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ABSTRACT
The purpose was to establish the current sero- prevalence of HCV among patients
attending Microbiology department in a tertiary care hospital. 12117 serum
samples were tested for detection of IgM anti HCV using commercially available
kits, from November2013 to October 2014. The study highlighted on different
Keywords epidemiological aspects such as age groups, sexes, likely mode of transmission and
probable cause for undergoing screening procedure. During the study period, the
Hepatitis C, sero-prevalence rate of HCV infection was 1.5 % & was significantly more
IgM anti-HCV, prevalent (71.6 %) in male patients. IgM anti HCV reactivity was highest (56.8%)
Viral Hepatitis, in <15 yrs of age group. Most cases were detected during routine screening of
Chronic multi-transfused patients attending Hematology OPD (51.6%). Multi-transfusion
hepatitis, was the most common risk factor associated (80.22%). Only 3 thalassemic children
Sero-prevalence and 2 HIV sero-positive adults suffered from dual infections by HBV & HCV.
Eighteen patients tested positive for HIV among Hepatitis C infected patients. This
study highlights blood transfusion as the commonest modality for disease
transmission of HCV which mostly presented as asymptomatic cases, thereby
indicating further need for epidemiological studies for better prevention of disease
transmission.
Introduction
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HIV (Fabrizi et al., 1999; Poynard et al., hospital in Kolkata, India. Our objective was
1997).Symptomatic acute hepatitis with to assess the demographic profiles of the
jaundice is seen in only 25% of patients and sero-positive persons and to highlight the
this virus usually does not cause fulminant most probable mode of transmission of the
hepatitis in immunocompetent individuals. disease. Our study looked for the prevalence
The only acute life threatening illness of HIV and/or HBV also, if any among the
caused by hepatitis C is a variant called HCV infected persons.
fibrosing cholestatic hepatitis which is seen
in liver transplant recipients (Taga et al., Materials and Methods
1998). The worrying aspect of acute
hepatitis C infection is that spontaneous The present study was undertaken in the
viral clearance is unusual with nearly 54%- Microbiology department of a tertiary care
86% of the infected individuals progressing hospital in Kolkata, India. Blood samples
to chronic hepatitis (Alter et al., 1992; were collected at the Serology laboratory in
Missiha et al., 2008). Approximately a fifth the Dept. of Microbiology from November
of the patients with chronic hepatitis C 2013 to October 2014 for detecting the
progress to cirrhosis over a time spanning presence of Hepatitis C infection among
nearly a decade (Panigrahi et al.,1997). patients admitted or attending OPD in our
hospital and was undergoing these
Serologic evidence for HCV infection laboratory procedures as part of routine pre-
occurs in 90% of patients with a history of operative screening or for diagnostic
transfusion-associated hepatitis. A specific purposes.
serologic diagnosis of hepatitis C can be
made by demonstrating the presence in At least 5ml of blood was collected
serum of anti-HCV. When contemporary aseptically by venepuncture into sterile,
immunoassays are used, anti-HCV can be disposable vials without anticoagulants &
detected in acute hepatitis C during the labelled with patient identification details.
initial phase of elevated aminotransferase Sample was allowed to clot at room
activity. This antibody may never become temperature for about 1 hour for clot
detectable in 5 10% of patients with acute retraction. Serum separation was done by
hepatitis C, and levels of anti-HCV may centrifugation at a speed of 3000 rpm for 10
become undetectable after recovery (albeit minutes & stored up to 48 hours at 2° 8°C.
