Performance and modification of EGCRISC among hepatitis C virus high-risk groups.

We have previously shown that the Egyptian Hepatitis C Virus Risk Score (EGCRISC), an Egyptian hepatitis C virus (HCV) risk-based screening tool, to be valid and cost-effective. Certain behaviours, occupations and diseases have been shown to be associated with an increased risk of exposure to HCV infection and constitute a major population reservoir of HCV infection. This study investigated the efficacy of EGCRISC in selected high-risk groups by testing 863 participants from four groups: slaughterhouse workers, illicit drug users (IDUs), female sex workers and human immune deficiency virus (HIV) patients. Data for this study were collected on EGCRISC and another pre-designed risk factor questionnaire. Sera were tested for HCV antibodies by ELISA. EGCRISC, at lower cut-off points, showed significantly good performance (P < 0.05) in all four groups except for females <45 years, but was reliable in detecting HCV cases (sensitivity: 84.21% and negative predictive value: 94.5%). Specific scores for IDUs and HIV patients were developed that showed high accuracy (P < 0.001). A modified EGCRISC for high-risk groups (EGCRISC-HRGs) was shown to be a valid tool that is recommended for use in high-risk populations if no other specific screening tool is available or universal screening is applied. EGCRISC for IDUs (EGCRISC-IDUs) and EGCRISC for HIV patients (EGCRISC-HIV) are useful tools for preselecting potentially HCV-infected cases for further testing in settings where serological analysis is not readily available or accessible.

Serological pattern of hepatitis B virus among Hbsag negative blood donors in Alexandria, Egypt.

This study in Alexandria, Egypt was conducted to investigate the distribution of different hepatitis B virus (HBV) markers in apparently healthy blood donors who were hepatitis B surface antigen (HBsAg) negative, and to determine the major independent risk factors. Evidence of past exposure to HBV was found in 148/508 screened donors (29.1%). The most prevalent marker was anti-NBc in 124/508 donors (24.4%), half of whom (63/124) showed anti-HBc only. Anti-HBs prevalence was 15.9%, combined anti-NBc and antiHBs was 12.0% and anti-HBe was 5.7%. Independent risk factors associated with the presence of at least 1 markerwere: being married (OR 3.82), history of blood transfusion (OR 3.04) and parenteral antibilharzial treatment (OR 2.49). Receiving a full HBV vaccination schedule was reported by 39 donors, but only 1 of them had isolated anti-HBs. The relatively high prevalence of HBV exposure necessitates solid infection control measures and adult vaccination programme awareness.

Serological pattern of hepatitis B virus among HBsAg negative blood donors in Alexandria, Egypt

This study in Alexandria, Egypt was conducted to investigate the distribution of different hepatitis B virus [HBV] markers in apparently healthy blood donors who were hepatitis B surface antigen [HBsAg] negative, and to determine the major independent risk factors. Evidence of past exposure to HBV was found in 148/508 screened donors [29.1%]. The most prevalent marker was anti-HBc in 124/508 donors [24.4%], half of whom [63/124] showed anti-HBc only. Anti-HBs prevalence was 15.9%, combined anti-HBc and antiHBs was 12.0% and anti-HBe was 5.7%. Independent risk factors associated with the presence of at least 1 marker were: being married [OR 3.82], history of blood transfusion [OR 3.04] and parenteral antibilharzial treatment [OR 2.49]. Receiving a full HBV vaccination schedule was reported by 39 donors, but only 1 of them had isolated anti-HBs. The relatively high prevalence of HBV exposure necessitates solid infection control measures and adult vaccination programme awareness

Immune response to hepatitis B vaccine in haemodialysis patients.

