Wasitthankasem Rujipat, Aiewsakun Pakorn, Lapchai Sutthinee, Raksayot Maneerat, Keeratipusana Chantisa, Jarupund Pakawat, Nakhonsri Vorthunju, Pimsing Napaporn, Tongsima Sissades, Poovorawan Yong
National Biobank of Thailand, National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, 144 Thailand Science Park (TSP), Phahonyothin Road, Khlong Nueng, Khlong Luang, Pathum Thani 12120, Thailand.
Department of Microbiology, Faculty of Science, Mahidol University, 272 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok 10400, Thailand.
Virus Evol. 2024 Sep 11;10(1):veae079. doi: 10.1093/ve/veae079. eCollection 2024.
The World Health Organization has set a target to eliminate viral hepatitis as a public threat by 2030. In pursuit of this goal, Thailand initiated a hepatitis C virus (HCV) microelimination project targeting Phetchabun province, a well-recognized high-burden HCV endemic area. However, the historical transmission dynamics of HCV in Phetchabun, and in Thailand in general, remain unclear. This study investigates the epidemic histories of HCV in Phetchabun, focusing on Subtypes 1b, 3a, and 6f, and their relationship with HCV in other regions of Thailand, using molecular phylogenetic analyses. Our results reveal nationwide the presence of Subtypes 1b and 3a, while Subtype 6f is mainly confined to Phetchabun. The initial spread of Subtype 1b was inferred to coincide with World War II and the period of suboptimal medical and hygienic standards in Thai blood transfusion services, suggesting a correlation between the two. The early expansion of Subtype 3a was, on the other hand, found to correlate with the epidemic of intravenous drug use in Thailand during the time of Vietnam War. The early expansion of Subtype 6f, in contrast, appears to coincide with the period of severe regional political conflict and social and economic instability. All these findings suggest the complex interplay between social determinants of health and HCV transmission. Post the mid-1990s/early 2000s, all subtypes showed significantly reduced population growth rates, aligning with improvements in blood transfusion safety standards, the nationwide "War on Drugs" policy, and enhanced accessibility to public healthcare and HCV treatments. These combined efforts likely have contributed to curbing the spread of HCV in Thailand. Nevertheless, our analyses reveal that the prevalence of HCV in Thailand remains high overall, emphasizing the need for further research and a nationwide approach to more effectively reduce the HCV burden in Thailand.
世界卫生组织设定了到2030年消除病毒性肝炎这一公共威胁的目标。为实现这一目标，泰国启动了一项丙型肝炎病毒（HCV）微消除项目，目标是呵叻府，该府是公认的HCV高负担流行地区。然而，呵叻府以及整个泰国HCV的历史传播动态仍不清楚。本研究利用分子系统发育分析，调查呵叻府HCV的流行病史，重点关注1b、3a和6f亚型，以及它们与泰国其他地区HCV的关系。我们的结果显示，在全国范围内存在1b和3a亚型，而6f亚型主要局限于呵叻府。推断1b亚型的最初传播与第二次世界大战以及泰国输血服务中医疗和卫生标准欠佳的时期相吻合，表明两者之间存在关联。另一方面，发现3a亚型的早期传播与越南战争期间泰国静脉注射吸毒的流行有关。相比之下，6f亚型的早期传播似乎与严重的地区政治冲突以及社会和经济不稳定时期相吻合。所有这些发现表明健康的社会决定因素与HCV传播之间存在复杂的相互作用。在20世纪90年代中期/21世纪初之后，所有亚型的种群增长率均显著下降，这与输血安全标准的改善、全国性的“禁毒战争”政策以及公共医疗保健和HCV治疗可及性的提高相一致。这些共同努力可能有助于遏制HCV在泰国的传播。尽管如此，我们的分析表明，泰国HCV的总体流行率仍然很高，强调需要进一步研究并采取全国性方法，以更有效地减轻泰国的HCV负担。
