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Evolving epidemiology of hepatitis C virus

The publication of the Global Burden of Disease Study 2010 (GBD 2010) and the accompanying collection of Lancet articles in December 2012 provided the most comprehensive attempt to quantify the burden of almost 300 diseases, injuries, and risk factors, including neglected tropical diseases (NTDs) [1]–[3]. The disability-adjusted life year (DALY), the metric used in the GBD 2010, is a tool which may be used to assess and compare the relative impact of a number of diseases locally and globally [4]–[6]. Table 1 lists the major NTDs as defined by the World Health Organization (WHO) [7] and their estimated DALYs [1]. With a few exceptions, most of the NTDs currently listed by the WHO [7] or those on the expanded list from PLOS Neglected Tropical Diseases [8] are disablers rather than killers, so the DALY estimates represent one of the few metrics available that could fully embrace the chronic effects of these infections.

Table 1
Estimated DALYs (in millions) of the NTDs from the Global Burden of Disease Study 2010.

Disease	DALYs from GBD 2010 (numbers in parentheses indicate 95% confidence intervals) [1]	
NTDs	26.06 (20.30–35.12)	
Intestinal nematode infections	5.19 (2.98–8.81)	
Hookworm disease	3.23 (1.70–5.73)	
Ascariasis	1.32 (0.71–2.35)	
Trichuriasis	0.64 (0.35–1.06)	
Leishmaniasis	3.32 (2.18–4.90)	
Schistosomiasis	3.31 (1.70–6.26)	
Lymphatic filariasis	2.78 (1.8–4.00)	
Food-borne trematodiases	1.88 (0.70–4.84)	
Rabies	1.46 ((0.85–2.66)	
Dengue	0.83 (0.34–1.41)	
African trypanosomiasis	0.56 (0.08–1.77)	
Chagas disease	0.55 (0.27–1.05)	
Cysticercosis	0.50 (0.38–0.66)	
Onchocerciasis	0.49 (0.36–0.66)	
Trachoma	0.33 (0.24–0.44)	
Echinococcosis	0.14 (0.07–0.29)	
Yellow fever	<0.001	
Other NTDs *	4.72 (3.53–6.35)	


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* Relapsing fevers, typhus fever, spotted fever, Q fever, other rickettsioses, other mosquito-borne viral fevers, unspecified arthropod-borne viral fever, arenaviral haemorrhagic fever, toxoplasmosis, unspecified protozoal disease, taeniasis, diphyllobothriasis and sparganosis, other cestode infections, dracunculiasis, trichinellosis, strongyloidiasis, enterobiasis, and other helminthiases.



Even DALYs, however, do not tell the complete story of the harmful effects from NTDs. Some of the specific and potential shortcomings of GBD 2010 have been highlighted elsewhere [9]. Furthermore, DALYs measure only direct health loss and, for example, do not consider the economic impact of the NTDs that results from detrimental effects on school attendance and child development, agriculture (especially from zoonotic NTDs), and overall economic productivity [10], [11]. Nor do DALYs account for direct costs of treatment, surveillance, and prevention measures. Yet, economic impact has emerged as an essential feature of the NTDs, which may trap people in a cycle of poverty and disease [10]–[12]. Additional aspects not considered by the DALY metrics are the important elements of social stigma for many of the NTDs and the spillover effects to family and community members [13], [14], loss of tourism [15], and health system overload (e.g., during dengue outbreaks). Ultimately NTD control and elimination efforts could produce social and economic benefits not necessarily reflected in the DALY metrics, especially among the most affected poor communities [11].

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The global burden of disease study 2010: interpretation and implications for the neglected tropical diseases.

Curcumin, the natural yellow-colored active principle, also called turmeric yellow, extracted from the perennial herb Curcuma longa L., has potent biological and pharmacological properties such as antioxidant, anti-inflammatory, antifungal, antibacterial, anti-ischemic, antitumor, and anticancer actions. The molecular mechanism of the hepatoprotective action of curcumin is due to its antioxidant properties and inhibitory activity against nuclear factor (NF)-κB that regulates different proinflammatory and profibrotic cytokines. Overall, scientific reports demonstrate that curcumin has high therapeutic ability for treating hepatic disorders. Here is a systematic discussion of the hepatoprotective activity of curcumin and its possible mechanisms of actions.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/1541-4337.12047

Curcumin and Liver Disease: from Chemistry to Medicine

Hepatitis C virus is the main cause of chronic liver disease and cirrhosis, and also liver cancer. According to global health importance of hepatitis C, decreasing the burden of HCV infection and HCV-related disease is so important. It need to design and implement preventive activity against HCV infection by introducing primary and secondary prevention activities. Hepatitis C has no effective vaccine. Considering counseling and education of people to avoid risk factors, such as IV drug abusing and having multiple sex partners, are important primary prevention activities.Public health surveillance is an effective strategy to detect new cases, risk factors and burden of disease. Early diagnosis and prompt treatment by expert specialists can decrease hepatitis C and HCV- related diseases prevalence, disease sequel and burden of hepatitis C. Monitoring and assessment of preventive programs is required to identify the strength and weakness of program and to re-establish newer one.

