Role of intrafamilial transmission in high prevalence of hepatitis C virus in Egypt

Abstract

Background: Egypt has the highest prevalence of hepatitis C virus (HCV) worldwide. Although an effective HCV treatment program has been adopted, it is estimated that the number of newly reported cases in Egypt is still high. Intrafamilial transmission may play a role in the high prevalence of HCV in Egypt. Identification of risk factors for the transmission of HCV may help in decreasing its prevalence and eliminating its infection. Aim: The aim of this study was to estimate the prevalence of HCV infection among the household contacts of HCV patients and identify the possible risk factors associated with intrafamilial transmission. Methods: This study was designed as a cohort study of 90 families of patients with confirmed chronic HCV and 38 families of non-HCV-infected persons. Diagnosis of HCV infection was performed by detection of HCV antibodies by fourth-generation enzyme-linked immunosorbent assay and confirmed by HCV RNA polymerase chain reaction. A pre-prepared questionnaire on risk factors was filled out by the participants. The prevalence of HCV was calculated, and univariate and multivariate analyses were carried out to identify the independent risk factors. Results: Among 90 positive-index families, 32 (35.6%) had contact persons with HCV infection compared to two of 38 (5.3%) negative-index families (P < 0.001, odds ratio [OR] = 9.9). Out of 257 index-positive contacts, 38 (14.8%) were infected compared to three of 75 (4%) of index-negative contacts (P = 0.01, OR = 4.3). Infection was associated with older age (6.9% of those aged <20 years, 10.4% of those aged 20-39 years, and 22% of those aged ≥40 years were infected) (P = 0.007). Husbands of infected wives were at a higher risk (33% infected) than wives (13.5%) and sons (16.9%) (P < 0.001). A history of hepatic encephalopathy was the independent predictor of intrafamilial transmission (P < 0.001, OR = 5.4). Conclusion: Intrafamilial transmission was found to possibly play a major role in the high prevalence of HCV in Egypt. Transmission was associated with older age and contact with patients with hepatic encephalopathy and was high among husbands of infected wives.

Clustering of hepatitis C virus antibody positivity within households and communities in Punjab, India

“…Further research is required to understand why infection clusters at the village and household levels. In households, there is a range of possible factors, including sexual transmission, sharing razors or using the same barber or healthcare provider with poor infection control practices [36]. …”

Risk factors for viral hepatitis C infection in Rwanda: Results from a Nationwide Screening Program

“…Our study found an association between familial history of viral hepatitis and HCVAb prevalence. Previous observational studies have reported clustering of cases within households and documented evidence of higher disease prevalence among individuals with an infected family member compared to the general population [20][21][22][23] . Moreover, a recent cross-sectional survey of HCV patients conducted in China showed that long term exposure to an infected family member was associated with infection 24 , an indication that a constant exposure to low-risk transmission routes such as razors, tooth brushes and nail clippers could still contribute to infection.…”

Risk factors for viral hepatitis C infection in Rwanda: Results from a Nationwide Screening Program

“…Our study found an association between familial history of viral hepatitis and HCVAb prevalence. Previous observational studies have reported clustering of cases within households and documented evidence of higher disease prevalence among individuals with an infected family member compared to the general population [19][20][21][22] . Moreover, a recent cross-sectional survey of HCV patients conducted in China showed that long term exposure to an infected family member was associated with infection 23 , an indication that a constant exposure to low-risk transmission routes such as razors, tooth brushes and nail clippers could still contribute to infection.…”