埃及大开罗地区丙型肝炎医源性和家庭内传播。

HCV iatrogenic and intrafamilial transmission in Greater Cairo, Egypt.

机构信息

Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris Cedex 15, France.

出版信息

Gut. 2010 Nov;59(11):1554-60. doi: 10.1136/gut.2009.194266.

DOI:10.1136/gut.2009.194266

PMID:20947889

Abstract

OBJECTIVES

To document hepatitis C virus (HCV) intrafamilial transmission and assess its relative importance in comparison to other current modes of transmission in the country with the largest HCV epidemic in the world. HCV intrafamilial transmission was defined as HCV transmission among relatives living in the same household.

DESIGN

Case-control study. Cases were adult patients with acute hepatitis C diagnosed in two 'fever hospitals' of Cairo. Controls were adult patients with acute hepatitis A diagnosed in the same two hospitals, and family members of cases. All consenting household members of cases provided blood for HCV serological and RNA testing. Homology of viral sequences (NS5b region) within households was used to ascertain HCV intrafamilial transmission. Exposures at risk for HCV during the 1-6 months previous to onset of symptoms were assessed in all cases and controls.

RESULTS

From April 2002 to June 2007, 100 cases with acute hepatitis C, and 678 controls (416 household members and 262 patients with acute hepatitis A) were recruited in the study. Factors independently associated with HCV infection and their attributable fractions (AFs) were the following: having had a catheter (OR=5.0, 95% CI=1.4 to 17.8; AF=6.7%), an intravenous perfusion (OR=5.8, 95% CI=2.5 to 13.3; AF=20.1%), stitches (OR=2.0, 95% CI=1.3 to 6.6; AF=10.7%), gum treatment (OR=3.7, 95% CI=1.1 to 11.9; AF=3.8%) and being illiterate (OR=2.4, 95% CI=1.4 to 4.4). Of the 100 cases, 18 had viraemic HCV-infected household members. Three long-married (>15 years) couples were infected with virtually identical sequences and none of the three index patients reported any exposure at risk, suggesting HCV intra-familial transmission.

CONCLUSION

While three new HCV infections out of 100 could be linked to intra-familial transmission, parenteral iatrogenic transmission (dental care included) was accountable for 34.6% of these new infections. Thus, the relative contribution of intrafamilial transmission to HCV spread seems to be limited.

摘要

目的

记录丙型肝炎病毒（HCV）的家族内传播情况，并评估其与该国其他当前传播途径相比的相对重要性。该国有世界上最大的 HCV 流行，HCV 的家族内传播定义为生活在同一家庭中的亲属之间的 HCV 传播。

设计

病例对照研究。病例为在开罗的两家“发热医院”诊断出的急性丙型肝炎成年患者。对照组为在同两家医院诊断出的急性甲型肝炎成年患者，以及病例的家庭成员。所有同意的病例家庭成员都提供血液进行 HCV 血清学和 RNA 检测。使用家庭内病毒序列（NS5b 区）同源性来确定 HCV 的家族内传播。在所有病例和对照组中，评估了发病前 1-6 个月内与 HCV 相关的风险暴露情况。

结果

从 2002 年 4 月至 2007 年 6 月，共招募了 100 例急性丙型肝炎病例和 678 例对照组（416 名家庭成员和 262 名急性甲型肝炎患者）。与 HCV 感染相关的独立因素及其归因分数（AFs）如下：有导管（OR=5.0，95%CI=1.4 至 17.8；AF=6.7%）、静脉输注（OR=5.8，95%CI=2.5 至 13.3；AF=20.1%）、缝合（OR=2.0，95%CI=1.3 至 6.6；AF=10.7%）、牙龈治疗（OR=3.7，95%CI=1.1 至 11.9；AF=3.8%）和文盲（OR=2.4，95%CI=1.4 至 4.4）。在 100 例病例中，有 18 例有病毒血症的 HCV 感染的家庭成员。三对结婚时间较长（>15 年）的夫妇感染了几乎相同的病毒序列，且这三例患者均未报告任何相关风险暴露，提示存在 HCV 家族内传播。