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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 27  |  Issue : 2  |  Page : 478-483

Intrafamilial transmission of hepatitis C virus in Menoufia Governorate


1 Tropical Medicine Department, Menoufia University, Menoufia, Egypt
2 Community Medicine Department, Menoufia University, Menoufia, Egypt
3 MOHP, Egypt

Date of Submission13-Jun-2013
Date of Acceptance01-Sep-2013
Date of Web Publication26-Sep-2014

Correspondence Address:
Islam A Zekry Farg
MBBCh, Family Health Center, Menoufia Governorate, Quesina District, Quesina
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.141732

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  Abstract 

Objective
This study was conducted to focus on the intrafamilial transmission of hepatitis C virus (HCV) infection and to determine the impact of a suggested health education program on the knowledge, the attitude and the practice of the participants regarding the prevention of intrafamilial transmission of HCV.
Background
The HCV is one of the most important causes of chronic liver disease in Egypt . Information on the current magnitude and the rate of intrafamilial transmission of HCV and its risk factors in Egypt is scarce.
Patients and methods
This study was a cross-sectional analytic study with an intervention (health education program) that was conducted in both the Monshaat Sultan University Hospital and the Menouf General Hospital on all previously diagnosed HCV-positive patients and their spouses as well as their family members with corresponding control groups.
Results
HCV-positive patients were significantly higher among family members of HCV-positive spouses compared with HCV-negative ones, 19.1 versus 15.4%, which indicates that HCV may be transmitted through social relations among different family members.
Conclusion
The data of this study provide evidence that there is a greater probability of intrafamilial transmission of HCV infection, especially wife-to-husband transmission rather than husband-to-wife transmission of HCV, in Egypt. The data also support the plausible hypothesis that the probability of transmission is greater if the spouse is positive for HCV RNA.

Keywords: Hepatitis C virus RNA, hepatitis C virus, intrafamilial transmission


How to cite this article:
El-Dien Nouh MA, AlFateh Mahrous OA, Zekry Farg IA. Intrafamilial transmission of hepatitis C virus in Menoufia Governorate. Menoufia Med J 2014;27:478-83

How to cite this URL:
El-Dien Nouh MA, AlFateh Mahrous OA, Zekry Farg IA. Intrafamilial transmission of hepatitis C virus in Menoufia Governorate. Menoufia Med J [serial online] 2014 [cited 2019 Nov 21];27:478-83. Available from: http://www.mmj.eg.net/text.asp?2014/27/2/478/141732


  Introduction Top


Hepatitis C is a blood-borne infection. The WHO [1] estimates that 170 million individuals throughout the world are infected with hepatitis C virus (HCV). HCV is one of the most important causes of chronic liver disease in Egypt [2]. Residents of Egypt's Nile Delta have among the world highest seroprevalence of HCV infection [3]. Transmission rates are markedly higher if the source patient is also HIV positive [4].

Transmission between spouses is often assumed to be sexual. However, other routes of transmission between married couples are possible. Some studies have found high rates of infection among nonspouse household transmission. It is supported by the fact that HCV RNA has often been found in the saliva of patients with and without serum HCV RNA [5].

Several studies aimed to show that the probability of spousal transmission increased with the duration of the marriage, but these studies failed to control for age, and age is a likely confounder; hence, we must consider these two factors [6].

The strong relationship between the risk of infection in children and the presence of anti-HCV in their parents suggests that the transmission of HCV occurs between family members, but does not define the exact routes [2].

Considering the magnitude of the problem, Egypt has possibly the highest HCV prevalence in the world: 10-20% of the general population is infected and HCV is the leading cause of hepatocellular carcinoma and chronic liver disease in the country [7].

Rationale of the study

Information on the current magnitude and the rate of intrafamilial transmission of HCV and its risk factors in Egypt is scarce [2]. Hence, this study was conducted to focus on the intrafamilial transmission of HCV infection.

The main aim of this work was improve the health status of HCV patients and their families and the prevention of disease spread, while achieving a better quality of their life. However, its specific objectives were to assess the extent of intrafamilial transmission of HCV and to determine the effect of the health education (HE) program on the knowledge, the attitude and the practice of the family members regarding the prevention of intrafamilial transmission of HCV.


