Epid Hepatitis Eng

Mohamoud et al.
BMC Infectious Diseases 2013, 13:288

http://www.iomedcent!al.com/1"#1$233"/13/288
%&'&(%C) (%*IC+& ,pen (ccess
*he epidemiolo-. of hepatitis C /i!us in &-.pt:
a s.stematic !e/iew and data s.nthesis
0ous!a ( Mohamoud
1
, 1hina % Mumta2
1
, 'u2anne %iome
1
, De3olfe Mille!
"
and +aith 4 (u$%addad
1,2,35
(st!act
Bac6-!ound: &-.pt has the hi-hest p!e/alence of hepatitis C /i!us 7)C89 in the wo!ld, estimated nationall. at
1".#:.
,u! stud.;s o<ecti/e was to delineate the e/idence on the epidemiolo-. of )C8 infection amon- the di=e!ent
population -!oups in &-.pt, and to d!aw anal.tical infe!ences aout the natu!e of )C8 t!ansmission in this cou
nt!..
Methods: 3e conducted a s.stematic !e/iew of all data on )C8 p!e/alence and incidence in &-.pt followin-
>%I'M( -uidelines. *he main sou!ces of data included >uMed and &mase dataases. 3e also used a multi/
a!iate
!e-!ession model to infe! the tempo!al t!end of )C8 p!e/alence amon- the -ene!al population and hi-h !is6
population in &-.pt.
%esults: 3e identi?ed 1@0 !ele/ant !eco!ds, fou! of which we!e incidence studies. )C8 incidence !an-ed f!om
0.8 to
A.8 pe! 1,000 pe!son$.ea!s. ,/e!all, )C8 p!e/alence amon- p!e-nant women !an-ed etween @$1@:, amon-
lood
dono!s etween @$2@:, and amon- othe! -ene!al population -!oups etween 0$"0:. )C8 p!e/alence amon-
multi$t!ansfused patients !an-ed etween 10$@@:, amon- dial.sis patients etween @0$B0:, and amon- othe
! hi-h
!is6 populations etween 10: and 8@:. )C8 p!e/alence /a!ied widel. amon- othe! clinical populations and
populations at inte!mediate !is6. %is6 facto!s appea! to e pa!ente!al anti$schistosomal the!ap., in<ections, t!a
nsfusions,
and su!-ical p!ocedu!es, amon- othe!s. %esults of ou! time t!end anal.sis su--est that the!e is no e/idence of
a
statisticall. si-ni?cant decline in )C8 p!e/alence o/e! time in oth the -ene!al population 7p$/alue: 0.21@9 an
d hi-h !is6
population 7p$/alue: 0."2A9.
Conclusions: &-.pt is conf!onted with an )C8 disease u!den of histo!ical p!opo!tions that distin-uishes this n
ation
f!om othe!s. ( massi/e )C8 epidemic at the national le/el must ha/e occu!!ed with sustantial t!ansmission s
till
on-oin- toda.. )C8 p!e/ention in &-.pt must ecome a national p!io!it.. >olic.ma6e!s, and pulic health and
medical
ca!e sta6eholde!s need to int!oduce and implement fu!the! p!e/ention measu!es ta!-etin- the !outes of )C8
t!ansmission.
Ce.wo!ds: )epatitis C 8i!us, &pidemiolo-., >!e/alence, Incidence, &-.pt, '.stematic %e/iew
Bac6-!ound
*he &-.ptian Demo-!aphic )ealth 'u!/e. 7&D
)'9, a
c!oss sectional su!/e. includin- hepatitis C /i!us 7)C
89
ioma!6e!s, was conducted in 2008 on a la!-e nation
all.
!ep!esentati/e sample D1E. It estimated )C8 p!e/
alence
amon- the 1@F@B .ea!s a-e -!oup to e
1".#: D1E.
(cco!din-l., &-.pt has the hi-hest )C8 p!e/
alence
in the wo!ld D2$"E. *his unpa!alleled le/el of eGp
osu!e
5 Co!!espondence: l<a2002HIata!$med.co!nell.edu
1
Infectious Disease &pidemiolo-. 1!oup, 3eill Co!nell Medical Colle-e $
Jata!, Co!nell Kni/e!sit., Jata! Loundation $ &ducation Cit., Doha, Jata
!
2
Depa!tment of >ulic )ealth, 3eill Co!nell Medical Colle-e, Co!nell
Kni/e!sit., Mew 0o!6, Mew 0o!6, K'(
to this infection appea!s to !eNect a national le/el
epidemic. It has een postulated that the epidemic
has een caused . eGtensi/e iat!o-enic t!ansmission
du!in- the e!a of pa!ente!al$antischistosomal$the!ap.
7>(*9 mass$t!eatment campai-ns D@,AE. *oda., )C8
infection and its complications a!e amon- the leadin-
pulic health challen-es in &-.pt D#E.
Multiple communit.$ and facilit.$ased studies we!e
conducted amon- di=e!ent population -!oups in &-.pt
o/e! the last two decades to assess the dist!iution of
infection in the population. *hese studies ha/e immensel.
imp!o/ed ou! unde!standin- of )C8 epidemiolo-. in
&-.pt. Me/e!theless, two lin-e!in- and c!itical Iuestions
Lull list of autho! info!mation is a/ailale at the end of the a!ticle
O 2013 Mohamoud et al.P licensee BioMed Cent!al +td. *his is an ,pen (ccess a!ticle dist!iuted unde! the te!ms of the
C!eati/e Commons (tt!iution +icense 7http://c!eati/ecommons.o!-/licenses/./2.09, which pe!mits un!est!icted use,
dist!iution, and !ep!oduction in an. medium, p!o/ided the o!i-inal wo!6 is p!ope!l. cited.
Mohamoud et al. BMC Infectious Diseases 2013, 13:288 >a-e 2 of 21
!e-a!din- )C8 t!ansmission in &-.pt a!e .et
to e
add!essed satisfacto!il.:
19 Does the hi-h )C8 p!e/alence !eNect mainl.
histo!ical eGposu!es du!in- the >(* campai-ns efo
!e
1B8@, with limited cu!!ent infection incidenceQ
29 If not, to what eGtent is )C8 t!ansmission still
on-oin-, and what a!e the d!i/e!s, !is6 facto!s, a
nd
modes of this t!ansmissionQ
*he o<ecti/e of ou! stud. is to attempt, at least in
pa!t,
to add!ess these two Iuestions th!ou-h a comp!ehe
nsi/e
s.stematic !e/iew and inte-!ated anal.sis of
multiple
sou!ces of data aout )C8 p!e/alence and inciden
ce in
&-.pt. ,u! stud. eGamined side$.$side info!mation
col$
lected . di=e!ent methods, . di=e!ent in/esti-ato!s,
and
in di=e!ent populations, allowin- us to co!!oo!ate
h.$
potheses ac!oss datasets, the!e. !educin- the imp
act of
potential iases that can eGist in a sin-le stud., datas
et, o!
line of e/idence. ,u! app!oach also facilitated an identi
?$
cation of the 6e. !esea!ch, polic., and p!o-!ammin- p!i
o!$
ities that !eIui!e fu!the! in/esti-ation and conside!at
ion.
Methods
Data sou!ces and sea!ch st!ate-.
3e conducted a s.stematic !e/iew of the p!e/alence a
nd
incidence of )C8 in the di=e!ent population -!oup
s in
&-.pt followin- the >%I'M( -uidelines D8E. *he >%I
'M(
chec6list can e found in *ale '1, see (dditi
onal ?le 1.
*he main data sou!ces fo! this in/esti-ation w
e!e:
>uMed 7Medline9 and &mase dataases. *he ao/
e data
sou!ces we!e sea!ched with no time o! lan-ua-
e !est!ic$
tions. >uMed and &mase we!e sea!ched usin-
oth
Me')/&mt!ee te!ms, !especti/el., and teGt te!ms.
Me')/
&mt!ee te!ms we!e eGploded to co/e! all suhe
adin-s.
Details of the sea!ch c!ite!ia fo! each of these
dataases
can e found elow:
>uMed: 77R)epatitis CSDMeshE ,% R)epatit
is C
(ntiodiesSDMeshE ,% R)epatitis C (nti-ensSDM
eshE
,% R)epaci/i!usSDMeshE ,% R)epatitis C, c
h!onic/
epidemiolo-.SDMeshE ,% R)epatitis C, ch!onic/e
tiolo-.S
DMeshE ,% R)epatitis C, ch!onic/t!ansmissionSDMe
shE ,%
R)epatitis C, ch!onic//i!olo-.SDMeshE ,% R)e
patitis
CSD*eGtE ,% R)C8SD*eGtE9 (MD 7R&-.ptSDMeshE o!
&-.pt
D*eGtE99.
&mase: 7e-.pt.mp. o! eGp &-.pt/9 and 7eGp hepa
titis C/
o! eGp )epatitis C /i!us/ o! hepatitis C.mp. o! )
C8.mp.
o! hepaci/i!us.mp.9.
&thics statement
,u! stud. did not need an ethics committee app!o/
al o!
w!itten info!med consent ecause it !elies enti
!el. on
pulished data.
'tud. selection
*he !esults of the sea!ches we!e impo!ted to a !efe!ence
mana-e!, &ndnote, whe!e duplicate pulications we!e iden$
ti?ed and eGcluded. *he !emainin- uniIue and potentiall.
!ele/ant !eco!ds we!e then impo!ted into Mic!osoft &Gcel
whe!e sc!eenin- fo! !ele/ance and eli-iilit. too6 place.
*he titles and ast!acts of all !eco!ds !et!ie/ed we!e
sc!eened fo! !ele/ance independentl. . two of the autho!s
70M and '%9. 'c!eenin- fo! !ele/ance was conducted in
two sta-es: 19 'ta-e 1 in/ol/ed sc!eenin- all titles and
ast!acts to eGclude all non$!ele/ant a!ticlesP 29 'ta-e 2
in/ol/ed !et!ie/in- and sc!eenin- the full$teGt of all a!ticles
deemed !ele/ant afte! the initial ast!act sc!eenin-, to
fu!the! eGclude an. !emainin- non$eli-ile a!ticles.
Inconsistencies etween !e/iewe!s we!e discussed and
so!ted out . consensus.
( pulication was conside!ed eli-ile fo! inclusion in
the !e/iew if it had data on at least one of the followin-
outcomes of inte!est: 19 p!e/alence of )C8 as detected
. )C8 antiodiesP and 29 incidence of )C8 as detected
. )C8 antiodies. ,nl. studies !epo!tin- p!ima!. data
we!e included. %e/iews of lite!atu!e we!e eGcluded, ut
all data !epo!ted we!e chec6ed and compa!ed to the
!esults of ou! sea!ch. (n. additional stud. identi?ed in
the eGcluded !e/iew and not !et!ie/ed . ou! sea!ch was