Widespread vaccination of haemodialysis patients had occurred during the year 1999 as a result of the promulgation of the Ministry of Health & Population. To our knowledge, this might be the first study in Egypt concerning post-vaccination response in haemodialysis patients and possible risk factors influencing this response. Eighty-three haemodialysis patients vaccinated with 10 microg dose of recombinant hepatitis B Merck Sharp vaccine at 0, 1 and 6 months were enrolled in the study. Blood samples were withdrawn one month after the third dose and sera were tested for anti-HBc to exclude those who had previous HBV exposure and for quantitative determination of antibodies to hepatitis B surface antigen (anti-HBs) using commercial enzyme immunoassay kits. Routine analysis for anti-HIV, anti-HCV and HBsAg every 3 months is done for all haemodialysis patients in the governmental sector. Only 65 patients negative for both anti-HBc and HBsAg were considered eligible for evaluating the immunogenicity of the vaccine. Seroconversion rate (anti-HBs>10 mlU/ml) was detected in 64.6% and adequate response (anti-HBs>100 mlU/ml) was achieved in 38% only. Non-responders were 35.4% reflecting the profound immune suppression in haemodialysis patients. Seroconversion rate was 84.2% in patients below 40 years of age and dropped to 33.3% in those 60 years or above. Seroconversion was significantly higher in females than males (76.5% vs. 51.6%). HCV infection was strikingly high among dialyzed patients (78.5%). Seroconversion rate was 58.8% in HCV-infected and 85.7% in non HCV-infected haemodialysis patients. Neither the duration of haemodialysis nor the frequency of blood transfusions had any significant association with seroconversion rate.

Hepatitis B and C virus infections among patients with gingivitis and adult periodontitis: seroprevalence and public health importance.

UNLABELLED: The aim of the present case control study was to identify seroprevalence of hepatitis B and C virus (HBV and HCV) infections among one hundred cases with periodontal disease (71% gingivitis and 29% adult periodontitis) and one hundred controls with healthy gingiva matdhed for age and sex. Moreover, it aimed to detect hepatitis markers in saliva samples corresponding to the positive sera. Different risk factors associated with hepatitis infection and detectability rate of hepatitis markers were also studied. METHODOLOGY: enzyme linked immunosorbent assay (ELISA) technique was used to detect the presence of hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti HBc), e antigen (eAg) and antibody to hepatitis C virus (anti HCV) both in serum and saliva samples. HCV RNA was detected by polymerase chain reaction (PCR) technique. Oral examination was performed for assessment of simplified Oral Hygiene Index (OHI-S), Papillary Bleeding Index (PBI), probing pocket depth and loss of fibre attachment. RESULTS: cases with periodontal disease showed higher percentages of hepatitis exposure (hepex; anti HCV and/or anti HBc) and significantly higher anti HCV seropositivity than the controls (26% and 13% versus 22% and 8%, respectively). No difference in HBsAg carrier rate nor in anti HBc seropositivity was elicited. Furthermore, cases with periodontal disease showed higher detectability rate of HBsAg, anti HBc, anti HCV or both anti HCV and/or anti HBc in whole unstimulated saliva than the controls (100% vs 66.7%, 50% vs 23.5%, 23.1% vs 0.0% and 42.3% vs 18.2%, respectively). Stepwise logistic regression delineated two significant factors associated with the risk of hepatitis exposure, the first predictor was the rural residence and the second one was the history of blood transfusion (OR=3.10, 2.94, respectively). Periodontal disease, severity of bleeding and bad oral hygiene were associated with the risk of hepatitis infection and with the detectability of hepatitis markers in the whole saliva.

Health status assessment of drug addicts in Alexandria.

The case-control study was conducted among addicts in Alexandria to determine the different health problems among them, as well as to study the correlation between addiction and these problems. One hundred drug addicts and eighty apparently healthy controls were included in this study. The whole sample was subjected to the following: filling a predesigned questionnaire sheet, clinical and electrocardiogram (ECG) examination, measurements of Body Mass Index (BMI), complete blood picture and antistreptolysin O titre (ASO), testing for hepatitis B surface antigen (HBsAg) and antibody to hepatitis B core antigen (anti HBc), skin scrapings from superficial fungal lesions in addition to complete urine and stool examination. The results revealed that chest rhonchi, hepatomegaly, central nervous system (CNS) abnormalities, skin lesions lymphadenopathy, underweight and anaemia were significantly higher among addicts than the controls. Hepatitis B virus (HBV) exposure and HBsAg seropositivity were found 48.0% and 21.0%, respectively among addicts compared to 26.3% and 5.0%, respectively among the controls. The intravenous injections and tattooing were the most risky routes for HBV infection among addicts. A positive correlation was revealed between HBV exposure and both the duration and the number of daily injections. Chest X-ray suggestive of pulmonary tuberculosis were found in 7.0% of the addicts. Addiction potentiated the risk of fungal infection among low social class, but it had no effect on the relationship between anaemia and social class nor on that between loss of appetite and underweight.

