE, Kotkat AM, Shatat HZ (2015). Seroprevalence, immunostatus and factors associated with blood borne viral infections among Egyptian municipal solid waste workers. J Virol Antivir Res 4:2. Sarvari J, Joharinia N, Shiri A, Vali A, Beigzadeh F, Davarpanah MA, Atapour A, Khoshbakht R, Jaberi O, Hosseini SY (2023). The Sero-Prevalence of Hepatitis B and C Viruses in Municipal Waste Collectors in Southwest of Iran. Indian J Occup Environ Med.27(2):172–6. Squeri R, La Fauci V, Sindoni L, Cannavo G, Ventura Spagnolo E (2006). Study on hepatitis B and C serologic status among municipal solid waste workers in Messina (Italy). J Prev Med Hyg.47(3):110–3. Rachiotis G, Papagiannis D, Markas D, Thanasias E, Dounias G, Hadjichristodoulou C (2012). Hepatitis B virus infection and waste collection: prevalence, risk factors, and infection pathway. Am. J. Ind. Med.55(7):650–5. Mengiste DA, Dirbsa AT, Ayele BH, Hailegiyorgis TT (2021). Hepatitis B virus infection and its associated factors among medical waste collectors at public health facilities in eastern Ethiopia: a facility-based cross-sectional study. BMC Infect. Dis.21:1–8. Rauf MU, Saleem MD, Anwer MO, Ahmed G, Aziz S, Memon MA (2013). HIV, hepatitis B and hepatitis C in garbage scavengers of Karachi. JPMA. J Pak Med Assoc.63(6):798–802. Yusuf RO, Sawyerr HO, Adeolu AT, Habeeb LM, Abolayo TT (2018). Seroprevalence of Hepatitis B virus and compliance to standard safety precautions among scavengers in Ilorin Metropolis, Kwara State, Nigeria. J. health pollut.8(19):180914. Tsovili E, Rachiotis G, Symvoulakis EK, Thanasias E, Giannisopoulou O, Papagiannis D, Eleftheriou A, Hadjichristodoulou C (2014). Municipal waste collectors and hepatitis B and C virus infection: a cross-sectional study. Age.43(8.25). Marinho TA, Lopes CL, Teles SA, Matos MA, Matos MA, Kozlowski AG, Oliveira MP, Silva ÁM, Martins RM (2014). Epidemiology of hepatitis B virus infection among recyclable waste collectors in central Brazil. Rev Soc Bras Med Trop.47(1):18–23. Souza-Silva G, Mol MP (2021). Hepatitis B prevalence in Brazilian waste pickers: a systematic review with meta-analysis. Rev Saude Publica.55:86. Corrao CR, Del Cimmuto A, Marzuillo C, Paparo E, La Torre G (2013). Association between Waste Management and HBV among Solid Municipal Waste Workers: A Systematic Review and Meta-Analysis of Observational Studies. Sci. World J.2 Mol MP, Gonçalves JP, Silva EA, Scarponi CF, Greco DB, Cairncross S, Heller L (2016). Seroprevalence of hepatitis B and C among domestic and healthcare waste handlers in Belo Horizonte, Brazil. Waste Management & Research.34(9):875–83. Al-Hegami MA, Al-Mamari A, Al-Kadasse AS, Al-Gasha’a FA, Al-Hag S, Al-Hegami AA (2015). Prevalence and risk factors of hepatitis B and hepatitis C virus infections among patients with chronic renal failure in Zabeed city, Yemen Republic. Open J. Med. Microbiol.5(3):136–42. Amran OA, Al-Shamahy HA, Al Hadad AM, Jaadan BM (2019). Explosion of hepatitis B and C viruses among hemodialysis patients as a result of hemodialysis crisis in Yemen. Universal J Pharm Res. 4 (5): 1–8. El-Morsy ES, Alghalibi S, Elbialy AA, Baddah K, Khalifa M (2022). Occult Hepatitis B Virus Infection Among Patients Undergoing Chronic Dialysis in Hodeidah City, Yemen. AJBAS. 3(1):64–73. Ruggieri A, Gagliardi MC, Anticoli S (2018). Sex-dependent outcome of hepatitis B and C viruses infections: synergy of sex hormones and immune responses?. Front Immunol. 9:2302. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 05 Jan, 2026 Read the published version in International Microbiology → Version 1 posted Editorial decision: Revision requested 22 Oct, 2025 Reviews received at journal 19 Oct, 2025 Reviews received at journal 14 Oct, 2025 Reviewers agreed at journal 12 Oct, 2025 Reviews received at journal 12 Oct, 2025 Reviewers agreed at journal 12 Oct, 2025 Reviewers agreed at journal 11 Oct, 2025 Reviewers invited by journal 10 Oct, 2025 Editor assigned by journal 29 Sep, 2025 Submission checks completed at journal 26 Sep, 2025 First submitted to journal 25 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7715119","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":522421861,"identity":"702dc269-89b9-4d8d-bb23-69d32ea9875c","order_by":0,"name":"Ali N. M. 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A.","lastName":"Mohammed","suffix":""},{"id":522421864,"identity":"5a2f4c2c-f313-4ba4-aa10-7948d45d58f7","order_by":3,"name":"Aisha Ali Abdullah","email":"","orcid":"","institution":"Aden University","correspondingAuthor":false,"prefix":"","firstName":"Aisha","middleName":"Ali","lastName":"Abdullah","suffix":""},{"id":522421865,"identity":"99381d0b-99ed-44a9-84e2-88bcc4453bb9","order_by":4,"name":"Ayat Gamal Ali","email":"","orcid":"","institution":"Aden University","correspondingAuthor":false,"prefix":"","firstName":"Ayat","middleName":"Gamal","lastName":"Ali","suffix":""},{"id":522421866,"identity":"8b87788b-841e-40ab-87bc-a723f7155b62","order_by":5,"name":"Bona Mohammad Saeed","email":"","orcid":"","institution":"Aden University","correspondingAuthor":false,"prefix":"","firstName":"Bona","middleName":"Mohammad","lastName":"Saeed","suffix":""},{"id":522421867,"identity":"2f28b4bb-37c2-4ec1-8b0d-a25af4639860","order_by":6,"name":"Nawras Hamza Abdullah","email":"","orcid":"","institution":"Aden University","correspondingAuthor":false,"prefix":"","firstName":"Nawras","middleName":"Hamza","lastName":"Abdullah","suffix":""},{"id":522421868,"identity":"443c9fb5-01c5-4e9a-999c-ddaf6960b992","order_by":7,"name":"Nadrah Aidroos Omar","email":"","orcid":"","institution":"Aden University","correspondingAuthor":false,"prefix":"","firstName":"Nadrah","middleName":"Aidroos","lastName":"Omar","suffix":""},{"id":522421869,"identity":"33233573-efed-4985-979a-ba964b96ea28","order_by":8,"name":"Fares M. S Muthanna","email":"","orcid":"","institution":"University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Fares","middleName":"M. S","lastName":"Muthanna","suffix":""}],"badges":[],"createdAt":"2025-09-25 16:53:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7715119/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7715119/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10123-025-00771-3","type":"published","date":"2026-01-05T15:59:25+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":92918538,"identity":"94e410d4-e528-4819-b51b-7ad44e19dd2c","added_by":"auto","created_at":"2025-10-07 06:19:26","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85824,"visible":true,"origin":"","legend":"","description":"","filename":"Mainmanuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-7715119/v1/018f13e664e00946a44bafd9.docx"},{"id":92918537,"identity":"39383276-5c6a-4c8f-afb9-c490c17e9f15","added_by":"auto","created_at":"2025-10-07 