Akiyama Matthew J, Khudyakov Yury, Ramachandran Sumathi, Riback Lindsey R, Ackerman Maxwell, Nyakowa Mercy, Arthur Leonard, Lizcano John, Walker Josephine, Cherutich Peter, Kurth Ann
Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, United States.
Division of Viral Hepatitis, Centers for Disease Control, Atlanta, United States.
Int J Infect Dis. 2024 Oct;147:107215. doi: 10.1016/j.ijid.2024.107215. Epub 2024 Sep 7.
Hepatitis C virus (HCV) disproportionately affects people who inject drugs (PWID) worldwide. Despite carrying a high HCV burden, little is known about transmission dynamics in low- and middle-income countries.
We recruited PWID from Nairobi and coastal cities and towns of Mombasa, Kilifi, and Malindi in Kenya at needle and syringe programs. Next-generation sequencing data from HCV hypervariable region 1 were analyzed using Global Hepatitis Outbreak and Surveillance Technology to identify transmission clusters.
HCV strains belonged to genotype 1a (n = 64, 46.0%), 4a (n = 72, 51.8%) and mixed HCV/1a/4a (n = 3, 2.2%). HCV/1a was dominant (61.2%) in Nairobi, whereas HCV/4a was dominant in Malindi (85.7%) and Kilifi (60.9%), and both genotypes were evenly identified in Mombasa (45.3% for HCV/1a and 50.9% for HCV/4a). Global Hepatitis Outbreak and Surveillance Technology identified 11 transmission clusters involving 90 cases. Strains in the two largest clusters (n = 38 predominantly HCV/4a and n = 32 HCV/1a) were sampled from all four sites.
Transmission clusters involving 64.7% of cases indicate an effective sampling of major HCV strains circulating among PWID. Large clusters involving 77.8% of clustered strains from Nairobi and Coast suggest successful introduction of two ancestral HCV/1a and HCV/4a strains to PWID and the existence of a widespread transmission network in the country. The disruption of this network is essential for HCV elimination.
丙型肝炎病毒（HCV）在全球范围内对注射毒品者（PWID）的影响尤为严重。尽管这些人群的HCV负担很高，但对于低收入和中等收入国家的传播动态却知之甚少。
我们在肯尼亚内罗毕以及蒙巴萨、基利菲和马林迪等沿海城镇的针头和注射器项目中招募了PWID。使用全球肝炎疫情与监测技术分析来自HCV高变区1的下一代测序数据，以识别传播集群。
HCV毒株属于1a基因型（n = 64，46.0%）、4a基因型（n = 72，51.8%）以及混合的HCV/1a/4a基因型（n = 3，2.2%）。HCV/1a在内罗毕占主导（61.2%），而HCV/4a在马林迪（85.7%）和基利菲（60.9%）占主导，两种基因型在蒙巴萨的分布较为均匀（HCV/1a为45.3%，HCV/4a为50.9%）。全球肝炎疫情与监测技术识别出11个传播集群，涉及90例病例。两个最大集群中的毒株（n = 38，主要为HCV/4a；n = 32，HCV/1a）来自所有四个地点。
涉及64.7%病例的传播集群表明对PWID中主要HCV毒株进行了有效抽样。涉及内罗毕和沿海地区77.8%集群毒株的大型集群表明，两种祖传的HCV/1a和HCV/4a毒株已成功传入PWID，且该国存在广泛的传播网络。破坏这一网络对于消除HCV至关重要。