Human chronic fascioliasis: hepatitis B and C among infected cases.

Sera from one hundred and fifty three chronic Fasciola cases were screened for the presence of HB markers (HBsAg, anti HBc and anti HBs) and anti HCV using ELISA technique. Quantitative stool examination and estimation of liver enzymes (AST-ALT-bilirubin) levels of the study population were performed. HBsAg was present in 5 (3.3%), anti HBs in 13 (8.5%), HBexposed (HBex) in 44 (28.8%) and anti HCV in 13 (8.5%) of examined sera. HBV and HCV markers were significantly higher among older age groups. Concerning familial aggregation of hepatitis markers, 7 (15.9%) of the 44 HBex cases had two individuals per family who had evidence of exposure to HBV. No significant change in Fasciola GMEC and liver function tests have been noticed.

The effect of praziquantel administration on the course of hepatitis B among cases with concomitant schistosome infection.

The present work was designed to study the course of HB virus infection among bilharzial and non-bilharzial patients and to assess the therapeutic effect of praziquantel administration on subsequent course of HB among individuals with concomitant infections. This study included 26 bilharzial cases, 14 cases with HB and 40 cases with both infections (HB and schistosomiasis). Praziquantel was administered to all bilharzial positive cases. Sera were collected from all groups prior to anti-bilharzial chemotherapy, and then later at three and six months post treatment. The results show improvement of both liver function tests and cell mediated immunity as estimated by increased mean value of CD3, CD4, helper/suppressor ratio among individuals who received praziquantel in the two groups with schistosomiasis and concomitant infection. Furthermore the individuals who lost their HB surface antigenaemia were found to have a higher mean pan T cells, CD4 values, normal helper/suppressor ratio and absence of Clc in their sera than those who retained their carrier state. The follow up of HB carriers demonstrated a higher cure rate (clearance of HBsAg) among the group with concomitant infection as compared to the group with virus hepatitis only. HBV type two infection was common among the study population accounting for 25.9% of HBsAg positive cases. 42.9% of them cleared their antigenemia after treatment with praziquantel.

Prevalence, impact and risk factors of hepatitis C infection.

The present study was designed to investigate the status of hepatitis C virus (HCV) infection and associated risk factors among Egyptian military recruits. The impact of HCV infection on liver function was also assessed. The sera of 726 military recruits were tested for HCV antibodies using second generation ELISA technique (Ortho). The overall prevalence was 330.4%. Considering the presence of hepatitis B and/or schistosomiasis infection, HCV antibodies were detected in 30.0% of HBsAg carriers, 36.8% of bilharzial patients and 48.8% of those with concomitant infections. Among individuals without schistosomiasis or HBV infection, the rate decreased to 22.5% positive with HCV. The present study indicated that parenteral exposure to the virus might be the most important route for acquiring infection, while blood transfusion had a very minor role. The study of the impact of HCV on liver functions revealed that a single infection with HCV only was associated with almost normal liver function tests. However, infection with more than one hepatitis virus revealed a greater impact on the liver function. Morbidity also increased when schistosomiasis infection was superimposed.

Association between chronic hepatitis B carrier state and schistosomiasis.

A case-control study was designed to investigate the association between chronic HB carrier state and schistosomiasis infection. Four hundred bilharzial and 370 non-bilharzial individuals were included in this study. Sera from all individuals were tested for HBsAg and antibodies to delta Ag using ELISA. Chronic HB carrier rate was significantly higher among bilharzial cases (12.5%) than non-bilharzial individuals (6.2%). However no association was observed between HBs antigenaemia and intensity of schistosoma infection estimated by geometric mean of number of S. mansoni eggs/gm stools and S. haematobium eggs/10 ml of urine. Among important hepatitis associated risk factors reported were parenteral injection, dental manipulation and hospitalization. Blood transfusion seemed to have very minor role. Antibodies to delta Ag were detected in 9.6% of chronic HBsAg carriers, especially in the high titered individuals.