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06:19:26","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":116717,"visible":true,"origin":"","legend":"","description":"","filename":"c45bf84eced84335ba129916940251ec1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7715119/v1/4373d11c03e14a3137594b31.xml"},{"id":92918545,"identity":"99d7cccd-1fd3-403f-abb9-096bf0bc7687","added_by":"auto","created_at":"2025-10-07 06:19:27","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":128426,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7715119/v1/f40339c9dc8fda2bde63cb27.html"},{"id":92919171,"identity":"b65d95e7-f79a-45c5-b41a-534db0d2a5c4","added_by":"auto","created_at":"2025-10-07 06:27:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":7651,"visible":true,"origin":"","legend":"\u003cp\u003eThe prevalence of HBV infection among municipal waste collectors in Aden-Yemen\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7715119/v1/dd08dc9f374a14b88a3ba619.png"},{"id":92919172,"identity":"7b87c884-3b56-412d-863d-74e1a31ca88e","added_by":"auto","created_at":"2025-10-07 06:27:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":15699,"visible":true,"origin":"","legend":"\u003cp\u003eClustering of HBV infection among municipal waste collectors according to Aden distracts.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7715119/v1/44150a8911fdbd55bc882f65.png"},{"id":100069456,"identity":"51bf022a-feaf-42d7-af15-c6c2d0d7af13","added_by":"auto","created_at":"2026-01-12 16:14:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":993542,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7715119/v1/fe57ac32-4798-44bd-b260-b26d8517b13f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sero-prevalence of Hepatitis B infection among the Municipal Waste collectors in Aden, Yemen","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHepatitis B infection is a serious viral infection of the liver caused by the hepatitis B virus (HBV) that leads to cirrhosis and liver carcinoma [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is considered a main public health problem globally [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. HBV is one member of a family called Hepadnaviruse [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It is an enveloped virus, and its deoxyribonucleic acid (DNA) genome is surrounded by an icosahedral capsid [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The World Health Organization (WHO) recently reported that more than a quarter people had chronic HBV infection [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. HBV is a bloodborne virus that is transmitted to susceptible persons by a variety of ways, including exposure to contaminated blood and body fluids, from infected mothers to their babies, and by sexual contact [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Exposure to needles and syringes and shaving tools contaminated with blood and other body fluids may also transmit HBV infection [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe barehanded workers, especially municipal waste collectors (MWCs) and waste pickers, are more susceptible to getting HBV infections. This occurs due to incorrect segregation and transportation of waste [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These workers are always exposed to sharp tools from different sources, especially medical center waste that contains infected blood and other secretions [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Even contacts with houses (domestic) wastes may increase the risk of infection due to contaminated tools used for treatment of chronically infected individuals at home, such as diabetic patients [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Socio-economic status, education level, and awareness about routes of transmission and prevention of the virus are the main factors that increase infection among MWCs [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGlobally, the rate of HBV among MWCs ranges from 1.6% to 57% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The studies that demonstrated the HBV rates among Yemeni municipal waste collectors were very rare. A study from Sana'a showed the HBV rate among medical waste handlers was 9.17% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The waste collectors face a higher risk of viral infections, including HBV, compared to the general population because they are directly exposed to wastes that may be contaminated with fluids from infected patients. This study is considered the first study to deal with this issue in Aden, Yemen, which aimed to determine the prevalence of HBV infection among municipal waste collectors and to identify risk factors associated with this infection among those MWCs in Aden, Yemen.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cb\u003eStudy area and design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAn analytical cross-sectional study design was employed in Aden governorate, Yemen, to determine the prevalence of HBV infection and risk factors associated with this infection among municipal waste collectors in Aden, Yemen, from May 1, 2024, to February 28, 2025. This type of study is observational, in which the collection and analysis of the data from the population are done at a specific time without follow-up. It used to detect both outcomes and exposures at the same time [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample size\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe sample size of municipal waste collectors was calculated after obtaining the prevalence of HBV among medical waste handlers from a study conducted in Sana, Yemen, where the HBV rate was 9.17% (14). The sample size was calculated based on Stephen Thompson's formula: N\u0026thinsp;=\u0026thinsp;expected minimum sample size, Z\u0026thinsp;=\u0026thinsp;standard, corresponding to 95% confidence (1.96), P\u0026thinsp;=\u0026thinsp;the % estimated prevalence at 99% (0.99), and D\u0026thinsp;=\u0026thinsp;maximum likely error taken as 5% [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eN\u003c/b\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:=\\frac{{\\varvec{Z}}^{2}\\varvec{P}(1-\\varvec{P})}{{\\varvec{d}}^{2}}=\\frac{{(1.96)}^{2}\\times\\:9.17\\varvec{\\%}(1-9.17\\varvec{\\%})}{{\\left(5\\varvec{\\%}\\right)}^{2}}=\\)\u003c/span\u003e\u003c/span\u003e135 MWCs. The sample size was 135 MWCs. Among 320 MWCs from all municipal waste centers in Aden governorate during that period of time, only 100 of them were accepted to participate in our study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe data was collected by a questionnaire that was previously designed with some modifications, which include sociodemographic data, such as sex, age, marital status, economic status, level of education, and accommodation. Risk factors that may contribute to infection include the duration of work with waste, sources of waste, previous exposure to blood transfusion, cupping, acupuncture, dental procedures, tattooing, catheterization, sharp items, needle sticks, and splashes of body fluid to the eye. The presence of clinical findings and complications such as fever, vomiting, nausea, loss of appetite, abdominal pain, jaundice, and liver cirrhosis was also collected from all participants [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Those males and females MWCs who were in direct contact with waste by collection, separation, and transportation were enrolled in this study. Other workers who do not directly contact waste, such as managers, drivers, etc., were excluded.