role of islamic teachings in prevention of chronic hepatitis b and c

8/13/2019 Role of Islamic Teachings in Prevention of Chronic Hepatitis B and C

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Role of Islamic teachings in prevention of chronic Hepatitis B and C

Prof. Najib ul HaqMRCP(UK),FRCP (Edin),FRCP (Glasg), MACG (U A)

GLOBAL EPIDEMIOLOG

!iral H"#a$i$is is on" of $%" &ajor global #robl"&s of %"al$%. A''ording $o $%" H r"#or$sabou$ *+ &illion #"o#l" ar" 'arr-ing %"#a$i$is /irus in $%"ir blood and 01 &illion suff"rfro& %"#a$i$is C 2%i'% 'oris" *3 of $%" orld #o#ula$ion.0 4%" nu&b"r of #"o#l" "5#os"d$o %"#a$i$is a$ so&" s$ag" of $%"ir lif" &a- b" $2o billion6

4%"ir "ff"'$s on %u&ans rang" fro& sub7'lini'al inf"'$ions and a'u$" %"#a$i$is $o '%roni' li/"r

dis"as"s li8" 'irr%osis li/"r and %"#a$o'"llular 'ar'ino&a. 9ns#i$" of r"'"n$ ad/an'"s in $%"ird"$"'$ion and $r"a$&"n$, $%"- 'on$inu" $o b" a &ajor #ubli' %"al$% #robl"&. o$% /irus"s'aus" $%" sa&" $-#" of 'lini'o7#a$%ologi'al s-ndro&"s of li/"r dis"as" and al$%oug%ful&inan$ %"#a$i' failur" is r"la$i/"l- 'o&&on in H ! inf"'$ions, '%roni' li/"r dis"as" is&u'% 'o&&on in HC! inf"'$ions.

!PREAD A"D #RA"!MI!!IO"4%"r" ar" &an- $-#"s of /irus"s 'ausing %"#a$i$is and $%"s" 'an b" grossl- grou#"d in$o $%"follo2ing:

a; 4rans&i$$"d $%roug% fo"'o oral rou$" (%"#a$i$is A and E ) b; Par"n$all- $rans&i$$"d (H"#a$i$is , C, < and G)

H"#a$i$is A and E ar" usuall- s"lf7li&i$ing and so&"$i&"s l"ad $o a'u$" s"rious s"qu"lla" in'"r$ain 'lini'al si$ua$ion bu$ $%"r" ar" no '%roni' s"qu"lla". Ho2"/"r H"#a$i$is and C /irus'an 'arr- on in $%" bod- af$"r an a'u$" "#isod" and in &an- 'as"s b"'o&" '%roni' 2i$% &ajors"rious 'lini'al 'oli'a$ions li8" 'irr%osis and %"#a$o'"llular 'ar'ino&a. 4%"s" '%roni' #robl"&s ar" $%" &an 'aus" of 'on'"rn for %"al$% #rof"ssional $oda-. 9roni'all- $%"$rans&ission of $%"s" /irus"s 'an b" #r"/"n$"d b- und"rs$anding and $%us a/oidan'" of $%"fa'$ors r"s#onsibl" for $rans&ission. 9 s%all 'on'"n$ra$" onl- on $rans&ission fa'$ors of%"#a$i$is and C and $%" rol" of 9sla&i' $"a'%ings in $%"ir #r"/"n$ion.R"s"ar'% on rou$"s of s#r"ad %as r"/"al"d $%" #"r'u$an"ous "5#osur" as $%" &os$ ior$an$&"an of a'quisi$ion of H"#a$i$is and C /irus"s. 4ransfusion of 'on$a&ina$"d blood and blood #rodu'$s*, us" and s%aring of 'on$a&ina$"d n""dl"s b- inj"'$ing drug us"rs and

$a$oois$s=, surgi'al #ro'"dur"s and us" of non7dis#osabl" s-ring"s b- lo'al #ra'$i$ion"rs+,>,

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%a/" all b""n ili'a$"d as ris8 fa'$ors for $rans&ission. Non7#"r'u$an"ous rou$"s su'% as #"rina$al6 and s"5ual $rans&ission1 ar" &or" ior$an$ in H ! $%an HC! $rans&ission.Ho2"/"r $%"r" is a d"fini$" ris8 of HC! inf"'$ion b- #"rina$al $rans&ission and $%roug%s"5ual "5#osur"?. 4%" ris8 of HC! a'quisi$ion in $%is 2a- is also su##or$"d b- finding ofHC! RNA in $%" s"&"n of inf"'$"d &"n@ and HC! RNA s"qu"n'" %o&olog- in s"5ual #ar$n"rs and s#ous"s0 .

