HCV iatrogenic and intrafamilial transmission in Greater Cairo, Egypt
- A Paez Jimenez1,
- N Sharaf Eldin2,
- F Rimlinger3,4,5,
- M El-Daly6,7,
- H El-Hariri2,
- M El-Hoseiny2,
- A Mohsen2,
- A Mostafa2,
- E Delarocque-Astagneau1,
- M Abdel-Hamid6,8,
- A Fontanet1,
- M K Mohamed2,
- V Thiers3,4,5
- 1Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
- 2Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- 3Virology Department, Institut Pasteur, Paris, France
- 4INSERM U785, Villejuif, France
- 5Université Paris SUD, Orsay, France
- 6Viral Hepatitis Research Laboratory, National Hepatology & Tropical Medicine Research Institute, Cairo, Egypt
- 7National Liver Institute, Menoufia University, Egypt
- 8Department of Microbiology, Faculty of Medicine, Minia University, Egypt
- Correspondence to Dr Arnaud Fontanet, Unité d'Epidémiologie des Maladies Emergentes – Institut Pasteur, 25 Rue du Docteur Roux – Bâtiment Laveran 3ème étage – 75724 Paris Cedex 15, France;
Contributors All the authors have substantially contributed to the study design as well as to the article review for important intellectual content. In addition, APJ, ED-A, AF, MKM and VT had the leading role in the conception, design, and interpretation of the data and drafting of the article. FR and MEl-D were in charge of the laboratory work. MEl-H, HEl-H and AM organised the participants' recruitment and interviews and were in charge of the data management.
- Revised 16 June 2010
- Accepted 15 July 2010
Objectives To document hepatitis C virus (HCV) intrafamilial transmission and assess its relative importance in comparison to other current modes of transmission in the country with the largest HCV epidemic in the world. HCV intrafamilial transmission was defined as HCV transmission among relatives living in the same household.
Design Case–control study. Cases were adult patients with acute hepatitis C diagnosed in two ‘fever hospitals’ of Cairo. Controls were adult patients with acute hepatitis A diagnosed in the same two hospitals, and family members of cases. All consenting household members of cases provided blood for HCV serological and RNA testing. Homology of viral sequences (NS5b region) within households was used to ascertain HCV intrafamilial transmission. Exposures at risk for HCV during the 1–6 months previous to onset of symptoms were assessed in all cases and controls.
Results From April 2002 to June 2007, 100 cases with acute hepatitis C, and 678 controls (416 household members and 262 patients with acute hepatitis A) were recruited in the study. Factors independently associated with HCV infection and their attributable fractions (AFs) were the following: having had a catheter (OR=5.0, 95% CI=1.4 to 17.8; AF=6.7%), an intravenous perfusion (OR=5.8, 95% CI=2.5 to 13.3; AF=20.1%), stitches (OR=2.0, 95% CI=1.3 to 6.6; AF=10.7%), gum treatment (OR=3.7, 95% CI=1.1 to 11.9; AF=3.8%) and being illiterate (OR=2.4, 95% CI=1.4 to 4.4). Of the 100 cases, 18 had viraemic HCV-infected household members. Three long-married (>15 years) couples were infected with virtually identical sequences and none of the three index patients reported any exposure at risk, suggesting HCV intra-familial transmission.
Conclusion While three new HCV infections out of 100 could be linked to intra-familial transmission, parenteral iatrogenic transmission (dental care included) was accountable for 34.6% of these new infections. Thus, the relative contribution of intrafamilial transmission to HCV spread seems to be limited.
- Hepatitis C virus
- risk factors
- Egypt, acute hepatitis
- molecular epidemiology
Funding Agence Nationale de Recherche sur le SIDA et les hépatites virales (ANRS Grant numbers 1203 and 12122.101), rue de Tolbiac, 75013 Paris, France.
Competing interests None.
Patient consent Obtained.
Ethics approval This study was conducted with approval from the Institutional Review Board of the Egyptian Ministry of Population and Health (MoPH) and the Ethics Committee of the National Hepatology and Tropical Medicine Research Institute (NHTMRI, Egypt).
Provenance and peer review Not commissioned; externally peer reviewed.