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 ~  Abstract
 ~  Materials and Me...
 ~  Subjects
 ~  Immunoassay
 ~  Results
 ~  Discussion
 ~  References

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Year : 2003  |  Volume : 21  |  Issue : 1  |  Page : 43-45

Seroprevalence of hepatitis C virus in a hospital based general population in South India

Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry - 605 006, India

Correspondence Address:
Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry - 605 006, India

 ~ Abstract 

Seroprevalence of Hepatitis C virus (HCV) among hospital based general population was determined using a third generation ELISA. The study population comprised of 661 individuals (including 36 health care workers) attending a tertiary care hospital in Pondicherry, south India. The overall seroprevalence was found to be 4.8% (95% confidence interval [CI]=3.2-6.4%). The seroprevalence in males and females was 5.9% (95% CI=3.5-8.3%) and 3.3% (95% CI= 1.2-5.4%) respectively. There was no statistically significant difference in the proportion of individuals who were positive in case of males and females (p>0.05). None of the health care workers tested positive for antibodies to HCV.

How to cite this article:
Bhattacharya S, Badrinath S, Hamide A, Sujatha S. Seroprevalence of hepatitis C virus in a hospital based general population in South India. Indian J Med Microbiol 2003;21:43-5

How to cite this URL:
Bhattacharya S, Badrinath S, Hamide A, Sujatha S. Seroprevalence of hepatitis C virus in a hospital based general population in South India. Indian J Med Microbiol [serial online] 2003 [cited 2021 Jan 18];21:43-5. Available from:

Hepatitis C virus (HCV) can cause asymptomatic infection.[1] The seroprevalence of HCV globally ranges between 0.2-2%.[2] Among Indian blood donors, the seroprevalence varies from 0.48% in Vellore[3] to 1.85% in New Delhi.[4] Presently, determination of the seroprevalence of HCV in general population is a priority. Community based seroprevalence studies are difficult to conduct in a developing country because of socioeconomic hurdles and logistic difficulties. A tertiary care hospital catering to the needs of a large population represents an important center for serological surveys. The present study was undertaken to estimate the seroprevalence of HCV in both sexes and different age groups in a hospital based general population.

 ~ Materials and Methods Top

The present study involved detection of IgG antibodies to HCV in serum samples collected from individuals attending JIPMER Hospital, Pondicherry, India. The samples were collected between October 1997 and July 1999.

 ~ Subjects Top

Individuals attending out patient and in patient departments of JIPMER Hospital were included in the study.
Patients with past or present history of hepatitis, cirrhosis, hepatocellular carcinoma, blood and blood product transfusion, intravenous drug abuse, needle-stick injuries, tattooing, haemodialysis, and transplantation and sexually transmitted diseases were excluded from the study.
Serum samples were collected from six different age groups (0-9 years, 10-19 years, 20-29 years, 30-39 years, 40-49 years, > 50 years). A minimum of 108 random samples was collected from each age group. Altogether 661 serum samples were collected. These included sera from 36 health care workers (HCWs) of the JIPMER Hospital.

 ~ Immunoassay Top

All the sera were tested for the presence of antibodies against HCV proteins c200, c22-3, and RNA polymerase by a third generation enzyme immunoassay kit (Innotest HCV Ab III from Innogenetics N.V., Belgium). The tests were performed according to the manufacturer's instructions with adequate controls, and the absorbance of the solution in the wells were read at 450 nm within 15 minutes of the final step by Titertek Multiskan Plus ELISA reader.

Statistical analysis
The results were analyzed using the chi-square test.

 ~ Results Top

The age and sex distribution among the hospital based general population is shown in the [Table - 1]. Thirty-two of 661 individuals tested positive for antibody to HCV (4.8%; 95% confidence interval [CI]=3.2-6.4%). The seroprevalence among males and females were 5.9% (95% CI=3.5-8.3%) and 3.3% (95% CI=1.2-5.4%) respectively. There was no statistically significant difference in the exposure rates of males and females (p>0.05). The highest seroprevalence was found to be among males of the age group 40-49 years (9.4%) and females of the age group 30-39 years (8.5%).
Among the 36 health care workers (HCWs), 20 were males and 16 females. None of the HCWs tested positive for antibodies to HCV.

