Hepatitis C virus infection in a community in the Nile Delta: Risk factorsfor seropositivity

The purpose of this study was to identify risk factors for hepatitis C viru s (HCV) infection in a rural village in the Nile Delta with a high prevalen ce of antibodies to HCV (anti-HCV). One half of the village households were systematically selected, tested for anti-HCV, and interviewed: 973 of 3,99 9 (24.3%) subjects were anti-HCV-positive (reflecting prior HCV infection b ut not necessarily current liver disease), with nearly equal prevalence amo ng males and females. Anti-HCV prevalence increased sharply with age among both males and females, from 9.3% in those 20 years of age and younger to > 50% in those older than 35, suggesting a cohort effect with reduced transm ission in recent years. Multivariate regression was used to estimate indepe ndent effects of risk factors on seropositivity. Among those over 20 years of age, the following risk factors were significantly associated with serop ositivity: age (P < .001); male gender (odds ratio [OR] = 2.5, 95% CI = 1.3 -4.7); marriage (OR = 4.1, 2.4-6.9); anti-schistosomiasis injection treatme nt (OR = 2.0, 1.3-2.9); blood transfusion (OR = 1.8, 1.1-2.9), invasive med ical procedure (surgery, catheterization, endoscopy, and/or dialysis) (OR = 1.5, 1.1-1.9); receipt of injections from "informal" health care provider (OR = 1.3, 1.0-1.6); and cesarean section or abortion (OR = 1.4, 1.0-1.9). Exposures not significantly related to anti-HCV positivity in adults includ ed: history of, or active infection with, Schistosoma mansoni, sutures or a bscess drainage, goza smoking in a group, and shaving by community barbers. Among those 20 years old or younger, no risk factors were clearly associat ed with anti-HCV positivity; however, circumcision for boys by informal hea lth care providers was marginally associated with anti-HCV (OR = 1.7, 1.0-3 .0). Prevention programs focused primarily on culturally influenced risks i n rural Egyptian communities are being implemented and evaluated.