rare) from acute hepatitis C. In patients with Patient s sera were subjected to qualitative
chronic hepatitis C, anti-HCV is detectable detection of IgM Anti-HCV antibody by
in >95% of cases. Comparable frequencies indirect third generation ELISA method
of HCV infection occur in most countries using ErbaLisa Hepatitis C kit. All samples
around the world, with 170 million persons were tested as per the manufacturer s
infected worldwide (Mukhopadhya, 2008). instructions with adequate quality control &
the absorbance value were read at 450nm as
There is still paucity of data related to the reference wavelength by ELISA reader. All
epidemiological aspects of HCV infection HCV reactive patients were analyzed on the
and previous studies mostly concentrated on basis of their demographic profiles, probable
the professional blood donors. The present cause for testing, symptomatic evidence &
study was undertaken to focus upon the probable mode of transmission. All positive
current prevalence of hepatitis C virus samples were further subjected to test using
among patients attending a tertiary care CombAids kit for the presence of HIV
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infections. Serum showing positive result by for liver transplantation, and is estimated to
CombAids test, were further tested using account for 8000 10,000 deaths per year in
Triline & Trispot kits as second & third line the United States. In Europe, general
tests. The samples reactive for all of the prevalence of HCV is about 1% but varies
three tests were counted as HIV sero- among the different countries (Wasley et al.,
positive in the study. All HCV positive 2000). The population prevalence of HCV is
samples were also subjected to determine estimated to be 1% in India which is in
the co-presence of HBsAg by sandwich concordance with our study.HCV infection
ELISA method using ErbaLisa Hepatitis B is transmitted predominantly by the
kit.. parenteral route. Sexual and vertical
transmission is infrequent except when HIV
Results and Discussion co-infection is present (Jain et al., 2009;
Tseng et al., 2008).
A total of 12117 serum samples were tested
for detection of IgM anti-HCV antibody. Blood transfusion is an effective mode of
During the study period, prevalence rate of transmission of hepatitis C infection as it
HCV infection was 1.5% (n=182) (Table 1, allows a large quantum of infective virions
Figure 1). into the susceptible patient. In India,
transfusion of blood or blood products is
HCV was mostly prevalent in patients <15 considered as most common route for HCV
yrs. of age (56.8%) (Table 2, Figure 2). transmission (Perez et al., 2005;
Sero-prevalence of HCV was significantly Amarapurkar et al., 2001). 50% of the
higher in male (71.6 %) patients in chronic hepatitis C patients had received
comparison with the females (28.4%) (Table blood transfusion(s) reportedly in a north
3, Figure 3). Indian study (Mehta et al., 2010). Blood
transfusion was responsible for 61% of 90
HCV mostly (51.6%) presented itself in patients with chronic HCV infection
patients attending Hematology OPD & according to a study from Vellore (Seeff et
requiring frequent blood & related product al., 1992).
transfusion for diseases such as Thalassemia
& Haemophilia. 21.4% of HCV sero- The prevalence of HCV was 21% in
positive cases were advised to undergo the thalassemia patients and correlated with
test because of hepatitis & other related advancing age as per a study in 2001
gastro-intestinal symptoms (Table 4). (Jaiswal et al., 2001). Studies from Mumbai
reported the prevalence of HCV in
Multiple blood transfusions was reported to thalasemics to be 16.7% and 17.5%,
be the most significant risk factor associated respectively (Amarapurkar et al., 1992;
with HIV infection in our study.18 patients Agarwal et al., 1993). In multiple transfused
tested positive for HIV among these haemophiliac patients the prevalence of
Hepatitis C sero-positive patients. Only 3 HCV was around 23.9% (Ghosh et al.,
thalassemic children and 2 HIV seropositive 2000). In a study from Kolkata the
adult suffered from dual HCV & HBV prevalence of HCV was 13% in multi-
infections (Table 5). transfused patients (Neogi et al., 1997).
Hepatitis C accounting for 40% of chronic Our study re-confirms blood transfusion as
liver disease, is the most frequent indication the most significant route of HCV
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Male female
Total no. of anti-HCV Ab 71.6% 28.4%
positive cases (n=182)
Table.4 Categorization of Hepatitis C patients depending upon the probable cause for
undergoing investigations
Associated RISK FACTORS No. of HCV infected Percentage of HCV infected patients
patients
Multiple blood transfusion 146 80.22
Multiple sexual partner 34 18.68
IV drug abuse 7 3.85
Hemodialysis patients 3 1.65
Infants born to HCV infected mothers 10 5.49
Associated HIV/HBV infection 21 11.54
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45-60 years
<5years
0 20 40 60
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Fabrizi, F., Martin, P., Dixit, V., Brezina, Mahanta, J., Medhi, G.K., Paranjape, R.S.,
M., Russell, J., Conrad, A., Schmid, P., Roy, N., Kohli, A., Akoijam, B.S., et
Gerosa, S., Gitnick, G. 1999. Detection al. 2008. Injecting and sexual risk
of de novo hepatitis C virus infection behaviours, sexually transmitted
by polymerase chain in hemodialysis infections and HIV prevalence in
patients. Am. J. Nephrol., 19: 383 388. injecting drug users in three states in
Ghosh, K., Joshi, S.H., Shetty, S., Pawar, India. AIDS, 22(Suppl. 5): S59 68.
