Prospective Study of Prevalence and Risk Factors for Hepatitis C in Pregnant Egyptian Women and Its Transmission to Their Infants

Abstract

Aim To estimate the hepatitis C virus (HCV) vertical transmission rate, the effect of potential risk factors, and the pattern of HCV antibody response and viremia in HCV-infected infants in Benha, Egypt.Methods A total of 1224 pregnant women who were treated at Benha University Hospital, Egypt, were included in the study. They completed a questionnaire about risk factors for HCV acquisition and suspected risk factors for mother-to-infant transmission and were tested for HCV antibody using a third-generation ELISA test. Women positive for HCV antibody were tested for HCV RNA by polymerase chain reaction. Peripheral blood of infants of positive HCV-RNA women was tested for HCV antibody and HCV-RNA at 1 and after 6 months of age.Results Out of 1224 pregnant women, 105 (8.6%; 95% confidence interval, 7.05-10.17) were positive for HCV antibody. Only 83 (6.8%; 5.39-7.21) were positive for HCV-RNA. HCV infection was associated with older age (1.16; 1.1-1.2, P = 0.001), blood transfusion (2.69; 1.2-6.0, P = 0.016), and HCV infection of the husband (5.47; 1.4-21, P = 0.014) or other household members (2.29; 1.2-4.6, P = 0.019). Out of 53 infants tested at first month, 43 (81%; 71-92%) were positive for HCV antibody, but only 7 (13%; 4.1-22%) were positive for HCV-RNA. After 6 months, only 2 (3.8%; 0-8.95%) remained positive for HCV RNA. ConclusionsThe prevalence of HCV in pregnant women in Egypt is lower than previously reported and the potential risk factors associated with HCV infection suggest intra-familial transmission. The frequency of vertical transmission of HCV in Egypt is not substantially different from other countries and does not play a role in the high prevalence of HCV in Egypt. CLINICAL SCIENCES doi: 10.3325/cmj.2010.51.219 CLINICAL SCIENCE 220Croat Med J. 2010; 51: 219-28 www.cmj.hrWorldwide, hepatitis C virus (HCV) infection is one of the most prevalent causes of liver diseases. There are estimated 300 million carriers of the virus all over the world (1). In the USA, the overall prevalence of HCV antibodies in the general population is 1.8%, the prevalence in children 6-11 years is 0.2%, and in adolescents 12-19 years old is 0.4% (2). In most developed countries, HCV infection is associated with percutaneous blood exposure, primarily as a result of blood transfusion and intravenous drug addiction (3).Egypt has the highest prevalence of hepatitis C in the world. Studies have found widely varying levels (10-50%) of the prevalence, depending on the populations covered; overall, estimates of the HCV rate in the general population range between 10 and 20% (4,5). Geographically, hepatitis C prevalence is higher in Lower Egypt (Nile delta) than Upper Egypt, and it is lower in urban than rural areas (6).In Egypt, the use of contaminated needles and syringes during mass schistosomiasis treatment campaigns during the period the 1960s-1980s has been identified as a key mode of transmission for HCV infection, suggesting that parenteral exposure continues to cause infections (7). Evidence of high interfamili...

Hepatitis B and C virus infections among pregnant women in Arab and African countries

“…Although specific data on age are scarce, the literature shows some variations in different geographical regions throughout the world [50]. Some researchers have found an association with low parity [24], whereas others have found no such relation [50]. Another sociodemographic factor of concern is educational level.…”

“…However, the risk of HCV transmission through blood still exists in some developing countries because of failure to adequately screen donors due to financial constraints [29,103]. However, most studies have found that blood transfusion is no longer a risk factor for HCV in pregnancy [50,104], and the same is generally true in Arab countries [24], although some Arab countries have found it to be a risk factor [50]. In contrast, blood transfusion might well be a risk factor among African countries, such as Ghana and Kenya, and probably a number of others, because of budget shortfalls [105,106,107].…”

“…Considerable effort to investigate the epidemiology of HCV is undertaken in Egypt, which has a high prevalence of HCV among pregnant women (8.6%) [23,49,50]. In Sudan, the prevalence of HCV among pregnant women (0.6%) is lower than that in the general population (2.2% to 3%) [30,51,52].…”

“…Some researchers have found that increasing age is a risk factor, which might be explained by the cumulative effect phenomena, probably attributed to the use of unsterile injections and other instruments used in traditional scarification and tattooing [10,50], but others have found no association [24]. Although specific data on age are scarce, the literature shows some variations in different geographical regions throughout the world [50]. Some researchers have found an association with low parity [24], whereas others have found no such relation [50].…”

Hepatitis C Virus in Egypt: Is More Than One Challenge

“…In Egypt, a study was conducted among intravenous drug users revealed 63.0% prevalence of HCV [29]. High HCV prevalence was also observed among pregnant women and children in Egypt, a prevalence of ~8.0% in Benha [30] and 15.8% in rural villages of the Nile Delta [14].…”