identi?ed and added to ou! !e/iew. Case !epo!ts and
case se!ies we!e eGcluded. (ll othe! stud. desi-ns we!e
eli-ile fo! inclusion. Distinction was made etween the
nume! of R!epo!tsS 7actual pulications i.e. pape!s,
confe!ence ast!acts etc.9 and the nume! of RstudiesS
7actual stud. and !esea!ch p!o<ect9. Multiple !epo!ts of the
same stud. we!e identi?ed as duplicates and counted as
one stud..
&li-ile studies we!e then cate-o!i2ed into two t.pes:
p!e/alence studies and incidence studies. (n. a!ticle
!epo!tin- oth the p!e/alence and incidence of )C8
was counted as two studies, one fo! incidence and one
fo! p!e/alence. %esults we!e then pooled into one list
containin- all eli-ile and uniIue studies.
Data eGt!action and population classi?cation
*he followin- data we!e then eGt!acted f!om each eli-ile
stud. included in the !e/iew: autho!, .ea! of data collec$
tion, .ea! of pulication, cit., stud. site, stud. desi-n,
samplin- techniIue, population 7lood dono!s, a!e!s,
health ca!e wo!6e!s, in<ectin- d!u- use!s 7IDKs9 etc.9,
socio$demo-!aphic cha!acte!istics of the population
7seG, a-e, !u!al /s. u!an etc.9, sample si2e, and p!e/alence
and/o! incidence of )C8. (lthou-h ou! sea!ch c!ite!ia
did not speci?call. ta!-et pulications !epo!tin- )C8
%M( p!e/alence o! !is6 facto!s in &-.pt, we eGt!acted this
info!mation f!om eli-ile pulications when a/ailale. %is6
facto!s we!e eGt!acted onl. if the. we!e statisticall.
si-ni?cant in a multi/a!iate !e-!ession anal.sis w
ithin a
stud. that was found !ele/ant acco!din- to ou! se
a!ch
c!ite!ia.
Data on the ao/e mentioned indicato!s we!e eGt!act
ed
f!om included !eco!ds and ente!ed into a compute!
i2ed
dataase on Mic!osoft &Gcel. &Gt!acted data we!e
then
classi?ed and anal.2ed on the asis of the stud. p
opula$
tion;s !is6 of acIui!in- )C8. *he fou! de?ned
ma<o!
population !is6 -!oups a!e:
19 >opulations at di!ect o! hi-h !is6: this -!oup
includes IDKs, multi$t!ansfused patients such as
hemophiliacs and thalassemics, dial.sis patients,
and
/i!al hepatitis patients, amon- othe!s.
29 >opulations at indi!ect o! inte!mediate !is6: this -
!oup
includes familial contacts of )C8 patients i.e. thei
!
child!en, spouses, and othe! household contactsP
select p!actitione!s of p!ofessions at !is6 of )C8 s
uch
as dentists, healthca!e wo!6e!s and a!e!sP
populations with potential IDK eGposu!es includin
-:
p!isone!s and )I8 patientsP and populations with
health facilit./in<ectin- eGposu!es such as diaeti
c
patients and hospitali2ed populations.
39 1ene!al population -!oups 7populations which a!
e
not at an ele/ated !is6 of )C8 eGposu!e9: p!e-na
nt
women, lood dono!s, child!en, !u!al populations,
a!m. !ec!uits o! ?!e !i-ade pe!sonnel, outpatien
t
clinic attendees, populations de?ned in caseF
cont!ol
studies as health. populations 7cont!ols9, amo
n-
othe! -!oups cate-o!i2ed to-ethe! as Rothe! -
ene!al
populationS -!oups.
"9 'pecial clinical population -!oups such as )od
-6in;s
l.mphoma 7)+9 patients, lichen planus 7+>9, an
d
li/e! disease patients, amon- othe!s. *his cat
e-o!.
includes patients with speci?c diseases that !
eIui!e
clinical ca!e, and thus can e eGposed to )C8
in
medical ca!e facilities, thou-h at /a!iale le/e
ls of
!is6 that is diTcult to cate-o!i2e amon- an. of
the
ao/e mentioned population -!oups.
3ithin an. speci?c cate-o!. of the ao/e po
pulation
-!oups, conside!ale hete!o-eneit. and di=e!
ent su$
-!oup t!ends ma. eGist.
In o!de! to c!eate p!e/alence ?-u!es, )C8 p
!e/alence
measu!es within each of the population -!oups
ao/e
we!e st!ati?ed into two st!ata: p!e$2001 and
post$2001,
ased on the .ea! in which the stud. was conducted
. *he
.ea! 2001 was chosen as the cut$o= .ea!, as
this was the
.ea! in which the &-.ptian Minist!. of )ealth
initiated
!oad infection cont!ol p!o-!ams in the count!. DBE
.
*ime t!end anal.sis
3e conducted a time t!end anal.sis in/esti-
atin- the
chan-e in )C8 p!e/alence amon- the -ene!al populatio
n
and hi-h !is6 population in &-.pt with !espect to time.
3e sta!ted . conductin- uni/a!iate linea! !e-!ession
anal.ses eGaminin- the chan-e in )C8 p!e/alence o/e!
time in each of the -ene!al population su-!oups sepa!atel..
( simila! anal.sis was conducted in each of the hi-h !is6
population su-!oups. *o a/oid s.stematic iases in an.
one su-!oup and to inc!ease the statistical powe! of the
time t!end anal.sis, we also used a multi/a!iate linea!
!e-!ession model estimatin- the tempo!al t!end in )C8
p!e/alence, while ad<ustin- fo! the di=e!ent su-!oups
in each population -!oupin-. *wo such models we!e
pe!fo!med: one fo! the -ene!al population and the othe!
fo! the hi-h$!is6 population. Mean )C8 p!e/alence was
modeled usin- a model that includes as p!edicto!s: time
7in .ea!s9 and the di=e!ent -ene!al population su-!oups
7o! hi-h !is6 population su-!oups9.
*he -ene!al population !e-!ession model stipulates
that:
Mean )C8 >!e/alence U V
0
W V
1
X *ime
W V
2
X (ntenatal clinic attendees
W V
3
X Blood dono!s W V
"
X %u!al /illa-e !esidents
W V
@
X Child!en W V
A
X )ealth. populations
W V
#
X (!m. !ec!uits W V
8
X ,the!
'imila!l., the hi-h !is6 population !e-!ession model
stipulates that:
Mean )C8 >!e/alence U V
0
W V
1
X *ime
W V
2
X Multi Y t!ansfused patients
W V
3
X 'chistosomiasis patients
W V
"
X *halassemic patients
W V
@
X 8i!al hepatitis patients
In oth models, Vi a!e the pa!amete!s of the statistical
model and *ime and su$population names a!e the
indicato! /a!iales.
Data used fo! these anal.ses we!e eGt!acted f!om the
eli-ile studies included in this !e/iew. In the p!esence
of oth an o/e!all )C8 p!e/alence measu!e as well as
st!ati?ed p!e/alence measu!es, we included onl. the
o/e!all p!e/alence measu!e. Includin- oth o/e!all and
st!ati?ed p!e/alence measu!es f!om the same stud.
would ha/e -i/en mo!e wei-ht to those studies, !elati/e
to othe!s, the!e. iasin- ou! !esults. *he .ea! of data
collection was estimated fo! studies missin- this /a!iale.
*his was done . conductin- a co!!elation anal.sis
etween the .ea! of data collection and the .ea! of
pulication fo! studies ha/in- data on oth, followed . a
pai!ed t$test to estimate the mean di=e!ence etween them.
3e then applied this di=e!ence to the .ea! of pulication
to estimate the .ea! of data collection when missin-.
Midpoints we!e calculated and used fo! studies conducted
o/e! a nume! of .ea!s. *he statistical anal.sis was
Mohamoud et al. BMC Infectious Diseases 2013, 13:288 >a-e " of 21
conducted usin- '*(*( /e!sion 11 7'*(*( co!po!ation
,
Colle-e 'tation, *eGas9.
%esults
'ea!ch !esults
*he stud. selection p!ocess is desc!ied in Li-u!
e 1, as
adapted f!om the >%I'M( 200B Now dia-!am D8E.
*he
nume! of !eco!ds !et!ie/ed th!ou-h oth >uMed
and
&mase was 1,1"A as of (u-ust 1, 2012, out of
which
""@ we!e eGcluded as duplicates. (fte! assess
in- all
documents acco!din- to thei! titles and ast!acts,
the
full$teGt of 183 !eco!ds we!e !et!ie/ed fo! sc!een
in- in
addition to 11 pape!s identi?ed th!ou-h !efe!ence
s of
!e/iews. ,f those, 1@0 !eco!ds we!e found eli-il
e fo!
inclusion in the p!esent a!ticle. ,nl. one !ele/ant !eco!d
was identi?ed outside the >uMed and &mase sea!chP
the &D)' D1E. Mo sin-le !epo!t has !epo!ted oth a
!ele/ant incidence measu!e and a !ele/ant p!e/alence
measu!e.
)C8 incidence
Li/e incidence measu!es we!e identi?ed th!ou-h ou!
sea!ch, !epo!ted in fou! incidence !epo!ts 7*ale 19. (ll
studies we!e conducted in !u!al a!eas of &-.pt amon-
/illa-e !esidents, p!e-nant women, and child!en D10$13E.
,/e!all hi-h )C8 incidence !ates we!e ose!/ed in these
studies !an-in- f!om 0.8 to A.8 pe! 1,000 pe!son$.ea!s.
Li-u!e 1 Llow of a!ticle selection fo! the )C8 p!e/alence and incidence in &-.pt sea!ch. *his cha!t, adapted f!om the >%I'M( 200B Now
dia-!am, displa.s the Now of a!ticle selection fo! the )C8 incidence and p!e/alence in &-.pt sea!ch of scienti?c dataases, namel. >uMed
and &mase.
Mohamoud et al. BMC Infectious Diseases 2013, 13:288 >a-e @ of 21
*ale 1 'tudies !epo!tin- hepatitis C /i!us incidence in &-.pt
Citation 0ea! +ocation 'tud. population 'ample si2e

