Gender differences in prevalence of hepatitis C virus infection in Egypt: a systematic review and meta-analysis

Egypt is the country with the highest known hepatitis C virus (HCV) prevalence worldwide. The origin of gender differences in HCV prevalence is not usually well understood. This systematic review and meta-analysis aimed to review and evaluate the gender differences in HCV infection rates amongst Egyptians. Such data would be important to support prevention and control programs aiming to minimize HCV-related morbidity and mortality. PubMed, Scopus, and Web of Science (WOS) were searched for relevant articles published from 1st January 2011 to 13th December 2021, using the search terms (HCV OR "hepatitis C" OR hepacivirus) AND (prevalence OR seroprevalence OR epidemiology OR incidence OR magnitude). At first, retrieved articles were screened, and then relevant data were extracted and analyzed. Descriptive statistics were used for data analysis. Out of 616 studies from databases, only 30 were included after the full-text screening, with 193,621 included participants: 97,597 male and 96,024 female. The overall seroprevalence of HCV antibodies in all included studies was 0.02 (CI - 0.23 to 0.28), with no significant difference between males and females. However, HCV RNA positivity was significantly more prevalent in males than females in adults and the general population (after excluding high-risk groups). In children, no statistically significant differences between males and females were found in the seroprevalence of HCV antibodies nor in the prevalence of PCR positivity. HCV RNA positivity is significantly higher in males than females in adults, while there are no gender differences in children.

Current situation of viral hepatitis in Egypt

An estimated 8-10 million people suffer from viral hepatitis in Egypt. Hepatitis A virus (HAV) and hepatitis E virus (HEV) are the major causes of viral hepatitis in Egypt as 50% or more of the Egyptian population are already exposed to HAV infection by the age of 15. In addition, over 60% of the Egyptian population test seropositive for anti-HEV in the first decade of life. HEV mainly causes self-limiting hepatitis; however, cases of fulminant hepatitis and liver failure were reported in Egypt. Hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) are the main causes of chronic hepatitis, liver cirrhosis, and liver cancer (hepatocellular carcinoma [HCC]) in Egypt. Globally, Egypt had the highest age-standardized death rate due to cirrhosis from 1990 to 2017. The prevalence rate of HBV (1.3%-1.5%) has declined after national infantile immunization. Coinfection of HBV patients with HDV is common in Egypt because HDV antibodies (IgG) vary in range from 8.3% to 43% among total HBV patients. After the conduction of multiple national programs to control HCV infection, a lower rate of HCV prevalence (4.6%) was recently reported. Data about the incidence of HCV after treatment with direct antiviral agents (DAAs) are lacking. An HCC incidence of 29/1000/year in cirrhotic patients after DAA treatment is reported. A higher rate of infiltrative pattern among HCC patients after DAA treatment is also recognized. Viral hepatitis is one of the major public health concerns in Egypt that needs more attention and funding from health policymakers.

Characterizing the historical role of parenteral antischistosomal therapy in hepatitis C virus transmission in Egypt

Background

Egypt is the nation most affected by hepatitis C virus (HCV) infection, following an epidemic of historic proportions. We aimed to characterize the epidemic’s historical evolution and to delineate the role of parenteral antischistosomal therapy (PAT) campaigns in transmission.

Methods

A mathematical model was constructed and analysed in order to understand HCV-transmission dynamics. The model was fitted to Egypt’s Demographic and Health Survey data and to a systematic database of HCV-prevalence data.

Results

The incidence rate peaked in 1966 at 15.7 infections per 1000 person-years—a period of time that coincides with the PAT campaigns—and rapidly declined thereafter, beginning the mid-1990s. The annual number of new infections peaked in 1993 at 581 200 (with rapid demographic growth), leading to a high-incidence-cohort effect, and declined to 67 800 by 2018. The number of individuals ever infected (1950–2018) was 16.4 million, with HCV prevalence peaking in 1979. The number of individuals ever exposed to PAT was 8.3 million; however, of these individuals, 7.3 million were alive in 1980 and only 3.5 million alive in 2018. The number of individuals ever infected due to PAT exposure was 963 900, with 850 200 individuals alive in 1980 and only 389 800 alive in 2018. The proportion of PAT-attributed prevalent infections peaked at 19.9% in 1972, declining to 5.5% by 2018.

Conclusions

PAT campaigns played an important role in HCV transmission, yet explain only 6% of infections—they appear to be a manifestation, rather than a cause, of the epidemic. A possible driver of the epidemic could be the mass expansion of inadequate-quality healthcare during PAT campaigns and subsequent decades. Despite a historic toll, the epidemic has been rapidly diminishing since the mid-1990s.

