O115: Assessing the role of intra‐familial transmission in the ongoing propagation of the Egyptian hepatitis C virus epidemic

Abstract

PURPOSE: Egypt has the highest global prevalence of HCV. The Egyptian government campaign to control schistosomiasis with parenteral tartar emetic, the source of Egypt's current HCV epidemic, ended in 1986. Recent studies have investigated risk factors associated with ongoing transmission of HCV and used the 2008 Egypt Demographic and Health Survey (DHS) to assess ecologic risk factors (1, 2). This study adds to recent work by merging the 2008 DHS Health Issues and biomarker datasets to examine evidence of intra-familial transmission (IFT) of HCV and by using paternity information to evaluate the importance of vertical transmission. METHOD: Birth prior to 1980 was used as a proxy for exposure to the campaign because the campaign ended in 1986 and only children 5 and older were treated. The outcome was defined as a positive HCV test in any respondent born in or after 1980. The odds of infection in respondents who were not exposed to the schistosomiasis campaign living in households where at least one household member who was potentially exposed tested positive were compared to the odds of infection in respondents who were not exposed to the campaign living in households where no exposed member tested positive. Marginal models were estimated using generalized estimating equations with household as the cluster variable. Logistic regressions were adjusted for surgery; blood transfusions; female genital mutilation; urban/rural residence; age; and education. RESULTS: Using data from 2640 households, the presence of a household member who tested positive for HCV and was born before 1980 was a significant predictor of infection in a member of the same household who was born in or after 1980 (OR: 2.06; 95% CI: 1.57, 2.70). The increasing probability of a positive test in respondents who were not exposed to the campaign with an increase in the number of HCV positive household members that were exposed suggests IFT as a pathway for incident HCV. Controlling for maternal HCV, a child whose father tested positive was 2.53 times more likely to have HCV than a child whose father did not have HCV, (95% CI: 1.56, 4.08) indicating the importance of modes of IFT beyond vertical transmission. CONCLUSION: The importance of IFT of HCV through intrafamiliar needle sharing by informal healthcare providers has only been explored in qualitative research. This analysis highlights the importance of exploring extra-vertical pathways of IFT to best understand ongoing HCV transmission.