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLaboratory procedures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAbout 5 ml of blood were collected from all municipal waste collectors in plain vacutainer tubes, and they were directly transported to the National Central for Public Health Laboratories, Aden. The sera were separated after clotting of blood using a centrifuge and then directly tested for the presence of hepatitis B antigens (HBsAg) using a commercially available, fully automated cobas\u0026reg; e 411 analyzer (Roche Diagnostics Germany). This system is based on electrochemiluminescence immunoassay (ECLIA), and it was selected for its sensitivity and specificity, which were greater than 97%. According to the manufacturer's instructions, calibration of the analyzer is performed using provided standards and controls before testing the patients' sera [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eStatistical analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eStatistical Package for the Social Sciences (SPSS) (Version 26) was used for analysis of the data. The quantitative data was normally distributed, so it was presented as mean and standard deviations (SD), while qualitative data was presented as percentages, and the chi-square (χ2) test was used to determine the association between two qualitative variables. p-value (\u0026lt;\u0026thinsp;0.05) was statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong 100 municipal waste collectors, the majority were males (89%), in the age groups 25\u0026ndash;35 and 36\u0026ndash;45 years (30% and 31%, respectively), married (83%), illiterate (94%), of low economic status (62%), and living with their families as accommodation 89% (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The total mean age of collectors was 36.74\u0026thinsp;\u0026plusmn;\u0026thinsp;10.98 years. The range of ages was 16 and 60 years.\u003c/p\u003e\u003cp\u003eThe overall prevalence of HBV among MWCs was 5 (5%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Clustering of HBV among MWCs was high (80%) in Khormaksar district compared to other districts in Aden governorate (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe highest rates were 3 (10%) in the age group 25\u0026ndash;35 years, 2 (18.2%) females, and 1 (5.9%) unmarried. Those MWCs whose economic status was medium, who had an illiterate education, who lived alone, whose duration of work as waste collectors was \u0026gt;\u0026thinsp;20 years, and who were exposed to biomedical waste had the highest HBV rates, which were 2 (5.3%), 4 (43%), 1 (9.1%), 2 (8.0%), and 2 (40%), respectively. The statistically significant associations between HBV positive and sex and exposure to biomedical waste (p\u0026thinsp;=\u0026thinsp;0.033 and 0.019), respectively (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSignificant associations between HBV were revealed among those exposed to catheterization (p\u0026thinsp;=\u0026thinsp;0.002) and needle stick (p\u0026thinsp;=\u0026thinsp;0.0001). Only 1 (25%) of vaccinated members had HBV infection with borderline significant association (p\u0026thinsp;=\u0026thinsp;0.061) (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The associations were also significant between HBV infection and the presence of clinical findings, including fever (p\u0026thinsp;=\u0026thinsp;0.0001), vomiting (p\u0026thinsp;=\u0026thinsp;0.0001), nausea (p\u0026thinsp;=\u0026thinsp;0.001), loss of appetite (p\u0026thinsp;=\u0026thinsp;0.0001), abdominal pain (p\u0026thinsp;=\u0026thinsp;0.001), and jaundice (p\u0026thinsp;=\u0026thinsp;0.005) (Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-demographic characteristics of municipal waste collectors in Aden-Yemen\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePercentage(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003eEducation level\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e94.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSecondary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003e\u003cb\u003eEconomical status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e62.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMedium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e38.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003e\u003cb\u003eAccommodation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAlone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNot alone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e89.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eVariables associated with HBV infection among municipal waste collectors in Aden-Yemen\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eHBV\u0026thinsp;+\u0026thinsp;ve\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eHBV\u0026thinsp;+\u0026thinsp;ve\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003eEconomical status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;25\u003c/p\u003e\u003cp\u003e(\u003cb\u003en\u0026thinsp;=\u0026thinsp;17\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.632\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u0026ndash;35\u003c/p\u003e\u003cp\u003e(\u003cb\u003en\u0026thinsp;=\u0026thinsp;30\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMedium\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36\u0026ndash;45\u003c/p\u003e\u003cp\u003e(\u003cb\u003en\u0026thinsp;=\u0026thinsp;31\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.505\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003eAccommodation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;45\u003c/p\u003e\u003cp\u003e(\u003cb\u003en\u0026thinsp;=\u0026thinsp;22\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.697\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAlone\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.449\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot alone\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;89)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003eDuration of work as waste\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;11)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;10\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e----\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10\u0026ndash;20\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.332\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUnmarried (n\u0026thinsp;=\u0026thinsp;17)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.614\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.367\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarried\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;83)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003eSources of waste\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHouses\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e----\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eBiomedical\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e40.