Frequent Transient Hepatitis C viremia without Seroconversion among Healthcare Workers in Cairo, Egypt

Abstract

BackgroundsWith 10% of the general population aged 15–59 years chronically infected with hepatitis C virus (HCV), Egypt is the country with the highest HCV prevalence worldwide. Healthcare workers (HCWs) are therefore at particularly high risk of HCV infection. Our aim was to study HCV infection risk after occupational blood exposure among HCWs in Cairo.Methodology/Principal FindingsThe study was conducted in 2008–2010 at Ain Shams University Hospital, Cairo. HCWs reporting an occupational blood exposure at screening, having neither anti-HCV antibodies (anti-HCV) nor HCV RNA, and exposed to a HCV RNA positive patient, were enrolled in a 6-month prospective cohort with follow-up visits at weeks 2, 4, 8, 12 and 24. During follow-up, anti-HCV, HCV RNA and ALT were tested. Among 597 HCWs who reported a blood exposure, anti-HCV prevalence at screening was 7.2%, not different from that of the general population of Cairo after age-standardization (11.6% and 10.4% respectively, p = 0.62). The proportion of HCV viremia among index patients was 37%. Of 73 HCWs exposed to HCV RNA from index patients, nine (12.3%; 95%CI, 5.8–22.1%) presented transient viremia, the majority of which occurred within the first two weeks after exposure. None of the workers presented seroconversion or elevation of ALT.Conclusions/SignificanceHCWs of a general University hospital in Cairo were exposed to a highly viremic patient population. They experienced frequent occupational blood exposures, particularly in early stages of training. These exposures resulted in transient viremic episodes without established infection. These findings call for further investigation of potential immune protection against HCV persistence in this high risk group.

199 Hepatitis C virus infection and risk factors in health-care workers at Ain Shams University Hospitals, Cairo, Egypt

“…This result was also described by Moens et al in a large cross-sectional survey of Belgian HCWs, in which the prevalence among HCWs was not higher than in the general population (19). We therefore propose a hypothesis-one that was also elaborated in several studies (20)(21)(22) including in Egypt (18,(23)(24)(25)-that a higher cell-mediated immune response against HCV in HCWs who are repeatedly exposed would partially protect them against infection.…”

“…The HCV prevalence among HCWs was similar to that of the Cairo population, which is surprising since those working at ASUHs are exposed to a highly viraemic HCV patient population; the prevalence of HCV RNA among patients at ASUHs was reported to be 37% in the study of Munier et al (18). This result was also described by Moens et al in a large cross-sectional survey of Belgian HCWs, in which the prevalence among HCWs was not higher than in the general population (19).…”

“…Abdelwahab et al reported anti-HCV prevalence of 16.6% among HCWs at the National Liver Institute in the Nile Delta (11), which was comparable to the background prevalence in the general population of the Nile Delta. Munier et al recently reported a baseline anti-HCV seroprevalence of 7.2% (95% CI: 5.3-10.0%) among a cohort of HCWs in ASUHs who had been exposed to needle-stick injuries from HCV-infected patients (18).…”

“…This was evident in the under-representation of physicians-in-training. Since physicians-in-training in our study setting had the highest occupational blood exposure rates (18), their under-representation in the survey sample would bias our estimates towards the null. Thus, selection bias may explain the absence of an association between occupational exposures and HCV infection.…”

TH1 cytokine response to HCV peptides in Egyptian health care workers: a pilot study

“…The authors concluded that HCWs of a general University hospital in Cairo were exposed to a highly viremic patient population and they experienced frequent occupational blood exposures, particularly in early stages of training. These exposures resulted in transient viremic episodes without established infection [42]. …”