Cross sectional study of schistosomiasis among military recruits in Alexandria.

A cross-sectional survey for schistosomiasis infection was carried out among 1170 military recruits in Alexandria. Data on prevalence-intensity of infection-subjective symptoms and history of antischistosomal chemotherapy administration were collected from participants. The results confirmed the endemicity of S. mansoni and the low prevalence of S. haematobium infection in Delta region (33.1% and 1.1%) respectively. Previous antischistosomal chemotherapy administration was associated with decreased geometric mean egg count inspite the increase in prevalence. It is recommended that mass chemotherapy with praziquantel of this young active adult group would be of beneficial effect in decreasing schistosomiasis morbidity among an important large section of the community.

Study of the opinion and level of knowledge about AIDS problem among secondary school students and teachers in Alexandria.

The level of knowledge and the opinion about HIV/AIDS problem of 571 students (179 females, 392 males) and 211 teachers (85 females, 126 males) were assessed using an interview-questionnaire. The results explored the little priority given to sex education in Egyptian schools in addition to the very minor role of schools as source of knowledge (about AIDS problem) for students and teachers who revealed much interest towards the problem and wanted to know more about it, reflecting the need for urgent organized health educational programme.

PIP: Preventing the spread of HIV/AIDS through behavioral change may be the best available defense against AIDS. Health and sex education programs have therefore been acknowledged as useful tools to bring about such change. To support the recommendation of appropriate education interventions, the knowledge and opinions about HIV/AIDS of 571 students and 211 teachers in Alexandria, Egypt, were assessed. 179 female students, 392 male students,m 85 female teachers, and 126 male teachers were interviewed. The study found a significant correlation between the degree of sexual experience and level of knowledge. While few respondents had discussed HIV and AIDS with friends and family, male students and female teachers were relatively better informed on the issue. Both teachers and students were somewhat misinformed about HIV transmission. 75% of respondents knew that HIV carriers may be infectious, yet only few were aware that those who are infectious may be asymptomatic. Overall, little priority is given to sex education in Egyptian schools, and schools provide only minor information on AIDS despite broad interest among interviewees in additional information. An organized health education program is called for with health education in school curricula; open discussion of sex encouraged with specialized personnel; consideration of the role of familial breakdown in increasing risky behavior; religious person encouragement of healthy behaviors; stress on the importance of premarital HIV antibody screening; education on the role of condom use; and discussion of the correlation of addiction and sex films with excitation and risky behaviors. Finally, athletic participation should be encouraged, and strict rules imposed to punish those who intend to infect others.

Vertical transmission of HBsAg in Alexandria.

A total of 735 pregnant women at delivery and their babies were screened for HBsAg to assess the vertical transmission of HB virus infection. The carrier rate among pregnant women was 5%, evidence of intrauterine transmission reached 8.1% and that of perinatal transmission was 33.3% The most important factors affecting the carrier rate in mothers were the social class, parity, injections, dental manipulation and hospitalization. Nevertheless, among the factors increasing the rate of materno-fetal transmission were the presence of "e" Ag, high titer of HBsAg in mothers serum, cord blood antigenaemia, age of the mother, prolonged duration of labour and breast-feeding.

Intra familial spread of asymptomatic hepatitis B in Alexandria.

A total of 107 family members were examined for HBsAg 86 members were in families with a persistent carrier index and 21 of them were in families free from a carrier index. Rate of HBsAg transmission was 100% in families with a carrier index and absent in those free from a carrier. Horizontal transmission of hepatitis B virus infection reached about 80% in the total sample examined. All babies born to a carrier mothers became positive at one year of age stressing the importance of screening of the mother in the planning for vaccination programmes for the prevention of hepatitis B infection in newly-born.