Towards realistic estimates of HCV incidence in Egypt

Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France.
Journal of Viral Hepatitis (Impact Factor: 3.91). 04/2013; 20(4):294-296. DOI: 10.1111/j.1365-2893.2012.01650.x
Source: PubMed


Accurate incidence estimates are essential for quantifying hepatitis C virus (HCV) epidemic dynamics and monitoring the effectiveness of public health programmes, as well as for predicting future burden of disease and planning patient care. In Egypt, the country with the largest HCV epidemic worldwide, two modelling studies have estimated age-specific incidence rates that, applied to the age pyramid, would correspond to more than 500 000 Egyptians getting infected annually. This is in contrast to figures of the Egyptian Ministry of Health and Population that estimates new infections to be approximately 100 000 per year. We performed new analyses of nationwide data to examine the modelling assumptions that led to these estimates. Thus, we found that the key assumption of these models of a stationary epidemic is invalid. We propose an alternate approach to estimating incidence based on analysing cohort data; we find that the number of annual new infections is <150 000.

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    • "As a result, 10–20% of the total Egyptian population are currently infected, most of them with genotype 4. Because of inadequate sterilization of healthcare equipment and the high prevalence in the general population, HCV continues to spread in Egypt [15]. Therefore, the annual number of new acute HCV infections is estimated to be approximately 150 000 [16]. Intrafamilial transmission (3%) and heterosexual transmission (0.07%) seem to be of limited importance [15] [17]. "
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    ABSTRACT: Acute hepatitis C virus (AHCV) infections are frequently seen worldwide in certain risk groups with an annual incidence rate varying between 0.08% and 66%. Although this incidence is substantial, a delayed diagnosis during chronic infection is most often made in the absence of clinical symptoms in the acute phase of the infection. Current used methods to diagnose AHCV are IgG antibody seroconversion and repeated HCV RNA measurements though no definite diagnostic test is currently available. Progress in the field of adaptive and innate immune responses has aided to both advancements in the field of HCV vaccine development and a more basic understanding of viral persistence. The rapid changes in the treatment of chronic HCV will affect therapeutic regimens in AHCV in the coming years leading to shorter treatment courses and pegylated interferon-free modalities. This review gives an overview of the current knowledge and uncertainties together with some future perspectives on acute HCV epidemiology, virology, immunology and treatment. Copyright © 2015. Published by Elsevier Ltd.
    Clinical Microbiology and Infection 04/2015; 21(8). DOI:10.1016/j.cmi.2015.03.026 · 5.77 Impact Factor
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    • "The total number of HCV infections reported here will be lower than those reported elsewhere since this analysis focuses on estimating the number of viraemic cases in the population after taking into account all age groups, mortality, new infections and cured patients. There is still evidence of high levels of ongoing HCV transmission [20] [21] [22] [23] with high HCV prevalence observed among young individuals [24] [25]. Table 1 shows that an estimated 168,000 new infections occurred in 2013, of which 102,000 went on to have chronic hepatitis C (CHC). "
    Arab Journal of Gastroenterology 06/2014; 15(2). DOI:10.1016/j.ajg.2014.04.003
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    • "With 14.7% of 15–59-year-olds testing anti-HCV positive, Egypt has the highest HCV prevalence in the world [1]. Although parenteral antischistosomiasis therapy (PAT) was important in the genesis of Egypt's HCV epidemic this was stopped over 25 years ago and HCV incidence remains high estimated between 150 000 and 500 000 new infections per year [2] [3] [4]. Infection from inadequate sterility of dental and medical devices has been shown to play a role in this regard [1, 2, 5–12]. "
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    ABSTRACT: Objective. To identify the risk factors for HCV infection within married couples in Egypt. Methods. In 2008 Egypt conducted its first nationally representative survey of HCV prevalence. 11126 of the 12780 individuals aged 15-59 year who were sampled agreed to participate and provided information via a questionnaire about demographic and behavioural characteristics and blood for HCV antibody and RNA analysis. We assessed the risk factors for HCV infection in a subsample of 5182 married individuals via multivariate logistic regression. Results. Overall HCV antibody prevalence in the married couples was 18.2% (95% CI, 16.8-19.6). HCV antibody prevalence was higher in the husbands (23.7%) than the wives (12.1%; P < 0.001). Having a spouse who was infected with HCV was an independent risk factor for HCV infection with odds ratios of 2.1 (95% CI, 1.6-2.9) and 2.2 (95% CI, 1.6-3.1) for women and men, respectively. Husbands whose wives had experienced female genital cutting (FGC) had a higher prevalence of HCV and this relationship was driven by a strong association in urban areas. Amongst the women there was no association between FGC and HCV overall but in urban areas only women who had experienced FGC were HCV infected. Conclusions. This study provides additional evidence of the importance of intrafamilial transmission of HCV in Egypt.
    03/2014; 2014:164357. DOI:10.1155/2014/164357
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