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary school\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMixed\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.632\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e----\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation between risk factors and HBV infections and vaccination status against HBV among municipal waste collectors in Aden-Yemen.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eRisk factors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eHBV\u0026thinsp;+\u0026thinsp;ve\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eRisk factors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eHBV\u0026thinsp;+\u0026thinsp;ve\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood transfusion\u003c/p\u003e\u003cp\u003e(\u003cb\u003en\u0026thinsp;=\u0026thinsp;8)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.303\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCatheterization\u003c/p\u003e\u003cp\u003e(\u003cb\u003en\u0026thinsp;=\u0026thinsp;6\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e33.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCupping\u003c/p\u003e\u003cp\u003e(\u003cb\u003en\u0026thinsp;=\u0026thinsp;12\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-----\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eExposed to sharp items (\u003cb\u003en\u0026thinsp;=\u0026thinsp;35\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.576\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcupuncture\u003c/p\u003e\u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;9\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-----\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eExposed to broken glass (\u003cb\u003en\u0026thinsp;=\u0026thinsp;44\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.135\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDental procedures\u003c/p\u003e\u003cp\u003e(\u003cb\u003en\u0026thinsp;=\u0026thinsp;13\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.537\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSplash of body fluid to eye (\u003cb\u003en\u0026thinsp;=\u0026thinsp;40\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.686\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTattooing\u003c/p\u003e\u003cp\u003e(\u003cb\u003en\u0026thinsp;=\u0026thinsp;5\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-----\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eExposed to needle stick (\u003cb\u003en\u0026thinsp;=\u0026thinsp;8\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e50.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVaccination against HBV\u003c/p\u003e\u003cp\u003e(\u003cb\u003en\u0026thinsp;=\u0026thinsp;4\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of clinical findings and complications of HBV infection among municipal waste collectors in Aden-Yemen.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSymptoms\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eHBV\u0026thinsp;+\u0026thinsp;ve\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSymptoms\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eHBV\u0026thinsp;+\u0026thinsp;ve\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFever\u003c/p\u003e\u003cp\u003e(\u003cb\u003en\u0026thinsp;=\u0026thinsp;22)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLoss of appetite\u003c/p\u003e\u003cp\u003e(\u003cb\u003en\u0026thinsp;=\u0026thinsp;21\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVomiting\u003c/p\u003e\u003cp\u003e(\u003cb\u003en\u0026thinsp;=\u0026thinsp;22\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAbdominal pain\u003c/p\u003e\u003cp\u003e(\u003cb\u003en\u0026thinsp;=\u0026thinsp;25\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNausea\u003c/p\u003e\u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;24\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eJaundice (\u003cb\u003en\u0026thinsp;=\u0026thinsp;36\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e33.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiver cirrhosis\u003c/p\u003e\u003cp\u003e(\u003cb\u003en\u0026thinsp;=\u0026thinsp;6\u003c/b\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.188\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAccording to this study, the prevalent rate of HBV infections among municipal waste collectors was 5.0%. Three studies conducted in Bangladesh and Ethiopia found that HBsAg were 6.3%, 6.04%, and 6.0% [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. A study done in Greece detected 7% of MWCs had HBV [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Lower percentages than ours were recorded in Afghanistan (4%), [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] Iran (3.06%) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], Malaysia (1.6%) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and Egypt and Iran (1.5%) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn contrast, higher results than our findings were shown in different countries globally, such as Thailand (57% and 42%) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], Egypt (36.1%) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], Italy (32.4%) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], Greece (23%) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], Eastern Ethiopia (20.4%) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], Pakistan \u003cem\u003e(\u003c/em\u003e18.8%) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], Nigeria (17.4%) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], Greece (15%) [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], and Brazil (12.8% and 14%) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Corrao and colleagues and Mol et al. showed (11% and 9.8%) of MWCs had had positive antibodies to hepatitis B core antigen (anti-HBc) [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. A study conducted among Yemeni medical waste handlers showed 9.17% of them were HBV positive [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These variations may be attributed to the education of workers, economic status, vaccination status of WMCs, type of waste, and availability of personal protective equipment such as gloves, masks, and glasses [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The prevalence of HBV among MWCs in our study is lower than the general population [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to the clustering of HBV infection in the Aden districts, 80% of those who were HBV positive were from the Khormaksar district. There was no literature that was in agreement or disagreement with ours. This result was also recorded as the first finding among MWCs.