Incidence 7pe! 1,000
pe!son$.ea!s9
Mohamed,0@ D1"E

1BB#$2000

Jalu.ia, +owe! &-.pt

8illa-e !esidents 2,"A3 A.8
Mohamed,0@ D1"E

1BB#$2000

(ssuit, Kppe! &-.pt 8illa-e !esidents ",2#@ 0.8
'aleh,08 D1@E 1BB#$200A

Menou?a, +owe! &-.pt

>!e-nant women 2,1## @.2
Mostafa,10 D1AE 2001$2003


8illa-e !esidents 3,@80 2."
'aleh,10 D1#E 2000$200A


Child!en of 3 /illa-es with hi-h p!e/alence of )C8 2,8@2 2.#
>!e/alence of )C8 in the -ene!al population
'iGt.$nine studies !epo!ted )C8 p!e/alence in the -e
ne!al
population. Details a!e shown in *ale 2. )C8 p!e/ale
nce
amon- the -ene!al population of &-.pt is documented to
e /e!. hi-h. *he 2008 &D)' measu!ed )C8 p!e/ale
nce
to e 1".#: amon- a nationall. !ep!esentati/e sa
mple of
11,12A &-.ptians a-ed 1@F@B .ea!s old D1E. *he
di/e!se
)C8 studies conducted amon- di=e!ent -ene!al pop
ula$
tion su-!oups, !e-a!dless of desi-n o! methodo
lo-.,
consistentl. !epo!t a /e!. hi-h )C8 p!e/alence, as hi-
h as
"1: in some studies D10E. ,/e!all, the p!e/alence ap
pea!s
to inc!ease d!amaticall. with a-e with the hi-hes
t !ates
ose!/ed amon- populations a-ed -!eate! than "0 .e
a!s.
( nume! of studies we!e conducted amon- lo
od
dono!s. ( hi-he! p!e/alence is ose!/ed amon- paid lood
dono!s and famil. !eplacement lood dono!s compa!ed to
/olunta!. dono!s D10$12E. Male lood dono!s had a hi-he
!
p!e/alence than thei! female counte!pa!ts D13E.
Blood
dono!s f!om !u!al a!eas had a hi-he! p!e/alence than th
ose
f!om u!an a!eas D38E.
Multiple studies we!e conducted amon- /illa-e
!esi$
dents in hi-h )C8 p!e/alence a!eas 7*ale 29. *he
o/e!all
p!e/alence in !u!al a!eas a/e!a-ed aout 20:, hi-h
e! than
the national a/e!a-e. ( stud. conducted in Cala
ma, a
/illa-e in the Mile Delta, !epo!ted )C8 p!e/alence
of "0:
amon- /illa-e !esidents DA0E. 'imila! to lood
dono!
studies, /illa-e !esidents we!e shown to ha/e
a hi-he!
p!e/alence amon- males compa!ed to females
DA2,81E,
and a ma!6ed -!owth in p!e/alence with a-e D@A,@
8,@BE.
( stud. conducted in 1BB#, amon- 3,BB3 !esident
s of a
/illa-e in the Mile Delta !e-ion, ose!/ed p!e/
alence
!ates in child!en, a-es 0F1B, !an-in- etween
# and
B.B:. *his !ate inc!eased to 2#.A: in those 2
0F3B .ea!s
and mo!e than douled to @A.#: amon- /illa-e !esi
dents
-!eate! than "0 .ea!s of a-e D82E.
)i-h )C8 p!e/alence was also ose!/ed amon- p!e
-nant
women and child!en in &-.pt. %ecent studies conduc
ted
amon- p!e-nant women !epo!ted a p!e/alence of aout
8:
in (ssuit D2#E and Benha D28E, and as hi-h as 1@.8: in
!u!al
/illa-es of the Mile Delta D2AE. 'tudies conducted
amon-
!u!al school child!en !epo!ted an a/e!a-e p!e/alen
ce of
aout #: D@3,AA,A8,ABE, while the a/e!a-e p!e/al
ence in
child!en attendin- outpatient clinics was found to
e
app!oGimatel. ": D18,1B,21,22E. )i-h p!e/alenc
e was
also ose!/ed amon- select su-!oups such as tou!ism
wo!6e!s D#0E, a!m. !ec!uits D@3,#BE and ?!e !i-ade
pe!sonnel D3"E.
Li-u!e 2( depicts the !an-e of p!e/alence within each
su-!oup in studies conducted p!e$ and post$2001.
(mon- lood dono!s, studies appea! to cluste! at lowe!
)C8 p!e/alence le/els post$ 2001 infection cont!ol
p!o-!ams, compa!ed to p!e$2001. )owe/e!, no distinct
patte!n can e ose!/ed within each of the othe!
su-!oups.
>!e/alence of )C8 amon- populations at di!ect o! hi-h
!is6 of eGposu!e
3e classi?ed populations at di!ect o! hi-h !is6 of )C8 eG$
posu!e into siG sucate-o!ies: /i!al hepatitis patients, multi$
t!ansfused patients, thalassemia patients, schistosmiasis
patients, patients on hemodial.sis and IDKs. *ale 3 lists
all the studies in each su$cate-o!. and the !epo!ted
p!e/alence measu!es.
(mon- patients dia-nosed with acute /i!al hepatitis,
)C8 p!e/alence !an-ed f!om as low as ".3: D8BE to as
hi-h as #8.#: D8@E. ,nce mo!e, we ose!/ed a hi-he!
p!e/alence amon- studies conducted in !u!al populations
/e!sus u!an populations. ( !ecent stud. conducted in
2010 !epo!ted an )C8 p!e/alence of 8.#: amon- child!en
with /i!al hepatitis D8#E.
*he ma<o!it. of studies in multi$t!ansfused and thalas$
semia patients we!e conducted amon- child!en. )i-h
)C8 p!e/alence !ates we!e ose!/ed with a/e!a-es of
aout "2: amon- multi$t!ansfused child!en and aout
@8: amon- child!en with thalassemia. Multiple studies
we!e also conducted amon- hemodial.sis patients 7mostl.
adults9. 8e!. hi-h )C8 p!e/alence was found in oth
adult populations and child!en on hemodial.sis.
*he!e we!e siG studies that in/esti-ated )C8 p!e/alence
amon- schistosomiasis patients. ,f these, onl. two eGpli$
citl. mentioned p!e/ious >(* eGposu!e. )owe/e!, f!om the
studies conteGt, and -i/en the hi-h )C8 p!e/alence ac!oss
all of these studies, eGposu!e to p!e/ious >(* campai-ns
seems to e implicitl. assumed. (cco!din-l., we chose to
classif. these siG studies in one su-!oup: schistosomiasis
patients, and not sepa!ate them into two cate-o!ies ased
on p!e/ious >(* eGposu!e.
M
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*ale 2 'tudies !epo!tin- hepatitis C /i!us p!e/alence amon- the -ene!al population in &-.pt
Citation 0ea!

+ocation 'amplin-

>opulation cha!acte!istic 'ample si2e

'e!o$p!e/alence

%M( p!e/alence
,utpatient clinic attendees
Chalifa,B3 D18E 1BB0$1

Cai!o cit., Cai!o C' Child!en 8" 0.0: M/(
&l$Manaw.,B@ D1BE M/(

(leGand!ia cit., (leGand!ia C' Child!en 110 11.8: M/(
Mi!as,02 D20E M/(

*anta, 1ha!ia, +owe! &-.pt C' In/out$patient child!en li/in- in )C8 10@

0.0:

M/(
endemic !e-ion
&l$%a2i6.,0# D21E 200"

Cai!o cit., Cai!o C' Child!en 1FB .!s old 1,0"2 1.": 0.@:
Candil,0# D22E 200"$A

Cai!o cit., Cai!o C' )ealth. child!en 20 @.0: M/(
(ntenatal clinic attendees
)assan,B3 D23E M/(

M/( C' 1,@3A ".3: M/(
(-ha,B8 D2"E 1BBA$#

Mansou!a, Da6ahlia, +owe! &-.pt C' #A# 13.#: 23.#:
Cassem,00 D2@E 1BBA

(leGand!ia cit., (leGand!ia C' 100 1B.0: 1".0:
'tos2e6,0@ D2AE 1BB#$03

3 !u!al /illa-es in Mile %i/e! Delta, +owe! &-.pt

C' 2,@8# 1@.8: 10.8:
[ah!an,10 D2#E 2008$B

(ssuit, Kppe! &-.pt C' @00 8.0: #.":
(dulIawi,10 D28E 2003$8

Benha, Jalui.a, +owe! &-.pt C' 1,22" 8.A: A.8:
(o &lma-d,11 D2BE M/(

M/( C' 20$"0 .ea! old mothe!s A1 13.0: M/(
Blood dono!s
Camel,B2 D30E 1BB2

Cai!o cit., Cai!o C' Male uni/e!sit. students, 20F2# .ea!s 2,1A" B.#: M/(
&l$[a.adi,B2 D31E M/(

M/( C' #A @.2: M/(
Da!wish,B2 D32E M/(

M/( C' B0 1".": M/(
Da!wish,B3 D33E 1BB2

Cai!o cit., Cai!o C' 1A3 13.A: M/(
&l$(hmad.,B" D10E M/(

M/( C' >aid lood dono!s BB 3@.": M/(
Juinti,B@ D3"E 1BB2$"

(leGand!ia cit., (leGand!ia C' 283 20.8: M/(
Bassil.,B@ D3@E M/(

Cai!o cit., Cai!o C' 188 2A.A: M/(
&l 1oha!.,B@ D3AE 1BB0$2

'ue2 cit., 'ue2 and Ismailia, +owe! &-.pt C' 1,18# 1".@: M/(
(ttia,BA D3#E M/(

Cai!o cit., Cai!o C' 1@A 21.8: M/(
(!thu!,B# D38E 1BB3

2" 1o/e!no!ates C' 2,A"" 2".8: M/(
&l$[a.adi,B# D3BE M/(

M/( C' 180 B.": M/(
1ad,01 D"0E 1BB8

Ismailia, +owe! &-.pt C' 20 20.0: M/(
*ana6a,0" D"1E 1BBB

13 -o/e!no!ates, Kppe! and +owe! &-.pt C' 3,A08 8.8: A.2:
)ashish,0@ D"2E M/(

(leGand!ia cit., (leGand!ia C' B@ 23.2: M/(
&l$1ilan.,0A D"3E 2002$3

Mansou!a, Da6ahlia, +owe! &-.pt C' 'tudent /olunta!. lood dono!s 2,1@# 2.#: M/(
(-ha,0A D""E M/(

