The epidemiological situation of hepatitis C in Turkey - · PDF fileEpidemiological Situation...

Epidemiological Situation of Hepatitis C in Turkey

Selda ErensoyEge University, Faculty of Medicine

Microbiology and Clinical Microbiologyİzmir

selda.erensoy@ege.edu.tr

Anti-HCV SeroprevalenceBlood donorsGeneral population – age groupsHemodialysis patientsHealth care workersDifferent patient groupsRisk groupsRisk factorsSexual partners and offsprings of chronic hepatitis C patients

0.5

0.5-0.7

0-0.3

1

0.5-3.21.3

0.3-0.7

1.20.3

0.3-1.6

Anti-HCV Seropositivity in blood donors (%)1995 – 1999 (~ 0.6%) / 2000-2007 (~ 0.54%)

0.6-2.11.4

0.7

1.1

0.2-0.7

0.3-1.5

0. 7

0.3-0.5 0.2

0.14

0.2 0.1

0.2-0.5

0.6

0.3-0.8

0.5

1.5

1

0.5-10.6

3.4

0. 70,07

0,810.37

0.68

1.1

Routine screening of anti-HCV has been started in all blood centers in Turkey in 1997.

Trends in HCV among blood donors over 8 years; 1996-2004Gurol E, 2006

0.27% increase 0.13% decreasePrimary screening: 0.60%Repeatable reactive: 0.58%Confirmation: 0.41%Indeterminate: 0.12%

Primary screening: 0.55%Confirmation: 0.35%

1996 - 2004; confirmed: 0.38%

0.13

0.48

0.29

0.28 0.81

0.44

0.37

0.46

0.47 0.33

0.49

0.670.52

0.34

0.870.55

0.19

0.95

0.25

0.33

0.26

Trends in HCV among blood donors over 8 years; 1996-2004Gurol E, 2006

0.4

1.7

0.17

Anti-HCV Seropositivity in General Population (%)1995 – 2009

(age: 0 – 99 years)

0.461.2

1

1.91.1-2.8

2.2

Children:Konya; n:460 (2 mnt -17yrs) 0,21% in 1999Diyarbakır; n:528 (5-16 yrs) 0,56% in 1999İstanbul; n:198 (11-14yrs) 0% in 2003

2.1

2.1

anti-HCV seropositivity in İstanbul 1999

0,00

0,50

1,00

1,50

2,00

total 0-4 5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-85

age (years)

%

n:119062 80

0,17

1,61,25

72 58 46 91 349128 98 46 39 32

89

Pahsa A; 1999

anti-HCV seropositivity in Ankara 1999

0,00

0,50

1,00

1,50

2,00

2,50

total 0-18 19-38 39-58 59-78 79-99

age (years)

%

Yousefi AR, 1999

n:3035 n:52 n:603 n:1139 n:1202 n:39

1,7

00,8

2,1 2

0

anti-HCV seroprevalence in Ankara 2003

0,000,200,400,600,801,001,201,401,60

1-5 6-10 11-15

16-20

21-25

26-30

31-35

36-40

41-45

46-50

51-55

56-60

age: years

%

Kurt H; 2003

anti-HCV seroprepalence in Kırıkkale in2003

0

1

2

3

4

5

6

0-19 20-39 40-59 60-

age

%

Seri 1Seri 2

Kaygusuz S, 2003

Female

Male

N (47) (284) (927) (689) (312) (293) (103) (59)

1,40,4 0,6

1,3

0,31

4,9

1,7

Anti-HCV seroprevalence in Tokat and Konya

012345678

0-11 18-29 30-39 40-49 50-59 60-69 70-79 >80 total

age: years

%

Seri 1Seri 2TokatVan

n:1095

n:40000,6 1

2,3 2,3

4 3,9

1,22,1

0,8

4,23,4

7,1

Tokat; Black Sea region of TurkeyVan; Eastern Turkey

Van

There is no significant difference between rural versus urban Yıldırım B, 2009Bozkurt H, 2008

1,2

14,4

18,6-66,6

32,7-62,7

82,8

28,5-32,7

1760,9

81,6

30,7-53,2

20,6-49,3 32,4-73,643,2 54,6

38,8

40,0-79,1

56,9-65,0

20,0

Anti-HCV Seropositivity in hemodialysis patients1991 – 1999 (41,5%)2000-2006 (27,4%)

5,9-43,6

43,581,4

52,3

45-52

49,6

Multi-center study (2005): 28%

12-20

1941

4,7

Multi-center (1995): 49,5%

1,3

0,5-1,7

0

0

0-0,70

1,1

0,2-0,9

0-1,6

0,4

2,9

Anti-HCV Seropositivity in Health Care Workers1992 – 1999 (~ 0,7%)2000-2006 (~ 0,4%)