\u003c/p\u003e\u003cp\u003eRegarding the age group in the current study, the highest rate was 10.0% in the 25\u0026ndash;35-year-old age group. In agreement with our findings, Mussa et al. reported that MWCs in the age group 20\u0026ndash;30 years had a high HBV rate [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].Shiferaw et al. observed that the highest anti-HBcAg was in the age group between 20 and 29 years [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].Sarvari et al. revealed that the highest rate was among the mean age of 38 years [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].Anagaw et al. noticed that HBV infection is high among those collectors in the age group\u0026thinsp;\u0026lt;\u0026thinsp;35 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].Two studies carried out in Bangladesh and Yemen revealed that workers in the 30-39-year and \u0026ge;\u0026thinsp;41 age groups had the highest HBV rates [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].Other studies demonstrated the highest HBV infection among those MWCs over age 50 [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].HBV infection decreases among new generation children and young adults by effectively using the type and doses of HBV vaccines [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this study, the significant high prevalent rates of HBV infection among MWCs were found among females (18.2%, p\u0026thinsp;=\u0026thinsp;0.033). Our results were in line with the results obtained from similar studies conducted in Ethiopia and Egypt [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Other studies showed the highest HBV rates were among males [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The prevalence of HBV infection among patients according to their sex may be attributed to variations in the physiology and hormones, immunity, and genes [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe obtained result detected that unmarried people had the highest prevalent rate of HBV infection (5.9%). Shiferaw et al. reported a similar finding [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Opposite results were reported in Ethiopia, Bangladesh, Iran, and Yemen [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. El-Wahab et al. reported that divorced MWCs had the highest HBV rate [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAs regards the economic status of municipal waste collectors, those members whose economic status was medium had the highest HBV rate (5.3%). Anagaw et al. and El-Wahab et al. found different results [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Despite the lack of significant results, in Yemen, there are no differences between those members whose economic status is either low or medium due to the consequences of war, where the costs of necessary requirements are continuously rising.\u003c/p\u003e\u003cp\u003eAccording to the education levels in our results, the illiterate MWCs had the highest HBV rate (43%), but this result was not statistically significant. Ansari-Moghaddam et al. and Edrees found similar results [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. El-Wahab et al. detected that primary education MWCs had the highest prevalence of HBV [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Three studies carried out in Ethiopia and Bangladesh showed that those waste collectors who had secondary and above education levels had the highest HBV rates [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Increasing education levels may increase the awareness of individuals about the risk of virus and preventive measures, thereby decreasing the rate of viral infection [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRegarding accommodation, 9.1% of members who live alone had HBV infection. There was no literature that either agreed or disagreed with our findings. In contrast, Gubran et al. revealed that HBV infection among Yemeni family members was common [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to the duration of work as waste collectors, the highest HBV infection rate, 8.0%, was among those who worked for more than 20 years. A similar result was demonstrated in Iran [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Data from Northwest Ethiopia reported that HBV infection was high among those whose duration of work was less than 20 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Lower than our finding was reported in Ethiopia\u0026thinsp;\u0026gt;\u0026thinsp;15 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], Brazil\u0026thinsp;\u0026gt;\u0026thinsp;10 [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], Yemen 5-10years [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and Northeast Ethiopia and Iran\u0026thinsp;\u0026le;\u0026thinsp;5 years [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Increasing the duration of work means increasing exposure to the infected waste tools, thus increasing the risk of infectious diseases (25).