Summary
Introduction
Hepatitis C virus (HCV) infection is an infection that may lead to cirrhosis and hepatocellular carcinoma. Most patients with HCV infection are asymptomatic. The previous study conducted in age group of 30-64 years and in two provinces. Additionally, most surveillance studies conducted in a point period; not longitudinally. This study aimed to evaluate HCV infection rate in all age groups in the northeastern, Thailand in a longitudinal fashion.
Methods
This was a surveillance study conducted in 20 provinces of northeastern, Thailand. The study period was between July 2010 and November 2019. During the surveillance, demographic data of participants were collected. HCV screening test was performed in each participant by using a rapid point-of-care assay. Rates of HCV infection in each province and in overall were calculated.
Results
During the surveillance period, there were 31,855 subjects who participated the project. Of those, 1,285 subjects (4.037%) were tested positive for HCV infection (Tab. I). The HCV infection rate was highest in 2011 (8.98%): ranges 1.28 to 9.59%. The age group of over 50 years had 690 subjects with HCV infection (5.45%) out of 12,660 subjected tested in this age group. There was significant different among age groups (p < 0.001) and difference of age over 30 years and sex (p 0.043).
Conclusions
This longitudinal surveillance showed that HCV infection rates in northeastern, Thailand were varied across the provinces with the highest rate of 9.59%. The HCV infection should be aware in male with age over 30 years.
Keywords: Hepatitis C virus, Sex, Age
Introduction
Hepatitis C virus (HCV) infection is an infection that may lead to cirrhosis and hepatocellular carcinoma. Its global prevalence was approximately 1.6% or 115 million persons [1]. HCV infection is much more common in adults compare with children (90%:10%) or 104 vs 11 million patients [1]. The prevalence rate of HCV infection is varied among countries with the highest rate in Egypt at 14.70%.
A serological surveillance in 310 Belgian forest workers showed seroprevalence of Lyme disease which determined the population at risk for those asymptomatic [2]. Patients with HCV infection are mostly asymptomatic. Therefore, community surveillance may be helpful to identify infected patients. In Thailand, endemic areas for HCV infection, found the prevalence of HCV infection was 6.9% reported in 2020 and previously reported to be 15.5% in 2017 [3, 4]. The previous study conducted in age group of 30-64 years and in two provinces [5]. Additionally, most surveillance studies conducted in a point period; not longitudinally. This study aimed to evaluate HCV infection rate in all age groups in the northeastern, Thailand in a longitudinal fashion.
Methods
This was a surveillance study conducted in 20 provinces of northeastern, Thailand. The study period was between July 2010 and November 2019. The surveillance was conducted in multiple areas in each province on a random basis. Each surveillance comprised of HCV screening and educational activities regarding HCV awareness by multidisciplinary health care team. The concept of awareness of HCV infection according to the world hepatitis alliance was implemented.
During the surveillance, demographic data of participants were collected. HCV screening test was performed in each participant by using a rapid point-of-care assay (One Step Rapid Test for HCV; HEALGEN, TX77401, USA). This rapid test has sensitivity and specificity for HCV infection of 98.1% and 98.9%, respectively. Those with test positive for HCV infection were referred for proper treatment. Rates of HCV infection in each province and in overall were calculated. Descriptive statistics were used to compute the differences by age group and sex. A p-value of less than 0.05 considered statistical significance.
The study protocol was approved by the ethic committee in human research, Khon Kaen University, Thailand (HE621134). An informed consent was not obtained due to retrospective data collection.
Results
During the surveillance period, there were 31,855 subjects who participated the project. Of those, 1,285 subjects (4.037%) were tested positive for HCV infection (Tab. I). The HCV infection rate was highest in 2011 (8.98%). Among 20 provinces, Udonthani and Khon Kaen province were the top two provinces with the highest HCV infection rate at 9.59%, and 7.86% (Tab. II). The HCV infection ranged from 1.28 to 9.59%. The age group of over 50 years had 690 subjects with HCV infection (5.45%) out of 12,660 subjected tested in this age group (Tab. III). There was significant different among age groups (p < 0.001) and difference of age over 30 years and sex (p 0.043).
Tab. I.
