The epidemiological situation of hepatitis C in Turkey

Epidemiological Situation of
Hepatitis C in Turkey
Selda Erensoy
Ege University, Faculty of Medicine
Microbiology and Clinical Microbiology
İzmir
[email protected]
Anti-HCV Seroprevalence
9Blood donors
9General population – age groups
9Hemodialysis patients
9Health care workers
9Different patient groups
9Risk groups
9Risk factors
9Sexual partners and offsprings of chronic
hepatitis C patients
Anti-HCV Seropositivity in blood donors (%)
1995 – 1999 (~ 0.6%) / 2000-2007 (~ 0.54%)
0.3-1.5
1.5
0.3-1.6
0.14
0.7
0.37
0.2-0.7
0,81
1 0. 7
0,07
1
3.4
0. 7
0.3-0.8
0.2-0.5
0.6-2.1
0.3-0.5
0.5-0.7
0.68
0.5-1
1.4
0.6
0.2
0.1
0.3-0.7
1.3
0.2 1.1
0.5-3.2
0.6
0.5
0-0.3
1.2
0.3 0.5
1.1
ƒ Routine screening of anti-HCV has been started in
all blood centers in Turkey in 1997.
0.27% increase
0.13% decrease
Primary screening: 0.60%
Primary screening: 0.55%
Confirmation: 0.35%
Repeatable reactive: 0.58%
Confirmation: 0.41%
1996 - 2004; confirmed: 0.38%
Indeterminate: 0.12%
Trends in HCV among blood donors over 8 years; 1996-2004
Gurol E, 2006
0.29
0.37
0.26
0.25
0.44
0.33
0.13
0.28
0.81
0.95
0.46
0.48
0.47
0.33
0.34
0.19
0.67
0.52
0.49
0.87
0.55
Trends in HCV among blood donors over 8 years; 1996-2004
Gurol E, 2006
Anti-HCV Seropositivity in General Population (%)
1995 – 2009
(age: 0 – 99 years)
0.17
1
2.1
1.7
2.2
1.1-2.8
1.9
0.46
0.4
Children:
Konya; n:460 (2 mnt -17yrs) 0,21% in 1999
Diyarbakır; n:528 (5-16 yrs) 0,56% in 1999
İstanbul; n:198 (11-14yrs) 0% in 2003
1.2
2.1
anti-HCV seropositivity in İstanbul 1999
2,00
1,6
1,25
1,00
0,00
0,17
62
80
n:1190
72
59
10
-1
4
15
-1
9
20
-2
4
25
-2
9
30
-3
4
35
-3
9
40
-4
4
45
-4
9
50
-5
4
55
-5
9
60
-8
5
0,50
to
ta
l
04
%
1,50
58
46
91
349
128
98
age (years)
46
39
89
32
Pahsa A; 1999
anti-HCV seropositivity in Ankara 1999
2,50
2,1
2,00
2
1,7
1,50
%
1,00
0,8
0
0,50
0,00
0
n:3035
n:52
n:603
n:1139
n:1202
n:39
total
0-18
19-38
39-58
59-78
79-99
age (years)
Yousefi AR, 1999
%
anti-HCV seroprevalence in Ankara 2003
1,60
1,40
1,20
1,00
0,80
0,60
0,40
0,20
0,00
1-5 6-10 1115
1620
2125
2630
3135
age: years
3640
4145
4650
5155
5660
Kurt H; 2003
anti-HCV seroprepalence in Kırıkkale in2003
6
4,9
5
%
4
3
2
1
1,7
1,3
1,4
0,4
0,6
Seri 1
Female
Seri
Male2
1
0,3
0
0-19
N (47) (284)
20-39
40-59
(927) (689) (312) (293)
age
60(103) (59)
Kaygusuz S, 2003
Tokat; Black Sea region of Turkey
Van; Eastern Turkey
%
Van
Anti-HCV seroprevalence in Tokat and Konya
8
7
6
5
4
3
2
1
0
7,1
4,2 4
2,3
1,2
0,6 1