Effect of health education intervention on hepatocellular carcinoma risk factor prevention in Menoufia governorate, Egypt

Background

Hepatocellular carcinoma is an important public health problem worldwide and in Egypt. It has a bad prognosis and few treatment options. HCV and HBV infection and exposure to pesticides and aflatoxins are major risk factors for its development, so paying more attention to prevention via raising population awareness about its risk factors may be useful in lowering HCC incidence. This study was implemented to study knowledge, attitude, and practice (KAP) of a rural community of Menoufia governorate, Egypt, pre- and post-health education intervention about HCC and prevention of its risk factors.

Results

Seroprevalence of HCV among study participants was 12.3%, and the health education intervention about HCC and the prevention of its risk factors was effective in increasing the percent of pre-intervention good knowledge score groups about HCC, HBV, and HCV, pesticides, aflatoxins, and total knowledge score from 66.5%, 88.8%, 83.8, 41.9%, and 73.7% respectively to 98.9%, 100%, 100%, and 98.9% post-intervention (p value = 0.000 for each) and was also effective in increasing the pre-intervention positive attitude score groups from 61.5 to 98.9% post-intervention. It was also effective in increasing the pre-intervention safe practice score groups of male and female study participants from 20% and 23% respectively to 94.3% and 93.1% post-intervention.

Conclusions

Health education intervention was effective in improving KAP about HCC and prevention of its risk factors and could be adopted by MOHP as a part of comprehensive program for HCC prevention in rural communities of Menoufia governorate.

Individual-level key associations and modes of exposure for hepatitis C virus infection in the Middle East and North Africa: a systematic synthesis

PURPOSE

To identify, map, and synthesize the individual-level key associations and modes of exposure for hepatitis C virus (HCV) infection in the Middle East and North Africa (MENA), the most affected region by HCV.

METHODS

Source of data was the MENA HCV Epidemiology Synthesis Project database, populated through systematic literature searches. Risk factors determined to be statistically significant after adjustment for confounders were extracted and categorized into key associations or modes of exposure.

RESULTS

In total, 329 risk factors were identified from 109 articles in 14 of 24 MENA countries. Among key associations, age was most frequently reported (n = 39; 34.2%), followed by other infections/diseases (n = 20; 17.5%), and incarceration (n = 17; 14.9%). Among modes of exposure, health care-related exposures were most frequently reported (n = 127; 59.5%), followed by injecting drug use exposures (n = 45; 20.9%), community-related exposures (n = 34; 15.8%), and sexual-related exposures (n = 8; 3.7%). Blood transfusion, hemodialysis, surgical and other medical procedures, dental work, and medical injections were identified as key health care-related exposures.

CONCLUSIONS

Health care appears to be the primary driver of prevalent (and possibly incident) infections in MENA, followed by injecting drug use. HCV screening should target the identified modes of exposure. Commitment to prevention should be an integral component of HCV response to achieve HCV elimination by 2030, with focus on strengthening infection control in health care facilities, improving injection safety and blood screening, and expanding harm reduction services for people who inject drugs.

Cross-infection and infection control in dentistry: Knowledge, attitude and practice of patients attended dental clinics in King Abdulaziz University Hospital, Jeddah, Saudi Arabia

The objective of the study was to determine the level of Knowledge, Attitude and Practice (KAP) of patients attended dental clinics at King Abdulaziz University Hospital (KAUH) regarding cross infections and infection control in dentistry. A cross-sectional study was conducted among 225 patients who attended the dental clinics of KAUH, Jeddah, Saudi Arabia, 2014. A standardized, confidential, anonymous, interviewing questionnaire was used. Knowledge about dental infections was assessed by 12 MCQs. The attitudes were assessed through answering seven statements on a three- point Likert scale. Patients' self reported practices were also evaluated. Descriptive and inferential statistics were done. Results of the study revealed that 39.5%, 38.7% and 21.8% of the participants obtained poor, fair and satisfactory level of knowledge about infections and infection control in dentistry, respectively. Social media was the commonest source of information about dental infection. Participant's educational level was significantly associated with the level of knowledge about dental infection. Patients had positive attitudes towards infection control in dentistry. Regarding self-reported practice, only few participants would ask dentists about sterilization of dental instruments (9.3%), wearing face mask (13.3%) and gloves (16.4%) if they don't do so. In conclusion, our participants had good attitudes towards infection control in dentistry. However, their knowledge and practice need improvements. Conduction of educational programs is needed through social media, mass media, schools and public places. These programs involve both patients and providers.

