title: Epidemiology of hepatitis C virus and genotype distribution in immigrants crossing to Europe from North and sub-Saharan Africa.
abstract: BACKGROUND
  The association between the prevalence of hepatitis C virus (HCV) and immigration is rarely studied, particularly for the immigrants crossing to the resettlement countries. Most of the published data are confined to those immigrants who were resident in European countries and rarely immigrated before they reach the final destination. Libya is a large country in North Africa with the longest coast of the Mediterranean Sea facing the European Union. It has been considered as the main transient station for African immigrants to Europe. The objectives of this study were to determine: (1) the prevalence of HCV in African immigrants gathered in Libya from different African countries on their way to Europe and (2) HCV genotype distribution in these immigrants and its correlation with different demographic factors.
  
  
  METHODS
  A total of 14 205 serum samples were collected in a 3-year period (2013-2015) from different immigrants from North and sub-Saharan Africa who resided in the African immigrant campus, Tripoli, Libya. The participants were interviewed, and relevant information was collected, including socio-demographic, ethnic, and geographic variables. Each serum sample was tested for anti-HCV antibody using ELISA. The genotypes were determined and assigned using a specific genotyping assay and correlated with demographic and potential risk factors of the recruited individuals.
  
  
  RESULTS
  Of the immigrants studied, 1078 (7.6%) were positive for HCV. The prevalence of HCV infection ranged from 1.4% to 18.7%; it was higher among individuals arriving from Nile river (3.6-18.7%) of North Africa, followed by those who arrived from the West African region (2.1-14.1%), Horn of Africa (HOA, 6.8-9.9%), and Maghreb countries (1.4-2.7%). The relative risk factor attributable to gender variation was not significant (95% Cl: 0.8513-1.2381). Five genotypes were detected in 911 African immigrants. Genotypic analysis showed that the predominant HCV genotypes in this group were genotypes 4, 1, and 2 that accounted for 329 (36.1%), 326 (35.8%), and 131 (14.4%) strains, respectively, followed by genotype 3 that accounted for 87 (9.5%) strains. Genotype 5 was isolated mainly from 18 HOA (2%) and 20 West African (2.2%) individuals.
  
  
  CONCLUSIONS
  The prevalence of HCV is considered high with a unique disparate distribution among African immigrants crossing to Europe. This indicated that the prevalence of HCV is high among these immigrants and thus may be reflected on the HCV prevalence in the guest countries. The broad genetic heterogeneity of HCV genotypes detected here may impact the efficacy of prevention and control efforts for HCV in both Europe and North and sub-Saharan Africa; hence, an integrated global policy of actions is needed.
authors: Department of Medical Microbiology, Faculty of Medicine, Tripoli University, CC 82668, Tripoli, Libya; Clinical Microbiology & Microbial Epidemiology, Acting Physician of Internal Medicine, Scientific Coordinator of Libyan National Surveillance Studies of Viral Hepatitis & HIV, Tripoli, Libya. Electronic address: mohamedadaw@gmail.com.
authors: Mohamed A
authors: MA
authors: Daw
authors: Department of Laboratory Medicine, Faculty of Biotechnology, Tripoli University, CC 82668, Tripoli, Libya. Electronic address: abdallaelbouzedi@gmail.com.
authors: Abdallah
authors: A
authors: El-Bouzedi
authors: Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, Tripoli University, CC 82668, Tripoli, Libya. Electronic address: m.ahmed@uot.edu.ly.
authors: Mohamed O
authors: MO
authors: Ahmed
authors: Department of Surgery, Tripoli Medical Centre, Faculty of Medicine, Tripoli University, CC 82668, Tripoli, Libya. Electronic address: dautmc@gmail.com.
authors: Aghnyia A
authors: AA
authors: Dau
authors: Department of Pharmacology and Toxicology, Faculty of Medical Technology, Naluit Alga-bal Algarbi University, Libya. Electronic address: mohamedagnan@gmail.com.
authors: Mohamed M
authors: MM
authors: Agnan
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000914:Antibodies, Viral / Q000097:blood; D054242:Emigrants and Immigrants; D004641:Emigration and Immigration; D005060:Europe; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics*; D006509:Hepatitis B / Q000453:epidemiology; D006526:Hepatitis C / Q000097:blood / Q000453:epidemiology* / Q000208:ethnology* / Q000821:virology; D006801:Humans; D008002:Libya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral
keywords: African Immigrants; Central Africa; HCV; Horn of Africa; North Africa; West Africa