\u003c/p\u003e\u003cp\u003eRelated to sources of waste, there was a statistically significant association between being HBV positive and being exposed to biomedical waste (p\u0026thinsp;=\u0026thinsp;0.019). No previous studies supported this finding. Biomedical waste from hospitals and other medical service centers may contain more harmful and serious infectious pathogens [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRegarding risk factors, statistically significant associations between HBV were noted among those who were exposed to catheterization and needle sticks (p\u0026thinsp;=\u0026thinsp;0.002 and 0.0001, respectively). Different results were recorded by Shiferaw et al., where those MWCs who were exposed to tattooing and dental procedures had significant associations [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Mussa et al. found that the history of surgical procedures and family history of hepatitis infection were significantly associated factors (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Edrees showed an association between HBV infection and receiving a blood transfusion [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Poor immunization status and contact with harmful waste containing blood and body secretions contaminated with HBV without any personal protective measures may be risk factors for transmission of infection [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRelated to vaccination status against HBV, there was only one of 4 MWCs, comprising 25%, who was previously vaccinated against HBV and had an infection. A study performed in Brazil showed 12.3% of the vaccinated MWCs had HBV infection [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Three studies from Yemen noticed that HBV rates among vaccinated individuals were 0%, 4.4%, and 14.3% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The vaccination status of persons may depend on the effectivity, type, and doses of HBV vaccines, as well as the time of administration [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to clinical findings, there were significant associations between HBV infection and fever, vomiting, nausea, loss of appetite, abdominal pain, and jaundice (p\u0026thinsp;=\u0026thinsp;0.0001, 0.0001, 0.001, 0.0001, 0.001, and 0.005), respectively. There was no literature among MWCs that agreed or disagreed with these results. These results were recorded as the first findings among MWCs.\u003c/p\u003e\u003cp\u003eSmall sample size of studied workers and molecular techniques, as real-time polymerase chain reaction (RT-PCR) was not used to detect viral genome and viral load, were the most common limitations of our study.\u003c/p\u003e"},{"header":"Conclusions and recommendations","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cp\u003eIt can be concluded from this study that the prevalence of HBV infection among municipal waste collectors in Aden, Yemen, was relatively low in comparison with most studies globally and lower than the prevalence of HBV infection among the Yemeni population. The highest rates of HBV were among females and those exposed to biomedical waste. Exposure to needle sticks and catheterization may increase the risk of HBV infections. Mandatory screening and vaccination for all for HBV should be implemented at all MWCs to reduce the HBV risks. Further studies are recommended to detect the HBV and other viral infections among informal waste pickers or garbage collectors.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eHBV\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHepatitis B virus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eHBsAg\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ehepatitis B surface antigen\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eDNA\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003edeoxyribonucleic acid\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eWHO\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eMWCs\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003emunicipal waste collectors\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eECLIA\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eElectrochemiluminescence immunoassay\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eSPSS\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003estandard deviations\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eχ2\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003echi-square\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eRT-PCR\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eReal time polymerase chain reaction\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to thank the municipal waste collectors who agreed to participate in their study. They would also like to express their gratitude to the team who collected the data and perform serological tests procedures\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent form\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval: The ethical\u0026nbsp;approval\u0026nbsp;of this study was obtained from the Ethics Committee of College of Medicine and Health Science at University of Science and Technology; MEC No. (MEC /AD043).\u0026nbsp;Ethical approval\u0026nbsp;was based on standards of Helsinki Declaration. The written consent form was obtained from each woman before performing any research procedure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data was presented in the manuscript, no further data available and it will be available from \u003cem\u003ecorresponding author\u0026nbsp;\u003c/em\u003eupon request. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eANMG supervision and revision and final editing of manuscript. HW, AAA and NHA collected of data and samples from all municipal waste collectors and tested of samples for the presence of HBsAg. \u0026nbsp;HAAM, FMSM, BMS, NAO and AGA wrote of introduction and methodology and analyzed, prepared of tables and figures and discussed of results. All authors arranged referencing style, read and made final revision of manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRug gieri A, Gagliardi MC, Anticoli S (2018). Sex-dependent outcome of hepatitis B and C viruses infections: synergy of sex hormones and immune responses?. Frontiers in Immunology.;8;9:2302.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGubran ANM, Qassim DH, Abdullah AK, Al Kaf FA, Abdullah AF, Moqlam AA, Thabet NJ, Ali HH, Mohammed BM (2024). Intra-Familial Transmission of Hepatitis B Virus In Aden-Yemen. EJUA-BA.5(2):210\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYou CR, Lee SW, Jang JW, Yoon SK (2014). Update on hepatitis B virus infection. World journal of gastroenterology: WJG.20(37):13293.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLevinson W, Chin-Hong P, Joyce E, Nussbaum J, Schwartz B (2018). Review of Medical Microbiology and Immunology: A Guide to Clinical Infectious Diseases. 13th ed. New York: McGraw-Hill Education..\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (2024),\"publishes new guidelines on hepatitis B\". Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news/item/29-03-2024-who-publishes-updated-guidelines-on-hepatitis-b\u003c/span\u003e\u003cspan address=\"https://www.who.int/news/item/29-03-2024-who-publishes-updated-guidelines-on-hepatitis-b\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThan TT, Jo E, Todt D, Nguyen PH, Steinmann J, Steinmann E, Windisch MP (2019). High environmental stability of hepatitis B virus and inactivation requirements for chemical biocides. J Infect Dis. 219(7):1044\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGubran ANM, AL-Ariqi AA, Hashem AR, Garadah EM, AL-Yafaee FN, Ba-Wazer SS, Mohame'd A BN, Tanbash MM (2024). Hepatitis B virus infection among hemodialysis patients in Aden-Yemen. YJMS.18(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRajasekar, R., Chinnakali, P., Kumar, S., Mohan, P., Dhodapkar, R., \u0026amp; Roy, G (2024). Seroprevalence of hepatitis B infection among municipal waste collectors in Puducherry, South India..