Epidemiology of Hepatitis C: Geographic Differences and Temporal Trends

• ABSTRACT
• GEOGRAPHIC PATTERNS OF HCV INFECTION
• DISEASE TRANSMISSION PATTERNS
• Injection Drug Use
• Transfusions and Transplants
• Unsafe Injections and Other Healthcare-Related Procedures
• Occupational Exposures
• Perinatal Transmission
• Sexual Activity
• Other Potential Risk Factors
• PREVENTION AND CONTROL OF HCV INFECTION AND HCV-RELATED LIVER DISEASE
• Primary Prevention
• Secondary Prevention
• ABBREVIATIONS
• REFERENCES

ABSTRACT

Hepatitis C Virus (HCV) infection appears to be endemic in most parts of the world, with an estimated overall prevalence of 3%. However, there is considerable geographic and temporal variation in the incidence and prevalence of HCV infection. Using age-specific prevalence data, at least three distinct transmission patterns can be identified. In countries with the first pattern (e.g., United States, Australia), most infections are found among persons 30-49 years old, indicating that the risk for HCV infection was greatest in the relatively recent past (10-30 years ago) and primarily affected young adults. In countries with the second pattern (e.g., Japan, Italy), most infections are found among older persons, consistent with the risk for HCV infection having been greatest in the distant past. In countries with the third pattern (e.g., Egypt), high rates of infection are observed in all age groups, indicating an ongoing high risk for acquiring HCV infection. In countries with the first pattern, injection drug use has been the predominant risk factor for HCV infection, whereas in those with the second or third patterns, unsafe injections and contaminated equipment used in healthcare-related procedures appear to have played a predominant role in transmission. Much of the variability between regions can be explained by the frequency and extent to which different risk factors have contributed to the transmission of HCV. Because different strategies are required to interrupt different patterns of HCV transmission, determining the epidemiology of HCV infection in areas where that information has not yet been assessed is critical for developing appropriate prevention programs.

Hepatitis C virus (HCV) is a bloodborne pathogen that appears to be endemic in most parts of the world. HCV is the most common cause of posttransfusion hepatitis worldwide and a leading cause of end-stage liver disease requiring liver transplantation. There is, however, considerable geographic and temporal variation in the incidence and prevalence of HCV infection. Much of this variability can be explained by differences in the frequency and extent to which different risk factors have contributed to the transmission of community-acquired HCV infection.

GEOGRAPHIC PATTERNS OF HCV INFECTION

It is estimated by the World Health Organization that the global prevalence of HCV infection averages 3%, representing approximately 170 million HCV-infected persons worldwide.[1] Although the most valid estimates of the prevalence of HCV infection are provided by data from population-based surveys, such information is not available from most parts of the world. Consequently, prevalence estimates from selected populations, such as blood donors, are frequently used to assess the burden of HCV infection. Many published studies reporting the prevalence of antibody to HCV (anti-HCV) among blood donors have been based on repeatedly reactive results by enzyme immunoassays (EIA) without supplemental testing, which may have resulted in their overestimating the prevalence of infection in this population group.

On the basis of studies among blood donors that used both EIA and supplemental testing (Fig. [1]) , the lowest anti-HCV prevalence rates (0.01-0.1%) have been reported from the United Kingdom [2] [3] [4] and Scandanavia.[5] [6] Low but slightly higher rates (0.2-0.0.5%) have been reported from Western Europe,[7] [8] [9] [10] North America,[11] [12] [13] most areas of Central and South America,[14] [15] [16] [17] [18] Australia,[19] and limited regions of Africa, including South Africa.[20] [21] [22] Intermediate rates of anti-HCV prevalence (1-5%) have been reported from Brazil,[23] [24] Eastern Europe, the Mediterranean,[25] [26] [27] [28] [29] [30] the Mideast, the Indian subcontinent,[31] [32] [33] [34] [35] parts of Africa,[36] [37] [38] [39] [40] [41] and Asia.[42] [43] [44] [45] [46] [47] [48] [49] [50] [51] [52] [53] [54] [56][SP55[RP A single study from Libya reported a rate of 7%,[57] but by far the highest HCV prevalence rates (17-26%) have been reported from Egypt.[58] [59] [60] Although estimates of prevalence derived from studies of blood donors provide information about the relative magnitude of regional differences in the prevalence of HCV infection, they underestimate the absolute burden of infection, because even first-time blood donors are highly selected populations and are not representative of the infection rates in the general population. For example, in the United States, the prevalence of HCV infection among volunteer blood donors in 1990 was 0.6%, threefold lower than the 1.8% prevalence in the general population.[61] Furthermore, even among studies of similar populations, such as blood donors, comparisons may not be valid because of differences in testing methodologies, as well as in the degree to which individuals with risk factors for HCV infection may have been excluded.