Details of hepatitis C virus (HCV) infection by the HCV surveillance project in northeastern, Thailand.
| Year | Total tested for HCV (n) | Test positive for HCV (n) | Test positive for HCV (%) |
|---|---|---|---|
| 2010 | 419 | 24 | 5.73 |
| 2011 | 846 | 76 | 8.98 |
| 2012 | 2,964 | 162 | 5.46 |
| 2013 | 4,761 | 253 | 5.31 |
| 2014 | 5,076 | 88 | 1.73 |
| 2015 | 3,139 | 66 | 2.10 |
| 2016 | 4,314 | 279 | 6.46 |
| 2017 | 4,811 | 255 | 5.30 |
| 2018 | 2,948 | 53 | 1.79 |
| 2019 | 2,577 | 29 | 1.12 |
| Total | 31,855 | 1,285 | 4.03 |
Tab. II.
Details of hepatitis C virus (HCV) infection by the HCV surveillance project in northeastern, Thailand categorized by province.
| Provinces | Year tested | Total tested for HCV (n) | Test positive for HCV (n) | Test positive for HCV (%) |
|---|---|---|---|---|
| Beung kan | 2017 | 603 | 25 | 6.51 |
| Khon Kaen | 2010-2019 | 4,913 | 386 | 7.86 |
| Sakon Nakhon | 2012-2014, 2017 | 981 | 26 | 2.65 |
| Si sa ket | 2014-2017 | 1,727 | 64 | 3.70 |
| Burirum | 2012-2016, 2018 | 1,647 | 58 | 3.52 |
| Mukdaharn | 2015, 2017 | 462 | 10 | 2.16 |
| Amnat Chareon | 2017 | 261 | 13 | 4.98 |
| Maha Sarakam | 2013, 2015-2017 | 1,459 | 56 | 3.84 |
| Udonthani | 2011-2017 | 1,365 | 131 | 9.59 |
| Nong khai | 2013-2019 | 4,332 | 118 | 2.72 |
| Nakorn Panom | 2015, 2017 | 766 | 22 | 2.87 |
| Ubon Ratchathani | 2013, 2014 2018 | 975 | 15 | 1.54 |
| Nakorn Ratchasima | 2012, 2014, 2016, 2019 | 1,571 | 43 | 2.74 |
| Chaiyaphum | 2013-2014, 2016, 2017 | 1,906 | 74 | 3.88 |
| Surin | 2011-2019 | 3,275 | 61 | 1.86 |
| Kalasin | 2013-2014, 2016-2019 | 2,151 | 114 | 5.29 |
| Loei | 2014, 2018 | 701 | 9 | 1.28 |
| Roi-et | 2012-2014, 2018 | 2,069 | 47 | 2.27 |
| Yasothon | 2018 | 304 | 7 | 2.30 |
| Nong bua lumphu | 2016, 2019 | 387 | 6 | 1.55 |
| Total | 31,855 | 1,285 | 4.03 |
Tab. III.
Details of hepatitis B virus (HCV) infection by the HCV surveillance project in northeastern, Thailand categorized by age group and sex.
| Age group | Total tested (n) | Test positive for HCV, n (%) | Test positive for HCV, n (%) | |
|---|---|---|---|---|
| Male | Female | |||
| 0-10 | 210 | 0 | 0 | 0 |
| 11-20 | 1,053 | 1 (0.9) | 1 (0.09) | 0 (0) |
| 21-30 | 3,919 | 25 (0.65) | 17 (0.43) | 8 (0.2) |
| 31-40 | 4,247 | 159 (3.74) | 135 (3.18) | 24 (0.56) |
| 41-50 | 9,766 | 410 (4.19) | 335 (3.43) | 75 (0.77) |
| > 50-60 | 12,660 | 690 (5.45) | 607 (4.79) | 83 (0.66) |
| Total | 31,855 | 1,285 (4.03) | 1,095 (3.44) | 190 (0.60) |
Discussion
As previously reported, estimation of disease is not enough for people who inject drugs [6]. HCV infection is estimated to be 52.3% of people with inject drug. This surveillance showed that average HCV infection rate in this 10-year cohort among 20 provinces. The highest rate of HCV infection was higher than the recent survey in 2020 (9.59% vs 6.9%) [3].
