The prevalence of HBV, HCV and HIV infection in Romania - a nationwide
screening program for surveillance of viral infections
Risk factors for HBV and HCV infection in two young cohorts in Romania
Dr. Oana Săndulescu, MD, PhDBucharest – Romania
October 2016
06 Oct 2016
Disclosures and acknowledgements
This study is part of the RO 19.02. Project “Strengthening the prevention and control of HIV/AIDS, HBV, HCV in Romania”, financed by the Norway Financial Mechanism 2009-2014, “Public Health Initiatives”.
License thesis “Hepatitis risk factors distribution in a young cohort” performed at the Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. Coordinator: Dr. Anca Streinu-Cercel, MD, PhD; Supervisor: Dr. Oana Săndulescu, MD, PhD.
No relevant conflicts of interestin relation to this presentation
HBV numbers and facts
1995: incidence of HBV in Romania is 25/100,000 population1
1996: Romania implements national vaccination against HBV in children (first dose at birth), healthcare workers
Subsequent catch-up immunization campaigns:o 1999: 9 y/oo 2004: 18 y/o
2015: Nationwide screening program for surveillance of viral infections
2015: incidence of HBV in Romania is 1.15/100,000 population2
1Pitigoi D, et al, Euro Surveill. 2008;13(2).pii:8012.2Romanian National Institute for Public Health 2015. http://www.cnscbt.ro/index.php/rapoarte-anuale/
Methods Nationwide screening program
o HBsAg, anti-HCV, anti-HIV
Confirmation and characterization of positive caseso HBV-DNA, HCV-RNA, HIV-RNA
Risk factor assessmento Standardized paper-based questionnaireo Romanian population vs. international students
Statistical analysis: IBM SPSS Statistics v.22 (Armonk, USA)
12000 persons screenedMedian age 46 (IQR: 36, 57) years
62.7% females
Results
Total number of tests
Number of positive tests
56
9
69
6
410
22 146
17
71
3
914
67
178
12
62
6
106
10
46
1033
5
105
2081
14 30
8
298
21
1209
104
129
13
385
29
1120
73
633
49
450
36
36
4
111
12
30 6
663
12445
9200
19
29
4
62
7
183
15199
15
734
3742
038
3
50
4
57
5
65
13
25
1
539
302166
70
190
6
HBV testing
● <2%
● 2-7%
● >=8%HBV hotspots
Positive HBV tests
7.7% positive tests 1 county in Romania was “HBV-free”
8% 7%10%
8%
4%
8%
12%
6%
11%
19%
9%10%
27%
5%7%
3%
20%22%
10%
17%
11%
8% 8%
20%
7%
40%
9% 9%
3%
8%
15%
20%
16%
0%
4%5%
19%
7%9% 8%
14%11%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
0
562
6926
410
14
146
6
71
3
42
0
38
28
914
5
178
6
62
3
1063
46
3
33 4
105
6
81
2
30
13
298
17
1209
36
1120
13
385
7
129
4
111
030
43
633
29
450
0
36
0
57
34
663
8
183
10
734
6
199
0
1901
50
3
2524
539
23
2166
2
62
0
29
9
200 1
45
0
65
HCV testing Total number of tests
Number of positive tests
HCV hotspots● <2%
● 2-7%
● >=8%
Positive HCV tests
3.3% positive anti-HCV tests
60.7% of the positive tests had negative HCV-RNA
9 counties in Romania were “HCV-free”
3% 3%
5%
6%
8%
0%
10%
4%4%
5%
0%
10%
7%
1%
4%
1%2%
7%5%
7%
3%2%
4%
0%
3%
0%
3% 3%
0%
7%
9%
0% 0%
7%
12%
6%
4%3%
1%
3%
0% 0%0%
2%
4%
6%
8%
10%
12%
14%
=> 1.9%
56 69410
146
71
914
178
62
106
46 33105 81
30 298
1209
129
385
1120
633
450
36
111
30
663
45
2002962
183
199
734
4238
50
5765
25539 2166
190
100
1
0
0
1
2
30
10
10
0
0
0
1
0 0
0
0
0
20 2 2
1
2
0
00
018
0
620
00
0
HIV testing Total number of tests
Number of positive tests
HIV hotspots● <2%
● 2-7%
● >=8%
Positive HIV tests
0.4% positive HIV tests 26 counties in Romania were “HIV-free”
0%0%
3%
0%0%0%
1%0%
0%
3%
0%0%0%0%
1%
0%0%0%
1%1%
0%0%
1%
0%0%0%
1%
0%0%0%
3%
0%0%0%0%0%0%0%0%0%
7%
0%0%
1%
2%
3%
4%
5%
6%
7%
8%
Risk factors
HB
V HIV infection OR: 13.2 (95%CI: 1.1, 157.1)
STIs – OR: 13 (95%CI: 1.1, 157.1)
Coagulopathy (p=0.030, χ(2)=6.999)H
CV Injected drug use
(p=0.003, χ(1)=305.000)
Needle sharing (p<0.001, χ(2)=305.000)
Coagulopathy (p<0.001, χ(2)=151.998)
Risk factors for viral hepatitis
Risk factors
Higher prevalence of risk factors in the male population:
o unprotected oral i/c OR: 5.5 (CI95%: 2.9, 10.2)
o history of STIs OR: 3.4 (CI95%: 1.3, 10.0)
o unprotected anal i/c OR: 2,6 (CI95%: 1.1, 6.0)
o unprotected vaginal i/c OR: 2.2 (CI95%: 1.5, 3.3)
o piercing/tattoos OR: 1.9 (CI95%: 1.4, 2.6)
Clustering of risk factors In patients with STIs:
o IDU OR: 372 (CI95%: 64, 2180)o Needle sharing OR: 124 (CI95%: 26, 598)
In patients with piercings/tattoos:o IDU OR: 69 (CI95%: 14, 346)o Needle sharing OR: 16 (CI95%: 4.5, 56.8)o Unprotected intercourse: oral OR: 34 (CI95%: 19, 61) anal OR: 25 (CI95%: 10, 64) vaginal OR: 13 (CI95%: 8, 23) homosexual OR: 10 (CI95%: 4.7, 21.2)
o Multiple sex partners OR: 10 (CI95%: 7, 14)
International students vs. general population
• Transfusion/transplantation (p=0.029)
• IDU (p=0.048)• Travel to endemic areas
(p<0.001)• Unprotected oral or
vaginal intercourse (p=0.004)
• Tattoos/piercing (p<0.001)
International students (n=77) General population (n=294)
Not seeking medical attention (p<0.001)
Median age: 25 years (IQR: 24, 26 years)
HBV
0%Study
4.4%Control
HCV
0%Study
0.4%Control
p=0.246 p=0.892
Prevalence of viral hepatitis
o International students had higher prevalence of risk factors
buto They were better informed on how to avoid riskand thereforeo They had a lower prevalence of HBV (0% vs. 4.4%) and
HCV (0% vs. 0.4%) infection.
Take home messages
Vaccination decreased the incidence of HBV infection 21-fold
12000 persons screenedo 7.7% positive HBsAgo 1.9% confirmed HCV infectiono 0.4% positive HIV tests
Targeted outreach programs in the identified hotspots
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