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Abstract
It is believed that community acquisition in Egypt
occurs as a result of the re-use of needles for injections in
traditional or formal health care settings. However, it was
difficult to obtain good information about re-use of
needles, and a history of injections is ubiquitous and thus
could not be used to identify those at higher risk for
community acquisition. Generally experienced risk factors
such as this are included in our models as part of the
background risk for community acquisition, represented by
the variable age.
The power of our analytical approach depends on the
presence of a strong risk factor for community acquisition
of disease that can provide information regarding which of
the two partners is more likely to be the source of the
disease. In this study, reporting of a parenteral risk factor
was only moderately predictive of anti-HCV. Another risk
factor in the model, age, was likely to be collinear between
the husbands and wives, reducing its effectiveness in
helping to probabilistically identify the source. The
method might be more powerful in populations where there
is a strong community risk factor such as intravenous drug
abuse.
The probabilities of transmission estimated in this
article are rather crude epidemiological parameters,
Summary and Conclusions
163
indicating only the probability of transmission at any time
between spouses. This necessarily averages over the
duration of infectious exposure in the couples, the nature
of contact between the couples, and the variability of
infectiousness over time. More specific parameters could
be estimated only if we knew the duration of infection, the
duration of the marriage, the number of contacts, and other
relevant information.
Egyptian children with infected parents are at high
risk of infection with hepatitis C (HCV). Analysis of data
collected during surveys of rural communities show
children whose parents had antibodies to HCV (anti-HCV)
were at higher risk for having anti-HCV than children
whose parents did not. The association was greater with
mothers than fathers and when the parent had HCV RNA.
For instance, 87 (14%) of 612 children had anti-HCV
whose mothers had HCV RNA compared with 28 (7%) of
401 whose mothers only had anti-HCV and 79 (2.6%) of
3,086 whose mothers were seronegative. These associations
persisted after controlling for age, parenteral exposures,
and serologic status of the other parent. Sequencing
isolates from 13 families with parent(s) and children
having HCV RNA showed 10 of 18 had genetically similar
viruses. These findings suggest Egyptian children are at
high risk of being infected with HCV by their parents and
Summary and Conclusions
164
identification of the transmission routes would allow for
preventive measures.