M/( C' 2,"00 8.0: M/(
&l Damat.,0# D"@E 2001

Cai!o cit., Cai!o C' 2,8"@ #.A: M/(
M
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*ale 2 'tudies !epo!tin- hepatitis C /i!us p!e/alence amon- the -ene!al population in &-.pt 7Continued9
&l$[a.adi,08 D"AE 200@

2A -o/e!no!ates %andom (ll lood dono!s #A0 @.0: M/(
&l$[a.adi,08 D"AE 200@

2A -o/e!no!ates Lemale lood dono!s 12" A.@: M/(
&l$[a.adi,08 D"AE 200@

2A -o/e!no!ates Male lood dono!s A3A ".#: M/(
Ismail,0B D"#E 2000$#

Mansou!a, Da6ahlia, +owe! &-.pt C' @@,B22 12.0: M/(
(shou!,0B D"8E 200A$8

8 -o/e!no!ates C' @1@,#@8 ".8: M/(
&l6a!eh,0B D11E 2008

Menou?a, +owe! &-.pt C' Lamil. !eplacement lood dono!s ",#0B 12.#: M/(
&l6a!eh,0B D11E 2008

Menou?a, +owe! &-.pt C' Blood dono!s 3,@AB A.3: M/(
&l6a!eh,0B D11E 2008

Menou?a, +owe! &-.pt C' Lamil. !eplacement lood dono!s 8,#0@ 1".A: M/(
&l6a!eh,0B D11E 2008

Menou?a, +owe! &-.pt C' Blood dono!s "1" 8.#: M/(
%ushd.,0B D13E 200A$#

'ue2 Canal a!ea C' (ll lood dono!s B,1@0 @.A: M/(
%ushd.,0B D13E 200A$#

'ue2 Canal a!ea Male lood dono!s #,1@@ 2.B: M/(
%ushd.,0B D13E 200A$#

'ue2 Canal a!ea Lemale lood dono!s 1,BB@ 1.#: M/(
&ita,0B D12E 200@$8

Da6hilia, +owe! &-.pt C' 8olunta!. lood dono!s #3,"31 ".A: M/(
&ita,0B D12E 200@$8

Da6hilia, +owe! &-.pt C' Lamil. lood dono!s 113,@0" @.@: M/(
Chatta,10 D3AE 2000$8

Min.a, +owe! &-.pt C' 211,##2 B.0: M/(
%adwan,10 D"BE 200B

M/( C' 2#,@3# ".0: M/(
3as?,11 D@0E 200#$8

(leGand!ia cit., (leGand!ia C' 3,"20 3.@: M/(
(wadalla,11 D@1E M/(

Cai!o cit., Cai!o C' 1,000 1A.8: M/(
La!awela,12 D@2E 2010$1

Cai!o cit., Cai!o C' 100 @: M/(
%u!al /illa-e !esidents
(del$3aha,B" D@3E 1BB2

Menou?a, +owe! &-.pt C' 2#0 18.1: M/(
Camel,B" D@"E 1BB2

'ada, Caf! &l 'hei6h, +owe! &-.pt (ll /illa-e
!esidents

'ue2 Canal a!ea C' )ealth. lood /oluntee!s !esident to
1,2@B

1@.B:

M/(
2#1

1".":

M/(
!u!al a!ea with hi-h schistosomiasis

Mo!th 'inai, f!ontie! C' Bedouin population with low schistosomiasis 1"8 1@.@: M/(
Da!wish,B@ D@@E M/(

M/( C' )ealth. /illa-e!s and non$p!ofessional lood 188

21.8:

M/(
dono!s
Da!wish,BA D@AE 1BB"

Calama, Jaluo.ia, +owe! &-.pt C' 8illa-e !esidents:1F3 .ea!s 12 0.0: M/(

Calama, Jaluo.ia, +owe! &-.pt C' 8illa-e !esidents: "FB .ea!s 21 0.0: M/(

Calama, Jaluo.ia, +owe! &-.pt C' 8illa-e !esidents: 10F1B .ea!s "A 8.0: M/(

Calama, Jaluo.ia, +owe! &-.pt C' 8illa-e !esidents: 20F3B .ea!s 2B 20.0: M/(

Calama, Jaluo.ia, +owe! &-.pt C' 8illa-e !esidents: "0FA# .ea!s old "# @1.0: M/(
&l$'a.ed,B# D@#E 1BB3$"

'inai, f!ontie! C' Immi-!ants to a newl. !eclaimed a!ea endemic
fo! schistosomiasis
@0A

10.3:

M/(
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Mafeh,00 D@8E M/(

(ssuit, Kppe! &-.pt C' 8illa-e !esidents \ @ .ea!s of a-e 7o/e!all9 A,031 8.#: @.":
Mafeh,00 D@8E M/(

(ssuit, Kppe! &-.pt C' 8illa-e !esidents ]30 .ea!s ",1A" 3.A: 2.0:
Mafeh,00 D@8E M/(

(ssuit, Kppe! &-.pt C' 8illa-e !esidents ^30 .ea!s 1,8A# 20.0: 12.B:
(del$(2i2,00 D@BE 1BB#

(-hou! &l 'ou-h!a, Jaluo.ia, +owe! &-.pt C' 8illa-e !esidents \@ .ea!s old 7o/e!all9 3,BBB 2".3: 1".8:

(-hou! &l 'ou-h!a, Jaluo.ia, +owe! &-.pt C' 8illa-e !esidents: ]20 .ea!s 2,10@ B.3: M/(

(-hou! &l 'ou-h!a, Jaluo.ia, +owe! &-.pt C' 8illa-e !esidents ^20 .ea!s 1,8B" "1.0: M/(
Da!wish,01 DA0E 1BB"$@

Calama, Jaluo.ia, +owe! &-.pt C' 8illa-e !esidents ^10 .ea!s of a-e #BA "0.0: M/(
&l$'adaw.,0" DA1E M/(

'ha!6ia, +owe! &-.pt C' 8"2 2#.": #.":
(!afa,0@ DA2E 2002$3

[awiat %a2in, Menou?a, +owe! &-.pt C' ",020 11.8: M/(
(!afa,0@ DA2E 2002$3

[awiat %a2in, Menou?a, +owe! &-.pt C' 8illa-e !esidents: unde! 20 .ea!s old 1,#@B 2.8: M/(
(!afa,0@ DA2E 2002$3

[awiat %a2in, Menou?a, +owe! &-.pt C' 8illa-e !esidents: 20 and o/e! .ea!s old 2,2@2 18.B: M/(
Mohamed,0A DA3E 2002

[awiat %a2in, Menou?a, +owe! &-.pt C' 8illa-e !esidents 18FA@ .ea!s of a-e 2,"2@ 18.@: M/(
&assa,0# DA"E 200A$#

[a-a2i- dist!ict, 'ha!6ia, +owe! &-.pt C' 8illa-e households 30" 10.B: M/(
(-uila!,08 DA@E M/(

La66ous and 8 su!!oundin- /illa-es C' 8illa-e !esidents: males #8 @1.3: 38.@:
(-uila!,08 DA@E M/(

La66ous and 8 su!!oundin- /illa-es, C'

8illa-e !esidents: females

81

"2.0:

2B.A:
'ha!6ia, +owe! &-.pt
Child!en

Menou?a, +owe! &-.pt C' %u!al male p!ima!. school child!en 1B0 12.1: M/(
&l$'he!ini,03 DAAE 1BB"

M/( C' 8illa-e school child!en AF1@ .ea!s old 2B" @.8: 2.":
Mohamed,0A DA#E 1BB#

Mile %i/e! Delta, +owe! &-.pt C' 8illa-e child!en @F18 .ea!s old 1,823 8.2: M/(
Mohamed,0A DA#E 1BB#

(ssuit, Kppe! &-.pt C' 8illa-e child!en @F18 .ea!s old 2,808 2.@: M/(
&l 'he!ini,0# DA8E 2002

*anta, 1ha!ia, +owe! &-.pt C' 'chool child!en "#0 2.1: 0.8:
Ba!a6at,11 DABE 200@

(leGand!ia cit., (leGand!ia >B' 'chool child!en @00 @.8: ".":
)ealth. indi/iduals
&l$'a.ed,BA D#0E 1BB"

'outh 'inai, f!ontie! C' *ou!ism wo!6e!s #"0 1".3: M/(
Mohamed,BA D#1E M/(

M/( C' &-.ptians appl.info! wo!6 a!oad @,0#1 31.@: M/(
Mohamed,BA D#1E M/(

M/( C' &-.ptians appl.info! wo!6 a!oad: Lemales M/( 13.2: M/(
Mohamed,BA D#1E M/(

M/( C' &-.ptians appl.info! wo!6 a!oad: Males M/( 3".0: M/(
1oha!,B@ D#2E M/(

M/( C' 1@ 13.3: M/(
)alim,BB D#3E 1BBA

Cai!o cit., Cai!o C' )ealth. sta= of the uni/e!sit. @0 A.0: M/(
)assan,01 D#"E 1BB@$A

Cai!o cit., Cai!o C' )ealth. indi/iduals /isitin- hospitali2ed f!iends 3@ "2.B: M/(
't!ic6land,02 D#@E M/(

