Academic journal article Iranian Journal of Public Health

Prioritizing High-Risk Practices and Exploring New Emerging Ones Associated with Hepatitis C Virus Infection in Egypt

Academic journal article Iranian Journal of Public Health

Prioritizing High-Risk Practices and Exploring New Emerging Ones Associated with Hepatitis C Virus Infection in Egypt

Article excerpt

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Introduction

Hepatitis C virus (HCV) is a major global health problem as 130-170 million people are chronically infected with HCV worldwide and more than 100,000 new cases of liver cancer that occur an- nually are caused by HCV (1,2).

Egypt is the country with the largest hepatitis C virus epidemic in the world. The high level of HCV infection has been attributed to the use of inadequately sterilized needles during mass cam- paigns undertaken to treat schistosomiasis in the 1960's and early 1980's. In 2008, a Demographic Health Survey (DHS) was carried out in Egypt, and provided for the first time an estimate of HCV prevalence on a nationwide representative sample of individuals (6,578 women and 5,430 men). The DHS showed that 15% of the Egyp- tian DHS respondents age 15-59 had antibodies to the HCV in their blood, indicating that they had been exposed to the virus at some point. Ten percent were found to have an active infection. Men were more likely to be infected than women and, the levels of infection increased sharply with age among both women and men (3,4). It is im- portant to identify the current risk factors for HCV infection among the Egyptian populati-on so that intervention programs would be appropri- ately focused. Moreover, digging deeper into identifying the characteristics of individuals who committed the risk practices is an essential step towards eradication of HCV.

The objective of this study was to identify and prioritize the high risk practices associated with transmission of HCV infection among Egyptians and identify newly emerging practices that is related to the Egyptian habits as well as to explore the individual and socioeconomic chara- cteristics of those who committed the risk practices

Methods

In order to identify and prioritize the current risky behaviors that may lead to transmission of HCV infection, we conducted a case control study from six governorates representing upper, lower, middle and canal region of Egypt. This study is part of a project funded by Science and Technology Development Fund (STDF) and im- plemented by National Research Centre in collab- oration with the Ministry of Health as a con- tribution for reduction of HCV endemicity in Egypt.

Interviewed participants and questionnaire

From January 2011 to January 2012, 540 HCV case patients and 102 of their family contacts who were HCV negative were interviewed. They were randomly selected from six governorates out of the 17 governorates in Egypt that included 9 Na- tional Viral Hepatitis Treatment Reference Cen- ters of the National Committee for Control of Viral Hepatitis- established by the Egyptian Min- istry of Health (MOH) with approximately 55 patients and 12 contacts from each treatment centre. These centres were selected as representa- tives to four locations within Egypt: Benisuef and Assuit as representative to urban and rural Upper Egypt, Dakahlia and Gharbia as representative to urban and rural Lower Egypt, Cairo as repre- sentative to middle Egypt and Ismailia as repre- sentative to the canal region.Both cases and con- trols were distributed along the six governorates as follows: 22.2% cases versus 18.6% contacts in Upper Egypt, 22.2% versus 24.5% in lower Egypt and 11.1% versus 21.6% in the canal region.

Cases are referred to these centres by a general practitioner, a specialist or on their own. Cases were the patients with serological evidence of HCV infection and received the treatment recom- mended by the referral centres, according to the national guidelines, and were selected from the outpatients' department. Controls were the family contacts of the cases without serological evidence with HCV infection.

Detection of anti-HCV antibodies was performed using the 4th generation qualitative ELISA test (Dia Sorin, Murex). However, reverse transcrip- tion polymerase chain reaction (RT-PCR) which is the accurate and standard technique for detec- tion of HCV was performed for all positive ELI- SA cases only. …

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