A., Chipkar, S., Pujari, V., et al. 2000. Mehta, S.H., Vogt, S.L., Srikrishnan, A.K.,
Transfusion transmitted diseases in Vasudevan, C.K. 2010. Epidemiology
haemophilics from western India. of hepatitis C virus infection & liver
Indian J. Med. Res., 112: 61 4. disease among injection drug users
Halfon, P., Khiri, H., Feryn, J.M., Sayada, (IDUs) in Chennai, India. Indian J.
C., Chanas, M., Ouzan, D. 1998. Med. Res., 132: 706 714.
Prospective virolocial followup of Mishra, S., Chayani, N., Sarangi, G.,
hepatitis C infection in a haemodialysis Mallick, B., Pati, S.B. 2002.
unit. J. Viral Hepat., 5: 115 121. Seroprevalence of anti HCV antibody
Hazari, S., Panda, S.K., Gupta, S.D., Batra, in and around Cuttack, Orissa. Indian
Y., Singh, R., Acharya, S.K. 2004. J. Med. Microbiol., 20: 40 1.
Treatment of hepatitis C virus infection Missiha, S.B., Ostrowski, M., Heathcote,
in patients of northern India. J. E.J. 2008. Disease progression in
Gastroenterol. Hepatol., 19: 1058 65. chronic hepatitis C: modifiable and
Jain, M., Chakravarti, A., Verma, V., Bhalla, nonmodifiable factors. Gastro-
P. 2009. Seroprevalence of hepatitis enterology, 134(6): 1699 714.
viruses in patients infected with the Mukhopadhya, A. 2008. Hepatitis C in
human immunodeficiency virus. Indian India. J. Biosci., 33: 465 473.
J. Pathol. Microbiol., 52: 17 9. Neogi, D.K., Bhattacharya, N., Chakrabarti,
Jaiswal, S.P., Chitnis, D.S., Jain, A.K., T., Mukherjee, K.K. 1997. HCV
Inamdar, S., Porwal, A., Jain, S.C. activity in Calcutta a serological study.
2001. Prevalence of hepatitis viruses J. Commun. Dis., 29: 1 6.
among multi-transfused homogenous Panigrahi, A.K., Panda, S.K., Dixit, R.K.,
thalassaemia patients. Hepatol. Rao, K.V., Acharya, S.K., Dasarathy,
Res., 19: 247 53. S., et al. 2005. Magnitude of hepatitis
Kumar, M.S., Mudaliar, S., Thyagarajan, C virus infection in India: Prevalence
S.P., Kumar, S., Selvanayagam, A., in healthy blood donors, acute and
Daniels, D. 2000. Rapid assessment chronic liver diseases. J. Med. Virol.,
and response to injecting drug use in 51: 167 74.
Madras, South India. Int. J. Drug Perez, C.M., Suarez, E., Torres, E.A.,
Policy, 11: 83 98. Roman, K., Colon, V.
Magder Fix, A.D., Mikhail, N.N., 2005. Seroprevalence of hepatitis C
Mohamed, M.K., Abdel-Hamid, M., virus and associated risk behaviours: a
Abdel-Aziz, F., Medhat, A., Strickland, population-based study in San Juan,
G.T. 2005. Estimation of the risk of Puerto Rico. Int. J. Epidemiol., 34(3):
transmission of hepatitis C between 593 9.
spouses in Egypt based on Poynard, T., Bedossa, P., Opolon, P. 1997.
seroprevalence data. Int. J. Epidemiol., Natural history of liver fibrosis
34: 160 165. progression in patients with chronic
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Int.J.Curr.Microbiol.App.Sci (2015) 4(3): 115-123
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