Mile %i/e! Delta, +owe! &-.pt C' 212 "A.#: 3A.3:
&l$sa.ed,0A D#AE 2002

Cai!o cit., Cai!o C' 3A 8.3: 2.8:
&l Bassuoni,08 D##E M/(

M/( C' 10 30.0: M/(
M
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(!m. !ec!uits/Li!e !i-ade pe!sonnel
La!-hal.,B3 D#BE M/( M/( C' (!m. !ec!uits #2A 33.0: M/(
(del$3aha,B" D@3E 1BB2 +owe! &-.pt C' (!m. !ec!uits 300 22.1: M/(
Juinti,B@ D3"E 1BB2$" (leGand!ia cit., (leGand!ia C' Li!e !i-ade pe!sonnel @"1 3B.0: M/(
,the! -ene!al populations
&l$(hmad.,B" D10E M/( Cai!o cit., Cai!o C' 2B2 2".3: M/(
&l$'adaw.,0" DA1E M/( 'ha!6ia, +owe! &-.pt >B' 1,"22 2@.8: #.#:
&l$'adaw.,0" DA1E M/( 'ha!6ia, +owe! &-.pt >B' 1ene!al population in u!an a!eas @80 23.": M/(
&l$'adaw.,0" DA1E M/( 'ha!6ia, +owe! &-.pt >B' 1ene!al population: _20 .ea!s "1" ".8: M/(
&l$'adaw.,0" DA1E M/( 'ha!6ia, +owe! &-.pt >B' 1ene!al population: 20 F 30 .ea!s 1A3 1".1: M/(
&l$'adaw.,0" DA1E M/( 'ha!6ia, +owe! &-.pt >B' 1ene!al population: 30 F "0 .ea!s 2@3 30.0: M/(
&l$'adaw.,0" DA1E M/( 'ha!6ia, +owe! &-.pt >B' 1ene!al population: ^"0 .ea!s @B2 "1.B: M/(
Mohamed,0" D80E 1BBA$# 10 -o/e!no!ates >B' 1ene!al population #,3@# 13.@: M/(
&l [anat.,0B D1E 2008 Mationwide >B' 11,12A 1".#: B.8:
C' con/enience samplin-, >B' p!oailit.$ased samplin-, M/( not a/ailale.
Firebrigade Blooddonors Children
A
55%
50%
45%
40%
35%
30%
Pre-2001
25%
20%
15%
10%
5%
0%
Post-2001
Antenatalclinic Armyrecruits/
attendees
Other
general
Healthy
populations
Outpatient
clinic
Ruralvillage
residents
B
100%
90%
80%
70%
60%
50%
populations attendees
Pre-2001
Post-2001
40%
30%
20%
10%
0%
Hemodialysis
patients
Injectiondrug
users
Multi
transfused
Schistosomiasis
patients
Thalassemic
patients
Viralhepatitis
patients
patients
Li-u!e 2 )epatitis C /i!us 7)C89 p!e/alence amon- the -ene!al population and populations at di!ect o! hi-h !is6 in &-.pt, in studies
conducted p!e$ and post$2001. (: 1!aph depictin- )C8 p!e/alence amon- di=e!ent -ene!al population -!oups. B: 1!aph depictin- )C8
p!e/alence amon- di=e!ent hi-h/di!ect !is6 populations. In this ?-u!e, we included onl. st!ati?ed )C8 p!e/alence measu!es, if these st!ati?ed
measu!es we!e a/ailale. ,the!wise, we included the o/e!all p!e/alence measu!es in the stud..
*ale 3 'tudies !epo!tin- p!e/alence of hepatitis C /i!us amon- populations at di!ect o! hi-h !is6 of eGposu!e in &-.pt
Citation 0ea!

+ocation 'amplin-

>opulation cha!acte!istic 'ample
si2e
'e!o$p!e/alence

%M(
p!e/alence
8i!al hepatitis patients

Cai!o cit., Cai!o C' @1 2@.@: M/(
&l$1oha!.,B" D83E M/(

'ue2 cit., 'ue2 C' 1"0 1B.2: M/(
&l 1aafa!.,0@ D8"E 2002

Cai!o cit., Cai!o C' 30B 1".B: M/(
Me6.,0A D8@E 2002$@

Mile %i/e! Delta, +owe! &-.pt

C' "# #8.#: #0.2:
[a6a!ia,0# D8AE 2001$2

1i2a, Kppe! &-.pt C' 200 13.0: M/(
Calil,10 D8#E 200"$@

(ssuit, Kppe! &-.pt C' Child!en with /i!al hepatitis 1@0 8.#: 8.#:
*alaat,10 D88E 2001$"

(leGand!ia cit., (leGand!ia/ C'

",18B

2B.8:

M/(
(assia, Cai!o/Mahalla,
1ha!ia, +owe! &-.pt/Jena
and (swan, Kppe! &-.pt
&ldin,10 D8BE M/(

M/( C' 23@ ".3: M/(
Badaw.,12 DB0E M/(

Cai!o cit., Cai!o C' Male milita!. !ec!uits BB

8:

M/(
with /i!al hepatitis
Multi$t!ansfused patients
Chalifa,B3 D18E 1BB0$1

Cai!o cit., Cai!o C' Multi$t!ansfused child!en 8" @@.0: M/(

Cai!o cit., Cai!o C' Multi$t!ansfused child!en #1 @".B: M/(
'aid,0B DB1E M/(

Cai!o cit., Cai!o C' Multi$t!ansfused child!en
with hematolo-ical diso!de!s
'aid,0B DB1E M/(

Cai!o cit., Cai!o C' Multi$t!ansfused child!en with
"B

81.A:

"B.0:
@1

1#.A:

23.@:
hematolo-ical mali-nancies
'alama,0B D#8E M/(

Cai!o cit., Cai!o C' Multi$t!ansfused child!en 33 1@.2: M/(
Calil,10 D8#E 200"$@

(ssuit, Kppe! &-.pt C' Multi$t!ansfused child!en 1A@ @8.2: "1.2:
*ona!.,10 DB2E 2000$8

Mansou!a, Da6ahlia, C'

Multi$t!ansfused child!en

#2

11.1:

M/(
+owe! &-.pt
&l$La!amaw.,12 DB3E M/(

Jena, Kppe! &-.pt C' Multi$t!ansfused child!en 33 3B: M/(
(delwaha,12 DB"E M/(

Cai!o cit., Cai!o C' Multi$t!ansfused child!en 100 "0: M/(
*halassemic patients

(leGand!ia cit., (leGand!ia C' Child!en with thalassemia 18 "".": M/(

Cai!o cit., Cai!o C' Child!en with thalassemia "@ #@.A: M/(
Chalifa,0" DB@E 2000$3

Cai!o cit., Cai!o C' Child!en with thalassemia @A AB.A: M/(
(dalla,0A DBAE 200@

Cai!o cit., Cai!o / Banha, C'

Child!en with thalassemia

33

A0.A:

M/(
Jalui.a, +owe! &-.pt
,ma!,11 DB#E M/(

Cai!o cit., Cai!o C' 1#" @1.#: 32.2:
Mansou!,12 DB8E 200B$10


Child!en with thalassemia

200

1B.@:

M/(
+owe! &-.pt
&l$La!amaw.,12 DB3E M/(

Jena, Kppe! &-.pt C' Child!en with thalassemia A# "8: M/(
'chistosomiasis patients
Bassil.,B2 DBBE M/(

Mile %i/e! Delta, +owe! &-.pt

C' 31 "1.B: M/(

(leGand!ia cit., (leGand!ia C' 21 38.1: M/(
&l$[a.adi,B# D3BE M/(

M/( C' 320 1A.3: M/(
[e6!i,02 D100E 1BB8$00

Cai!o cit., Cai!o C' "# "2.@: M/(
(!afa,0@ DA2E 2002$3

[awiat %a2in, Menou?a,
+owe! &-.pt
&l$'aah,11 D101E M/(

%u!al a!ea, Cai!o/ 1ha!ia,
C'

'chistomiasis patients
t!eated with >(*
C'

20A

@1.@:

M/(
@0

8".0:

M/(
+owe! &-.pt
&l$'aah,11 D101E M/(

%u!al a!ea, Cai!o/ 1ha!ia,
+owe! &-.pt
t!eated with >(*
C'

@2

#.#:

M/(
*ale 3 'tudies !epo!tin- p!e/alence of hepatitis C /i!us amon- populations at di!ect o! hi-h !is6 of eGposu!e in &-.pt
7Continued9
t!eated o!all. up to
8 .ea!s a-o
)emodial.sis patients
)assan,B3 D102E M/(

M/( C' 10@ A#.0: M/(

Cai!o cit., Cai!o C' #8 "A.2: M/(

Cai!o cit., Cai!o C' 2@ 8".0: M/(

'ue2 cit., 'ue2 and C'

108

#0.":

M/(
Ismailia, +owe! &-.pt
1oha!,B@ D#2E M/(

M/( C' A" 8#.@: M/(
)assan,00 D103E 1BBA

Cai!o cit., Cai!o C' 210 @B.0: M/(
'hatat,00 D10"E 1BBB

M/( C' 83 #8.@: M/(
1ad,02 D10@E 1BB8

Ismailia, +owe! &-.pt C' "# #2.0: M/(
[e6!i,02 D100E 1BB8$00

Cai!o cit., Cai!o C' 30 @A.A: M/(
&l 0a2eed,0A D10AE 2002$"

Cai!o cit., Cai!o C' "0 100.0: M/(
Candil,0# D22E 200"$A

Cai!o cit., Cai!o C' 31 @1.A: M/(
)ammad,0B D2@E 2008


3"

B".1:

M/(
+owe! &-.pt
(ttia,10 D10#E 2008$B

Cai!o cit., Cai!o C' 20A "A.1: M/(
I!ahim,10 D108E 200#

Cai!o cit., Cai!o C' 100 #@.0: M/(
In<ection D!u- Kse!s 7IDKs9
&l$1ha22awi,B@ D10BE M/(

