Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA.
Proc Natl Acad Sci U S A. 2010 Aug 17;107(33):14757-62. doi: 10.1073/pnas.1008877107. Epub 2010 Aug 9.
Egypt has the highest prevalence of antibodies to hepatitis C virus (HCV) in the world, estimated nationally at 14.7%. An estimated 9.8% are chronically infected. Numerous HCV prevalence studies in Egypt have published various estimates from different Egyptian communities, suggesting that Egypt, relative to the other nations of the world, might be experiencing intense ongoing HCV transmission. More importantly, a new national study provided an opportunity to apply established epidemiologic models to estimate incidence. Validated mathematical models for estimating incidence from age-specific prevalence were used. All previous prevalence studies of HCV in Egypt were reviewed and used to estimate incidence provided that there was sufficient age-specific data required by the models. All reports of anti-HCV antibody prevalence were much higher than any single other national estimate. Age was the strongest and most consistently associated factor to HCV prevalence and HCV RNA positivity. It was not possible to establish a prior reference point for HCV prevalence or incidence to compare with the 2009 incidence estimates. The modeled incidence from the national study and collectively from the modeled incidence from the previous community studies was 6.9/1,000 [95% confidence interval (CI), 5.5-7.4] per person per year and 6.6/1,000 (95% CI, 5.1-7.0) per person per year, respectively. Projected to the age structure of the Egyptian population, more than 500,000 new HCV infections per year were estimated. Iatrogenic transmission is the most likely, underlining exposure to the ongoing transmission. The study demonstrates the urgency to reduce HCV transmission in Egypt.
埃及是世界上丙型肝炎病毒 (HCV) 抗体流行率最高的国家，全国估计为 14.7%。估计有 9.8%的人患有慢性感染。埃及有许多 HCV 流行率研究发表了来自不同埃及社区的各种估计，表明埃及相对于世界上其他国家，可能正在经历强烈的 HCV 持续传播。更重要的是，一项新的国家研究提供了一个应用既定流行病学模型来估计发病率的机会。使用了用于从特定年龄流行率估计发病率的经过验证的数学模型。对埃及以往所有 HCV 流行率研究进行了回顾，并用于估计发病率，前提是模型需要足够的特定年龄数据。所有抗 HCV 抗体流行率报告都远高于任何其他单一国家估计。年龄是 HCV 流行率和 HCV RNA 阳性率的最强和最一致的相关因素。由于无法建立 HCV 流行率或发病率的参考点，因此无法与 2009 年的发病率估计进行比较。国家研究的模型发病率和以前社区研究的模型发病率的总和分别为每年每 1000 人 6.9/1000（95%置信区间[CI]，5.5-7.4）和每年每 1000 人 6.6/1000（95% CI，5.1-7.0）。根据埃及人口的年龄结构预测，每年估计有超过 50 万例新的 HCV 感染。医源性传播是最有可能的，这突显了接触正在进行的传播。该研究表明，在埃及减少 HCV 传播的紧迫性。
