IJE Advance Access originally published online on May 6, 2009
International Journal of Epidemiology 2009 38(3):757-765; doi:10.1093/ije/dyp194
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Community transmission of hepatitis B virus in Egypt: results from a case–control study in Greater Cairo
1 Emerging Disease Epidemiology Unit, Institut Pasteur, Paris, France.
2 Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
3 Viral Hepatitis Research Laboratory, National Hepatology & Tropical Medicine Research Institute, Cairo, Egypt.
4 National Liver Institute, Menoufia University, Shibin El Kom, Egypt.
5 Department of Microbiology, Faculty of Medicine, Minia University, Minia, Egypt.
6 Hepatitis Section, Imbaba Fever Hospital, Cairo, Egypt.
7 Hepatitis Section, Abassaia Fever Hospital, Cairo, Egypt.
8 Department of Preventive Affairs, Ministry of Health and Population, Cairo, Egypt.
* Corresponding author. Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, 25–28, rue du Docteur Roux, Bâtiment Laveran 3ème étage, 75724 Paris cedex 15, France. E-mail: fontanet{at}pasteur.fr
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Abstract |
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Background To identify current risk factors for hepatitis B virus (HBV) transmission in Greater Cairo.
Methods A 1:1 matched case–control study was conducted in two ‘fever’ hospitals in Cairo. Acute hepatitis B cases were patients with acute hepatitis, positive HBs antigen, and high anti-HBc IgM titres. Control subjects were acute hepatitis A patients (positive anti-HAV IgM) or relatives of patients diagnosed with acute hepatitis C, identified at the same hospitals, with no past HBV infection (negative anti-HBc) and matched to cases on the same age and sex. Conditional logistic regression was used to identify factors associated with acute hepatitis B.
Results Between April 2002 and June 2006, 233 cases and 233 controls were recruited to the study. In multivariate analysis, factors associated with an increased HBV risk in males were illiteracy [odds ratio (OR) = 6.1, 95% confidence interval (CI) = 2.8–13.1], shaving at barbers (OR = 2.1, 95% CI = 1.1–3.9) and injecting drug use (IDU) (OR = 3.4, 95% CI = 1.0–11.4). In females, factors associated with an increased HBV risk were illiteracy (OR = 2.2, 95% CI = 1.0–5.0), recent (<1 year) marriage (OR = 42.0, 95% CI = 3.8–463.9 compared with single women) and giving birth (OR = 3.7, 95% CI = 1.0–13.9).
Conclusion In this study, HBV transmission took place primarily in the community, whether as a result of recent marriage (presumably first sexual intercourse), shaving at barbershops or IDU, and was more common among illiterates. Health promotion campaigns should be carried out to increase awareness about community transmission of HBV. In addition to routine immunization for infants and other populations, premarital screening might be useful to identify at-risk spouses in order to propose targeted immunization.
Keywords Acute hepatitis, risk factors, hepatitis B infection, epidemiology, Egypt
Accepted 7 October 2008