The purpose of this study was to identify risk factors for hepatitis C virus (HCV) infection in a rural village in the Nile Delta with a high prevalence of antibodies to HCV (anti-HCV). One half of the village households were systematically selected, tested for anti-HCV, and interviewed: 973 of 3,999 (24.3%) subjects were anti-HCV-positive (reflecting prior HCV infection but not necessarily current liver disease), with nearly equal prevalence among males and females. Anti-HCV prevalence increased sharply with age among both males and females, from 9.3% in those 20 years of age and younger to >50% in those older than 35, suggesting a cohort effect with reduced transmission in recent years. Multivariate regression was used to estimate independent effects of risk factors on seropositivity. Among those over 20 years of age, the following risk factors were significantly associated with seropositivity: age (P < . Previous studies of hepatitis C viral (HCV) infection in Egypt have shown a high prevalence of antibody to HCV (anti-HCV) among blood donors 1-4 and residents of rural areas endemic for schistosomiasis. 5 Anti-HCV was found in 12.1% of primary schoolchildren, 18.1% of residents of rural villages, and 22.1% of army recruits, 6 as well as in 31% of Egyptians applying to work abroad. 7,8 It is widely believed that parenteral exposure to the virus is the most important route for acquiring infection in Egypt. 7,9 We have recently reported data that suggest the very high prevalence of HCV infection in the adult population of rural areas of Egypt, particularly in men living in villages where schistosomiasis is endemic, is at least partially the result of extensive mass-control campaigns using parenteral tartar emetic conducted from the 1950s up until 1982. 10 Although the prevalence of infection among those too young to be exposed to these mass antischistosomiasis injection campaigns is lower than among the older population, infection in this younger cohort indicates that other modes of transmission have perpetuated the infection in the community. Uncertainty remains regarding the relative importance of various types of parenteral exposures and widely practiced community activities, e.g., circumcisions, goza smoking in a group, or being shaved at a community barber.To resolve this uncertainty, we conducted a large serologic survey in a rural Egyptian community. The purpose of this article is to report the observed associations of HCV infection with both the acknowledged parenteral exposures (e.g., blood transfusions, injections, invasive hospital procedures, dental treatment) and widely practiced community activities that are usually not considered to be determinants of HCV transmission. PATIENTS AND METHODSStudy Population. In 1997, one half of the households of a village in the Nile Delta, Aghour El Soughra, were systematically selected and interviewed with a structured questionnaire to identify potential exposures that might be related to HCV acquisition. Adults and children older than 10 years of age were interv...

The epidemiology of hepatitis E virus (HEV), an enterically-transmitted cause of acute viral hepatitis (AVH), is not fully understood. During outbreaks on the Indian subcontinent and elsewhere, HEV causes severe AVH with mortality rates around 20% during pregnancy. In Egypt, where prevalence of HEV antibodies (anti-HEV) in rural communities is very high, severe HEV-caused AVH in pregnant women has not been reported. This study examined a cohort of 2,428 pregnant women in the Nile Delta to assess prevalence of, and risk factors for, anti-HEV and correlated these with history of liver disease. Anti-HEV prevalence was 84.3%. Several risk factors associated with anti-HEV included older age, many siblings, not using soap to wash produce and frequent contact with cats. History of jaundice and liver disease was rare and not increased in those having anti-HEV. Our results confirm Egypt's high HEV endemicity and show that almost all women of childbearing age in these communities had prior HEV exposures without a history of liver disease. Reasons for the lack of clinical hepatitis remain unclear but could be the result of early childhood HEV exposures, producing long-lasting immunity and/or modify subsequent responses to exposure. Alternatively, the predominant HEV strain(s) in Egypt are less virulent than those in South Asia.

Abstract. This investigation's objective was to identify risk factors for hepatitis C virus (HCV) in a village in Upper Egypt with a moderately high prevalence (8.7%) of antibodies to HCV (anti-HCV). A representative sample of 6,012 (63%) of the 9,581 village inhabitants was included in the study. A questionnaire solicited information regarding risk factors for infection, and blood samples were tested for anti-HCV. Parenteral risks identified in age-adjusted analysis included blood transfusions, dental procedures, hospital admission, surgery, complicated deliveries, history of injection therapy for schistosomiasis, and history of frequent injections. Circumcision was pervasive and was not associated per se with ant-HCV; however, circumcision by an informal, rather than formal, health care provider was associated with anti-HCV among young men and boys. The results did not reveal any unique community-acquired exposures that caused HCV infections: inhabitants who had tattoos, who smoked goza, who were shaved by a community barber, or who had their ears pierced were not at greater risk for anti-HCV than those who did not. Risks identified in multivariate analysis for both those older and younger than 30 years included prior parenteral therapy for schistosomiasis and blood transfusion; for those 30 or younger, circumcision by an informal rather than formal health care provider, and frequent injections; and for those older than 30, never attending college, invasive medical procedures, and complicated deliveries. Selecting for those with blood transfusion, prior parenteral therapy for schistosomiasis, and invasive medical procedures would identify less than half of those infected. Inclusion of frequent injections would identify 80% of those infected with HCV, but as a result of the pervasive use of injections, it would not discriminate from those uninfected. Nonetheless, general reduction of these exposures and assuring sterile practices are logical goals for intervention.

Bill & Melinda Gates Foundation.

HighlightsPentavalent reassortant rotavirus vaccine was tested for efficacy in infants.The vaccine (BRV-PV) showed excellent tolerability and a good safety profile.Primary analysis efficacy was 36% against SRVGE and up to 60.5% against VSRVGE.The efficacy through 2 years of age was 39.5% (SRVGE) and 54.7% (VSRVGE).The intent to treat analyses confirmed all the per protocol analyses.