Hepatobiliary Division and Hepatitis Centre, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Faculty of Internal Medicine,College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
BMJ Open. 2021 Mar 15;11(3):e042861. doi: 10.1136/bmjopen-2020-042861.
Hepatitis C virus (HCV) infection is the leading cause of cirrhosis and hepatocellular carcinoma worldwide. Tzukuan, located in the southwestern area of Taiwan, is an HCV hyperendemic area (>30%). This study aimed to assess the changing epidemiological characteristics of HCV infection and to evaluate the long-term outcomes after the implementation of public health strategies for two decades.
A population-based retrospective cohort study.
A comprehensive care programme was implemented, namely COMPACT Study, in Tzukuan since 1997.
A total of 10 714 residents participated the screening.
The HCV status, demographic and clinical profiles of the participants were recorded and validated annually from 2000 through 2019.
The HCV infection prevalence rates were 21.1% (1076/5099) in 2000-2004, 18.8% (239/1269) in 2005-2009, 14.1% (292/2071) in 2010-2014 and 10.3% (234/2275) in 2015-2019 (p for trend test <0.0001). Among them, 1614 underwent repeated tests during the follow-up period. The annual incidence rates were 0.54% in 2005-2009, 0.4% in 2010-2014 and 0.22% in 2015-2019, respectively (p=0.01). In addition to old age, lower education level was a major risk factor for HCV infection across different periods. HCV infection prevalence rate among those illiterates reached 40.9%, followed by 28.5% in those with elementary school level, and <10% in those with high school or higher levels. The major risk factor has shifted from iatrogenic exposure in 2000-2009 to household transmission after 2010.
HCV infection has been decreasing and the epidemiological features are changing in the hyperendemic area by continuing education, prevention and treatment strategies.
丙型肝炎病毒（HCV）感染是全球肝硬化和肝细胞癌的主要原因。台湾西南部的左营是 HCV 高度流行地区（>30%）。本研究旨在评估 HCV 感染的变化流行特征，并评估实施公共卫生策略 20 年后的长期结果。
一项基于人群的回顾性队列研究。
自 1997 年以来，在左营实施了一项综合护理计划，即 COMPACT 研究。
共有 10714 名居民参加了筛查。
2000 年至 2019 年，参与者的 HCV 状况、人口统计学和临床特征每年记录并验证一次。
2000-2004 年 HCV 感染率为 21.1%（1076/5099），2005-2009 年为 18.8%（239/1269），2010-2014 年为 14.1%（292/2071），2015-2019 年为 10.3%（234/2275）（趋势检验 P<0.0001）。其中，1614 人在随访期间进行了重复检测。2005-2009 年的年发病率为 0.54%，2010-2014 年为 0.4%，2015-2019 年为 0.22%（P=0.01）。除了年龄较大，教育水平较低也是 HCV 感染的主要危险因素。不同时期文盲 HCV 感染率高达 40.9%，其次是小学文化程度者 28.5%，高中及以上文化程度者<10%。主要危险因素已从 2000-2009 年的医源性暴露转变为 2010 年后的家庭传播。
通过继续开展教育、预防和治疗策略，HCV 感染在高度流行地区呈下降趋势，流行特征发生变化。
