| Abstract |
Epidemiological and molecular analysis of hepatitis viruses, in a well-defined rural area of Crete
Aim: An observational seroepidemiological study was carried out in a well-defined primary-care district on the island of Crete in order to determine the recent endemicity of viral hepatitis in Cretan-population.
Setting and participants: The setting, consisted of a semi-urban group and a remote & rural group. Serum samples were collected from 876 subjects (437 males, 439 females) aged 15 years or above. Subjects were randomly selected from the permanent population of the area that consisted of 5,705 individuals. The aim was to measure the prevalence of selected viral-hepatitis markers. The molecular analyses, and the possible routes of hepatitis B and C transmission were additional questions to be answered by the study.
Results: Hepatitis-B surface-antigen (HBsAg) was found positive in twenty-nine individuals, (3.3%). Antibodies to hepatitis-B virus core-antigen (HBcAb) were detected in 287 subjects (32.8%) and antibodies to hepatitis-C virus (anti-HCV) were detected in nineteen subjects (2.2%). Seropositivities for the semi-urban group were: 3.4%, 19.1%, 2.1% and 3.2%, 48.8%, 2.2% in remote & rural group respectively. Virtually, all subjects >45 years old were seropositive for antibodies to hepatitis-A, whereas approximately 80% of those in the 15-44 age-group were found to be seropositive.
Conclusion: A threefold increase in the HBV exposure and carrier proportion was found in Cretan native-population and in rural-areas compared to older studies carried out in other rural-populations of the island. It is still unknown whether the recent economic crisis or the demographic changes in Cretan-population contributed to these findings. HCV endemicity remains relatively constant, however an alteration of hepatitis-C genotypes was observed. Regarding HBV infection, genotype D appears to be predominant and Crete, as it is throughout the eastern Mediterranean. Exposure to HAV was found to be higher in remote and rural areas compared to semi-urban areas. The modes of transmission of hepatitis in the present study seem to follow mainly the hematogenous route. They can also result from habits, the use of tobacco, alcohol, and the spread of drug abuse in the countryside. Important emerging unfortunately iatrogenic factors and the domestic diaspora, especially for hepatitis B. More generally, the increasing trend of hepatitis B and C, was more evident in individuals very little conscious of the danger of Hepatitis’ infection, and those living under poor hygiene conditions. Furthermore some shift was observed in prevalence of hepatitis B and C, toward the younger age groups.
Keywords: Crete, Greece, viral-hepatitis, markers, prevalence.
Abbreviations: HAV, hepatitis-A virus; anti-HAV, antibodies to hepatitis-A virus antigen; HBsAg, hepatitis-B surface antigen; HBcAb, antibodies to hepatitis-B core-Ag; Anti-HBs, antibodies to hepatitis-B surface antigen; Anti-HBe antibodies to hepatitis-B e-core antigen; HCV, hepatitis-C virus; anti-HCV, antibodies to hepatitis-C virus antigen; AHC, Arkalochori Health-Centre.
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