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AM MastromatteoØ{*}, GL RapacciniØ{*}, S
UrsinoØ{*}, G CapelliØ{*}, L PuglisiØ{*}, GB
GasbarriniØ{*} and GC VaniniØ{*}. Ø{*}Institute of
Internal Medicine Catholic University, Rome; Ø{*}Institute of
Hygiene; Catholic University, Rome.
Introduction: Several epidemiological studies have shown the
existence of other ways of transmission of the hepatitis C virus
(HCV) besides the parenteral one, but the mechanisms involved are
not yet clear. The aim of this study is to evaluate the prevalence
of HCV infection in family contacts of infected patients and to
analyse the epidemiological risk factors and the possible
transmission routes, with particular regard to saliva, associated
with intrafamiliar transmission of HCV.
Material and methods: We studied 138 relatives of 45 patients
(index cases) affected by C virus related chronic hepatitis: 45
spouses, 89 children, 4 cohabitants. The index cases were chosen
for socioeconomical condition, geographical area, marital status
and age. To assess the risk factors for the infection an anonymous
questionnaire was provided to each subject. All the studied
subjects underwent physical examination, serology for anti HCV
antibodies (Elisa 2°, Riba 3°) and ALT values. The
subjects were tested for the presence of HCV RNA both in blood
serum and in saliva by nested PCR amplification of the 5'UTR
region. The genotype was studied using specific primers of the core
region. The statistical analysis of data was made with K Cohen
Test. Results: The questionnaires have confirmed a role for the
following risk factors: transfusion, sexual contact, contaminated
needle injury and dental surgery. No one of the index cases was
intravenous drug user or haemodialysis patient. Antibodies to HCV
were detected in 8/138 (5.7%) of the family members of the index
cases. Of the positive contacts 4 (44%) were positive for serum
HCV-RNA: spouses 2, children 1, cohabitant 1. Of antibodies
negative contacts 3(2.3%) were positive to HCV-RNA (spouses). In
total the 11.1% of the analysed spouses was infected. Comparative
genetic analysis was used to confirm the correlation between the
index cases and the affected relatives. The genotype 1b was
predominant in the studied population. HCV-RNA was found in 44%
examined saliva and 39% of these were found serum HCV-RNA negative.
A significant correlation existed between the detectability of
HCV-RNA in saliva and in serum(K 0.4435, Z 7.98, Pr greater than Z
0.000: Agreement 76.61% and the expected agreement 57.96%)
Conclusions: We observed an high risk of infection between
relatives of the index cases, in particular spouses. We found
HCV-RNA also in saliva of serum PCR-negative patients. The
epidemiological data on the intrafamiliar spread of HCV may be
underestimated by the existence of infected relatives serum
negative but saliva positive for the presence of the virus. In
general, the whole of these observations suggests a possible major
role of biological fluids in the intrafamiliar spread of HCV.
Source: American Association for the Study of Liver Diseases -
1996 Annual Meeting
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