Seroprevalence of Hepatitis B Infection in Nigeria: A National Survey

Hepatitis B virus (HBV) infection accounts for about 1 million deaths worldwide annually. This study was to determine the prevalence, distribution of HBV, and factors associated with infection in an apparently healthy population in Nigeria. A cross-sectional study among the general population was conducted employing a multistage sampling technique. Data on demographic, social, and behavioral indicators were collected using questionnaires and blood samples tested for HBV seromarkers. Descriptive, bivariate, and multivariate analyses were done. Prevalence of hepatitis B infection was 12.2% (confidence interval [CI] = 10.3-14.5). Of the participants, more than half, 527 (54.6%), had evidence of previous exposure to HBV, while 306 (31.7%) showed no serologic evidence of infection or vaccination. Only 76 (7.9%) participants showed serologic evidence of immunity to HBV through vaccination. Factors associated with testing positive for HBV infection were dental procedure outside the health facility (odds ratios [OR] = 3.4, 95% CI = 1.52-7.70), local circumcision (OR = 1.73, 95% CI = 1.17-2.57), and uvulectomy (OR = 1.65, 95% CI = 1.06-2.57). With logistic regression, only dental procedure outside the health facility (adjusted OR = 3.32, 95% CI = 1.38-7.97) remained significant. This first national survey on seroprevalence of hepatitis B describes the epidemiology and high prevalence of HBV infection in Nigeria and highlights the need for improved vaccination against HBV.

Seroprevalence of HCV among Cairo University students in Egypt

Hepatitis C virus (HCV) is highly prevalent in Egypt. This work aimed at determining the seroprevalence of HCV among Cairo University students. The present study included 3,000 students from Cairo University, Egypt. Blood sample was obtained from each participant to be tested for HCV seromarker. HCV RNA detection by polymerase chain reaction (PCR) was carried out for those with positive anti-HCV. Overall prevalence rate of HCV antibody (anti-HCV) was 4.6%. It showed that the prevalence was relatively higher among females (86/1660; 5.2%) while males (51/1340; 3.8%) with no significant difference. PCR for HCV RNA was detected in 31.4% of the HCV antibody positive subjects (43/137). Which showed statistical significant difference between males (29/51) and females (14/86) at P = 0.001. Despite the prevalence rate reported in the present study was similar to anti-HCV prevalence among persons in the same age group, confirmed that HCV infection is detected among Cairo University students. J. Med. Virol. 88:1384-1387, 2016. © 2016 Wiley Periodicals, Inc.

Hepatitis B and C prevalence among hemodialysis patients in the West Bank hospitals, Palestine

Background

Hepatitis B and C virus infection is a lead cause of morbidity and mortality among hemodialysis patients. Yet, little research has focused on the morbidity measures of these serious disorders in low and middle income countries. The study aims to estimate the prevalence of hepatitis B and C among hemodialysis patients in the West Bank hospitals in Palestine.

Methods

A retrospective medical records review design was performed for all governmental and private hospitals in the West Bank which provide hemodialysis services for the patients. Data was retrieved from the patients’ medical files and from the computerized health information system in some hemodialysis centers. SPSS software version 16 was used for data entry and analysis.

Results

In overall, 868 hemodialysis patients attending nine hemodialysis hospitals in the West Bank was recruited. The overall prevalence of hepatitis B virus was found to be 3.8 % (33 cases) with a range from 0.0 % (in Jericho and Qalqelia districts) to 11.8 % (in Bethlehem district). Regarding hepatitis C virus, the overall prevalence was estimated around 7.4 % (64 cases) with a range from 2.9 % (in Nablus district) to 15.9 % (in Qalqelia district).

Conclusions

Although relatively low prevalence of both hepatitis B and C virus was found in a couple of hemodialysis hospitals, some higher prevalence values urge for the implementation of stricter infection prevention measures and more effective follow up procedures.

Schistosomiasis, hepatitis B and hepatitis C co-infection

BACKGROUND

Schistosomiasis is a significant health problem in more than 70 countries distributed between Africa, Asia and South America, with an infection rate of one in 30 individuals. Data on Schistosomiasis, Hepatitis B virus (HBV) and Hepatitis C virus (HCV) co-infection are scarce; however, there is a high prevalence in countries where schistosomiasis is endemic.

METHODS

A systematic search was performed on published data from 1980-2014. Published papers in the databases Google, Medline, PubMed, and MiPc library were searched using the keywords epidemiology, pathogenesis and outcomes of HBV, HCV and schistosomiasis and data were extracted from the relevant studies.

RESULTS

The prevalence of HBV/schistosomiasis co-infection in countries where schistosomiasis is endemic was high, ranging between 9.6 to approximately 64% in Egypt, and a maximum of 15.8% among hospitalized patients in Brazil. Concurrent infection between HBV and schistosomiasis is often associated with countries where schistosomiasis is endemic and may lead to chronic liver inflammation. Similarly, HCV infection rates in schistosomiasis populations range from 1% in Ethiopia reaching up to 50% in Egypt.

CONCLUSION

There is controversy regarding the effects of HBV and HCV on schistosomiasis and vice versa. Vaccination might be a solution to the era of schistosomiasis and co-infection with HBV and HCV.