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Sood A, Suryaprasad A, Trickey A, Kanchi S, Midha V, Foster MA, Bennett E, Kamili S, Alvarez-Bognar F, Shadaker S, Surlikar V, Garg R, Mittal P, Sharma S, May MT, Vickerman P, Averhoff F. The burden of hepatitis C virus infection in Punjab, India: A population-based serosurvey. PLoS One 2018; 13:e0200461. [PMID: 30048454 PMCID: PMC6061991 DOI: 10.1371/journal.pone.0200461] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/27/2018] [Indexed: 12/15/2022] Open
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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Affiliation(s)
- Ajit Sood
- Dayanand Medical College, Ludhiana, Punjab, India
| | - A. Suryaprasad
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - A. Trickey
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | | | - V. Midha
- Dayanand Medical College, Ludhiana, Punjab, India
| | - M. A. Foster
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - E. Bennett
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - S. Kamili
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - S. Shadaker
- CDC Foundation, Atlanta, GA, United States of America
| | | | - R. Garg
- Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - P. Mittal
- Mittal Liver and Gastroenterology Centre, Patiala, Punjab, India
| | - S. Sharma
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - M. T. May
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - P. Vickerman
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - F. Averhoff
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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