(leGand!ia cit., (leGand!ia C' 100 A3.0: M/(
C' con/enience samplin-, M/( not a/ailale, >(* pa!ente!al antischistosomiasis the!ap..
,/e!all, the a/e!a-e )C8 p!e/alence amon- sc
histo$
somiasis patients was aout 38:. ( !ecent s
tud. .
'aah et al. !epo!ted a p!e/alence of 8".0: amon- sc
his$
tosomiasis patients t!eated with >(* 20 to 30 .ea!s a
-o,
and a p!e/alence of #.#: amon- schistosomiasis patie
nts
t!eated o!all. up to 8 .ea!s a-o D101E.
3e we!e ale to identif. onl. one stud. conduc
ted
amon- IDKs in &-.pt D10BE. *he stud. was conducted
in
(leGand!ia, amon- 100 IDKs, and )C8 p!e/alenc
e was
!epo!ted to e A3.0: D10BE.
Li-u!e 2B depicts the !an-e of p!e/alence wi
thin each
su-!oup in studies conducted p!e and post$
2001. Mo
distinct patte!n can e disce!ned in the dist!i
ution of
)C8 p!e/alence p!e$ and post$2001 within eac
h of the
di=e!ent su-!oups.
>!e/alence of )C8 amon- populations at indi!ect o!
inte!mediate !is6 of eGposu!e
>opulations at indi!ect o! inte!mediate !is6 of
eGposu!e
to )C8 we!e classi?ed into the followin- sucat
e-o!ies:
diaetic patients, hospital outpatient attendees, hospitali2
ed
populations, household contacts of indeG cases
7)C8
positi/e cases9, seGuall. t!ansmitted infection 7'*I9 pat
ients,
pe!iodontal disease patients, p!isone!s, and popul
ations
wo!6in- in select p!ofessions. Details a!e sho
wn in
*ale '2, see (dditional ?le 1.
Conside!ale )C8 p!e/alence was !epo!ted amon-
diaetic child!en in &-.pt compa!ed to othe! count!ies.
( !ecent stud. conducted in 2010, amon- AB2 diaetic
child!en with an a/e!a-e a-e of 10." .ea!s, !epo!ted a
p!e/alence of 2.@: D110E. >!e/ious studies conducted
amon- diaetic child!en !epo!ted much hi-he! le/els of
2B.": D1BE and "".1: D22E. In cont!ast, )C8 p!e/alence
amon- adult diaetic patients was 20.0: D100E and A0.3:
D111E. 'ustantial )C8 p!e/alence was also ose!/ed
amon- patients attendin- hospitals, !an-in- etween 0:
D8#E and #2.8: D112E. 3e identi?ed one stud. conducted
amon- pe!iodontal disease patients !epo!tin- a p!e/alence
of 13.0: D113E. Multiple studies we!e conducted in/esti$
-atin- )C8 p!e/alence amon- the child!en, spouses, and
famil. contacts of )C8 positi/e cases. 'tudies conducted
amon- child!en of indeG cases usuall. focused on child!en
of infected mothe!s to eGamine the /e!tical t!ansmission
of )C8. )C8 %M( p!e/alence amon- infants o!n to
)C8 positi/e mothe!s !an-ed etween 3.8: D28E and
2@.0: D2BE. )C8 p!e/alence amon- spouses of indeG
patients was as hi-h as 3@.@: D11"E. In a stud. of famil.
contacts of indeG patients, the p!e/alence was @.#: D11@E.
'iG studies we!e conducted amon- populations in select
)C8$!ele/ant p!ofessions 7*ale '2 of (dditional ?le 19.
)C8 p!e/alence amon- health ca!e wo!6e!s a/e!a-ed
aout 1#:, whe!eas amon- a!e!s it was 12.3: D11AE.
3e we!e ale to identif. onl. one stud. amon- p!isone
!s
which !epo!ted a p!e/alence of 31.": D3"E.
*he !an-e of )C8 p!e/alence within each su-!oup i
n
studies conducted p!e$ and post$2001 can e ose!
/ed
in Li-u!e 3(. Mo distinct patte!n can e disce!ned in t
he
dist!iution of )C8 p!e/alence p!e$ and post$
2001
D1#E. Communit. and info!mal health p!o/ide! !elated
eGposu!es such as ci!cumcision, caute!., and in<ections
we!e also associated with )C8 infection DA2,82,120E. (
nume! of studies ha/e also su--ested int!afamilial t!ans$
mission thou-h the eGact eGposu!es !esponsile a!e not
clea! D1",121E.
within each of the di=e!ent su-!oups.
*ime t!end anal.sis
>!e/alence of )C8 amon- special clinical populations
( la!-e f!action of studies we!e conducted amon- di=e!
ent
clinical populations 7*ale '3 of (dditional ?le 19. ,/e
!all,
)C8 p!e/alence was /e!. hi-h ac!oss all special
clinical
population -!oups. *he a/e!a-e )C8 p!e/alence am
on-
non$)od-6in;s l.mphoma 7M)+9 patients was !ou
-hl.
"1:, while amon- o!thopedic patients it was aout
3B:.
)C8 p!e/alence amon- hepatocellula! ca!cinoma 7
)CC9
cases !an-ed etween A1.0: and B0.3:, with a hi
-he!
p!e/alence ose!/ed amon- !u!al /e!sus u!an populations
D11#E. *h!ee studies we!e conducted amon- pe
diat!ic
cance! patients D81,118,11BE. )C8 p!e/alence am
on-
child!en with leu6emia was 1B.0: D118E. )C8 p!e/al
ence
amon- patients with pediat!ic mali-nancies who had <
ust
ended chemothe!ap. was 3B.A: D11BE. Mo!e !
ecentl.,
'ha!af$&ldeen et al. !epo!ted )C8 p!e/alence of
"3.0:
amon- child!en with mali-nant cance!s D81E.
Mo distinct patte!n can e disce!ned in the dist!i
ution
of )C8 p!e/alence p!e$ and post$2001 within each
of the
di=e!ent special clinical population su-!oups 7Li-u
!e 3B9.
%M( p!e/alence
Measu!es of %M( p!e/alence a!e included in *ale
s 2F3,
and '2$'3 of (dditional ?le 1. %M( p!e/alence wa
s hi-h
ac!oss studies in the di=e!ent population -!oups.
)i-he!
%M( p!e/alence was ose!/ed amon- studies cond
ucted
amon- hi-h !is6 -!oups and special clinical po
pulations
compa!ed to the -ene!al population and in
di!ect o!
inte!mediate !is6 -!oups. ,/e!all, the a/e!a
-e %M(
p!e/alence amon- those )C8$antiod. positi/e
was ap$
p!oGimatel. A0:.
%is6 facto!s of )C8
Inc!easin- a-e, a histo!. of >(*, and !esidin-
in !u!al
a!eas we!e . fa! the most common !is6 facto!s o! as
so$
ciations with )C8 infection ac!oss studies D2A
,A2E.
,the! common !is6 facto!s we!e !elated to healt
hca!e
settin-s such as histo!. of lood t!ansfusions, in
/asi/e
p!ocedu!es, in<ections, pe!inatal ca!e, and dental
wo!6
D1@,A1,A2,AB,#1,82,8#E. 'aleh et al. !epo!ted a
-!eate!
!is6 fo! incident infection amon- women whose
aies
we!e deli/e!ed . a ph.sician !athe! than . a nu!s
e o!
a t!aditional i!th attendant, in a health facilit.
!athe!
than at thei! home, and in women ha/in- compli
cated
/a-inal deli/e!ies D1@E. (mon- child!en, incident infec
tion
was associated with hospitali2ation and low i!th
wei-ht
1ene!al population model
*went. siG of the 8# -ene!al population studies had the
.ea! of data collection missin-. *he !esults of ou! pai!ed
t$test identi?ed a mean di=e!ence of 3.1 .ea!s 7B@: CI:
2.A to 3.A9 etween the .ea! of pulication and the .ea!
of data collection, fo! studies with oth /alues p!esent.
3e applied this time la- to estimate the .ea! of data
collection fo! studies missin- this /alue.
In the uni/a!iate linea! !e-!ession anal.ses fo! each
su-!oup sepa!atel., lood dono!s we!e the onl. su$
-!oup showin- a statisticall. si-ni?cant chan-e in )C8
p!e/alence o/e! time 7p$/alue of 0.0019. *ale '", see
(dditional ?le 1, !epo!ts the !esults of the uni/a!iate
anal.ses.
In the multi/a!iate linea! !e-!ession anal.sis fo! the
comined -ene!al population su-!oups, the!e was no
e/idence of a statisticall. si-ni?cant decline in )C8
p!e/alence o/e! time 7p$/alue of 0.21@9. )C8 p!e/alence
in the -ene!al population chan-ed at a !ate of `0.2":
pe! .ea! 7B@: CI: $0.A3 to 0.1"9. Li-u!e " displa.s the
t!end in )C8 p!e/alence with time in each of the ei-ht
-ene!al population su-!oups.
Di!ect o! hi-h !is6 population model
*went. ?/e of the "A di!ect o! hi-h !is6 population studies
had the .ea! of data collection missin-. *he !esults of
the pai!ed t$test identi?ed a mean di=e!ence of 3.3 .ea!s
7B@: CI: ".0 to 2.A9 etween the .ea! of pulication and
the .ea! of data collection. 3e applied this time la- to
estimate the .ea! of data collection fo! studies missin-
this /alue.
(s was the case fo! the -ene!al population uni/a!iate
and multi/a!iate anal.ses, the!e was no e/idence of a
statisticall. si-ni?cant decline in )C8 p!e/alence o/e!
time fo! each hi-h !is6 population su-!oup 7!esults
not shown9 and in the hi-h !is6 population as a whole
7p$/alue of 0."2A9. )C8 p!e/alence in the hi-h !is6 popu$
lation declined at a !ate of `0.38: pe! .ea! 7B@: CI: $1.3@
to 0.@89. Li-u!e '@, of (dditional ?le 1, displa.s the t!end
in )C8 p!e/alence with time in each of the ?/e hi-h !is6
su-!oups. IDKs we!e eGcluded f!om this ?-u!e as the!e
was onl. one ose!/ation.
Discussion
3e ha/e s.stematicall. !e/iewed )C8 infection p!e/alence
and incidence ac!oss the di=e!ent population -!oups in
Mohamoud et al. BMC Infectious Diseases 2013, 13:288 >a-e 1" of 21
A
90%
80%
70%
60%
50%
40% Pre-2001
Post-2001
30%
20%
10%
0%
Childrenofindex
patients
Diabetics

Familycontactsof
indexpatients
Hospitalizedpopulations

Hospitalized
outpatients
Periodontaldisease

Prisoners

Selectprofessions

STIpateints Spousesofindex
patients
B
100%
90%
80%
70%
60%
Pre-2001
Post-2001
50%
40%
30%
20%
10%
0%
BC