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Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease

Background and Aims: Health care workers (HCWs) are at risk of contracting and spreading hepatitis B virus (HBV) and hepatitis C virus (HCV) to others. The aim of this study was to evaluate knowledge, attitudes and behavior of physicians concerning HBV and HCV. Methods: A 29-item questionnaire (reliability coefficient = 0.7) was distributed at two national/regional congresses and two university hospitals in Iran. Five medical groups (dentists, general practitioners, paraclinicians, surgeons and internists) received 450 questionnaires in 2009, of which 369 questionnaires (82%) were filled out. Results: Knowledge about routes of transmission of HBV and HCV, prevalence rate and seroconversion rates secondary to a needlestick injury was moderate to low. Concern about being infected with HBV and HCV was 69.4±2.1 and 76.3±2 (out of 100), respectively. Complete HBV vaccination was done on 88.1% of the participants. Sixty percent had checked their hepatitis B surface antibody (anti-HBs), and 83.8% were positive. Only 24% of the surgeons often used double gloves and 28% had reported a needlestick. There was no significant correlation between the different specialties and: concern about HBV and HCV; the underreporting of needlestick injuries; and correct knowledge of post-needlestick HBV infection. Conclusions: Although our participants were afraid of acquiring HBV and HCV, knowledge about routes of transmission, prevalence, protection and post-exposure seroconversion rates was unsatisfactory. By making physicians aware of possible post-exposure prophylaxis, the underreporting of needlestick injuries could be eliminated. Continuous training about HBV and HCV transmission routes, seroconversion rates, protection, as well as hepatitis B vaccination and checking the anti-HBs level, is a matter of necessity.

Knowledge, Attitudes and Practice of Iranian Medical Specialists regarding Hepatitis B and C

books by two independent reviewers. We also searched the research projects of 29 out of 40 Iranian universities of medical sciences from their websites. We contacted the Center for Disease Control (CDC) of the Iranian Ministry of Health and the Iranian Blood Transfusion Organization (IBTO) for searching national reports from the study time period. Medical students’ theses were also evaluated by two independent reviewers from the Iranian center for scientific documents and records (IranDoc). Finally, we consulted eight expert HCV researchers in Iran and searched their personal archives for additional citations. Forward and backward citations of searched items were also performed. Critical appraisal and selection of studies Two independent reviewers reviewed all citations thoroughly and checked for eligibility criteria to include the studies in the analysis. The inclusion criteria were all cross-sectional studies that specified temporal and geographic characteristics of the study; sufficiently declared objectives; and that used a valid 213 Seyed Moayed Alavian et al. Hepatitis Monthly, Summer 2009; 9(3): 211-223 sampling method that allowed for a generalization of the findings to the target population, valid measurement instruments for all study subjects, and appropriate analytic methods for the given sampling design and demographic characteristics. We revised the criteria developed by Sharifi et al. for this purpose (12). Data extraction After evaluating studies on these criteria, we extracted the findings of the included studies to Excel spreadsheets. The extracted data were year of the study, first author, province and district of the study, sample population, sampling method, sample size, HCV Antibody detection method, HCV Antibody kit name, mean age and standard error (SE) of subjects, percentage of male subjects, and HCV point prevalence in study subjects and/or in males/females and its SE. If there were other parameters reported other than SE, such as standard deviation, confidence interval, and/or P.value, the proper modifications were performed to calculate SE. Statistical analysis We analyzed the extracted data to estimate the point prevalence of HCV infection and its 95% confidence interval (CI) and used a Cochrane Q-test with a significance level of < 0.1 for checking the statistical heterogeneity of the results. We used a meta-analysis method with the “meta” command using fix/random model based on the results of the heterogeneity test. It seems that the meta-analysis method would not have been a suitable method to achieve the objectives of this systematic review because the weighting system of this method only considers sample size and not the size of the provincial population. We used a survey data analysis method to calculate the estimate of the nationwide prevalence rate considering the weight of each province as the ratio of the provincial population to the sample size(s), where the population of each province was retrieved from the Iranian national census at 2006 (7). In provinces with more than one prevalnce study (Tehran and Sistan-va-Baluchestan), the provincial prevalence was calculated by a meta-analysis of the studies, and the total sample size was determined by adding all study sample sizes. The analysis was performed with STATA 9.1 software (STATA Corp. LP). The results were shown in geographic maps using Arc View 3.2a software (ESRI Inc. NY).

Bahrami Ahmadi Amir

Papers

Hepatitis C infection in the general population of Iran: a systematic review.