Global epidemiology of hepatitis C virus infection New estimates of agespecific antibody to HCV seroprevalence Mohd Hanafiah K et al57 4 Hepatology 2013 HCV Epidemiology in West Africa ID: 1043491
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2. % of Global HCV Seropositive Cases
3. Global epidemiology of hepatitis C virus infection: New estimates of age‐specific antibody to HCV seroprevalenceMohd Hanafiah, K. et al.57 (4) Hepatology, 2013
4. HCV Epidemiology in West AfricaPrevalence:Most recent estimates: >2%Limitations on estimatesPublished studies: 0-45%Limited, or no, population based studiesBased on serology (Ab test)Over time, Serologic testing methods have changed1st 3rd generation ELISA assaysRapid detection assays
5. HCV Epidemiology in West AfricaIncidence:?Severity of disease:?Level of chronicity?Transmission:?Hypothesized theories: Contaminated needlesMedical or cosmetic based procedures (hospital or community based)Association with HBV infectionGenotype distribution:Limited data
6. Genotype distribution from HCV Database (Los Alamos National Laboratory)
7. HCV Genotype DistributionsLANL DatabaseCountryGenotype DistributionTotal N (viruses sequenced)Ghana11.4% genotype 188.6% genotype 244Nigeria100% Genotype 14Burkina28.6% Genotype 171.4% Genotype 214Cameroon40.0% Genotype 124.9% genotype 235.0% genotype 4443Uganda100% Genotype 49Egypt98% genotype 4957South Africa 11.6% genotype 114.6% genotype 273.4% genotype 5a267
8. Issues / unique findings identified from studies in AfricaCorrect testing strategy to provide estimatesEstimates of seroprevalence?, clearance?Need to account for assay sensitivity / specificityHigh false positive rates or High spontaneous clearance rates? Several studies: +Ab positive, HCV RNA negativeHigher rate than expected for spontaneous clearanceLow viral levelsLess severe disease?Diversity of viral genotype distributionEndemic for at least 500 years
9. HCV in Africa:Why Study?Vastly understudiedLarge burden of diseaseSuspected, but not proven geographic origin of HCVLong-standing host-viral relationshipHost / viral adaptation studiesViral evolutionary processNumerous ‘race’ based variations in HCV outcomesClearance of infection, natural history, treatment response
10. HCV in Africa:Why study?Vast potential to study: Host genomic factors associated with HCV outcomesHost adaptation for HCVViral diversity / heterogeneity of HCVAfrica specific epidemiologyAllow for identification and control of epidemicAllow appropriate studies on above aspects
11. Multi-Disciplinary Approach to HCV in Africa
12. HepNet objectivesOver-riding objectives: --establish a multi-disciplinary, structured ‘hepatitis network’ that will enhance our collective ability to address the fundamental questions surrounding the viral hepatitis epidemics in West Africa --to enable the successful competition for grants that will address critical issues surrounding viral hepatitis in West Africa
13. VirologyMolecular / DiagnosticEpidemiologyAfrica Based Sites and Experts / InvestigatorsKumasiObuasiIbadanHost Genetics
14. JHSPHCambridgeLUMCAfrica Based Sites and Experts / InvestigatorsKumasiObuasiIbadanDukeCDC
15. Current ‘Goals’ of HepNetEstablish / Strengthen collaborationsMulti-disciplineInternationalEstablish HepNet communication routesInaugural meetingAugust 12-13, 2013Kumasi, Ghana
16. Growth of HepNetEstablishing Effective NetworkCentersExpertsCommunicationShared Resources / Data / SamplesIdentifying Critical Questions
17. Current HepNet ProtocolsMETS Pilot DataNigeria Pilot DataKumasi Blood Bank ProtocolObuasi Community Based SurveyHBV Vertical Transmission Feasability Survey??
18. Planned GrantsHCV In Africa: Transmission and Host/Viral Genetic StudyPlanned October Submission: NIH R01Co-PI mechanism with LUMC as applicant institutionJHSPH: K NelsonDuke: T UrbanCDC: J Forbi, Y KhadanovSanger/Cambridge: M Sandhu
19. HepNetQuestions as we proceed thru meetingWhat are the critical questions surrounding viral hepatitis in Africa?What are the limiting factors to address and study such issues?How can a multi-disciplinary approach be utilized to address these questions?’How can HepNet foster collaboration and communication to enhance the collective ability to perform research and improve viral hepatitis control?
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