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Back to Gastroenterology Articles
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Egyptian & American researchers examine the incidence and risk
factors associated with Hepatitis C infection in rural Egypt.
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The prevalence of antibodies to Hepatitis C Virus (HCV) in Egypt
is among the highest in the world. From the 1950s until 1982
hundreds of thousands were infected during mass campaigns to control
schistosomiasis (a parasitic disease) using mass therapy with
intravenous antimony compounds, but little is known about current
risk factors and rates of transmission. Studies of high risk
populations, such as intravenous drug users, shed little light on
HCV transmission in Egypt where this high risk behavior is rare.
In a study led by G. Thomas Strickland, M.D. of the
Department of Epidemiology and Preventive Medicine at the University
of Maryland School of Medicine in Baltimore, MD and published in the
September 2005 issue of Hepatology, Egyptian and American
researchers surveyed rates of
HCV infection in two
rural communities having a prevalence of antibody to HCV of 24 and 9
percent.
A total of 10,112 HCV negative individuals were identified during
an annual survey in 1997, with follow-up performed on an average of
1.6 years later in 6,738 subjects. Of these, 33 developed HCV
antibodies, an incidence of 3.1/1000 person-years (PY), and 6.8/1000
PY in the 28 subjects in the village having the 24 percent
prevalence of HCV. None of the 33 individuals was diagnosed with
viral hepatitis or reported symptoms of acute hepatitis. An analysis
of risk factors showed the strongest predictor of infection with HCV
was having and anti-HCV positive family member. Among those that
did, incidence was 5.8/1000 PY, compared to 1.0/1000 PY; 27/33
incident cases had an anti-HCV positive family member. Parenteral
exposures increased the risk of HCV, but were not statistically
significant; 67 percent of seroconverters were less than 20 years
old, and the highest incidence rate (14.1/1000 PY) was in children
under 10 living in households with an anti-HCV positive parent in
the village with the high prevalence of HCV antibodies. The
infection rate was also increased (13.1/1000 PY) in men married to
an HCV positive woman.
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"We believe HCV
exposures in rural Egyptian communities are usually less intense
than those in individuals infected by contaminated blood, either
from transfusion of blood or a blood product, or from abuse of
intravenous drugs," the authors state. Although not statistically
proven to be a risk in this study, they cite frequent injections,
usually given at home for health purposes with syringes and needles
sometimes used for more than one person, as the most common
parenteral exposure route. The strong relationship between the risk
of infection in children and the presence of HCV antibodies in their
parents suggests that transmission of
HCV is occurring
between family members, possibly by exposure to infectious blood or
saliva, or by sharing needles. In the past, mass treatment campaigns
for schistosomiasis involving multiple injections may have caused
numerous HCV infections
in families, but this would not account for current infection rates,
other than placing younger members of families living with those who
contracted HCV in this way at higher risk.
The authors conclude: "It is exceedingly important to learn the
mechanisms by which HCV
transmission is occurring between family members so that preventive
measures can be initiated, particularly in children having HCV-infected
parents."
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Article: "Intrafamilial Transmission of Hepatitis C in
Egypt," Mostafa K. Mohamed, Mohamed Abdel-Hamid, Nabiel N. Mikhail,
Fatma Abdel-Aziz, Ahmed Medhat, Laurence S. Magder, Alan D. Fix, and
G. Thomas Strickland, Hepatology, Vol. 42, No. 3, September 2005.
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