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Millbourn C, Lybeck C, Psaros Einberg A, Nordin M, Lindh G, Hökeberg I, Fredlund H, Fischler B, Fadl H, Duberg AS, Lindahl K. Anti-HCV prevalence and risk factor-based screening for hepatitis C in pregnant women and their partners in Sweden. Infect Dis (Lond) 2020; 52:776-785. [PMID: 32654571 DOI: 10.1080/23744235.2020.1784456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The hepatitis C virus (HCV) prevalence in Sweden is estimated to be <0.5%, but unclear in pregnant women. The dominating route of transmission is drug use (DU), blood transfusions constituted a risk before 1992. The aim was to examine the anti-HCV prevalence and risk factors for HCV among pregnant women and their partners to evaluate screening strategies. METHODS Pregnant women and partners in Örebro County and in southern Stockholm were offered HCV-screening when visiting an antenatal clinic in 2013-2016, and completed a questionnaire concerning the country of birth, knowledge of HCV-status and HCV risk factors. RESULTS In Örebro 2,827 pregnant women and 707 partners, and in Stockholm 1,281 pregnant women and 320 partners participated. Anti-HCV was positive in 34 (0.7%) (25 pregnant women) and the associated risk factors were DU (n = 27), partner with HCV (n = 24) and not born in Sweden (n = 8). HCV RNA was positive in 23 (0.4%), 4 previously unknown and 10 who had been lost to follow-up. The most effective risk factor-based screening model for pregnant women included DU, blood transfusions, born in high prevalence country, partner with HCV, resulting in 538 (13%) pregnant women tested with 96% sensitivity, 87% specificity. CONCLUSIONS In this study of expecting parents in two Swedish regions, the anti-HCV prevalence was 0.7% and 0.4% were viraemic, of which about 60% were previously unknown or lost to follow-up. Awaiting more studies, including cost-benefit analysis evaluating universal screening, we recommend this improved risk factor-based screening model to identify HCV-infected individuals who need follow-up and therapy.
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Affiliation(s)
- Charlotta Millbourn
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Huddinge, Sweden.,Department of Infectious Diseases, Danderyd Hospital, Stockholm, Sweden
| | - Charlotte Lybeck
- Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Afrodite Psaros Einberg
- Department of Clinical Science, Intervention and Technology, CLINTEC, Stockholm, Sweden.,Department of Pediatrics, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Nordin
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Gudrun Lindh
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Ingegerd Hökeberg
- Department of Communicable Disease Prevention and Control, Stockholm County Council, Stockholm, Sweden
| | - Hans Fredlund
- Department of Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Björn Fischler
- Department of Clinical Science, Intervention and Technology, CLINTEC, Stockholm, Sweden.,Department of Pediatrics, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Fadl
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ann-Sofi Duberg
- Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karin Lindahl
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Huddinge, Sweden
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Millbourn C, Psaros Einberg A, Lindh G, Hökeberg I, Fischler B, Lindahl K. Prevalence and outcome of post-transfusion hepatitis C acquired at different ages and detected in look-back screening. Scand J Gastroenterol 2018; 53:870-875. [PMID: 29909701 DOI: 10.1080/00365521.2018.1476911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The prevalence of hepatitis C virus (HCV) infection in Sweden is estimated to 0.5%. Before 1992, blood transfusion posed a risk of HCV transmission. The primary aim of this study was to estimate anti-HCV prevalence in Stockholm County among individuals receiving blood transfusions 1965-1991. The secondary aim was to study the effect of age at transfusion on the development of liver disease and treatment outcome. MATERIALS AND METHODS This is a retrospective analysis of individuals found to be anti-HCV tested positive in Stockholm County during a national screening campaign in Sweden 2008-2010. All anti-HCV-positive individuals were also HCV RNA tested. Data on age at transfusion, age at diagnosis, HCV genotype, viral load, fibrosis score, liver histology and antiviral treatment were recorded. RESULTS Out of 7473, 134 (1.8%) tested individuals were anti-HCV positive and 102 were HCV RNA positive resulting in a prevalence of chronic hepatitis C (CHC) of 1.4%. The rate of advanced liver damage was 18% (10/56). Patients younger than 19 years of age at transfusion were significantly more often started on antiviral treatment compared to adult patients, 65% vs 29% p < .001. No significant correlation was found between treatment outcome and gender or age at transfusion. CONCLUSIONS In this study, we found an anti-HCV prevalence of 1.8% which is considerably higher than the estimated prevalence in the Swedish general population (0.5%), and patients infected during childhood were more likely to receive antiviral treatment. Additional data on the HCV epidemic in Sweden are needed regarding prevalence and age distribution.
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Affiliation(s)
- Charlotta Millbourn
- a Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden.,b Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Afrodite Psaros Einberg
- c Department of Pediatrics , Karolinska University Hospital , Stockholm , Sweden.,d CLINTEC Karolinska Institutet , Stockholm , Sweden
| | - Gudrun Lindh
- a Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
| | - Ingegerd Hökeberg
- e Department of Communicable Disease Prevention and Control , Stockholm , Sweden
| | - Björn Fischler
- c Department of Pediatrics , Karolinska University Hospital , Stockholm , Sweden.,d CLINTEC Karolinska Institutet , Stockholm , Sweden
| | - Karin Lindahl
- a Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
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