Cancer

CLD

CRF

CV

GIB

GN

HCC

HCCA

HL

Jaundice

KTP Leukemia

LP Dermatoses MDS Meningitis NHL Organo Orthopedic RHD

SLE suspected Urology
megally w/LD
Li-u!e 3 )epatitis C /i!us 7)C89 p!e/alence amon- populations at indi!ect o! inte!mediate !is6 and special clinical populations in &-.pt, in
studies conducted p!e and post the 2001. (: 1!aph depictin- )C8 p!e/alence amon- di=e!ent populations at indi!ect o! inte!mediate !is6 in &-.pt.
B: 1!aph depictin- )C8 p!e/alence amon- di=e!ent special clinical populations
1
in &-.pt. In this ?-u!e, we included onl. st!ati?ed )C8 p!e/alence
measu!es, if these st!ati?ed measu!es we!e a/ailale. ,the!wise, we included the o/e!all p!e/alence measu!es in the stud..
1
(c!on.ms: BC: ladde!
cance!, C+D: ch!onic li/e! disease, C%L: ch!onic !enal failu!e, C8: cutaneous /asculitis, 1IB: -ast!ointestinal leedin-, 1M: -lome!uloneph!itis, )CC:
hepatocellula! ca!cinoma, )CC(:hila!cholan-ioca!cinoma, )+: )od-6in;s l.mphoma, C*>: 6idne. t!ansplant patients, +D: li/e! diseae, +>:lichen planus,
MD': m.elod.splastic s.nd!ome M)+: non$)od-6in;s l.mphoma, %)D: !heumatic hea!t disease, '+&: s.stematic lupus e!th.matosus.
&-.pt. *he !esults of ou! stud. indicate that &-.
pt is
endu!in- a la!-e )C8 disease u!den, and is li6el.
to e
the most a=ected nation wo!ldwide . this infection. )
C8
p!e/alence and incidence ac!oss the di/e!se populati
on
-!oups we!e found to e much hi-he! than those in othe!
count!ies a!ound the -loe D3,122,123E. *his ma6es )C8
and its complications one of the leadin- pulic health
p!olems that &-.pt has to conf!ont toda..
2
0
4
0
6
0
0
2
0
4
0
6
0
0
2
0
4
0
6
0
0
2
0
4
0
6
0
0
Mohamoud et al. BMC Infectious Diseases 2013, 13:288 >a-e 1@ of 21
Outpatientclinicattendees Antenatalclinicattendees
Blooddonors Ruralvillageresidents
Children Healthypopulations
Armyrecruits/Firebrigadepersonnel Othergeneralpopulations
1990 1995 2000 2005 2010 1990 1995 2000 2005 2010
Time(years)
seroprevalence(%) Fittedvalues
Li-u!e " *ime t!end of hepatitis C p!e/alence amon- the di=e!ent -ene!al population su-!oups in &-.pt.
*he !esults of this s.nthesis indicate that &-.pt
has
endu!ed a la!-e )C8 epidemic at the national le/
el, and
that the!e is sustantial endemic )C8 t!ansmissio
n in this
count!.. )C8 p!e/alence is at hi-h le/els ac!o
ss essen$
tiall. all population -!oups, demonst!atin- the e
Gpansi/e
natu!e of this epidemic, and that it is not isolate
d to
speci?c population -!oups o! -eo-!aphic a!eas.
Despite ein- a ma<o! d!i/e! of )C8 incidence
and
p!e/alence in man. count!ies D12"E, the !elati/e
cont!i$
ution of IDKs to )C8 incidence and p!e/alence
in
&-.pt is much smalle! than that in othe! count!ies. *
his
is ecause of the speci?c conteGt of )C8 in
&-.pt,
whe!e )C8 t!ansmission is associated with m
edical
eGposu!es in the conteGt of a -ene!al population
)C8
epidemic. 'till, the!e is a cont!iution f!om in<ectin-
d!u-
use to )C8 t!ansmission that is, in te!ms of as
olute
scale, compa!ale to othe! count!ies. *he p!e/alen
ce of
in<ectin- d!u- use in &-.pt is estimated to e 0.21: D
12@E,
and acco!din- to the onl. stud. we found, )C8 p!e/a$
lence amon- IDKs is A3: D10BE. Conside!in- that )C8
p!e/alence in the population is 1".#: D1E, in<ectin- d!u-
use ma. eGplain at most onl. aout 1: of the national
)C8 p!e/alence in &-.pt.
It is widel. elie/ed that the >(* campai-ns to cont!ol
schistosomiasis a!e the ma<o! d!i/e!s of the )C8 epidemic
in &-.pt D@E. Du!in- the ea!l. twentieth centu!., schisto$
somiasis was hi-hl. p!e/alent in &-.pt, especiall. in !u!al
a!eas DAE. L!om the 1B@0s to the ea!l. 1B80s, the &-.ptian
Minist!. of )ealth led la!-e$scale campai-ns to cont!ol the
disease DAE. Millions of people we!e t!eated with int!a/en$
ous in<ections of ta!ta! emetic, efo!e an o!al d!u- !eplaced
this standa!d of ca!e ac!oss the count!. in the 1B80s D@E.
%euse of -lass s.!in-es and laG ste!ili2ation p!actices du!in-
>(* campai-ns appea! to ha/e caused widesp!ead infection
with )C8, which . the 1BB0s, had !eplaced schistosomia$
sis as the p!ima!. cause of li/e! disease in &-.pt DA,12AE.
Mohamoud et al. BMC Infectious Diseases 2013, 13:288 >a-e 1A of 21
,u! stud. suppo!ts a ma<o! !ole fo! the >(* c
am$
pai-ns in d!i/in- )C8 incidence. Di=e!ent studies
ha/e
shown a d!amatic inc!ease in )C8 p!e/alence wi
th
a-eP a coho!t e=ect that ma. e eGplained, at l
east in
pa!t, . the ea!l. association etween >(* and
)C8
t!ansmission D2A,A0$A2,82,12#E. ,u! !esults also
hi-hli-ht
-ende! and -eo-!aphical di=e!ences in )C8 p!e/al
ence
D3A,A",#1,#@,128,12BE, with hi-he! p!e/alence ose!
/ed
in males and !u!al dwelle!s compa!ed to females
and
indi/iduals li/in- in u!an a!eas. *hese di=e!ences
ma.
also e in pa!t att!iuted to the >(* campai-ns, a
s !u!al
a!eas and males we!e mo!e a=ected . the schistosomi
asis
disease u!den and hence we!e main ta!-ets of
these
campai-ns D@E.
)owe/e!, the totalit. of the e/idence s.nthesi2ed
he!e
su--ests that the >(* campai-ns a!e one d!i/e! a
mon-
othe!s of )C8 t!ansmission in &-.pt, and that susta
ntial
)C8 t!ansmission is still on-oin-. )i-h )C8 p!e/alenc
e
is found amon- hospitali2ed and the special clinical pop
u$
lationsP populations that ha/e eGpe!ienced /a!ious facil
it.$
ased medical p!ocedu!es. &le/ated )C8 p!e/alen
ce is
also found amon- indi/iduals eGposed to e/en
mino!
medical ca!e p!ocedu!es, within and e.ond est
alished
health ca!e facilities. Communit. studies ha
/e found
st!on- co!!elations etween )C8 infection and
di=e!ent
medical eGposu!es such as in<ections, lood t!an
sfusions,
su!-ical p!ocedu!es, pe!inatal ca!e, and dental t
!eatment
D1@,A1,A2,AB,#1,82,8#E.
)C8 p!e/alence amon- child!en, in pa!ticula!, hi-
hli-hts
the on-oin- t!ansmission of )C8 in &-.pt. Mo
t onl.
we!e these child!en o!n well afte! the end o
f the >(*
campai-ns, ut also a la!-e f!action of them
we!e o!n
afte! the implementation of the mo!e st!in-ent inf
ection
cont!ol measu!es in the count!.. Me/e!theless,
conside!$
ale p!e/alence le/els a!e found amon- chil
d!en in
multiple studies. *hese studies su--est that child!e
n ha/e
een eGposed to )C8 /e!ticall. th!ou-h mothe!$
to$child
t!ansmission D2",2@,2#$2BE 7hi-h %M( p!e/al
ence was
documented amon- infants of )C8 positi/e
mothe!s,
!an-in- etween 3.8: and 11.1: D2",2@,2#$
2B,130,131E9,
o! ho!i2ontall. possil. th!ou-h household eGp
osu!es
D1",11",11@,121,131E. Medical eGposu!es to )C8
at a /e!.
.oun- a-e ha/e een also indicated D1B,22,110,132
E. )i-h
)C8 le/els we!e !epo!ted amon- thalassemic
child!en
D1B,BA,133E, child!en on hemodial.sis D22,132E an
d diaetic
child!en D1B,22,110E.
)C8 p!e/alence amon- the mothe!s of infected chil
$
d!en, who tend to e .oun- themsel/es, has e
en also
associated with medical eGposu!es and/o! househ
old
eGposu!es D2",2@,2#,28E. In<ectin- d!u- use is un
li6el.
to cont!iute much to )C8 p!e/alence amon- th
ese
mothe!s, -i/en the conteGt of the )C8 epidemic
in
&-.pt. Mo!eo/e!, in<ectin- d!u- use amon- wome
n in
the Middle &ast and Mo!th (f!ica !e-ion is elie/ed to
e ma!-inal with onl. aout 10: o! less of IDKs ein-
females in this !e-ion D13"$13AE.
%esults of ou! time t!end anal.sis su--est that, cont!a!.
to eGpectations, the!e appea!s to e a small decline,
thou-h statisticall. not si-ni?cant, in )C8 p!e/alence
o/e! time in the -ene!al population and hi-h !is6 popula$
tion in &-.pt. In the uni/a!iate su-!oup$speci?c anal.ses,
onl. lood dono!s ha/e shown a statisticall. si-ni?cant
decline in )C8 p!e/alence. )owe/e!, this decline is
diTcult to inte!p!et since !ec!uitment of lood dono!s
chan-ed o/e! time, pa!ticula!l. . eGcludin- )C8 positi/e
indi/iduals. 3hile it can ta6e a lon- time fo! the p!e/a$
lence of )C8 to decline afte! the >(* eGposu!es, this fact
ma. not e suTcient to eGplain the lac6 of tan-ile
decline. &-.pt;s population has almost douled in the past
two to th!ee decades since the epidemic was ?!st disco/$
e!ed, and well afte! the end of the >(* campai-ns. *he
la!-e inNuG of uninfected i!th coho!ts does not appea! to
ha/e !educed )C8 p!e/alence, possil. su--estin- that
)C8 incidence has not declined as eGpected followin- the
end of the >(* campai-ns and adoption of mo!e st!in-ent
