Hepatitis C in a community in Upper Egypt: I. Cross-sectional survey.

Abstract

Abstract. The prevalence of antibody to hepatitis C virus (anti-HCV) was determined in a cross-sectional survey in a village in Upper Egypt. Exposure and demographic characteristics were obtained through a questionnaire. Antibody to hepatitis C virus was assessed using a second generation enzyme immunoassay, and the presence of HCV RNA was tested using a reverse transcriptaseϪpolymerase chain reaction. Collection of blood samples was targeted at those Ն 5 years old, and obtained from 62.8%. This report describes the community, the HCV infection characteristics of the subjects, and evaluates some factors associated with presence of anti-HCV. Of the 6,031 participants, 522 (8.7%) were anti-HCV positive. Prevalence was higher among males than females (11.3% versus 6.5%; P Ͻ 0.001). It was greater among those Ͼ 30 years of age than among those Յ 30 years of age (20.0% versus 3.6%; P Ͻ 0.001). Those who were less educated, farmed, provided health care, and were currently married had a significantly higher anti-HCV prevalence than those who were not; however, these associations were not significant after adjusting for age. Although active infections with Schistosoma haematobium were not associated with anti-HCV, a history of past infection was (age-adjusted risk ratio [RR] ϭ 2.1, 95% confidence interval [CI] ϭ 1.8, 2.4); 134 persons who had a history of receiving parenteral anti-schistosomal therapy had a higher age-adjusted RR (3.0; 95% CI ϭ 2.5, 3.7) for anti-HCV than those who did not. Hepatitis C virus RNA was detected in 62.8% of the anti-HCV positive subjects, without significant variation by age, gender, education, or marital status. The prevalence of anti-HCV in Upper Egypt is high, albeit lower than in Lower Egypt, with continuing but limited transmission indicated by the lower prevalence in residents Յ 30 years old.

Seroprevalence and Risk Factors for Human Herpesvirus 8 Infection, Rural Egypt1

“…None of the original household survey participants had a history of KS (13). HHV-8 seroprevalence was lower among children compared with adults (14.3% vs. 24.2%, p<0.001).…”

“…Egypt offers the opportunity to investigate how HHV-8 correlates in the general population with well-characterized hepatitis C virus (HCV) (13) and schistosomal infections (14). Hundreds of thousands of Egyptians were exposed to multiple intravenous injections during treatment campaigns to control schistosomiasis from the 1950s until 1982, which resulted in an epidemic of HCV (15).…”

“…We randomly selected residual frozen serum samples from 965 of ≈6,000 persons who had participated in the HCV and schistosomiasis epidemiologic, populationbased, household survey in Assiut Governorate, in rural southern Egypt in 1992 (13 (13). The proportion of children included in our study was slightly lower than in the original survey because serum samples from some children had been exhausted by tests for HCV and other hepatitis viruses.…”

International Trends in Liver Cancer Incidence Rates

“…In Egypt, for example, the primary risk factor for liver cancer, hepatitis C viral infection, was widely transmitted by inoculations to control schistosomiasis, which is a disease more common among Egyptian men particularly those in rural areas who acquire it occupationally as farm workers (24). The prevalence of HCV in some areas of Egypt is nearly twice as high in men as in women (35). In contrast, low male to female liver cancer rate ratios in registries such as Quito, Ecuador, Cali (Columbia), Costa Rica, and Harare (Zimbabwe) may indicate similar prevalence of risk factors between the sexes because there are no known susceptibility differences for developing liver cancer by sex (2).…”

Liver disease in Egypt: Hepatitis C superseded schistosomiasis as a result of iatrogenic and biological factors

“…Cross-sectional studies of 10,000 subjects living in two rural communities with 9% and 24% prevalence of anti-HCV showed that age, male sex, parenteral therapy for schistosomiasis, blood transfusion, invasive medical procedures, injections, circumcision of boys by "informal" health care providers, and complicated birth deliveries were all risk factors for HCV in the past. 17,18,21,22 HCV infections congregated within families, with children being at increased risk if their parents were infected and spouses being at greater risk if their partner was infected, particularly in the case of husbands with HCVinfected wives. 23 The risk of HCV infection was higher for children when their mothers were anti-HCV positive than when their fathers were positive and was higher when the parent had circulating HCV-RNA.…”