n:1095
Tokat
Seri
1
3,9
3,4
2,3
2,1
1,2
0,8
0-11 18-29 30-39 40-49 50-59 60-69 70-79 >80
Van2
Seri
n:4000
total
age: years
There is no significant difference between rural versus urban
Yıldırım B, 2009
Bozkurt H, 2008
Anti-HCV Seropositivity in hemodialysis patients
1991 – 1999 (41,5%)
2000-2006 (27,4%)
4,7
30,7-53,2
40,0-79,1
49,6
20,0
52,3
82,8
38,8
20,6-49,3
19
18,6-66,6
5,9-43,6
56,9-65,0
60,9
43,5
81,6
81,4
17
32,4-73,6
43,2
54,6
45-52
28,5-32,7
41
14,4
32,7-62,7
12-20
Multi-center (1995): 49,5%
Multi-center study (2005): 28%
Anti-HCV Seropositivity in Health Care Workers
1992 – 1999 (~ 0,7%)
2000-2006 (~ 0,4%)
0,2-0,9
0,5
0,4
0
0
0
0
0,5-1,7
1,1 0,96
2,9
0-1,1
0-1,6
0,15- 0,2
2,1
0
0
1,3
0-0,7
n: 26 (1994; Bursa; hemodialysis; 0) - 54 (2005; Bursa; anaesthesiology; 0)
n: 577 (1994; İstanbul; 0,2%)
n: 703 (2006; Manisa; 0.15)
n: 95 (2000; Malatya;hemodialysis; 2,1%)
Anti-HCV Seropositivity in Prostitutes
(%) 1992 – 2000 (~ 4,55%)
4
12
2,3-3,2
10,3
5,7-3,3
5,7
3,9
Sivas 1995: 12%
İzmir 1993: 3,2 – 1998: 2,3%)
Diyarbakır 1992: 5,7% - 2000: 3,3%
Malatya 1992: 10,3%
Patient groups
Province
number
Anti-HCV + (%)
Hematologic dis. / +multl.
transfusion
Adana
Ankara
Malatya
Samsun
Hatay
Multicenter
40
10
35
83
399
999
12,5
20
2,8
30,1
4,5
12,6
Diyarbakır
Ankara
İstanbul
72
160
50
*transfusions
23,6
1,9
2 (at diagnosis)
14 (end)
children
Hematol/oncolog.dis (6mt-18yrs)
Acute lymph. Leukemia (2-10)
Solid tm (1-16yrs)
Renal Tx
Adana
Ankara
İstanbul
41
74
35
12,5
52,7
48,5
Renal Tx (PTDM-)
Post Tx diabetes mell.
İstanbul
43
43
37
72
Patient groups
Province
number
Anti-HCV +
(%)
Renal tx
Adana
Ankara
İstanbul
41
74
35
12,5
52,7
48,5
Psychiatric Pat.
Elazığ
Manisa
158
180
2,53
1,7
IV drug users
İstanbul
82
107
54,8
44,9
Patient groups
Province
number
Anti-HCV +
(%)
Non-hodg. Lymph.
Ankara
İstanbul
Ankara
Erzurum
Adana
31
30-84
334
70
223-228
22,5
13-7,1
1,8
1,4
8,1-11,1
Lymphoproliferative
disorders
Gaziantep
334
2,6
Lichen planus
Ankara
Gaziantep
Diyarbakır
Ankara
41
73
128
54
4,8
6,8
6,2
12,9
Behçet’s Disease
İzmir
Ankara
İstanbul
Kırıkkale
137
35
50
74
0,8
0
0
2,7
Hepatic disease
Province
number
Anti-HCV +
(%)
Chronic liver
disease
Ankara (1991)
İstanbul (1997)
İzmir (1996)
101
526
107
16
35
18
HCC
Ankara (1987)
Diyarbakır (1992-93)
İzmir (1996)
Multicenter (1994-2007)
35-31
31
221
15
17/12,5
29
21,3
Cryptogenic
hepatitis
Ankara (1992)
İstanbul (1991)
Adana (1991)
78
64
29
26,9
52
72,4
Chronic B hepatitis
Adana (1991)
İstanbul (1991)
129
132
18
12
Alcoholic cirh.