4%" ris8 fa'$ors for $rans&ission of H"#a$i$is and C d"#"nd on $%" so'ial b"%a/ior and 'ul$uralnor&s of a so'i"$- and $%us /ar- fro& on" 'oun$r- $o ano$%"r. 9n Musli& 'oun$ri"s li8" Pa8is$an$%" &ajor ris8 fa'$or is r"#"a$"d us" of inj"'$ions00 for 'o&&on illn"ss"s, 2%il" addi'$ion ands"5ual $rans&ission &a- b" /"r- ior$an$ ris8 fa'$ors in U A, 2%"r" s"5ual b"%a/ior indi'a$"s&or" $%an 0 #ar$n"rs in * 7*=3 all ag" grou#s and &or" $%an + #ar$n"rs in =306 i&ilarl- blood $ransfusion is a &ajor ris8 fa'$or in d"/"lo#ing 'oun$ri"s b"'aus" of $%" #oor bloods'r""ning #rogra&s 2%il" i$ %as b"'o&" al&os$ insignifi'an$ in "s$"rn 'oun$ri"s and U Adu" $o "ff"'$i/" blood s'r""ning #rior $o $ransfusion.0* Addi'$ion &a- no$ b" /"r- signifi'an$ris8 fa'$or in our so'i"$- 2%il" i$ &a- b" /"r- ior$an$ in "s$"rn and #ar$i'ularl-A&"ri'an so'i"$- 2%"r" o/"rall Co'ain" us" a$ so&" s$ag" of lif" is abou$ 0=3 and &a- b"s$ill %ig%"r (663) in $%" -oung"r ag" grou# of 6+76@ -"ars and us" of Marijuana =+3 a$so&" s$ag" of lif" 2%il" &or" $%an 0 $i&"s in 013 #o#ula$ion in $%" ag" grou# of * 7*@-"ars06.

4%" o/"rall fa'$ors of $rans&ission of %"#a$i$is and C 'an b" su&&ari "d as und"r 0=

R"#"a$"d us" of inj"'$ions (#ar$i'ularl- addi'$s)lood $ransfusion

4a$$ooing

A''id"n$al "5#osur" $o 'on$a&ina$"d blood $%roug% s%ar#s (n""dl"s, 8ni/"s "$')"5ual $rans&ission (s#"'iall- s"5ual #ro&is'ui$- and %o&os"5ual b"%a/ior)

4%"s" ris8 fa'$ors 'an b" grou#"d und"r $2o &ain %"adings.Parental transmission$ Pri&aril- fro& "5#osur" of s8in or &u'osa $o 'on$a&ina$"d blood$%roug% s%ar#s in'luding n""dl" s$i'8 injuri"s and s%ar#s ('on$a&ina$"d d"n$al B surgi'alins$ru&"n$s and barb"rs blad"sB8ni/"s "$') s%aring $oo$% brus%"s, /"r$i'al $rans&ission and

$a$$ooing "$'.

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!e%&al transmission $%roug% "5#osur" of &u'osa $o 'on$a&ina$"d s"'r"$ions or blood fro&inf"'$"d 9ndi/iduals.

PRE'E"#IO"

!a''ina$ion #la-s a &"asur" rol" agains$ #r"/"n$ion of %"#a$i$is bu$ $ill $%is $i&" /a''in"'ould no$ b" d"/"lo#"d agains$ %"#a$i$is C, b"'aus" of $%" s$ru'$ural '%ara'$"ris$i's of $%is /irus.Ho2"/"r ado#$ing &"asur"s $o /oid ris8 fa'$ors of $rans&ission 'an b" of u$&os$ ior$an'" in$%" #r"/"n$ion of $%"s" /irus"s.