This study found similar findings with the previous study on HCV infection rate among age groups [4]. The seroprevalence was low at age group of under 35-40 years: ranges 0.0-3.5%. In this study, we found that the HCV infection rate was dramatically increasing from 0.0%-0.90% in age group below 30 years to 3.74% in age group of 31-40 years (Tab. III) which was also statistically significant (p < 0.001). However, this rising rate was not shown in both groups: only male sex (p = 0.043). The female group had quite steady rate from 0.0% to 0.77% (Tab. III). These findings may be explained from higher rate of people with inject drug in male patients. A study from northern, Thailand found that 81.8% out of 164 people with inject drug were male and 57.3% of subjects had first intravenous drug use at age below 24 years [7]. These finding may also explain why the HCV infection was significantly increased after age group of 30 years.
This study showed 10-year surveillance in almost provinces in the northeastern, Thailand. However, there are some limitations. First, participants in the project were those participated the world hepatitis alliance in that province. The total population tested for HCV infection was quite large at 31.855 persons though. And, the HCV test was the point of care test but it has a good sensitivity and specificity [8]. Some related conditions were not studied [9-16]. Finally, HCV genotypes were not evaluated.
Conclusions
This longitudinal surveillance showed that HCV infection rates in northeastern, Thailand were varied across the provinces with the highest rate of 9.59%. The HCV infection should be aware in male with age over 30 years.
Acknowledgements
None.
Figures and tables
Footnotes
Conflict of interest statement
The authors declare no conflict of interest.
Authors’ contributions
Tanita Suttichaimongkol: study design, data interpretation, writing a draft; Chitchai Rattananukrom: data interpretation, review a manuscript; Arthit Wongsaensook: data interpretation, review a manuscript; Wattana Sukeepaisarnjaroen: study design, data interpretation, review a manuscript; Kittisak Sawanyawisuth: study design, data interpretation, review a manuscript.
References
- [1].Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol 2014;61(Supp l):S45-57. https://doi.org/10.1016/j.jhep.2014.07.027 10.1016/j.jhep.2014.07.027 [DOI] [PubMed] [Google Scholar]
- [2].De Keukeleire M, Robert A, Luyasu V, Kabamba B, Vanwambeke SO. Seroprevalence of Borrelia burgdorferi in Belgian forestry workers and associated risk factors. Parasit Vectors 2018;11:277. https://doi.org/10.1186/s13071-018-2860-2 10.1186/s13071-018-2860-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [3].Wasitthankasem R, Pimsingh N, Treesun K, Posuwan N, Vichaiwattana P, Auphimai C, Thongpan I, Tongsima S, Vongpunsawad S, Poovorawan Y. Prevalence of Hepatitis C Virus in an endemic area of Thailand: burden assessment toward HCV elimination. Am J Trop Med Hyg 2020;103:175-82. https://doi.org/10.4269/ajtmh.19-0817 10.4269/ajtmh.19-0817 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [4].Wasitthankasem R, Vichaiwattana P, Siripon N, Posuwan N, Auphimai C, Klinfueng S, Thanetkongtong N, Vuthitanachot V, Saiyatha S, Thongmai C, Sochoo S, Sukthong P, Poovorawan K, Tangkijvanich P, Poovorawan Y. Birth-cohort HCV screening target in Thailand to expand and optimize the national HCV screening for public health policy. PLoS One 2018;13:e0202991. https://doi.org/10.1371/journal.pone.0202991 10.1371/journal.pone.0202991 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [5].Wasitthankasem R, Vichaiwattana P, Siripon N, Posuwan N, Auphimai C, Klinfueng S, Thaneskongtong N, Vuthitanachot V, Saiyatha S, Thongmai C, Suwanpatoomlerd S, Sochoo S, Pongsuwan N, Poovorawan K, Tangkijvanich P, Vongpunsawad S, Poovorawan Y. Assessment of hepatitis C virus infection in two adjacent Thai provinces with drastically different seroprevalence. PLoS One 2017;12:e0177022. https://doi.org/10.1371/journal.pone.0177022 10.1371/journal.pone.0177022 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [6].Prins M, Bruneau J. Estimates are not enough: scaling-up interventions to improve the health of people who inject drugs. Lancet Glob Health 2017;5:e1162-3. https://doi.org/10.1016/S2214-109X(17)30430-8 10.1016/S2214-109X(17)30430-8 [DOI] [PubMed] [Google Scholar]