  Patients and methods Top


This was a cross-sectional analytic study with an intervention (HE program). It was conducted in a time frame of 1 year and 8 months (from 1 May 2011 to the end of December 2012).The study was conducted in both the Monshaat Sultan University Hospital and the Menouf General Hospital; they were selected by a multistage stratified random sampling technique.

The target population of the study included all previously diagnosed HCV patients attending the selected sites (n = 100) and their spouses (n = 85) as well as their family members (n = 235). Matched control groups of patients previously diagnosed as HCV-negative attending the selected sites (n = 120) and their spouses (n = 105) as well as their family members (n = 195) were also included.

Tools of the study

(a) Informed consent for every patient; (b) Questionnaire A: a predesigned questionnaire for patients and their family members with special emphasis on the intrafamilial transmission; (c) Questionnaire B: a predesigned questionnaire for the assessment of the knowledge, the attitude and the practice of the participants regarding HCV transmission before and after an intervention program.

The pilot study

A pilot study was conducted on 10 patients with the following purpose: (a) To evaluate the adequacy of the study tools 'questionnaire, sheets' (contents, language, and time consumption) and the availability of the needed data and feasibility of the research methods. (b) To determine the time needed for filling every part of the questionnaire. (c) To explore potential obstacles and difficulties that confront the execution and the flow of the work. On the basis of the feedback obtained from this initial pilot study, the following changes were made: (a) Some useful modifications were made in the study format and a more feasible time-table for execution was constructed. (b) The language of some questions in the questionnaires was modified to be understood by the patients and their family members. (c) On average, each questionnaire took about 20 min.

Data collection

Patients were reached through their family health files.

All spouses of patients and their family members were subjected to an interview that had the following aims: (a) Discussion of the study aims and designs before obtaining a formal written consent. (b) Complete physical examination and study investigations.

Blood samples were obtained from both hepatitis 'C' patients and their spouses and controls for HCV antibody (anti-HCV) in the serum and HCV RNA by a quantitative PCR in the serum for index male and female patients.

All family members were subjected to an interventional HE program that was conducted in the family club of the family health center of Monshaat Sultan Hospital to assess and improve their knowledge, attitude and practice regarding HCV infection and its intrafamilial transmission.

Aim of the program

Use of this program will help patients achieve knowledge, attitude and skills for HCV prevention. The implementation of the program is carried out through step-by-step instructions and interventions to improve knowledge, attitude and practice of HCV prevention. Tools of the education program included data show, pamphlets and post educational videos. Program evaluation was performed through the use of a test questionnaire before and 6 months after the program.

Statistical analysis

  1. Student's t-test: It is a single test used to collectively indicate the presence of any significant difference between two groups for a normally distributed quantitative variable.
  2. c2 -test: It is used to compare two groups or more regarding one qualitative variable in a 2 × 2 contingency table or an r c complex table.
  3. Z test: It is used to compare two groups before and after the test regarding one qualitative variable in a 2 × 2 contingency table.



  Discussion Top


Information on the current magnitude of transmission and risk factors for the transmission of HCV in communities in Egypt is scarce [2]. Hence, this study was conducted to focus on the intrafamilial transmission of HCV infection.

This study showed that the overall rate of HCV infection was significantly higher among spouses of HCV-positive compared with HCV-negative patients: 27.1 versus 14.3%, respectively. These results emphasize on the role of sexual activity among partners in increasing the rate of viral transmission among families.

The study showed that the overall rate of HCV-positive cases was significantly higher among family members of HCV-positive spouses compared with HCV-negative patients: 19.1 versus 15.4%, which indicates that HCV may be transmitted through social relations among different family members, and saliva may play a role in its transmission through kissing and the use of common towels. These results agree with those of Rao et al. [8]. Several studies have aimed to show that the probability of spousal transmission increased with the duration of the marriage [9].

Epidemiologic studies have suggested that household contact with an infected person may be associated with nonsexual transmission of HCV. Seroprevalence studies have found an average anti-HCV rate of 4% (range, 0-11%) among household contacts with no other apparent risk factors for HCV occurring in the household. It is most likely the result of direct contact with blood, and the risk appears to be extremely low [10]. The strong relationship between the risk of infection in children and the presence of anti-HCV in their parents suggests that the transmission of HCV occurs between family members but does not define the exact routes [2].

Current data provide evidence that there is a greater probability of intrafamilial transmission of HCV infection, especially wife-to-husband transmission rather than husband-to-wife transmission of HCV, in Egypt. The data also support the plausible hypothesis that the probability of transmission is greater if the spouse is positive for HCV RNA.

