DTIC ADA280333: Low Risk of Sexual Transmission of Hepatitis C Virus in Somalia

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4 1994 Journal article
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Low risk of sexual transmission of hepatitis C virus in Somalia
PE 62787A
PR -33M162787A870
6.A UTHOR(S) TA - AR
Watts DM, Corivin AL, Omar MA, Hyams KC 1u288
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Reprinted fr--: Transactions of the Royal Society of Tropical Medicine and Hygiene 1994 Vol.88
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sexually transmitted diseases, viral hepatitis, hepatitis C, epidemiology,
serology 16. PFICE CODE
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Low risk of sexual transmission of hepatitis C virus in Somalia
Douglas M. Watts', Andrew L. Corwin2, Mahmoud A. Omar3 and Kenneth C. Hyam$s W(cid:127)ava) Medical Research
Instinue, Bethesda, Maryland, USA; 2US Naval Medical Research Unit No. 3, Cairo, Egot; Minisna' of Health,
Mogadishu, Somalia
Abstract
The prevalence in Somalia of antibody to hepatitis C virus (anti-HCV) was determined in a survey of 236 fe-
male prostitutes, 80 sexually transmitted disease (STD) clinic patients, 79 male soldiers, and 43 tuberculosis
patients. Of 98 (22%) serum samples repeatedly anti-HCV reactive by first and second generation enzyme-
linked immunosorbent assay kits, only 8 (1-8%) were anti-HCV positive by immunoblot assay (CRIA-2).
Anti-HCV seropositiviry by immunoblot assay was not associated with any risk group or with positive sy-
philis serology (found in 18% of subjects) or antibody to human immunodeficiency virus I (in 1-4% of sub-
jects). These data indicate that sexual transmission of hepatitis C virus is not common in Somalia among
sexually active populations, including female prostitutes and other groups at high risk of STDs and the ac-
quired immune deficiency syndrome.
Introduction which were also reactive by first-generation assay and 15
Hepatitis C virus (HCV) has been found in developed additional sera which were negative by first-generation
countries to be a common cause of post-transfusion he- EuSA. Among all 98 repeatedly ELISA-reactive sera, only
patitis and a common infection among groups with fre- 8 (1-8%) were anti-HCV positive and 6 (1.4%) were in-
quent parenteral exposure, such as illicit drug abusers determinate by RIBA-2. All 8 RJBA-positive sera were
(ALTER et al., 1989a; ESTEBAN et al., 1990; VAN DEN identified by the second generation ELISA, however, 4 of
HOEK et al., 1990). The role of sexual transmission in the the 8 were missed by the first-generation ELISA. Sera
spread of HCV is not as well understood, particularly in from 79 subjects (18.0%) were positive by FTA-ABS
developing countries, although HCV does not seem to be and 6 (1-4%) were positive for HIV-1 antibody by West-
transmitted by sexual contact as easily as hepatitis B ern blotting.
virus (ALTER e al., 1989b; EVERIIART el al., 1990). There was no significant association between HCV in-
In developing countries, HCV infection has not been fection, determined by RIBA-2, and the age, sex, or risk
found as frequently as hepatitis B infection; however, group of study subjects (Table). The mean age of the 8
high-risk groups in these countries have not been com-
prehensively evaluated (AL-FALE. et al., 1991; JACKSON T
et al., 1991; SAUED er al., 1991). In this investigation, ibm.unoidmemfiacoednf cic ¢,v(cid:127)yr us1, adposittiov eh 1apyaptNi iliasCe(cid:127)ro lmogya, anmd onhgu m4a3n1
populations living in Somalia and at high risk of sexually ubjects living in Somalia and at high risk of sexually trausmitted
transmitted diseases (STDs) and human immunoderi- diseases and Am
ciency virus (HIV) infection were investigated for HCV
infection. Number positive
No. (percentages in parentheses)
Patients and Methods Risk group evamined Anti4-CVAnti-HJV-1b FTA-ABS'
During 1990, the Somali Ministry of Health surveyed Female prostitutes 236 4 (1-7) 5 (2"1) 73 (30.9)
438 subjects living in 3 major urban centres in Somalia: STD clinic patients 80 2 (25!) 0 (-) 3 (3.8)
Mogadishu, Merca, and Chismayu. Subjects included Mita personnel ,9 1(3) 1 (1-3) 3 (3-8)
236 female prostitutes, 80 STD patients (69% male), 79 Tuberculosis patients 43 1 (2-3) 0 (-) 0 (-)
male military personnel, and 43 patients (58% male) with "lmmucoblot for anti-hepatitis C antibody.