There are a limited number of population-based studies on the age-specific prevalence of HCV infection. These studies demonstrate at least three distinct epidemiologic profiles of HCV transmission that can be identified worldwide (Fig. [2]). These profiles reflect not only regional variations in the prevalence of HCV infection but also variations in the time period(s) during which there was an increased risk for acquiring HCV infection.

In the first pattern, age-specific prevalence is low among persons less than 20 years old; rises steadily through middle age, with most infections occurring among adults 30-49 years old; and declines sharply among persons greater than 50 years old. This pattern, found in the United States[61] and Australia,[62] [63] suggests that most HCV transmission occurred in the relatively recent past (10-30 years ago) and primarily among young adults. In the United States, estimates derived from catalytic modeling of these age-specific prevalence data indicate that the incidence of newly acquired HCV infection was low (18/100,000) before 1965, increased steadily through 1980, and remained high (130/100,000, corresponding to an average of 240,000 infections per year) through 1989.[64] Since 1989, the incidence of HCV infection has declined more than 80% based on trends in reported cases.[65]

In the second pattern, age-specific prevalence is low in children and younger adults but increases sharply among older persons, who account for most infections. This type of pattern is seen in Japan[66] [67] and Italy[68] [69] and is consistent with the risk for HCV infection having been greatest in the distant past (30-50 years ago).

In the third pattern, the prevalence of HCV infection increases steadily with age, and high rates of infection are observed among persons in all age groups. This pattern, seen in Egypt,[70] [71] indicates an increased risk in the distant past followed by an ongoing high risk for acquiring HCV infection.

These age-specific prevalence patterns provide information to assess how the burden of disease due to HCV infection may change during the coming years. In the United States and other countries where the emergence of HCV infection is a relatively recent event, the magnitude of the burden of HCV-related chronic liver disease has yet to be realized. In contrast, in countries where the emergence of HCV infection occurred in the distant past, the burden of disease might have already peaked, although changes in disease transmission patterns that result in increased infection rates among younger persons could result in future increases in chronic disease as this cohort ages. In countries where there have been ongoing high levels of HCV transmission, the magnitude of both the current and future burden of disease are of concern.

DISEASE TRANSMISSION PATTERNS

Many geographic and temporal differences in prevalence of HCV infection can be related to the relative importance of different risk factors over time. Globally, the most frequently cited risk factors for HCV infection are blood transfusion from unscreened donors and injection drug use. However, in some parts of the world, exposures to infectious blood from other healthcare-related procedures and cultural practices are being increasingly recognized as playing an important role in HCV transmission.

Injection Drug Use

Injection drug use is one of the most efficient routes for HCV transmission. In the United States and Australia (pattern 1), where most infections have been acquired in young adults, illegal use of injection drugs has been the dominant mode of HCV transmission during the past 30 years, accounting for 60%[61] and 80%,[62] [63] respectively, of prevalent infections. HCV infection is acquired more rapidly after initiation of injection drug use than other viral infections, and after 5 years of injection, 50-90% of users are infected with HCV.[72] [73] [74]

In the United States, drug-use-related risk factors for acquiring HCV infection include frequent use, sharing of drug paraphenalia, injecting cocaine, and first injecting with an older user.[72] [73] Thus, the rapid acquisition of HCV infection among injection drug users is likely explained by their high prevalence of chronic infection and their particular drug-using behaviors, both of which facilitate the likelihood of exposure among new users to an HCV-infected person. A high proportion of new HCV infections continues to be associated with injection drug use, but for reasons that are unclear, the dramatic decline in the incidence of acute hepatitis C since 1989 in the United States correlates with a decrease in cases among injection drug users.[65] [72] [75]

