The Epidemiology of Hepatitis C Virus in the Fertile Crescent: Systematic Review and Meta-Analysis

Abstract

ObjectiveTo characterize hepatitis C virus (HCV) epidemiology in countries of the Fertile Crescent region of the Middle East and North Africa (MENA), namely Iraq, Jordan, Lebanon, Palestine, and Syria.MethodsWe systematically reviewed and synthesized available records of HCV incidence and prevalence following PRISMA guidelines. Meta-analyses were implemented using a DerSimonian-Laird random effects model with inverse weighting to estimate the country-specific HCV prevalence among the various at risk population groups.ResultsWe identified eight HCV incidence and 240 HCV prevalence measures in the Fertile Crescent. HCV sero-conversion risk among hemodialysis patients was 9.2% in Jordan and 40.3% in Iraq, and ranged between 0% and 3.5% among other populations in Iraq over different follow-up times. Our meta-analyses estimated HCV prevalence among the general population at 0.2% in Iraq (range: 0–7.2%; 95% CI: 0.1–0.3%), 0.3% in Jordan (range: 0–2.0%; 95% CI: 0.1–0.5%), 0.2% in Lebanon (range: 0–3.4%; 95% CI: 0.1–0.3%), 0.2% in Palestine (range: 0–9.0%; 95% CI: 0.2–0.3%), and 0.4% in Syria (range: 0.3–0.9%; 95% CI: 0.4–0.5%). Among populations at high risk, HCV prevalence was estimated at 19.5% in Iraq (range: 0–67.3%; 95% CI: 14.9–24.5%), 37.0% in Jordan (range: 21–59.5%; 95% CI: 29.3–45.0%), 14.5% in Lebanon (range: 0–52.8%; 95% CI: 5.6–26.5%), and 47.4% in Syria (range: 21.0–75.0%; 95% CI: 32.5–62.5%). Genotypes 4 and 1 appear to be the dominant circulating strains.ConclusionsHCV prevalence in the population at large appears to be below 1%, lower than that in other MENA sub-regions, and tending towards the lower end of the global range. However, there is evidence for ongoing HCV transmission within medical facilities and among people who inject drugs (PWID). Migration dynamics appear to have played a role in determining the circulating genotypes. HCV prevention efforts should be targeted, and focus on infection control in clinical settings and harm reduction among PWID.

Hepatitis B and C in the Syrian Arab Republic: a review

“…The prevalence of both infections is low among blood donors, however, the 2004 populationbased serological survey indicated that the prevalence of HBV is of low-intermediate level and that of HCV is low. The prevalence of both infections is lower than that reported in other countries in the Arabic-speaking world (6,26). However, the high prevalence of HBV and HCV in the northern and eastern regions of the Syrian Arab Republic is worth noting.…”

“…Chemaitelly and colleagues also reported a high prevalence of HCV among highrisk populations in the Syrian Arab Republic compared to other neighbouring countries (6).…”

“…However, a more recent and up-to-date systematic review by Chemaitelly and colleagues indicated that HCV prevalence is <1% (6).…”

Epidemiology of hepatitis C virus among hemodialysis patients in the Middle East and North Africa: systematic syntheses, meta-analyses, and meta-regressions

“…However, this diversity appeared to reflect the distribution of circulating genotypes in each country Table 6. The maximum value for Shannon Diversity Index is 1·95 assuming full genotype diversity of seven HCV genotypes [17,37].…”

“…This study was conducted under the umbrella of the MENA HCV Epidemiology Synthesis Project, an on-going effort to characterize HCV epidemiology and inform key public health research, policy, and programming priorities in MENA [13][14][15][16][17][18][19].…”