The relationship between therapeutic injections and high prevalence of hepatitis C infection in Hafizabad, Pakistan

Abstract

To determine the prevalence and routes of transmission of hepatitis C virus (HCV) infection in Hafizabad, Pakistan, we collected sera in 1993 from a geographically based random sample of residents, and in 1994 identified 15 HCV-infected individuals (cases) and 67 age and sex matched uninfected individuals (controls). Initially we approached 504 households, and collected serum from a randomly selected household member in 309 (64%). Twenty persons (6.5%) had anti-HCV antibody; 31% percent had hepatitis B core antibodies, and 4.3% had hepatitis B surface antigen. In the case-control study, persons who received more therapeutic injections (categorized as averaging 1, 2-4, 5-9 or > 10 injections per year in the previous 10 years) were more likely to be infected with HCV (odds ratio 0, 1.5, 2.5 and 6.9 respectively, P = 0.008) compared to persons averaging 0 injections per year. Efforts to limit therapeutic injections to only those that are medically indicated and that use sterile equipment are essential in order to prevent transmission of HCV.

PIP: To determine the prevalence of hepatitis C virus (HCV) infection in Hafizabad, Pakistan, sera were collected in 1993 from a geographically representative random sample of 309 adults and children. 20 serum samples (6.5%) had anti-HCV antibodies, 89 (31%) had hepatitis B core antibodies, and 12 (4.3%) had hepatitis B surface antigens. The prevalence of HCV increased markedly with age; no cases were detected among children under 10 years old. A follow-up study of 15 of these HCV cases and 67 age- and sex-matched healthy controls was conducted in 1994. Compared to noninfected controls, HCV cases were significantly more likely to have received 5 or more injections in the previous 10 years (odds ratio, 5.4; 95% confidence interval, 1.2-28.0). Only 5 HCV cases had received blood transfusions, and none reported intravenous drug use. Inspection of 3 private health clinics in Hafizabad exposed disposable syringes and needles--used primarily for vitamin B complex, chloroquine, and penicillin--soaking in a bowl of tepid water. Extrapolation of this study's findings suggests 800 new cases of HCV and 109 HCV-related deaths in Hafizabad each year. HCV infection could be reduced substantially by efforts to limit injections to those that are medically essential and to ensure the use of sterile equipment.