Viral hepatitis infection is still a global health problem. The infection caused by a group of viruses, which include hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HC V), hepatitis D virus (HDV), hepatitis E virus (HEV), hepatitis F virus (HFV), hepatitis G virus (HGV), and torque teno virus (TTV) [1-4]. The burden of infection on society is mainly attributed to the induction of chronic infection, liver cirrhosis and development of hepatocellular carcinoma (HCC). The chronic infection is caused by HBV, HCV, HDV, and TTV are the major causes of severe illness and death and are characterized by induction of chronic infections and carrier state that may lead to HCC [2-6]. Primary HCC in 78% of cases are attributed to HBV and HCV, while 57% of liver cirrhosis are due to HBV and HCV [4,6-7].
Disease high endemicity trend was associated with low socioeconomic levels which may influence the availability of resources  UN, 2012. Although, WHO is interested in performing research and control and prevention programs, still the incidence of viral hepatitis not declined with time. In addition, the health system situation in developing countries indicating that inequitable access to health  and lack of the documentation of the chronic viral hepatitis and development of national guidelines. Effective national programs for prevention and control of HBV and HCV infection must be established , especially in developing countries with infrastructure destruction due to conflict.
In the Mediterranean region HBV Seroprevalence ranged from intermediate (≥2%) to high prevalence (≥7%) . In Iraq, a recently one national wide community based study was performed  and indicated that national prevalence of HBsAg was 1.6% and correlated positively with age, while the prevalence of anti-HBs and anti-HBc antibodies was 17% and 9.7% respectively. However, in a retrospective study (published in this issue of the journal), which included 16165 individuals; we found that Seroprevalence of HBsAg was 3.2% in Samara city, Iraq . These two studies indicated a regional variation in prevalence of HBsAg and this reflect a regional variation of HBV infections in Iraqi population. Our study illustrated a trend on prevalence increase with time as it was 1.6% for 2011, 3.55% for 2012 and 4.73% for 2013. HCV infection shows the same pattern of prevalence increase with time. Both HBV and HCV prevalence was significantly increased with time, which in contrast with expectation and this illustrate a pocket gag in the Endemicity and epidemicity of the disease. The prevalence of 3.2% of HBsAg is too much higher than goal prevalence (<1%).
In Iraqi community, the proposed pattern of chronic hepatitis B infection is a combination of the first and third global patterns, where the infection transmission occurs vertically and horizontally. This pattern illustrates difficulty in performing control and prevention programs because it must cover a wide range of community. However, implementation of effective antenatal screening, infant vaccination program, blood screening and safe injection will contribute to reduction in HBV and HCV infection and chronicity. The overall prevalence of HCV is on decline, but the isolated pockets of very high prevalence in different districts within the same country (for e.g. Iraq) pose a serious health care problem. In addition, the most widely screening test for HCV is detection of antibody and thus early infection and those non- seroconvert individuals show a negative result. These hidden cases are responsible for HCV spread in Iraqi population and warranted use of test that detect HCV antigen such as PCR.
The reported studies in Iraq indicated that HCV Seroprevalence decreased with time, however, our recent study shows an increase in anti-HCV in 2013 as compared to 2012 and 2011. This suggest increased pockets in Iraq, which represent a serious health problem and thus a regional and national well designed survey is warranted. The impact of HCV on health and medical care in Iraq is a major problem for the community and infectious disease physicians and evolving of
new epidemiological characteristics is expected.
There are insufficient data about HCV prevalence in most
of the Iraqi governorates and information about the prevalence
of HCV infections is generally been limited to laboratory data
and personal interest of research projects in certain education
institution. Majority of regional health authorities and hospital
director’s poor collaboration with educational institutes
strengthen the complexity of the problem. Health care setting
need to implement and address primary prevention programs
and a grass root programs and support is an essential in
control and prevention of HCV infections in health setting. Good
collaboration between educational institutes and regional health
authority is vital to achieve good outcome for hepatitis research