Pasha O ¹, Khan AJ¹ , A. Shah², J. McCormick¹, S. Fisher-Hoch³ , Luby SP¹

¹Department of Community Health Sciences, AKU, ²Aga Khan Health System, Punjab, ³Department of Pathology, AKU.

Infection with hepatitis C virus is endemic in Pakistan. Health care provider dispensed injections have been shown to be the catalyst driving the epidemic. The role of intrafamilial spread of hepatitis C has been cited, however the route of transmission between family members is not well documented. We wanted to document familial clustering of hepatitis C infection and characterize its transmission.

The population of Hafizabad, a rural marketing town in Punjab, has a hepatitis C infection rate of 7% from a general survey. Hepatitis C infection rises from 2.7% in people less than 19 years to 35% over the age of 60 years. We interviewed 24 people infected with hepatitis C and 74 family members, including 18 spouses, all of whose sera were tested for hepatitis C antibody. 3/18 (17%) of the spouses and 9/56 (16%) of the other family members were hepatitis C positive. Family members of HCV positive persons are two and a half times more likely to be infected with HCV then the general population (OR = 2.8; 95% CI 1.21 -6.39; p = 0.007). Twenty nine per cent (7/24) of the families had at least one family member who was hepatitis C positive. The age of the population in the family survey is the same as the age of the population in the general survey of the town. The family members who were hepatitis C positive, were 2.4 times more likely to have received 5 or more injections in the past year than those family members who were not infected with hepatitis C (OR 8.8; p = 0.002). They were 3.8 times more likely to have received 10 or more injections per year between 1983 and 1993 than those who were hepatitis C negative (OR 6.6; p = 0.009). The relationship between injections in the past 5 and 10 years and HCV infection was dose dependent ( Chi square for linear trend p = 0.09 and p = 0.01). No other risk behaviour was associated with HCV infection; including intravenous drug abuse, sexual risk behaviour, blood transfusions, and occupational hazards. Interspousal transmission was not demonstrated as spouses were no more likely to be infected than other family members. There was no association with seropositivity and sharing of tooth brush or razors, contact with needles used by other family members, or contact with family members ’blood.

We conclude that HCV infection in families is determined by the prevalence of high risk needle exposure. The clustering in families is dependent upon similar risk behaviours, rather than upon intrafamilial routes of transmission. To stem the tide of the epidemic improved needle practices are required.

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