Musli& 'an #la- a &ajor rol" in #r"/"n$ing $%" s#r"ad of %"#a$i$is b- #r"a'%ing and #ra'$i'ing$%" $"a'%ings of 9sla&. Mos$ of $%" &ajor ris8 fa'$ors lis$"d abo/" ar" #r"/"n$abl". 9f 2" as8 our

#ubli' $o #ra'$i'" 9sla&i' #rin'i#l"s i$ 2ill %a/" a $r"&"ndous ia'$ on #r"/"n$ion of $%"s"d"adl- dis"as"s. 9$ 2ill no$ onl- %"l# us in $%is 2orld bu$ Alla% 2ill also r"2ard us for $%is on $%"da- of judg&"n$. Alla% lo/"s %is 'r"a$ion (%u&an b"ings) so &u'% $%a$ %" d"'lar"d in uran:

77777 D IJ I L I O Q S I L T I VWIX Y Z [ 7777and if an- on" sa/"d a lif", i$ 2ould b" as if %" sa/"d $%" lif" of $%" 2%ol" #"o#l"0+.

4%is A-a% do"s no$ &"n$ion of sa/ing a Musli& onl- bu$ sa/ing a %u&an b"ing, b" a Musli& ora Non Musli&. " s%ould #ro#aga$" our &"ssag" abou$ #r"/"n$ing %"#a$i$is. 9f $%is &"ssag"r"a'%"s $o so&" #"o#l" and #ra'$i'"d b- onl- f"2 of $%"&, i$ 2ill #r"/"n$ %"#a$i$is and sa/" a$l"as$ f"2 %u&an li/"s. Alla% 2ill r"2ard us for $%is a'$ of sa/ing His 'r"a$ur"s. 4%" Pro#%"$Mu%a&&ad ( A ) also said,\ %oso"/"r r"&o/"s $%" #ain and $roubl" of ano$%"r b"li"/"r, Alla% 2ill r"&o/" %is $roubl"on $%"


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A( Parental #ransmission

)( Repeated &se of in*ections or re&se of in*ections . E/"n 2%"n s&all a&oun$ of blood fro& an inf"'$"d indi/idual on a us"d n""dl" is inj"'$"d in$o ano$%"r #"rson (b- inj"'$ing

%i& 2i$% $%a$ n""dl" or s-ring") %"#a$i$is 'an b" $rans&i$$"d $o %i&. 9$ &a- b" as li$$l" as$%ousand #ar$ of a blood dro#. R"#"a$"d us" of inj"'$ions ob/iousl- in'r"as"s $%is ris8 0?. ur #ro#%"$ Mu%a&&ad ( A ) %as s forbidd"n $%" us" of "5'"ssi/" &"di'a$ions. H" ( A ) said,\_"a/" asid" &"di'in"s as long as -ou 'an &anag" 2i$%ou$ i$.\0@

%"n 'oar"d $o $%" oral &"di'a$ion, inj"'$ibl" rou$" 2ould d"li/"rs &a5i&u& a&oun$ of&"di'in" $o $%" bod-. n" s%ould $%"r"for" $r- $o us" oral &"di'a$ions as &u'% as #ossibl" andinj"'$ions s%ould onl- b" us"d in una/oidabl" 'lini'al si$ua$ions 2%"r" oral &"di'a$ions 'anno$

b" gi/"n du" $o $%" s"riousn"ss or urg"n'- of si$ua$ion. 4%is 'lini'al #ra'$i'" 2ould b" in lin"2i$% $%" guid"lin" s"$ in $%" abo/" Hadi$% of $%" #ro#%"$ 2%"r" $%" #ro#%"$ ad/is"d $o us&ini&u& a&oun$ of &"di'a$ion.H" %as also forbidd"n $%" us" of K%abi$% &"di'in"s\ 4%" Hol- Pro#%"$ %as #ro%ibi$"d #"o#l" fro& using K%abi$% (i.". "5#ir"d and #ro%ibi$"d)

&"di'in"s.\ 6

`K%abi$%^ &"di'in" is an- subs$an'" $%a$ is us"d for $r"a$&"n$ %a/ing a signifi'an$ #o$"n$ial $%ar& $%" indi/idual using i$. 9$ &a- b" a $o5i' &"di'in"s or a 'on$a&ina$ions ".g. fro& r"us" of'on$a&ina$"d s-ring"s and blood or blood #rodu'$s inf"'$"d 2i$% %"#a$i$is or C.

