Schramm Birgit, Ashakin Khondaker A, Firuz Wasim, Hadiuzzaman Md, Ben-Farhat Jihane, Arias-Rodríguez Andrés, Rahman Anisur, Gupta Pradip Sen, Bhuiyan Abu Toha Rezuanul Haque, Duka Marve, Balkan Suna, Hossain Farah
Epicentre, Paris, France.
Médecins Sans Frontières, Cox's Bazar, Bangladesh.
Lancet Gastroenterol Hepatol. 2025 Jul;10(7):648-657. doi: 10.1016/S2468-1253(25)00094-9. Epub 2025 Apr 30.
Hepatitis C virus (HCV) infection is a significant public health concern. Limited data have shown unusually high HCV seroprevalence among Rohingya refugees residing in camps in Cox's Bazar, Bangladesh. We aimed to assess the prevalence of HCV seropositivity and active infection and identify risk factors to inform the HCV response.
A cross-sectional survey was conducted between May 10 and June 14, 2023, in adult (≥18 years) residents of seven camps in Cox's Bazar. Households were selected by simple random geosampling and one participant per household was selected at random. Participants were screened for HCV antibodies with a rapid finger prick blood test and, if seropositive, venous samples were tested for HCV viral load. A structured questionnaire collected information about demographics, HCV knowledge, and exposure risks. Survey-adjusted prevalence estimates of HCV seropositivity and active infection were generated by applying sampling weights. Factors associated with HCV seropositivity were identified using univariable and multivariable current status analysis and those associated with active infection via logistic regression.
The survey included 641 participants, of whom 425 (66%) were women and for whom the median age was 34 years (IQR 28-46). 191 individuals tested positive for HCV antibodies. 187 of these individuals were tested for active infection and 124 had a detectable HCV viral load. The survey-adjusted prevalence estimate of HCV seropositivity was 30·4% (95% CI 26·5-34·5), and that of active infection 19·8% (95% CI 16·5-23·4). Current status analysis identified higher odds of HCV seropositivity among individuals reporting medical injection(s) (adjusted odds ratio 1·8 [95% CI 1·2-2·8]) or surgery (5·9 [1·9-18·4]), and among women (2·1 [1·3-3·2]). 328 (51%) of 641 participants had never heard of hepatitis C. Five (4%) of 124 participants with HCV viraemia reported previous HCV treatment.
There is a substantial burden of active HCV infection among adult Rohingya camp residents, highlighting the urgent need to scale up testing and treatment capacities. The survey had constraints in identifying risk factors and could not provide data on HCV incidence. Reassessing infection prevalence after mass interventions and prospective surveillance are recommended to monitor ongoing transmission. A well-concerted multi-stakeholder action plan is needed to prevent future large-scale burden of severe liver disease and halt ongoing transmission.
Médecins Sans Frontières.
丙型肝炎病毒（HCV）感染是一个重大的公共卫生问题。有限的数据显示，居住在孟加拉国科克斯巴扎尔营地的罗兴亚难民中HCV血清阳性率异常高。我们旨在评估HCV血清阳性和活动性感染的患病率，并确定风险因素，以为应对HCV提供信息。
2023年5月10日至6月14日，在科克斯巴扎尔七个营地的成年（≥18岁）居民中进行了一项横断面调查。通过简单随机地理抽样选择家庭，并从每个家庭中随机选择一名参与者。通过快速手指采血检测对参与者进行HCV抗体筛查，如果血清呈阳性，则对静脉样本进行HCV病毒载量检测。一份结构化问卷收集了有关人口统计学、HCV知识和暴露风险的信息。通过应用抽样权重得出HCV血清阳性和活动性感染的调查调整患病率估计值。使用单变量和多变量现况分析确定与HCV血清阳性相关的因素，并通过逻辑回归确定与活动性感染相关的因素。
该调查包括641名参与者，其中425名（66%）为女性，中位年龄为34岁（IQR 28 - 46）。191人HCV抗体检测呈阳性。其中187人接受了活动性感染检测，124人检测到HCV病毒载量。HCV血清阳性的调查调整患病率估计值为30.4%（95%CI 26.5 - 34.5），活动性感染的估计值为19.8%（95%CI 16.5 - 23.4）。现况分析发现，报告有医疗注射（调整比值比1.8 [95%CI 1.2 - 2.8]）或手术（5.9 [1.9 - 18.4]）的个体以及女性（2.1 [1.3 - 3.2]）中HCV血清阳性的几率更高。641名参与者中有328名（51%）从未听说过丙型肝炎。124名HCV病毒血症参与者中有5名（4%）报告曾接受过HCV治疗。
成年罗兴亚营地居民中存在大量活动性HCV感染负担，凸显了扩大检测和治疗能力的迫切需求。该调查在识别风险因素方面存在局限性，且无法提供HCV发病率数据。建议在大规模干预措施后重新评估感染患病率，并进行前瞻性监测以监测正在进行的传播。需要一个协调一致的多利益相关方行动计划，以预防未来严重肝病的大规模负担并阻止正在进行的传播。
无国界医生组织。