\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEl-Gilany AH, Abou-ElWafa HS, El-Bestar SF, El-Sayed Zaki M (2013). Prevalence of hepatitis C virus antibodies among municipal solid waste collectors in Mansoura, Egypt. Occup Med Health Aff.1(133):2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMajumdar A, Sahoo J, Roy G, Kamalanathan S (2015). Improper sharp disposal practices among diabetes patients in home care settings: need for concern?. Indian J Endocrinol Metab.19(3):420\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbdulrahman SA, Maideen SF, Rahim FF, Rashid A. Seroprevalence, knowledge, attitude and practice regarding prevention of Hepatitis C among municipal waste collectors in Penang Island, Malaysia. J. Clin. Health. 2019; 4(1): 47\u0026ndash;57\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLuksamijarulkul P., Sujirarat D., Charupoonphol P. (2008) Risk Behaviors, Occupational Risk And Seroprevalence Of Hepatitis B And A Infections Among Public Cleansing Workers Of Bangkok Metropolis. Hepatitis Monthly[Internet].8(1):35\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKader Maideen SF, Rahim FF, Rashid A, Abdulrahman S (2020). Seroprevalence of Hepatitis B Among Municipal Waste Collectors in Penang Island, Malaysia and Their Knowledge, Attitude and Practice Towards the Prevention of Hepatitis B. Glob. J. Health Sci.12(7):20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEdrees WH (2022). Hepatitis B. Hepatitis C, and HIV Infection: Prevalence, Knowledge, Practice,and Attitude among Medical Waste Handlers Working in some Hospitals at Sana\u0026rsquo;a City-Yemen;.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang X, Cheng Z (2020). Cross-sectional studies: strengths, weaknesses, and recommendations. Chest.1;158(1):S65-71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDaniel W, Wiley J (1999). Biostatistics: a foundation for analysis in the health sciences.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGubran ANM, Al-Moyed KA, Al-Haddad AM, Ageel AA (2023). Intra-Household Transmission of Hepatitis B Virus in Rasd, Abyan-Yemen. LJMAS.5:50\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWadood M, Usman M (2019). Comparative analysis of electrochemiluminescence assay and chemiluminescent microparticle immunoassay for the screening of hepatitis C. Indian Journal of Hematology and Blood Transfusion.25;35(1):131\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShiferaw Y, Abebe T, Mihret A (2011). Hepatitis B virus infection among medical waste handlers in Addis Ababa, Ethiopia. BMC Res. Note.4:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnagaw B, Shiferaw Y, Anagaw B, Belyhun Y, Erku W, Biadgelegn F, Moges B, Alemu A, Moges F, Mulu A (2012). Seroprevalence of hepatitis B and C viruses among medical waste handlers at Gondar town Health institutions, Northwest Ethiopia. BMC Res. Note.5:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUddin MS, Islam MN, Khan ME, Yeasmin S, Ahmed F, Amiruzzaman M (2017). Frequency of hepatitis B and C viral infection among the medical waste handlers. Bangladesh J Infect Dis.4(1):3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMussa S, Kasew D, Wondimeneh Y (2022). Seroprevalence of Hepatitis B and C viruses and associated factors among medical waste handlers, Northeast Ethiopia. EJHBS.12(2).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDounias G, Kypraiou E, Rachiotis G, Tsovili E, Kostopoulos S (2005). Prevalence of hepatitis B virus markers in municipal solid waste workers in Keratsini (Greece). Occup Med.55(1):60\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHosseini SM, Ranjbar R, Sarshar M, Ebrahimi E (2013). Prevalence of HB-sAg positive among Afghan sweepers in Tehran 2009. Iran J Infect Dis.18:9\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnsari-Moghaddam A, Ansari H, Khosravi S, Sanei-Moghaddam E, Mohammadi M, Alavian SM, Poustchi H (2016). The prevalence of hepatitis B virus among municipal solid waste workers: necessity for immunization of at-risk groups. Hepatitis Monthly.16(3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEl-Wahab EW, Eassa SM, Lotfi SE, Kotkat AM, Shatat HZ (2015). Seroprevalence, immunostatus and factors associated with blood borne viral infections among Egyptian municipal solid waste workers. J Virol Antivir Res 4:2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSarvari J, Joharinia N, Shiri A, Vali A, Beigzadeh F, Davarpanah MA, Atapour A, Khoshbakht R, Jaberi O, Hosseini SY (2023). The Sero-Prevalence of Hepatitis B and C Viruses in Municipal Waste Collectors in Southwest of Iran. Indian J Occup Environ Med.27(2):172\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSqueri R, La Fauci V, Sindoni L, Cannavo G, Ventura Spagnolo E (2006). Study on hepatitis B and C serologic status among municipal solid waste workers in Messina (Italy). J Prev Med Hyg.47(3):110\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRachiotis G, Papagiannis D, Markas D, Thanasias E, Dounias G, Hadjichristodoulou C (2012). Hepatitis B virus infection and waste collection: prevalence, risk factors, and infection pathway. Am. J. Ind. Med.55(7):650\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMengiste DA, Dirbsa AT, Ayele BH, Hailegiyorgis TT (2021). Hepatitis B virus infection and its associated factors among medical waste collectors at public health facilities in eastern Ethiopia: a facility-based cross-sectional study. BMC Infect. Dis.21:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRauf MU, Saleem MD, Anwer MO, Ahmed G, Aziz S, Memon MA (2013). HIV, hepatitis B and hepatitis C in garbage scavengers of Karachi. JPMA. J Pak Med Assoc.63(6):798\u0026ndash;802.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYusuf RO, Sawyerr HO, Adeolu AT, Habeeb LM, Abolayo TT (2018). Seroprevalence of Hepatitis B virus and compliance to standard safety precautions among scavengers in Ilorin Metropolis, Kwara State, Nigeria. J. health pollut.8(19):180914.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTsovili E, Rachiotis G, Symvoulakis EK, Thanasias E, Giannisopoulou O, Papagiannis D, Eleftheriou A, Hadjichristodoulou C (2014). Municipal waste collectors and hepatitis B and C virus infection: a cross-sectional study. Age.43(8.25).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarinho TA, Lopes CL, Teles SA, Matos MA, Matos MA, Kozlowski AG, Oliveira MP, Silva \u0026Aacute;M, Martins RM (2014). Epidemiology of hepatitis B virus infection among recyclable waste collectors in central Brazil. Rev Soc Bras Med Trop.47(1):18\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSouza-Silva G, Mol MP (2021). Hepatitis B prevalence in Brazilian waste pickers: a systematic review with meta-analysis. Rev Saude Publica.55:86.