Mycobacteium tuberculosisi nfection. The mean age of the 'Western blot for human immunodeficiency virm L.
entire population was 28 years (range 13-79 years). All 'Fluorescent treponemal antibody absorption test.
subjects were chosen sequentially during clinic or hospi-
tal visits on the days that the study was conducted; no se- subjects positive for anti-HCV was 32 years, compared to
lection criterion was used. a mean age of 28 years for the other study subjects. None
A serum sample was obtained from all study subjects of the anti-HCV positive subjects had HIV-1 antibody,
and tested for total anti-HCV antibody using both first and only 3 of 8 subjects with anti-HCV were FTA-AIBS
and second generation commercial enzyme-linked immu- positive.
nosorbent assay (ELJS.A) kits (Abbott Laboratories, Ab-
bott Park, Illinois, USA). Repeatedly reactive sera were Discussion
faussrathy e(rI MvAe-r2if9i;e d Cwhiitrho n aC oserpcoonradt-igoenn, erEamtioerny viimllem, uCnaolbiolort- BBassedd oo n cuurrrneln tly avviaaill able teestts foor anntii.HHCVV, thhesse
assa,'USBA).; CironCorporationh EL erviA , CaRw-iefoeA data indicate that sexual transmission of HCV is not com-
nia, USA). Sera reactive by both ELISA and RIBA-o were mon in Somalia among sexually active populations, in-
considered to be positive for anti-HCV and to represent cluding female prostitutes and individuals with anti-
active infection (FOLLETT el al., 1991). Sera were also HIV-1 antibody and positive syphilis serology. A low
screened for HIV-1 antibody by EUISA, and repeatedly risk of HCV infection has been found in other prostitute
reactive samples were confirmed by Western blotting, populations in developing countries, suggesting that
Lastly, sera were tested for syphilis infection by the rapid HCV is not readily transmitted by sexual contact even
plasma reagin card test, with confirmation by the fluores- among highly sexually active groups (HYAMsS or al.,
cent treponemal antibody-absorption test (FTA-ABS). 1992).
These data also indicate that false-positive anti-HCV
Results ELISA serological results are common in the Somali popu-
Among 438 study subjects, 83 (18.9%) had serum lation and that the second generation EULSA assay is much
samples repeatedly reactive for anti-HCV by first-gener- better than the first generation assay for identifying im-
ation EI.SA. By second generation ELISA, 74 (16.9%) sera munoblot positive sera. Other studies of African popula-
were repeatedly reactive for anti-HCV: 59 serum samples tions have found a high prevalence of false-positive anti-
Address for correspondence: Dr K. C. Hyams, Naval Medical HCV ELISA results, which has been attributed to malaria
Research Institute, 12300 Washington Avenue, Rockville, MD or flavivirus infection, cross-reactive antibody to un-
20852, USA. known antigens, and infection by HCV variants (ACE'T
56
elca l., 1990; WONG at al., 1990; CHAN el a1., 1991; ELLIS of antibodies to hepatiuis C virus in a study of transfusion-as-
el al., 1991; JACKSON Of al., 1991; TIBBS et al., 1991; sociated hepatitis. Neu, England Journal of Medicine, 323,
HyAms etal., 1993). 1107-1112.
Our results suggest that HIV-l infection was not corn- Everhart, 1. E., Di Bisceglie, A.M ., Murray, L.M ., Alter, H.
mon in Somalia at the time this study Wvas conducted. A J. , Melpolder, 1. J., Kuo, G. & Hofinagle, j -H. ( 1990). Risk
pri~or ~ ~ ~ ~ ~ ~ ~ o nSoonaiu(tAia,t dntaoynI-- 1ifcinpe C) hepatitis through sexual or house-
wariosrt udy widesomead indicatretdhiant bl nbe-Nca uoe hold contact with chronic carriers. Annals of Internial Me-
was ot henwni tdsaptr ade gin, ossblybecuse dicine, 112,544--545.
of minimnal commerce between Somalia and the rest of Folltt, E. A. C., Dow, B. C., McOmish, F., Lee Yap, P.,
Africa (SCOTT et al., 1991). Hughes, W., Mitchell, R. & Siminonds, P. (1991). HCVI con-
firmatory testing of blood donors. Lancet, 338, 1024.
Ackanowledgemenza Hvams, K. C., Phillips, I.A ., Moran, A. Y., Teinda. A. &
This research was supported by the US Naval Medical Re- Wignall, F. S. (1992). Seroprevalence of hepatitis C virus
search and Development Command, Bethesda, Maryland, antbod inPeru.journaloMedical Viroloo',,37,127-131.
USA, Work Units no. 3M463105H29AA335 ad Hvams K. C., Okoth, F. A., Tukei, P. M., VallarDi., S .,
3M]62787AS70AR1288. The opinions and assetions herein ar Morrill, J. C., Long, G., Banisal, 1. & Constantine, N. (1993).
the private ones of the authors and are not to be construed as of- Inconclusive hepatitis Cdvrus antibody results in African sera.
ficial or as reflecting the views of the US Navy Department, the Journa of Infectious Diseases, 167, 254-255.
Department of Defense, or the Sonial Governmfent. Jackson, 3. B., Guay, L., Goldfarb, J., Olness, K., Ndugwa.
C., Mmiro, F., Kataaha, P. & Allain, 1.-P. (1991). Hepatitis
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