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%)

0-1,1

0,5

0

0,96

0

0,15- 0,22,1

0

5,7

4

5,7-3,3

3,9

2,3-3,2

10,3

12

Anti-HCV Seropositivity in Prostitutes(%) 1992 – 2000 (~ 4,55%)

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

AdanaAnkaraMalatyaSamsunHatayMulticenter

40 103583399999

12,5202,830,14,512,6

children Hematol/oncolog.dis (6mt-18yrs)Acute lymph. Leukemia (2-10)Solid tm (1-16yrs)

DiyarbakırAnkaraİstanbul

7216050*transfusions

23,61,92 (at diagnosis)14 (end)

Renal Tx AdanaAnkaraİstanbul

417435

12,552,748,5

Renal Tx (PTDM-)Post Tx diabetes mell.

İstanbul 4343

3772

Patient groups Province number Anti-HCV + (%)

Renal tx AdanaAnkaraİstanbul

417435

12,552,748,5

Psychiatric Pat. ElazığManisa

158180

2,531,7

IV drug users İstanbul 82107

54,844,9

Patient groups Province number Anti-HCV + (%)

Non-hodg. Lymph. AnkaraİstanbulAnkaraErzurumAdana

3130-8433470223-228

22,513-7,11,81,48,1-11,1

Lymphoproliferative disorders

Gaziantep 334 2,6

Lichen planus AnkaraGaziantepDiyarbakırAnkara

417312854

4,86,86,212,9

Behçet’s Disease İzmirAnkaraİstanbulKırıkkale

137355074

0,8002,7

Hepatic disease Province number Anti-HCV + (%)

Chronic liver disease

Ankara (1991)İstanbul (1997)İzmir (1996)

101526107

163518

HCC Ankara (1987)Diyarbakır (1992-93)İzmir (1996)Multicenter (1994-2007)

35-3131221

1517/12,52921,3

Cryptogenic hepatitis

Ankara (1992)İstanbul (1991)Adana (1991)

786429

26,95272,4

Chronic B hepatitis Adana (1991)İstanbul (1991)

129 132

1812

Alcoholic cirh. İstanbul (1991) 20 20

1,4%

2 -2,7%2%

0,5%(children)

İstanbul (n:720) 1998 İzmir (n:398-518) 1998 /2000Diyarbakır (n:148) 1998

Adana (n:388 children) 1998

HCV etiology in Acute viral hepatitis

3%

Konya 1990-2004 (retrospective)

Anti-HCV (+) %

Akçam FZ, 2009Isparta

Anti-HCV (+) %

Anti-HCV (+) % Anti-HCV

%

Risk Factors for the transmission of HCV infection in Turkish population (%)

Surgical operation 98,1- 68,9- 64,9Transfusion 39,7- 21,2- 24,1Dental procedure 27,5- 77,5- 73,8Abortion 21,2Hemodialysis 10IV drug abuse 3,1- 1,3- 0Long-hospitalization 3,1- 8,4Multi-partner sex 1,5- 12,6- 0,5Other (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 Index case (n)

n HCV(+)%

Sexual partners

Afyon (2003)1

İstanbul (2005)3

İstanbul (2004)4

174600109

174600109

3,425,5

Children Afyon (2003)1

İstanbul (2003)2

191107

230222

2,171,35

1.Aykın N, 2003; 2.Tahan V, 2003; 3.Tahan V, 2005; 4.Yenice N

Conclusions -1Anti-HCV has been screened in all blood centers in Turkey since 1997.Seroprevalence of HCV among blood donors: 0,2-1,1% (0,5%).Epidemiological studies differ in sample size and sampling methodologies.HCV seroprevalence in general population: 0,17-2,8.

* Higher at the ages over 35.Lower in western part of Turkey.

HCV seroprevalence among hemodialysis patients:

Significant decrease from 1996 to 2006(41,5% 27,4%)

Seroprevalence is low among health care workers in Turkey; decrease (0,7% to 0,4%)Comparative studies regarding different groups (doctors versus nurses, other employee) are meaningful.

Conclusions - 2

Multiple transfusion has an impact on anti-HCV seroprevalence (especially before 2000 and in older patients): 4,5% - 30%Anti-HCV seroprevalence is high among IV drug users (45-55%).Seroprevalence is high among non-Hogkin lymphoma (1,4% - 22,5%).High among patients with liver disease (chronic liver dis., hepatocellular carcinoma, cryptogenic cirrhosis): 11-72%.

Conclusions - 3

No significant difference in anti-HCV seroprevalence between males and females.Most of the contributing risk factors for the transmission of HCV are;History of blood transfusionHistory of surgeryHistory of hospitalization (invasive procedures)Most of the anti-HCV positive patients are HCV RNA positive (>50%).

Conclusions - 4

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