为了估计埃及丙肝感染新病例的发生率，DeWolfe Miller 和Laith Abu-Raddad对一系列研究的数据进行了流行病学建模，这些数据包括2008年的一次全国丙肝调查，该调查含有富有代表性的样本以及记载清楚的研究设计。这组作者估计，每年埃及新发50万例以上的丙肝感染，这很可能意味着这个超过7700万人的国家正在流行该病。这组作者提出，埃及丙肝传播的准确途径尚不清楚，但是医源性传染是一个可能的担忧。这组作者说，该研究表明需要进一步分析埃及的丙肝传染，并改善公共卫生措施，从而减少病毒在医院和非医院环境下的传播。
PNAS doi: 10.1073/pnas.1008877107
Evidence of intense ongoing endemic transmission of hepatitis C virus in Egypt
F. DeWolfe Millera,1 and Laith J. Abu-Raddadb,c,d
aDepartment of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813;
bInfectious Disease Epidemiology Group, Weill Cornell Medical College–Qatar, Cornell University, Qatar Foundation–Education City, Doha, Qatar;
cDepartment of Public Health, Weill Cornell Medical College, Cornell University, New York, NY 10065; and
dVaccine and Infectious Disease Institute, Fred Hutchinson Cancer Research Center, Seattle, WA 98109
Egypt has the highest prevalence of antibodies to hepatitis C virus (HCV) in the world, estimated nationally at 14.7%. An estimated 9.8% are chronically infected. Numerous HCV prevalence studies in Egypt have published various estimates from different Egyptian communities, suggesting that Egypt, relative to the other nations of the world, might be experiencing intense ongoing HCV transmission. More importantly, a new national study provided an opportunity to apply established epidemiologic models to estimate incidence. Validated mathematical models for estimating incidence from age-specific prevalence were used. All previous prevalence studies of HCV in Egypt were reviewed and used to estimate incidence provided that there was sufficient age-specific data required by the models. All reports of anti-HCV antibody prevalence were much higher than any single other national estimate. Age was the strongest and most consistently associated factor to HCV prevalence and HCV RNA positivity. It was not possible to establish a prior reference point for HCV prevalence or incidence to compare with the 2009 incidence estimates. The modeled incidence from the national study and collectively from the modeled incidence from the previous community studies was 6.9/1,000 [95% confidence interval (CI), 5.5–7.4] per person per year and 6.6/1,000 (95% CI, 5.1–7.0) per person per year, respectively. Projected to the age structure of the Egyptian population, more than 500,000 new HCV infections per year were estimated. Iatrogenic transmission is the most likely, underlining exposure to the ongoing transmission. The study demonstrates the urgency to reduce HCV transmission in Egypt.