+( #attooing( n" o$%"r ior$an$ fa'$or in $rans&ission is $a$$ooing b"'aus" a'on$a&ina$"d n""dl" or ins$ru&"n$ fro& an inf"'$"d #"rson 'an $rans&i$ $%" dis"as" $o %"al$% #"rson g"$$ing $a$$oo"d 2i$% $%" sa&" n""dl" or ins$ru&"n$. 4%" #ro#%"$ %as forbidd"n $a$$and d"'lar"d i$ `Hara&.^ 4%"r" ar" &an- sa-ings (A%adi$%s) of $%" Holl- #ro#%"$ in $%is r"gardand so&" ar" quo$"d as r"f"r"n'" b"lo2 fro& ` a%i% u8%ari,^ 2%i'% is 'onsid"r"d $o b" $%"&os$ au$%"n$i' boo8 of $%" a-ings (A%adi$%) of $%" #ro#%"$ Mu%a&&ad ( A )"arrated A,& H&raira +)

A 2o&an 2%o us"d $o #ra'$i'" $a$$ooing 2as broug%$ $o U&ar. U&ar go$ u# and said, \9 b"s""'% -ou b- Alla%, 2%i'% of -ou %"ard $%" Pro#%"$ sa-ing so&"$%ing abou$ $a$$ooinggo$ u# and said, \ '%i"f of $%" "li"/"rsc l %"ard so&"$%ing.\ H" said, \ %a$ did -ou %"ar \9 said, \9 %"ard $%" Pro#%"$ (addr"ssing $%" ladi"s), sa-ing,


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"arrated -A,d&llah ++

Alla% %as 'urs"d $%os" 2o&"n 2%o #ra'$i'" $a$$ooing"arrated A,& .&haifa +/

4%" Pro#%"$ forbad" $%" us" of $%" #ri'" of blood and $%" #ri'" of a dog, $%" on" 2%o $a8"("a$s) usur- $%" on" 2%o gi/"s usur-, $%" 2o&an 2%o #ra'$i'"s $a$$ooing and $%" 2o&an 2%og"$s %"rs"lf $a$$oo"d."arrated A,& H&raira +0

4%" Pro#%"$ said, \4%" "ff"'$ of an "/il "-" is a fa'$.\ And %" #ro%ibi$"d $a$$ooing

/$ Addiction Main lin" addi'$s %a/" /"r- %ig% #r"/al"n'" of H"#a$i$is and C and

$%"- signifi'an$l- 'on$ribu$" $o $%" #ool of '%roni' %"#a$i$is n $%" "s$ and A&"ri'a.Addi'$ion in all for&s is forbidd"n in 9sla&. 9n uran i$ is s$a$"d in r"f"r"n'" $o drin8ing 6+ (a'o&&on #ra'$i'" in Ma88a b"for" 9sla&)

I Ie D ZV WWh I O kZ m V W Z V W Ip OW t W v [ w ZD xy Z z{ Z I| } VW~ h Z [ IS X V { h Z

-" 2%o b"li"/"c 9n$o5i'an$s and ga&bling, (d"di'a$ion of) s$on"s, and (di/ina$ion b-)

arro2s, ar" an abo&ina$ion, of a$an s %and2or8; "s'%"2 su'% (abo&ina$ion) $%a$ -" &a- #ros#"r.

Ho2"/"r $%" #ro#%"$ Mu%a&&ad %as 'larifi"d, $%a$ all in$o5i'an$s ar" Hara& (absolu$"l-forbidd"n). H" said; \ E/"r- in$o5i'an$ is 8%a&r, and "/"r- 8%a&r is %ara&.\ U&ar, $%"s"'ond K%alifa% of $%" Pro#%"$, d"'lar"d fro& $%" #ul#i$ of $%" Pro#%"$; \K%a&r is $%a$ 2 b"fogs $%" &ind.\

4%is issu" %as b""n d"'isi/"l- addr"ss"d in $%" follo2ing A%adi$% of $%" #ro#%"$ ( A )

"arrated Aisha( +1

4%" Pro#%"$ said, \All drin8s $%a$ #rodu'" in$o5i'a$ion ar" Hara& (forbidd"n $o drin8).