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCorrao CR, Del Cimmuto A, Marzuillo C, Paparo E, La Torre G (2013). Association between Waste Management and HBV among Solid Municipal Waste Workers: A Systematic Review and Meta-Analysis of Observational Studies. Sci. World J.2\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMol MP, Gon\u0026ccedil;alves JP, Silva EA, Scarponi CF, Greco DB, Cairncross S, Heller L (2016). Seroprevalence of hepatitis B and C among domestic and healthcare waste handlers in Belo Horizonte, Brazil. Waste Management \u0026amp; Research.34(9):875\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAl-Hegami MA, Al-Mamari A, Al-Kadasse AS, Al-Gasha\u0026rsquo;a FA, Al-Hag S, Al-Hegami AA (2015). Prevalence and risk factors of hepatitis B and hepatitis C virus infections among patients with chronic renal failure in Zabeed city, Yemen Republic. Open J. Med. Microbiol.5(3):136\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmran OA, Al-Shamahy HA, Al Hadad AM, Jaadan BM (2019). Explosion of hepatitis B and C viruses among hemodialysis patients as a result of hemodialysis crisis in Yemen. Universal J Pharm Res. 4 (5): 1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEl-Morsy ES, Alghalibi S, Elbialy AA, Baddah K, Khalifa M (2022). Occult Hepatitis B Virus Infection Among Patients Undergoing Chronic Dialysis in Hodeidah City, Yemen. AJBAS. 3(1):64\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRuggieri A, Gagliardi MC, Anticoli S (2018). Sex-dependent outcome of hepatitis B and C viruses infections: synergy of sex hormones and immune responses?. Front Immunol. 9:2302.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-microbiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"intm","sideBox":"Learn more about [International Microbiology](https://www.springer.com/journal/10123)","snPcode":"10123","submissionUrl":"https://submission.nature.com/new-submission/10123/3","title":"International Microbiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Sero-prevalence, Hepatitis B infection, Municipal Waste collectors, Aden, Yemen","lastPublishedDoi":"10.21203/rs.3.rs-7715119/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7715119/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ethe study aimed to determine the prevalence of HBV infection among municipal waste collectors and to identify risk factors associated with this infection among those collectors in Aden, Yemen.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eAn analytical cross-sectional study was carried out on 100 municipal waste collectors. The samples were collected and tested for HBsAg using a Cobas technique.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe overall prevalence of HBV was 5%, and clustering of infection was 80% in the Khormaksar district. The highest significant rates were 18.2% and 40% among female MWCs and those exposed to biomedical waste (p\u0026thinsp;=\u0026thinsp;0.033, 0.019), respectively. Significant associations between HBV were revealed among those who were exposed to catheterization (p\u0026thinsp;=\u0026thinsp;0.002) and needle stick (p\u0026thinsp;=\u0026thinsp;0.0001). Only 1 (25%) of vaccinated members had HBV infection with a borderline significant association (p\u0026thinsp;=\u0026thinsp;0.061). Associations were also significant between HBV infection and clinical findings, including fever (p\u0026thinsp;=\u0026thinsp;0.0001), vomiting (p\u0026thinsp;=\u0026thinsp;0.0001), nausea (p\u0026thinsp;=\u0026thinsp;0.001), loss of appetite (p\u0026thinsp;=\u0026thinsp;0.0001), abdominal pain (p\u0026thinsp;=\u0026thinsp;0.001), and jaundice (p\u0026thinsp;=\u0026thinsp;0.005).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eIt can be concluded from this study that the prevalence of HBV infection among municipal waste collectors in Aden, Yemen, was relatively low in comparison with most studies globally and lower than the prevalence of HBV infection among the Yemeni population. The highest rates of HBV were among females and those exposed to biomedical waste. Exposure to needle sticks and catheterization may increase the risk of HBV infections. Mandatory screening and vaccination for all for HBV should be implemented at all MWCs to reduce the HBV risks. Further studies are recommended to detect the HBV and other viral infections among informal waste pickers or garbage collectors.\u003c/p\u003e","manuscriptTitle":"Sero-prevalence of Hepatitis B infection among the Municipal Waste collectors in Aden, Yemen","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-07 06:19:22","doi":"10.21203/rs.3.rs-7715119/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-22T10:47:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-19T13:57:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-14T08:28:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"106935153730328692690921630641781635941","date":"2025-10-13T03:02:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-12T19:16:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49947714245640038885387624338148905739","date":"2025-10-12T18:06:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"258034846519768312773292868832838457593","date":"2025-10-11T07:22:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-10T08:04:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-29T17:11:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-26T07:26:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Microbiology","date":"2025-09-25T16:45:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-microbiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"intm","sideBox":"Learn more about [International Microbiology](https://www.springer.com/journal/10123)","snPcode":"10123","submissionUrl":"https://submission.nature.com/new-submission/10123/3","title":"International Microbiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3394ed37-90cf-4f82-80c4-beda8858bc36","owner":[],"postedDate":"October 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:06:54+00:00","versionOfRecord":{"articleIdentity":"rs-7715119","link":"https://doi.org/10.1007/s10123-025-00771-3","journal":{"identity":"international-microbiology","isVorOnly":false,"title":"International Microbiology"},"publishedOn":"2026-01-05 15:59:25","publishedOnDateReadable":"January 5th, 2026"},"versionCreatedAt":"2025-10-07 06:19:22","video":"","vorDoi":"10.1007/s10123-025-00771-3","vorDoiUrl":"https://doi.org/10.1007/s10123-025-00771-3","workflowStages":[]},"version":"v1","identity":"rs-7715119","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7715119","identity":"rs-7715119","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}