Letter to editor
ARCH GASTROENTEROHEPATOL 2000; 19 ( No 3 – 4 ):
PREVALENCE OF HCV infection among different population groups in the area of PIRAEUS: A STUDY IN GENERAL PRACTICE
Prevalencija HCV infekcije u razlicitim populacionim grupama u regiji grada Pireja: Studija lekara opste prakse
To the Editor: Hepatitis C in one of the major public health problem in many parts of the world. In Greece, the prevalence of HCV infection in blood donors and in high – risk groups is similar to that of Western Europe. Recently, two groups of Greek general practitioners became involved in the management and follow up of anti-HCV seropositive patients ( 1 ). According to Alter group, general practitioners participate in diagnosing HCV seropositive patients by detecting persons with high-risk behaviors and analysing patient , s questionnaires ( 2 ).
The aim of this study was to investigate the prevalence of HCV infection in various population groups in the area of Piraeus. This area is with low to moderate socio-economic level and relatively stable population. This study lasted from January 1993 until December 1996.
In total, 12 633 subjects enrolled this study. According to their origin they were divided into 6 groups:
1) blood donors: 11 581
2) medical and paramedical staff ( mean hospital service 9.1+6.9 years ): 430
3) dentists- members of the Dentist Society of Piraeus ( mean number of practicing years ) 10.4+ 7.2 years ) 73
4) diabetics ( 46 IDDM, 253 NIDDM ) ( mean duration of illness 12.7+6.1 ): 299
5) cornea transplantation patients: 46
6) immigrants from former Soviet Union: 86
Anti-HCV seropositivity was tested using an immunoenzymatic method of second generation ( ELISA II, Abbott, Chicago, IL, US ). Confirmation of the positivity was made by RIBA-2 test ( Chiron, Emeryville, CA, US ).
A specially designed epidemiological protocol was used in order to accurately record the various clinico-epidemiological parameters and risk factors in the study group.
The seropositivity for HCV in the above-sited groups is demonstrated on Table 1. The lowest percentage of anti-HCV seropositive persons was found among blood donors ( 0.35% ), followed by medical and paramedical staff ( 0.62% and 0.84% respectively ), and diabetic cases ( 1% ). All dentists were HCV negative.
The highest percentage of HCV seropositive persons was observed among the immigrants from former Soviet Union ( 7 our of 86, 8.13% ) ( p<0.0001 ). Two of them were members of the same family. Two out of 7 positive subjects were exposed to known risk factors, blood transfusion.
There were 41 ( 0.35% ) ( males 31, females 10 ) anti-HCV positive blood donors. Seven ( 17% ) had a history of blood transfusion, 17 ( 41% ) intravenous drug abuse.
Two seropositive nurses and 1 doctor denied any exposure to known risk factors to HCV infection.
Three diabetic patients were exposed to known risk factors, blood transfusion.
This study demonstrates that the prevalence of HCV infection in Piraeus is low. Since this is an area of low socio-economic level, this contrast with expected anti-HCV seropositivity of 15% for people of such socio-economic background. We have no obvious explanation for this discrepancy except high standards Greek medical services employed in this country for about 20 years. The high sropositivity among immigrants is an expected phenomenon due to high rate of HCV infection in their country of origin ( 3 ). Studies from former Soviet Union demonstrate the prevalence of anti-HCV seropositivity ranging from 2% to 9.2%. An increased prevalence in this particular group underlines the importance of unfavorable socio-economic conditions and low living standard for HCV transmission.
1.Lionis C, Fragoylis E, Skliros S, et al. How Greek GPs manage hepatitis C infected patients: experience gained from primary health care district in rural Crete. Aust Fam Physician 1999; 28: 207-8.
2.Moyer LA, Mast EE, Alter MJ. Hepatitis C: routine serologic testing and diagnosis. Am Fam Physician 1999; 59: 79-88.
3.Skliros S, Sotiropoulos A, Lionis C, et al. High prevalence of HCV infection markers in refugees from Eastern countries. Ital J Gastroenterol Hepatol 1999; 31: 84-5.
The authors are members of the Hepatitis Study Group of Greek Association of General Practitioners.
Health Center of Nemea, Nemea, Grece.
Address correspondence to: Dr Statis Skliros
Director, Health Center of Nemea
Nestoros 32, Egaleo
122-44 Athens, Greece
E-mail: [email protected]