infection cont!ol measu!es.
(nothe! potential eGplanation fo! the lac6 of sustantial
decline in incidence is the /e!. hi-h aseline )C8 p!e/a$
lence in the count!.. Lo! a -i/en mode of t!ansmission,
such as !euse of unclean needles o! s.!in-es, the t!ansmis$
sion !is6 is dependent on the p!oailit. that the needle/
s.!in-e was used p!e/iousl. on an )C8 infected pe!son,
which is )C8 %M( p!e/alence. &/en if the p!e/alence of
the modes of t!ansmissions in &-.pt toda. is simila! to
othe! nei-ho!in- count!ies, the hi-h ac6-!ound p!e/a$
lence can d!i/e much mo!e incidence. In nei-ho!in-
+i.a fo! eGample, with an )C8 %M( p!e/alence of less
than 1: D13",13#E, a !euse of an unclean needle is mo!e
than ten$fold less li6el. to lead to an )C8 t!ansmission
than in &-.pt whe!e )C8 %M( p!e/alence is B.8: D1E.
,u! stud. identi?ed the lac6 of an empi!ical nationall.$
!ep!esentati/e incidence stud.. It is a p!io!it. to document
cu!!ent )C8 incidence !ate in the population, which
continues to e the most c!itical open Iuestion in )C8
epidemiolo-. in &-.pt toda., and is su<ect to much
deate D12#,138E. ( !ecent mathematical modelin- stud.,
ased on the &D)' data, estimated that the a/e!a-e )C8
incidence !ate o/e! the lifetime of the li/in- &-.ptian
population coho!t to e A.B pe! 1,000 pe!son$.ea! D#E. *his
estimate howe/e! does not captu!e the tempo!al t!end in
)C8 incidence !ate and ma. not e !ep!esentati/e of
the cu!!ent le/el of )C8 t!ansmission. ( !ecent stud.
su--ested that cu!!ent )C8 incidence !ate is aout 2.0
pe! 1000 pe!son$.ea! D12#E.
3hile the e/idence fo! an epidemic at the national le/el
is o/e!whelmin-, some of the potential d!i/e!s of this
epidemic, such as the >(* campai-ns and contaminated
lood, a!e no lon-e! p!esent. *he!efo!e, it seems plausile
Mohamoud et al. BMC Infectious Diseases 2013, 13:288 >a-e 1# of 21
that )C8 incidence !ate has declined d!asticall.
in the
last two decades since the disco/e!. of the epid
emic in
1BB1F1BB2 D30,13BE, as B!ean et al. ha/e !
ecentl.
su--ested th!ou-h thei! incidence estimate D12#E.
Me/e!$
theless, ou! stud. could not identif. a si-natu!e f
o! a
ma<o! !eduction in incidence, and the totalit. of e/iden
ce
points towa!ds sustantial on-oin- )C8 t!ansm
ission,
thou-h the p!ecise scale of which is not .et 6nown.
In te!ms of limitations, the!e was an element of su<e
ct$
i/it. in classif.indi=e!ent studies into di=e!ent popul
ation
su-!oups. Lo! eGample, studies conducted in
!u!al
child!en we!e classi?ed unde! child!en e/en thou
-h
the. fall into two su-!oups: !u!al population
s and
child!en. Lu!the!mo!e, the!e was /a!iailit. in
the
dia-nostic assa.s used ac!oss the studies. &a!lie!
studies
t.picall. !epo!ted the use of 1st and 2nd -ene!ation &
+I'(
tests, which lac6 the sensiti/it. and speci?cit. of
the 3!d
-ene!ation &+I'( tests. 'uch /a!iailit. in assa.s
ma.
impact the !ep!esentati/eness of the !epo!ted p!e
/alence
measu!es. *he!e was also conside!ale /a!iailit. in
meth$
odolo-. and Iualit. amon- the studies assessed. M
ost of
the studies identi?ed we!e c!oss$sectional o! caseF
cont!ol
in stud. desi-n. 'ample si2e /a!ied widel. ac!os
s studies.
*he samplin- was most often con/enience s
amplin-,
thou-h se/e!al studies ha/e used p!oailit
.$ased
samples D1,A1,ABE, most notal. the &D)' co
nducted
in 2008 D1E. Lo! a f!action of the studies the
.ea! of
data collection was not a/ailale ut was es
timated
usin- the .ea! of pulication, this ma. a=ect
the time
t!end anal.sis. 1i/en that onl. statisticall. si-
ni?cant
!is6 facto!s we!e eGt!acted, this ma. ha/e int!odu
ced a
positi/e$association selection ias in ou! !epo!
tin- of
!is6 facto!s.
Conclusions
,u! stud. hi-hli-hts that &-.pt is conf!onted
with an
)C8 disease u!den of histo!ical p!opo!tions.
(n )C8
epidemic at the national le/el must ha/e occu
!!ed with
sustantial t!ansmission still on-oin- toda.. (s
opposed
to othe! count!ies whe!e )C8 d.namics is foc
used in
speci?c hi-h !is6 -!oups, such as IDKs, )C8 t!ans
mission
in &-.pt has !eached di/e!se population -!oups inclu
din-
those not con/entionall. identi?ed to e at !is6
of infec$
tion. )C8 t!ansmission appea!s to e focused
in fo!mal
and info!mal health ca!e settin-s, thou-h t!ans
mission
ma. e occu!!in- in the communit. and at the house
hold
le/el, ut th!ou-h poo!l.$identi?ed eGposu!es.
)C8 p!e/ention in &-.pt must e a national p!
io!it..
>olic.ma6e!s and pulic health and medical ca!e s
ta6e$
holde!s need to int!oduce and implement fu!the! p!e/e
n$
tion measu!es ta!-etin- the iat!o-enic t!ansmission
!outes, such as /e!. st!in-ent infection cont!ol p!
actices.
'cienti?c !esea!ch needs to e eGpanded to
measu!e
cu!!ent )C8 incidence !ate and to identif. p!ecis
el. the
modes of )C8 t!ansmission in medical ca!e, communit.,
and household settin-s. 'uch studies will pa/e the wa. fo!
e=ecti/e p!e/ention inte!/entions that can e de/eloped,
eGpe!imentall. tested, and implemented. It is also essential
to de/elop cost$e=ecti/e st!ate-ies fo! t!eatment and case
mana-ement of the la!-e pool of @F# million ch!onicall.
infected pe!sons with )C8 in &-.pt.
(dditional ?le
(dditional ?le 1: *ale '1. >%I'M( Chec6list. *ale '2. >!e/alence of
hepatitis C /i!us amon- populations at indi!ect o! inte!mediate !is6 of
eGposu!e in &-.pt. *ale '3. >!e/alence of hepatitis C /i!us amon-
special clinical populations in &-.pt. *ale '". )epatitis C /i!us time
t!end anal.sis fo! each -ene!al population su-!oup. Li-u!e '@. )epatitis
C /i!us time t!end anal.sis amon- populations at di!ect o! hi-h !is6 of
eGposu!e.
(!e/iations
)C8: )epatitis C /i!usP &D)': &-.ptian demo-!aphic health su!/e.P
>(*: >a!ente!al antischistosomiasis the!ap.P IDK: In<ectin- d!u-s useP
'*I: 'eGuall. t!ansmitted infectionP M)+: Mon$)od-6in;s l.mphomaP
)CC: )epatocellula! ca!cinomaP >B': >!oailit.$ased samplin-P
C': Con/enience samplin-P )CC(: )ila!cholan-ioca!cinomaP C*>: Cidne.
t!ansplant patientP +>: +ichen planusP )+: )od-6in;s l.mphomaP
C8: Cutaneous /asculitisP C+D: Ch!onic li/e! diseaseP BC: Bladde! cance!P
%heumatic )D: %heumatic hea!t diseaseP C%L: Ch!onic !enal failu!eP +D: +i/e!
diseaseP 1IB: 1ast!ointestinal leedin-P '+&: '.stemic lupus e!.thematosusP
MD': M.elod.splastic s.nd!omeP 1M: 1lome!uloneph!itis.
Competin- inte!ests
*he autho!s decla!e that the. ha/e no competin- inte!ests.
(utho!s; cont!iutions
0M and '% conducted the lite!atu!e !e/iew and data !et!ie/al. 0M conducted
eGt!action, anal.sis and w!ote the ?!st d!aft of the pape!. 1M pa!ticipated in
stud. desi-n. LDM cont!iuted to the stud. desi-n and anal.ses. +4(
concei/ed and led the desi-n of the stud., anal.ses, and d!aftin- of the
a!ticle. (ll autho!s cont!iuted to discussion of the !esults and w!itin- of the
manusc!ipt. (ll autho!s !ead and app!o/ed the ?nal manusc!ipt.
(c6nowled-ements
3e a!e -!ateful fo! the Jata! Mational %esea!ch Lund fo! suppo!tin- this
wo!6 7M>%> 0"$B2"$3$2@19, and the suppo!t p!o/ided . the Biostatistics,
&pidemiolo-., and Biomathematics %esea!ch Co!e at the 3eill Co!nell
Medical Colle-e in Jata!. *he autho!s a!e also -!ateful fo! the /aluale
su--estions and comments . the !e/iewe!s of this a!ticle.
Lundin-
*he Jata! Mational %esea!ch Lund 7M>%> 0"$B2"$3$2@19 and the Biostatistics,
&pidemiolo-., and Biomathematics %esea!ch Co!e at the 3eill Co!nell
Medical Colle-e$ Jata!.
(utho! details
1
Infectious Disease &pidemiolo-. 1!oup, 3eill Co!nell Medical Colle-e $
Jata!, Co!nell Kni/e!sit., Jata! Loundation $ &ducation Cit., Doha, Jata!.
2
Depa!tment of >ulic )ealth, 3eill Co!nell Medical Colle-e, Co!nell
Kni/e!sit., Mew 0o!6, Mew 0o!6, K'(. 3
8accine and Infectious Disease
Di/ision, L!ed )utchinson Cance! %esea!ch Cente!, 'eattle, 3ashin-ton, K'(.
"
Depa!tment of *!opical Medicine, Medical Mic!oiolo-. and >ha!macolo-.,
4ohn (. Bu!ns 'chool of Medicine, Kni/e!sit. of )awaii, )onolulu, )I BA813,
)awaii.
%ecei/ed: 1" (u-ust 2012 (ccepted: 1B 4une 2013
>ulished: 2" 4une 2013
%efe!ences
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Cite this a!ticle as: Mohamoud et al.: *he epidemiolo-. of hepatitis C
/i!us in &-.pt: a s.stematic !e/iew and data s.nthesis. BMC Infectious
Diseases 2013 13:288.
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