It has been pointed out that estimating spousal transmission on the basis of concordance in married couples can lead to an overestimation due to the possibility that both spouses acquire the infection from community exposures. Alberti and Benvegnu [11] suggest that familial clustering of HCV is largely due to parenteral treatments for schistosomiasis experienced in common by a family. Transmission between spouses is often assumed to be sexual. However, other routes of transmission between married couples are possible. Some studies have found high rates of infection among nonspouse household contacts of individuals with HCV. The plausibility of nonsexual, nonparenteral household transmission is supported by the fact that HCV RNA has often been found in the saliva of patients with and without serum HCV RNA. Pooling studies in a systematic review, Ackerman et al. reported that HCV RNA was found in the saliva of 79 out of 168 patients (47%) with circulating HCV RNA, and in seven out of 54 patients (7%) with anti-HCV but no circulating RNA. Parenteral transmission between spouses is also a possibility (e.g. the sharing of a needle for injections, which often happens in formal and informal healthcare settings in these communities). A previous study reported data suggesting that male-to-female HCV transmission in the USA occurs with greater probability than female-to-male transmission. In the USA, the most common route of current transmission is intravenous drug use.

In this study, it was found that the mean age of both HCV-positive index women and men was above 40 years (44.3 ± 10.8 and 43.4 ± 8.4 years, respectively).In a previous study, similar results were obtained, wherein anti-HCV prevalence was much higher among individuals older than 20 years of age, with the highest level (56.7%) in those over 40 years [12]. There was a statistically significant difference regarding education in HCV women and men index patients compared with controls, wherein the highest percent of HCV prevalence (25.9 and 18.5%) was among the illiterate up to basic educated, respectively.

In a similar study, it was found that among individuals older than 20 years, a small group with at least some university education had a lower prevalence than the remaining individuals [13].

Although HCV is endemic in Egypt, there was a significant shortage of studies on the impact of educational programs on the knowledge, attitude, and practice of Egyptian population regarding the disease until now.

All of the participants knew HCV as a name that may be attributed to the great dilemma about the disease. They gained their knowledge from TV, newspapers, or their friends. Evaluation of the effect of the applied HE program of this study revealed that in the current study, there was a statistically significant increase in the level of good knowledge, positive attitude and healthy practice after the implementation of the program. This was in agreement with a study in Taif, Saudi Arabia, which found that health education is needed to increase students' awareness and to promote health consciousness for the prevention of the disease at any level. Also, centers for disease control and prevention [14] stated that health education is an important tool to reduce the prevalence of the disease. In addition, Attia [15] demonstrated that the role of health education in the modern world is increased with the goal to provide individuals with the information, the skill and the motivation necessary to make intelligent decisions concerning lifestyle and personal health behavior nearer to their own community with the help of different mass media, especially TV [Figure 1],[Figure 2] and [Figure 3] and [Table 1],[Table 2],[Table 3],[Table 4] and [Table 5].
Figure 1:

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Figure 2:

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Figure 3:

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Table 1: Sociodemographic characteristics of the studied HCV index patients and their control

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Table 2: Prevalence of hepatitis C virus infection among spouses of index compared with control

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Table 3: Prevalence of hepatitis C virus infection regarding spouses' sex of index compared with control groups

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Table 4: Positive hepatitis C virus RNA as a risk factor for hepatitis C virus intrafamilial transmission

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Table 5: Knowledge, attitude and practice scores of the studied participants before and after implementation of the health education program

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  Conclusion Top


The data of the present study provide evidence that there is a greater probability of intrafamilial transmission of HCV infection, especially wife-to-husband transmission rather than husband-to-wife transmission, in Egypt. The data also provide a support for the plausible hypothesis that the probability of transmission is greater if the spouse is positive for HCV RNA. Implementation of family health services and programs in the appropriate manner according to international guidelines has a good impact on the general health state of HCV patients and their outcomes, reducing risks of complications and transmission by education, counseling, skill building and support through behavioral interventions offered by the family physicians, thereby reducing intrafamilial transmission.

Recommendations

  1. Proper training and qualification of family physicians and other health team members on methods of prevention of intrafamilial transmission of HCV infections
  2. Implementation of a well-designed HE program for the prevention of intrafamilial transmission of HCV infections with special emphasis on the proper application for infection control measures.


