title: Spatial epidemiology of hepatitis C virus infection in Egypt: analyses and implications.
abstract: Egypt has the highest hepatitis C virus (HCV) prevalence in the world (14.7%). The drivers of the HCV epidemic in Egypt are not well understood, but the mass parenteral antischistosomal therapy (PAT) campaigns in the second half of the 20th century are believed to be the determinant of the high prevalence. We studied HCV exposure in Egypt at a microscale through spatial mapping and epidemiological description of HCV clustering. The source of data was the 2008 Egypt Demographic and Health Survey. We identified clusters with high and low HCV prevalence and high and low PAT exposure using Kulldorff spatial scan statistics. Correlations across clusters were estimated, and each cluster age-specific HCV prevalence was described. We identified six clusters of high HCV prevalence, three clusters of low HCV prevalence, five clusters of high PAT exposure, and four clusters of low PAT exposure. HCV prevalence and PAT exposure were not significantly associated across clusters (Pearson correlation coefficient [PCC] = 0.36; 95% confidence interval [CI] -0.12 to 0.71). Meanwhile, there was a strong association between HCV prevalence in individuals older than 30 years of age (who could have been exposed to PAT) and HCV prevalence in individuals 30 years of age or younger (who could not have been exposed to PAT) (PCC = 0.81; 95% CI 0.55-0.93).
  
  
  CONCLUSIONS
  The findings illustrate a spatial variation in HCV exposure in Egypt. The observed clustering was suggestive of an array of iatrogenic risk factors, besides past PAT exposure, and ongoing transmission. The role of PAT exposure in the HCV epidemic could have been overstated. Our findings support the rationale for spatially prioritized interventions.
authors.affiliation: Infectious Disease Epidemiology Group, Weill Cornell Medical College - Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, NY, USA.
authors.forename: Diego F
authors.initials: DF
authors.lastname: Cuadros
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Branscum
authors.forename: F DeWolfe
authors.initials: FD
authors.lastname: Miller
authors.forename: Laith J
authors.initials: LJ
authors.lastname: Abu-Raddad
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016000:Cluster Analysis; D003710:Demography / Q000706:statistics & numerical data*; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D016174:Hepacivirus; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012552:Schistosomiasis / Q000150:complications / Q000628:therapy; D055815:Young Adult