Is the hepatitis C virus epidemic over in Egypt? Incidence and risk factors of new hepatitis C virus infections.
OBJECTIVE
To estimate hepatitis C virus (HCV) incidence rates and identify risk factors for current HCV transmission with emphasis on the role of living with infected household family members in rural Egypt.


METHODS
A 4-year population-based, cohort study of seronegative villagers was conducted to identify incident HCV seroconversion cases. A risk factor questionnaire and blood samples for anti-HCV EIA-3 and HCV RNA polymerase chain reaction testing were collected at two rounds of follow-up. Incidence rates, relative risks and 95% confidence interval (CI) were calculated based on a Poisson distribution. A matched case-control analysis to explore specific behavioural predictors of infection was conducted and odds ratios were obtained by conditional logistic regression.


RESULTS
Twenty-five participants (11 females) seroconverted in 10,578 person years of follow-up (PY), (incidence rate of 2.4/1000 PY; 95% CI: 1.6-3.5). The median age at seroconversion was 26 years [interquartile range (IQR) 19-35] among males and 20 years (IQR 13-24) among females. The only significant risk factor identified for these cases was receiving injections [adjusted odds ratio (OR(adj))=3.3; 95% CI: 1.1-9.8]. Two of the 17 viraemic seroconvertors were infected with the same strain as at least one of their family members.


CONCLUSIONS
This study identified the important role of injections in spreading HCV infection in this rural community. National healthcare awareness and infection control programmes should be strengthened to prevent further transmission. Screening of families of infected HCV subjects should be an essential part of case management for early detection and management.
Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Aya
A
Mostafa
Sylvia M
SM
Taylor
Mai
M
el-Daly
Mostafa
M
el-Hoseiny
Iman
I
Bakr
Naglaa
N
Arafa
Valérie
V
Thiers
François
F
Rimlinger
Mohamed
M
Abdel-Hamid
Arnaud
A
Fontanet
Mostafa K
MK
Mohamed
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D003140:Communicable Disease Control / Q000458:organization & administration*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D004534:Egypt / Q000453:epidemiology; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification* / Q000472:pathogenicity; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology*; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012698:Serologic Tests / Q000379:methods; D017678:Sex Distribution; D012959:Socioeconomic Factors; D055815:Young Adult