İstanbul (1991)
20
20
HCV etiology in Acute viral hepatitis
1,4%
2 -2,7%
3%
2%
0,5%
(children)
İstanbul
İzmir
Diyarbakır
(n:720)
(n:398-518)
(n:148)
1998
1998 /2000
1998
Adana
Konya
(n:388 children)
1998
1990-2004 (retrospective)
Akçam FZ, 2009
Isparta
Anti-HCV (+) %
Anti-HCV (+) %
Anti-HCV
(+) %
Anti-HCV
%
Risk Factors for the transmission of HCV infection
in Turkish population (%)
Surgical operation
98,1- 68,9- 64,9
Transfusion
39,7- 21,2- 24,1
Dental procedure
27,5- 77,5- 73,8
Abortion
21,2
Hemodialysis
10
IV drug abuse
3,1- 1,3- 0
Long-hospitalization
3,1- 8,4
Multi-partner sex
1,5- 12,6- 0,5
Other (tattooing, acupuncture, sharing
razors etc.)
8,1- 8,5- 3,7/6,8
Karaca Ç, 2006 (1996-2002; İstanbul-320pts)
Yıldırım B, 2005 (1997-2001; İstanbul-151)
Aykın, 2008 (2002-2006; Afyon-191)
Anti-HCV seroprevalence in sexual partners
and children of chronic Hepatitis C
Province
Sexual
Afyon (2003)1
partners İstanbul (2005)3
İstanbul (2004)4
Index case
(n)
174
600
109
Children Afyon (2003)1
191
İstanbul (2003)2 107
n
HCV(+)%
174
600
109
3,4
2
5,5
230
222
2,17
1,35
1.Aykın N, 2003; 2.Tahan V, 2003; 3.Tahan V, 2005; 4.Yenice N
Conclusions -1
ƒ Anti-HCV has been screened in all blood
centers in Turkey since 1997.
ƒ Seroprevalence of HCV among blood
donors: 0,2-1,1% (0,5%).
ƒ Epidemiological studies differ in sample size
and sampling methodologies.
ƒ HCV seroprevalence in general population:
0,17-2,8.
* Higher at the ages over 35.
ƒ Lower in western part of Turkey.
Conclusions - 2
ƒ HCV seroprevalence among hemodialysis
patients:
Significant decrease from 1996 to 2006
(41,5% Æ 27,4%)
ƒ Seroprevalence is low among health care
workers in Turkey; decrease (0,7% to 0,4%)
ƒ Comparative studies regarding different
groups (doctors versus nurses, other
employee) are meaningful.
Conclusions - 3
ƒ Multiple transfusion has an impact on antiHCV seroprevalence (especially before
2000 and in older patients): 4,5% - 30%
ƒ Anti-HCV seroprevalence is high among IV
drug users (45-55%).
ƒ Seroprevalence is high among non-Hogkin
lymphoma (1,4% - 22,5%).
ƒ High among patients with liver disease
(chronic liver dis., hepatocellular carcinoma,
cryptogenic cirrhosis): 11-72%.
Conclusions - 4
ƒ No significant difference in anti-HCV
seroprevalence between males and
females.
ƒ Most of the contributing risk factors for the
transmission of HCV are;
¾History of blood transfusion
¾History of surgery
¾History of hospitalization (invasive
procedures)
ƒ Most of the anti-HCV positive patients are
HCV RNA positive (>50%).
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YOUR ATTENTION