In countries where the increased incidence of HCV infection occurred in the distant past (patterns 2 and 3), injection drug use appears to have played a minor role, although its contribution to more recent transmission may be increasing. In both Japan and Italy, the highest incidence of infection is now among young adults.[76] [77] In Italy, a history of injection drug use is reported by half of persons with newly acquired hepatitis C and by 40% of persons less than 40 years old with chronic hepatitis C.[77] [78] In contrast, none of those with chronic infection over 40 years old reported injection drug use.[78] In one study from Egypt, a history of injection drug use was reported by two thirds of HCV-positive paid professional blood donors.[58]

Intranasal cocaine use as a route for HCV transmission remains to be established. Although it is biologically plausible that such transmission could occur through the shared use of blood-contaminated straws, to date only one study has reported an association between intranasal cocaine use and HCV infection that was independent of injection drug use.[79] Not only was this study performed in a highly selected population (i.e., volunteer blood donors), but cross-sectional seroprevalence surveys have serious limitations for making causal inferences, particularly when the studies do not use random (probability) sampling.[80] Furthermore, cocaine use (by injection or noninjection) has been reported by a high proportion (13% overall; 22% among 25-39 year olds) of the general population in the United States,[61] and intranasal cocaine use specifically has been reported by >10% of HCV-negative blood donors.[79] [81] In contrast, such a history is uncommon (<5%) in the absence of injection drug use among patients with recently acquired hepatitis C.[65] Thus, we cannot conclude that intranasal cocaine use places persons at risk for HCV infection until more data are available, including whether persons with a history of intranasal cocaine use alone are likely to be infected with HCV.

Transfusions and Transplants

Transfusion of blood or plasma-derived products and transplantation of solid organs from HCV-infected donors to their recipients are highly effective routes for transmitting HCV.[82] In areas of the world where HCV testing of blood and organ donations has not been feasible, these exposures remain important sources for infection. However, in most developed countries, infectious disease screening and testing practices have eliminated most transfusion- and transplant-related transmission of HCV and other bloodborne pathogens. In such countries, incidence rates of posttransfusion hepatitis C ranged from 5% to 13% before 1986,[83] [84] [85] [86] [87] [88] [89] [90] declined to between 1.5% and 9% from 1986 to 1990,[85] [87] [89] and then to between 0.6% and 3% after the introduction of first-generation anti-HCV testing.[88] [90] [91] [92] The implementation of more sensitive multiantigen testing has further reduced the risk of transfusion-associated HCV infection to an estimated 0.01%-0.9% per recipient transfused.[90] [93] It can be assumed that the use of anti-HCV-negative organ and tissue donors also has reduced the risk of HCV transmission from transplantation.

Hemophilia patients who were heavily transfused with nontreated factor concentrates have prevalence rates of anti-HCV exceeding 90%, which along with those for injection drug users are the highest of any group studied.[82] However, in countries that have implemented effective viral inactivation of clotting factor concentrates, these blood products as a source for HCV infection have been virtually eliminated.

Unsafe Injections and Other Healthcare-Related Procedures

In developed countries, appropriate use of disposable equipment and effective disinfection and sterilization procedures have reduced the transmission of bloodborne pathogens, including HCV. Transmission of HCV from healthcare-related procedures is rarely reported (except in the chronic hemodialysis setting) , and in the United States, case control studies have not found an association between standard medical care procedures and transmission of HCV.[94] [95] However, because most individuals acutely infected with HCV have no or mild symptoms, detecting cases of nosocomial transmission of HCV is difficult, and those episodes that are detected may represent a relatively small proportion of healthcare-related cases of HCV infection. Consequently, although it is still unlikely that such infections occur frequently, it is possible that they may occur more often than is currently recognized.