"arrated A,i B&rda +2

4%a$ Abu Musa Al7As% ari said $%a$ $%" Pro#%"$ %ad s"n$ %i& $o "&"n and %" as8"

Pro#%"$abou$ '"r$ain (al'o%oli') drin8 2%i'% us"d $o b" #r"#ar"d $%"r". 4%" Pro#%"$said, \ %a$ ar"$%"- \ Abu Musa said, \Al7 i$ and Al7Mi r \ H" said, \Al7 i$ is an

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al'o%oli' drin8 &ad" fro& %on"-: and Al7Mi r is an al'o%oli' drin8 &ad" fro& barl"-.\ 4%"Pro#%"$ said, \All in$o5i'an$s ar" #ro%ibi$"d.\

B( !e%&al #ransmission(Pros$i$u$"s and %o&os"5uals ar" ior$an$ sour'"s of 'arr-ing %"#a$i$is and C /irus"s and$rans&i$$ing i$ $o o$%"rs. Al$%oug% $%is &a- no$ b" /"r- ior$an$ 'aus" of $rans&issionour so'i"$- bu$ i$ is a &ajor 'aus" in "s$ and A&"ri'a.

)$ Prostit&tion( Pros$i$u$"s ar" on" of $%" &ain sour'" of s#r"ading $%" dis"as" b"'aus" $%"- %a/" on" of $%" %ig%"s$. 6?, 6@ 'arri"r ra$" of H"#a$i$is and C and also H9!. 9$/ari"s fro& @7063* . 9sla& do"s no$ allo2 #ros$i$u$ion and s$rongl- 'ond"&ns i$ as 'l"arl-

"/id"n$ fro& $%" follo2ing Hadi$%."arrated A&n ,in A,& .&haifa *0

`. H" r"#li"d, \Alla% s A#os$l" #ro%ibi$"d $a8ing &on"- for blood, $%" #ri'" of a dog,and $%" "arnings of a sla/"7girl b- #ros$i$u$ion: %" 'urs"d %"r 2%o $a$$oos and %"r 2%o g"$a$$oo"d, $%" "a$"r of Riba (usur-), and $%" &a8"r of #i'$ur"s.\

9sla& forbids s"5 2i$% a 2o&"n o$%"r $%an 2if" and dis'ourag"s and 2arns no$ "/"n $o g"$

indulg" in a'$i/i$- 2%i'% &ig%$ l"ad $o abnor&al s"5ual $"$a$ions and $%us a ris8 ofin/ol/"&"n$ in adul$"r-."5ual 'on$a'$ 2i$% a #"rson o$%"r $%an 2if" is forbidd"n in 9sla&.

9n uran i$ is s$a$"d*6

y Z I Y } L Z IS { I O kZ O x VW Wh Nor 'o&" n"ar $o adul$"r-; for i$ is a s%a&"ful (d""d) and an "/il, o#"ning $%" road ($o o$%"r"/ils).

9n ano$%"r ura% $%" good s"5ual b"%a/ior of #"o#l" is d"s'rib"d as a s$andard of %u&an`su''"ss^ in $%" "-"s of Alla% and $%os" 2%o 'ross $%" #r"s'rib"d li&i$s, ar" lab"l"d as$ransgr"ssors

) . S {h Z V W 4%" b"li"/"rs &us$ ("/"n$uall-) 2in $%roug%,3 D ZV W J e Z [ Z V Z{h S ZIL %o abs$ain fro& s"5

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1$ kZ z e Z [ Z W t I e O I e O ZS D Z h E5'"#$ 2i$% $%os" join"d $o $%"& in $%" &arriag" bond, or 2%o& $%"ir rig%$ %ands #oss"ss(in $%"ir 'as") $%"- ar" fr"" fro& bla&",

2$ D Z S WWw V Z ZV Q S J{ IX V W $u$ $%os" 2%os" d"sir"s "5'""d $%os" li&i$s ar" $ransgr"ssors

4%" #ro#%"$ Mu%a&&ad ( A ) also s$r"ss"s on $%" issu". 9n a%i% u8%ari, 9bn Abbquo$"d a Hadi$% fro& $%" #ro#%"$ ( A )**

`9 %a/" no$ s""n a $%ing r"s"&bling la&a& (&inor sins) $%an 2%a$ Abu Huraira narrafro& $%" Pro#%"$ 2%o said \Alla% %as 2ri$$"n for Ada& s son %is s%ar" of adul$"r- 2%i'%'o&&i$s in"/i$abl-. 4%" adul$"r- of $%" "-"s is $%" sig%$ ($o ga " a$ a forbidd"n $%ing), $%adul$"r- of $%" $ongu" is $%" $al8, and $%" inn"r s"lf 2is%"s and d"sir"s and $%" #ri/a$" #ar$"s$if- all $%is or d"n- i$.\

