Frequent transient hepatitis C viremia without seroconversion among healthcare workers in Cairo, Egypt.

BACKGROUNDS: With 10% of the general population aged 15-59 years chronically infected with hepatitis C virus (HCV), Egypt is the country with the highest HCV prevalence worldwide. Healthcare workers (HCWs) are therefore at particularly high risk of HCV infection. Our aim was to study HCV infection risk after occupational blood exposure among HCWs in Cairo. METHODOLOGY/PRINCIPAL FINDINGS: The study was conducted in 2008-2010 at Ain Shams University Hospital, Cairo. HCWs reporting an occupational blood exposure at screening, having neither anti-HCV antibodies (anti-HCV) nor HCV RNA, and exposed to a HCV RNA positive patient, were enrolled in a 6-month prospective cohort with follow-up visits at weeks 2, 4, 8, 12 and 24. During follow-up, anti-HCV, HCV RNA and ALT were tested. Among 597 HCWs who reported a blood exposure, anti-HCV prevalence at screening was 7.2%, not different from that of the general population of Cairo after age-standardization (11.6% and 10.4% respectively, p = 0.62). The proportion of HCV viremia among index patients was 37%. Of 73 HCWs exposed to HCV RNA from index patients, nine (12.3%; 95%CI, 5.8-22.1%) presented transient viremia, the majority of which occurred within the first two weeks after exposure. None of the workers presented seroconversion or elevation of ALT. CONCLUSIONS/SIGNIFICANCE: HCWs of a general University hospital in Cairo were exposed to a highly viremic patient population. They experienced frequent occupational blood exposures, particularly in early stages of training. These exposures resulted in transient viremic episodes without established infection. These findings call for further investigation of potential immune protection against HCV persistence in this high risk group.

Surveillance system for HCV infection: testing a model based on blood banks.

Developing a National surveillance system for hepatitis C virus infection could provide a reasonable tool for reflecting changes in the trend of the disease in the Egyptian community. The aim of the study is to develop a national sentinel surveillance system, based on blood banks, by measuring the prevalence of hepatitis C virus antibody in the sera of blood donors. The results were compared with that of the National community-based survey (NS) of the year 1997 from the areas surrounding the blood banks by age-standardized methods. Data were collected retrospectively from 3 blood banks in Cairo. The study population included 2845 consecutive blood donors from the years 1999 and 2000: 1265 (998 males and 267 females) from Mansheyat Elbakry blood bank, 986(840 males and 146 females) from El Galaa blood bank, and 594 (531 males and 63 females) from Ahmed Maher blood bank. Data collected from sheet includes personal data, blood banks serology results of HCV through testing with third generation ELISA. The over all prevalence of HCV among blood donors aged from 18-59 years was 7.6% (males 7.8%, females 6.9%) (NS=15.2%, males 15.5%, females 15.0% for the same age group). Among different age groups the total prevalence of HCV was; 4.2% in the 18-29 years age group (NS=5.3%), 9.1% in the 30-39 age group (NS=17.9%), 19.0% in the 40-49 age group (NS=19.0%) and 20% in the 50-59 age group (NS=23%). The prevalence of HCV is higher among replacement blood donors than those in campaign blood donors (8.9%, 3.9% respectively, OR=2.9). It is also higher among blood donors living in rural areas than those living in urban areas (14.1%, 6.8% respectively, OR=2.3). Age adjusted rates of HCV among the blood donors were; totally 10.6% (NS=14.7%), males 12.5% (NS=15.1%), females 8.5% (NS=14.5%). Age and gender standardized HCV prevalence ratio (blood donors/NS) was; total ratio=0.7. Among the different age groups the ratio was; 18-29 years=0.8, 30-39 years=0.5, 40-49 years=0.9, and the 50-59 years age group=0.8. In conclusion, as a sentinel group, the total - as well as the female- population of blood donors have a lower prevalence of HCV with comparison to the National survey. However, with regards to the male population in the 18-29 years age group of blood donors, after age standardization, the rate of HCV among them is equal to that of the National survey, suggesting that male blood donors aged 18-29 years may provide an appropriate group for monitoring HCV prevalence in males of same age group in the general population.