 ~ Discussion Top

In any seroprevalence estimation, the appropriate study subject would probably be a sample from the general population. However, general population seroprevalence are rarely available and the prevalence in blood donors is often used. Blood donor groups are usually young adults, hence seroprevalence in other age groups, like children and aged cannot be estimated. A hospital based serological survey offers several advantages. Individuals attending a hospital undergo a battery of investigations that necessitate giving a blood sample. All the samples in the present study were collected, after consent, from laboratories meant for other investigations. Hence, no extra episode of venepuncture was needed for serum sampling. This saved time, man power and cost. Securing the consent of healthy individuals in a less informed community for blood testing is a difficult exercise. The problem is aggravated if the subject happens to be a child or a senior citizen. These problems were avoided by conducting the study in a hospital, where serum samples sent for routine investigations were tested for HCV seroprevalence.
In the present study, the seroprevalence of HCV among hospital-based population was found to be 4.8%. This is similar to other hospital-based study done in Mauritius in 1994 (5.9%).[5] In Ethiopia 6.0% of patients attending a clinic for neurologic disorder tested positive for anti-HCV.6 The seroprevalence of HCV ranges between 0.2-2% globally.[2] In India among blood donors it varies from 0.48% in Vellore [3] to 1.85% in New Delhi.[4] In rural Maharashtra only one of 1054 apparently healthy persons tested positive for anti-HCV.[7] Geographical variation in the seroprevalence of HCV, as noted here in comparison to others, has been documented even in small countries like Taiwan.[8] Pondicherry has a heavy load of migrant population due to tourism and industrial activities. It is an important destination for tourists, labourers and truck drivers. Some of the areas of the city and that of the neighboring state of Tamil Nadu is socio-economically backward. Education and access to health information is limited. Safe practices like use of disposable syringes is restricted to privileged sections. Persistent endemic state of HCV infection within a community can be due to medical injections.[8] The high prevalence of alcoholism (which is an independent risk factor for HCV transmission[9] among males in this region, may have a contributory effect on the overall seroprevalence of HCV.
The prevalence seems to increase with age either because of a continuing risk of exposure or a cohort effect with declining risk in more recent times.[10] The prevalence of HCV in the 0-9 year age group could be due to the enhanced risk of exposure from perinatal transmission of the virus.[11] In conformity with other studies a higher prevalence of HCV was found among males (5.9%) than among females (3.3%).[12]
The interval from the onset of hepatitis to seroconversion to anti-HCV antibody is 4-32 weeks and from transfusion to development of anti-HCV antibody is 10-39 weeks.[13] In the present study, the blood samples were collected soon after hospital visit or admission, thus ruling out the possibility of iatrogenic transmission during diagnostic, therapeutic, and preventive procedures in the hospital. However, the relatively high seroprevalence among the hospital based population merits mandatory screening of high-risk individuals. This should be supplemented with health education of general population to increase awareness about this virus and its modes of transmission. The large reservoir of HCV infection in the community provides an opportunity to investigate risk factors for transmission, the natural history of infection and effectiveness of preventive methodologies. It also raises concern about the prospects of an increasing incidence of chronic liver disease in future. 

 ~ References Top

1.Sampietro M, Caputo L, Annoni G, Corbetta N, Ticozzi A, Fiorelli G, Vergani C, Lunghi G, Prescott L, Yap PL. High prevalence of clinically silent HCV infection in older people. J Am Geriatr Soc 1998;46:1057-1058.  Back to cited text no. 1    
2.Wilber JC. Hepatitis C virus. In: Murray PR. Manual of Clinical Microbiology, 6th ed. (ASM Press, Washington DC) 1995:1050-1055.  Back to cited text no. 2    
3.Issar SK, Ramakrishna BS, Ramakrishna B, Christopher S, Samuel BU, John TJ. Prevalence and presentation of Hepatitis C related chronic liver diseases in southern India. J Trop Med Hyg 1995;98:161-165.  Back to cited text no. 3    
4.Panigrahi AK, Panda SK, Dixit RK, Rao KV, Acharya SK, Dasarathy S, Nanu A. Magnitude of Hepatitis C virus infection in India. Prevalence in healthy blood donors, acute and chronic liver diseases. J Med Virol 1997;51:167-174.  Back to cited text no. 4    
5.Schwarz TF, Dobler G, Gilch S, Jager G. Hepatitis C and arboviral antibodies in the island population of Mauritius and Rodrigues. J Med Virol 1994;44:379-383.  Back to cited text no. 5    
6.Frommel D, Tekle-Haimanot R, Berhe N, Aussel L, Verdier M, Preux PM, Denis F. A survey of antibodies to Hepatitis C virus in Ethiopia. Am J Trop Med Hyg 1993;49:435-439.  Back to cited text no. 6    
7.Chadha MS, Tungatkar SP, Arankalle VA. Insignificant prevalence of antibodies to Hepatitis C in a rural area of western Maharashtra. Indian J Gastroenterol 1999;18:22-3.  Back to cited text no. 7  [PUBMED]  
8.Sun CA, Chen HC, Lu SN, Chen CJ, Lu CF, You SL, Lin SH. Persistent hyperendemicity of Hepatitis C virus infection in Taiwan: the important role of iatrogenic risk factors. J Med Virol 2001;65:30-4.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.Laskus T, Radkowski M, Lupa E, Halama G, Nowicka R, Cianciara J, Slusarczyk J. Occurrence of antibodies against Hepatitis C virus (HCV) among alcoholics. Pol Arch Med Wewn 1992;87:1-7.  Back to cited text no. 9  [PUBMED]  
10.Oshita M, Hayashi N, Kasahara A, Yuki N, Takehara T, Hagiwara H. Prevalence of Hepatitis C virus among family members of patients with hepatitis C. J Med Virol 1993;41:251-255.  Back to cited text no. 10    
11.Thaler MM, Park CK, Launders DV, Wara DW, Houghton M, Veerman-wauers G, Sweet RL, Han JH. Vertical transmission of Hepatitis C virus. Lancet 1991;338:17-18.  Back to cited text no. 11    
12.Abdel-Aziz F, Habib M, Mohamed MK, Abdel-Hamid M, Gamil F, Madkour S, Mikhail NN, Thomas D, Fix AD, Strickland GT, Anwar W, Sallam I. Hepatitis C virus (HCV) infection in a community in the Nile Delta: population description and HCV prevalence. Hepatology 2000;32:111-115.  Back to cited text no. 12    
13.Shimotohno K, Feinstone SM. Hepatitis C virus and Hepatitis G virus. Chapter 50. In: Richman DD, Whithey RJ, Hayden FR. Clinical Virology. (Churchill Livingstone, New York) 1997:1187-1215.  Back to cited text no. 13    
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