- [7].Prouté M, Le Coeur S, Tiv MH, Dub T, Jongpaijitsakul P, Ratnamhin A, Angkurawaranon C, Aramrattana A, Lallemant M. Risky injection practices and HCV awareness in Chiang Mai Province, Thailand: a respondent-driven sampling study of people who inject drugs. BMC Public Health 2020;20:1450. https://doi.org/10.1186/s12889-020-09549-w 10.1186/s12889-020-09549-w [DOI] [PMC free article] [PubMed] [Google Scholar]
- [8].Charoentanyarak S, Sawunyavisuth B, Deepai S, Sawanyawisuth K. A point-of-care serum lactate level and mortality in adult sepsis patients: a community hospital setting. J Prim Care Community Health 2021;12:21501327211000233. https://doi.org/10.1177/21501327211000233 10.1177/21501327211000233 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [9].Tongdee S, Sawunyavisuth B, Sukeepaisarnjaroen W, Boonsawat W, Khamsai S, Sawanyawisuth K. Clinical factors predictive of appropriate treatment in COPD: a community hospital setting. Drug Target Insights 2021;15:21-5. https://doi.org/10.33393/dti.2021.2291 10.33393/dti.2021.2291 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [10].Martins EC, Silva MC, De Oliveira JA, Pereira R, Reis TM. Sleep disturbances in hepatitis C patients undergoing treatment: minisleep questionnaire as a screening tool. Minerva Gastroenterol Dietol 2015;61:125-30. [PubMed] [Google Scholar]
- [11].Khamsai S, Chootrakool A, Limpawattana P, Chindaprasirt J, Sukeepaisarnjaroen W, Chotmongkol V, Silaruks S, Senthong V, Sittichanbuncha Y, Sawunyavisuth B, Sawanyawisuth K. Hypertensive crisis in patients with obstructive sleep apnea-induced hypertension. BMC Cardiovasc Disord 2021;21:310. https://doi.org/10.1186/s12872-021-02119-x 10.1186/s12872-021-02119-x [DOI] [PMC free article] [PubMed] [Google Scholar]
- [12].Jeerasuwannakul B, Sawunyavisuth B, Khamsai S, Sawanyawisuth K. Prevalence and risk factors of proteinuria in patients with type 2 diabetes mellitus. Asia Pac J Sci Technol 2021;26:APST-26-04-02. https://doi.org/10.14456/apst.2021.32 10.14456/apst.2021.32 [DOI] [Google Scholar]
- [13].Soontornrungsun B, Khamsai S, Sawunyavisuth B, Limpawattana P, Chindaprasirt J, Senthong V, Chotmongkol V, Sawanyawisuth K. Obstructive sleep apnea in patients with diabetes less than 40 years of age. Diabetes Metab Syndr 2020;14:1859-63. https://doi.org/10.1016/j.dsx.2020.09.008 10.1016/j.dsx.2020.09.008 [DOI] [PubMed] [Google Scholar]
- [14].Manasirisuk P, Chainirun N, Tiamkao S, Lertsinudom S, Phunikhom K, Sawunyavisuth B, Sawanyawisuth K. Efficacy of generic atorvastatin in a real-world setting. Clin Pharmacol 2021;13:45-51. https://doi.org/10.2147/CPAA.S285750 10.2147/CPAA.S285750 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [15].Sawunyavisuth B. What are predictors for a continuous positive airway pressure machine purchasing in obstructive sleep apnea patients? Asia-Pac J Sci Technol 2018;23:APST-23-03-10. https://doi.org/10.14456/apst.2018.10 10.14456/apst.2018.10 [DOI] [Google Scholar]
- [16].Tomar A, Bhardwaj A, Choudhary A, Bhattacharyya D. Association of Obstructive Sleep Apnea with Nocturnal Hypoxemia in Metabolic-Associated Fatty Liver Disease Patients: A Cross-sectional Analysis of Record-based Data. J Family Med Prim Care 2021;10:3105-10. https://doi.org/10.4103/jfmpc.jfmpc_412_21 10.4103/jfmpc.jfmpc_412_21 [DOI] [PMC free article] [PubMed] [Google Scholar]