Viral hepatitis C infection among Egyptians: the magnitude of the problem: epidemiological and laboratory approach

ABSTRACT

This study examines the relative importance of risk factors for viral hepatitis C infection and estimates the magnitude of HCV problem among Egyptians. It is a continuation of a recently performed cross-sectional study conducted on more than 5000 Egyptians. Serum samples [1945] were analyzed for liver enzymes [SGPT and SGOT] to evaluate the status of liver affection. One hundred and sixty nine samples [103 confirmed HCV seropositives and 66 seronegative] were analyzed for PCR HCV RNA to estimate the frequency of HCV viraemia among those individuals. Rates for HCV seropositivity by ELISA test in mass screening were corrected using predictive value of a positive test at prevalence between 5-50%. Attributable risk and population attributable risk estimates were calculated for those significant factors in logistic regression analysis. Overall number of HCV infected individuals was estimated for age groups of 15-65 years and the numbers of HCV related liver complications were estimated. HCV PCR RNA was positive for 50% of ELISA-seropositive samples and for 13.8% of the seronegative samples. However, only 5% of those individuals with HCV seropositivity and 3.7% of those with PCR RNA positivity Showed SGPT serum levels above 1.5 normal. The overall age, sex and urban/rural adjusted rate of true HCV seropositivity is estimated to be 15.6% among working Egyptians between 15-65 years. Attributable risk due to injections for the treatment of bilharziasis is estimated to be 47% [95% CL=38%-55%] among exposed males. Blood transfusion was estimated to be responsible for 87% [95% CL=57%-96%] of cases among previously transfused females. Population attributable risk for injections for treatment of bilharziasis among working urban and rural males is estimated to be 15% and 11% respectively. Blood transfusion and sharing contaminated needles contributed by 24% of cases [for each] among working urban females. Previous hospitalization contributed by 36% of cases among working rural females and by 10% among working urban males. As for the national estimate of cases of HCV seropositivity we estimated more the 5 million individuals with an expected number of chronic hepatitis of varying degrees of 3.5 millions. HCV viraemia with high probability for transmission is present in more than 50% of those individuals and liver cirrhosis cases expected to develop within an average of 20 years of infection are in the range of 350-700 thousand cases. The major proportions of population attributable risk are due to other undefined risk factors associated with age, male sex, living in rural areas and in lower and upper Egypt. Further research is needed to elucidate those factors prevailing in these areas, associated with increased risk of HCV infection