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. 2018 Jul 26;13(7):e0200461.
doi: 10.1371/journal.pone.0200461. eCollection 2018.

The burden of hepatitis C virus infection in Punjab, India: A population-based serosurvey

Ajit Sood  1 , A Suryaprasad  2 , A Trickey  3 , S Kanchi  4 , V Midha  1 , M A Foster  2 , E Bennett  2 , S Kamili  2 , F Alvarez-Bognar  5 , S Shadaker  6 , V Surlikar  4 , R Garg  7 , P Mittal  8 , S Sharma  9 , M T May  3 , P Vickerman  3 , F Averhoff  2
Affiliations

The burden of hepatitis C virus infection in Punjab, India: A population-based serosurvey

Ajit Sood et al. PLoS One. .

Abstract

Introduction: Hepatitis C virus (HCV) infection prevalence is believed to be elevated in Punjab, India; however, state-wide prevalence data are not available. An understanding of HCV prevalence, risk factors and genotype distribution can be used to plan control measures in Punjab.

Methods: A cross-sectional, state-wide, population-based serosurvey using a multi-stage stratified cluster sampling design was conducted October 2013 to April 2014. Children aged ≥5 years and adults were eligible to participate. Demographic and risk behavior data were collected, and serologic specimens were obtained and tested for anti-HCV antibody, HCV Ribonucleic acid (RNA) on anti-HCV positive samples, and HCV genotype. Prevalence estimates and adjusted odds ratios for risk factors were calculated from weighted data and stratified by urban/rural residence.

Results: 5,543 individuals participated in the study with an overall weighted anti-HCV prevalence of 3.6% (95% Confidence Interval [CI]: 3.0%-4.2%) and chronic infection (HCV Ribonucleic acid test positive) of 2.6% (95% CI: 2.0%-3.1%). Anti-HCV was associated with being male (adjusted odds ratio 1.52; 95% CI: 1.08-2.14), living in a rural area (adjusted odds ratio 2.53; 95% CI: 1.62-3.95) and was most strongly associated with those aged 40-49 (adjusted odds ratio 40-49 vs. 19-29-year-olds 3.41; 95% CI: 1.90-6.11). Anti-HCV prevalence increased with each blood transfusion received (adjusted odds ratio 1.36; 95% CI: 1.10-1.68) and decreased with increasing education, (adjusted odds ratio 0.37 for graduate-level vs. primary school/no education; 95% CI: 0.16-0.82). Genotype 3 (58%) was most common among infected individuals.

Discussion: The study findings, including the overall prevalence of chronic HCV infection, associated risk factors and demographic characteristics, and genotype distribution can guide prevention and control efforts, including treatment provision. In addition to high-risk populations, efforts targeting rural areas and adults aged ≥40 would be the most effective for identifying infected individuals.

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Conflict of interest statement

S Kanchi, F Alvarez-Bognar, and V Surlikar are, or have previously been, employees of Merck. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. The percentage of participants sampled in each district that had Hepatitis C virus antibodies.
Fig 2
Fig 2. Prevalence of Hepatitis C antibodies (95% confidence interval) by age category and sex.
Fig 3
Fig 3. Prevalence of Hepatitis C antibodies by number of medical injections received in the last 6 months.
Fig 4
Fig 4. Prevalence of Hepatitis C antibodies by unique potential exposures (whether or not they had a permanent tattoo, whether they had ever received a blood transfusion and whether in the last 6 months they had received a medical injection).
See this image and copyright information in PMC

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