+$ Homose%&alit4$ 9$ is 2"ll 8no2n $%a$ %o&os"5ual b"%a/ior is a &ajor ris8 fa'$or in$rans&ission of %"#a$i$is and C. C%roni' %"#a$i$is and C ar" &or" 'o&&on in Gu- &"n

2%"n 'oar"d 2i$% g"n"ral #o#ula$ion.*= 4%is b"%a/ior also, l"ads $o $rans&ission of o$%"rdis"as"s in'luding 4


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9n ano$%"r A-a% Alla% sa-s, *1

{ h Q { W VWD Z{ w 7D Z V IX V WI V w D Z

[ Z W t y O vh { Iz\ f all $%" 'r"a$ur"s in $%" 2orld, 2ill -" a##roa'% &al"s and l"a/" $%os" 2%o Alla% %as'r"a$"d for $o b" -our &a$"s, Na- -" ar" a #"o#l" $ransgr"ssing (all li&i$s)Pro#%"$ Mu%a&&ad ( A ) also 'ond"&ns $%is abnor&al b"%a/ior. 42o A%adi$% ar" quo$"d b"lo2 as "5al":\ %"n a &an &oun$s ano$%"r &an, $%" $%ron" of God s%a8"s.\\Kill $%" on" $%a$ is doing i$ and also 8ill $%" on" $%a$ i$ is b"ing don" $o.\ (in r"f"r"n'" $o $a'$i/" and #assi/" #ar$n"rs in ga- s"5ual in$"r'ours")

/$ A,normal se%&al ,ehavior

Anal s"5 is also s$ri'$l- forbidd"n in 9sla& and i$ %as b""n "qua$"d $o sodo&-. F"2 A%adi$%ar" quo$"d b"lo2 $o "5#lain $%is:Ha i&a bi abi$ narra$"d. fro& Mu%a&&ad ( A )`


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4%"- as8 -ou 'on'"rning 2o&"n s 'ours"s. a-; 4%"- ar" a %ur$ and #ollu$ion; o 8""# a2a-fro& 2o&"n in $%"ir 'ours"s, and do no$ a##roa'% $%"& un$il $%"- ar" 'l"an. u$ 2%"n $%"-%a/" #urifi"d $%"&s"l/"s, -" &a- a##roa'% $%"& in an- &ann"r, $i&", or #la'" ordain"d for-ou b- Alla%. For Alla% lo/"s $%os" 2%o $urn $o Hi& 'ons$an$l- and H" lo/"s $%os" 2%o 8""#$%"&s"l/"s #ur" and 'l"an.

4%"s" ar" so&" of $%" basi' $"a'%ings of %u&an b"%a/ior in 9sla&. 9$ is 'l"arl- "/id"n$ fro&$%"s" 9sla&i' $"a'%ings $%a$ follo2ing and #ro#aga$ing $%"s" #rin'i#l"s 'an no$ onl- #ro$"'$%u&an b"ings fro& d"adl- dis"as"s li8" %"#a$i$is and C bu$ also saf"guard $%"& agains$A9< and o$%"r dis"as" s%aring si&ilar rou$"s of $rans&ission.

RE5ERE"CE!

0. Fa'$ %""$ No. 0>= H"#a$i$is C, H B6 =: H"#a$i$is R"/is"d '$ob"r 6 ,6. roo8 MG. "5uall- a'quir"d %"#a$i$is "5 4rans& 9nf"'$ 6 6:1?;6*+76=*. i&&"r&an RK, Rubin F_, A%2"s% ER. H"#a$i$is /irus inf"'$ion %"#a$i$is /a''in"

and %"#a$i$is i&&unoglobulins. J Fam Pract 0@@1: =+; 6@+7*0+.

=. "al KH, Edlin R, '%oa KC, 4uls8- ]P, Moss AR, Ka%n ]A. Ris8 of %"#a$i$is inf"'$ion a&ong -oung inj"'$ing drug us"rs in an Fran'is'o: o##or$uni$i"s forin$"r/"n$ion.est J !ed 6 : 016;0>76 .

+. K%an AA. End"&i' $rans&ission of %"#a$i$is. J oll Physician #urg Pa$istan0@@+:+;0670*

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