(a) Prevention of nonsexual routes of infection

  1. Do not share drug needles with anyone.
  2. Wear gloves if you have to touch anyone's blood.
  3. Wash hands before injecting
  4. Do not share any personal hygiene items such as razors, toothbrushes, nail clippers, pierced earrings, or anything else that could have blood on it.
  5. Make sure tattoo and piercing equipment is sterile.
  6. Cover any open cuts or wounds with clean and sterile dressing.


(b) Prevention of sexual route of infection:-

(1) Condoms or barriers will help reduce the risk of HCV transmission.

(3) Routine HCV testing is needed for the following individuals:

  1. Long-term steady sex partners of HCV-positive persons.
  2. Children born to HCV-positive women.



  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.World Health Organization (WHO). Global surveillance and control of hepatitis C. Report of a WHO consultation organized in collaboration with the Viral Hepatitis Prevention Board, Antwerp, Belgium. J Viral Hepat 1999; 6 :35-47.  Back to cited text no. 1
    
2.Mohamed M, Abdel-Hamid M, Mikhail N, Adbel-Aziz F, et al. Intrafamilial transmission of hepatitis C in Egypt. Hepatology 2005; 42 :683.  Back to cited text no. 2
    
3.Darwish MA, Raouf TA, Rushdy P, Constantine NT, Rao MR, Edelman R. Risk factors associated with a high seroprevalence of hepatitis C virus infection in Egyptian blood donors. Am J Trop Med Hyg 2001; 49 : 440-447.   Back to cited text no. 3
    
4.Habib M, Mohamed M, Abdel-Aziz F, Magder L, Abdel-Hamid M, Sallam I. Hepatitis C virus infection in a community in the Nile delta: risk factors for seropositivity. Hepatology 2001; 33 :248-253.  Back to cited text no. 4
    
5.Hermid M, Ferreiro MC, Barral S, Laredo R, Castro A, Diz Dios P. Detection of HCV RNA in saliva of patients with hepatitis C virus infection by using a highly sensitive test. J Virol Methods 2002; 101 :29-35.  Back to cited text no. 5
    
6.Kao J, Hwang Y, Chen P. Transmission of hepatitis C virus between spouses: the important role of exposure duration. Am J Gastroenterol 1996; 91 :2087-2090.  Back to cited text no. 6
    
7.El-Zayadi A, H Abaza, S Shawky, MK Mohamed, O Selim. Prevalence and epidemiological features of hepatocellular carcinoma in Egypt, a single centre experience Hepatology 2001; 19 :170-179.  Back to cited text no. 7
    
8.Rao MR, Naficy AB, Darwish MA, Darwish NM, Edelman R. Further evidence for association of hepatitis C infection with parenteral schistosomiasis treatment in Egypt. BMC Infect Dis 2002; 2 :29.  Back to cited text no. 8
    
9.Abdel-Aziz F, Habib M, Mohamed MK, Abdel-Hamid M, Sallam I. Hepatitis C virus infection in a community in the Nile Delta: population description and HCV prevalence. Hepatology 2000; 32 :111-115.  Back to cited text no. 9
    
10.Fried MW, Hoofnagle JH. Therapy of hepatitis C. Semin Liver Dis 1995; 15 :82-91.  Back to cited text no. 10
    
11.A Alberti, L Benvegnu. Management of hepatitis C. J Hepatol 2003; 38 :5104-5118.  Back to cited text no. 11
    
12.Arthur RR, Hassan NF, Abdallah MY, el-Sharkawy MS, Saad MD, Hackbart BG. Hepatitis C antibody prevalence in blood donors in different governorates in Egypt Emerg Infect Dis J 2005; 11 :271-274.  Back to cited text no. 12
    
13.Attia MA. Prevalence of hepatitis B and C in Egypt and Africa. Antivir Ther 1998; 3 :1-9.  Back to cited text no. 13
    
14.Centers for Disease Control and Prevention (CDC). HCV infection should be tested for HCV and counseled about the risk of sexual and perinatal transmission, 2006. Available at: http://www.cdc.gov/hepatitis/HCV/PDFs/HRSA-HIV-HCV  Back to cited text no. 14
    
15.Alter HJ, Seeff LB. Recovery, persistence, and sequelae in hepatitis C virus infection: a prospective on long term outcome. Semin Liver Dis 2002; 20 :17-35.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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