The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt
The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt
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DOI：
10.1016/s0140-6736(99)06527-7
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发表时间：
2000-03-11
期刊：
影响因子：
168.9
通讯作者：
Sallam, I
中科院分区：
文献类型：
--
作者：
Frank, C;Mohamed, MK;Sallam, I
背景埃及人口患有严重的肝脏疾病，主要是由于慢性感染丙型肝炎病毒（HCV）。一般人群中HCV抗体的总体流行率约为15- 20%。HCV传播的风险因素，特别是设置埃及除了其他国家是一个人的历史，肠外抗病毒治疗（PAT）。对1980年代才停止的埃及PAT大规模治疗运动的审查表明，血液传播病原体的可能性很大。我们研究PAT的相对重要性，在HCV的传播在Egyptian.Methods暴露于PAT队列的程度估计从1961年至1986年卫生部的数据。一个队列特定的暴露指数PAT计算和队列特定的HCV的患病率在四个regions.Findings HCV的患病率进行了比较，计算了8499埃及人年龄在10-50岁。在四个不同地区发现HCV抗体血清阳性率与暴露指数之间存在显著相关性（1.31 [95%CI 1.08-1.59]; p=0.007）。在所有地区，儿童和年轻人的群体特异性HCV患病率最低。这些较低的患病率相吻合的PAT与口服抗组胺药物在不同的时间点在四个regions.Interpretation-数据表明，PAT在整个埃及的丙型肝炎病毒的传播中发挥了重要作用的逐步和最终的替代。这种密集的传播建立了一个巨大的慢性HCV感染库，导致HCV感染的高患病率和目前的高传播率。埃及的大规模PAT运动可能代表了世界上最大的血源性病原体医源性传播。
Background The population of Egypt has a heavy burden of liver disease, mostly due to chronic infection with hepatitis C virus (HCV). Overall prevalence of antibody to HCV in the general population is around 15-20%. The risk factor for HCV transmission that specifically sets Egypt apart from other countries is a personal history of parenteral antischistosomal therapy (PAT). A review of the Egyptian PAT mass-treatment campaigns, discontinued only in the 1980s, show a very high potential for transmission of blood-borne pathogens. We examine the relative importance of PAT in the spread of HCV in Egypt.Methods The degree of exposure to PAT by cohort was estimated from 1961-86 Ministry of Health data. A cohort-specific exposure index for PAT was calculated and compared with cohort-specific HCV prevalence rates in four regions.Findings HCV prevalence was calculated for 8499 Egyptians aged 10-50 years. A significant association between seroprevalence of antibodies to HCV and the exposure index (1.31 [95% CI 1.08-1.59]; p=0.007) was identified across four different regions. In all regions cohort-specific HCV prevalence was lowest in children and young adults than in older cohorts. These lower prevalence rates coincided with the gradual and final replacement of PAT with oral antischistosomal drugs at different points in time in the four regions.Interpretation The data suggest that PAT had a major role in the spread of HCV throughout Egypt. This intensive transmission established a large reservoir of chronic HCV infection, responsible for the high prevalence of HCV infection and current high rates of transmission. Egypt's mass campaigns of PAT may represent the world's largest iatrogenic transmission of blood-borne pathogens.