In the healthcare setting, patients may serve as a reservoir for transmission, and the prevalence among patients in hospital-related (inpatient and outpatient) settings has been reported to range from 2 to 18%[96] [97] [98] [99] and in chronic hemodialysis settings to average 20%.[82] The few reported episodes of HCV transmission from patient to patient in hospital-related settings have mostly involved unsafe injection practices resulting in contamination of equipment used for phlebotomy or flushing intravenous lines or of multiple dose medication vials.[100] [101] [102] [103] Contaminated equipment that was not adequately cleaned or disinfected and was shared among patients has been implicated in one report of HCV transmission to two patients during colonoscopy[104] and is the likely source for transmission among chronic hemodialysis patients.

Among hemodialysis patients, the prevalence of HCV infection varies widely across different geographic regions,[25] [105] ^- [125] which may reflect differences not only in background rates of infection but also in practices related to infection control. The lowest rates have been reported in the United Kingdom and South Africa (1-5%) and the highest in Eastern Europe (20-91%). Intermediate anti-HCV prevalence rates of 10-50% have been reported among hemodialysis patients in North America, Scandanavia, Western and Southern Europe, and Asia. Among anti-HCV-negative hemodialysis patients with no other identified risk factors for infection, the incidence of HCV infection has been estimated at approximately 2-2.6%/year.[105] [125] [126] [127] A correlation between increasing years on dialysis and anti-HCV positivity that was independent of blood transfusion has been demonstrated in both incidence and prevalence studies.[105] [112] [122] [128] [129] [130]

These studies, as well as investigations of dialysis-associated outbreaks of hepatitis C, indicate that HCV might be transmitted among these patients because of incorrect implementation of infection-control procedures. In a recent investigation of an outbreak of HCV infection among chronic hemodialysis patients in the United States, 17% of the susceptible patients acquired HCV infection during a 16-month period, and infection was associated with chronically infected patients at the same station (and same machine) on the same day (Centers for Disease Control and Prevention [CDC], unpublished data, 1999). Multiple opportunities for cross-contamination between patients were observed, including shared equipment and supplies that were not disinfected between patient use, shared multiple-dose medication vials that were placed at patients' stations on top of machines; and contaminated priming buckets that were not routinely changed or cleaned and disinfected between patients.

In countries where the period of increased risk for HCV infection occurred in the distant past, healthcare-related procedures performed both by professionals and nonprofessionals appear to have been a major mode of HCV transmission. In Japan and Italy, geographic clustering of infections among older persons has been reported that is associated not only with transfusions from unscreened donors but also with unsafe injection practices (including reuse of contaminated glass syringes and at-home administration by nonprofessionals using shared syringes among family, friends, and neighbors), surgical procedures, and folk medicine practices (e.g., in Japan, acupuncture performed by unlicensed therapists and traditional remedies performed by family members using nonsterile instruments).[68] [78] [131] [132] [133] The lower prevalence in younger age groups in these populations suggest that these exposures may no longer play a role in transmission.

In countries where the increased risk for HCV infection has been ongoing for many decades, there is evidence that healthcare-related procedures have been the major source for transmission. In Egypt, transmission of HCV has been attributed to unsafe injection practices associated with reuse of glass syringes during mass campaigns to treat schistosomiasis with injection therapy during 1960-1987.[59] [70] [71] [134] Although those campaigns no longer exist, use of common syringes and a history of medical care procedures involving injections or hospitalization continue to be associated with HCV infection, suggesting that unsafe injection practices are playing an ongoing role in transmission.[59]

The role of unsafe injections in the transmission of bloodborne pathogens is being increasingly recognized and has been documented in several other countries, including Romania, Moldova, and Pakistan.[135] [136] [137] Injection-associated bloodborne pathogen transmission occurs when infection control practices are inadequate, and overuse of injections to administer medications might increase opportunities for transmission. In many developing countries, supplies of sterile syringes may be inadequate or nonexistent, injections are often administered outside the medical setting by nonprofessionals, and injections are often given to deliver medication that could be otherwise delivered by the oral route. In addition to unsafe injection practices, inadequate cleaning and disinfection of equipment used in medical and dental settings may also be a major source of HCV transmission in developing countries.

The risk of HCV transmission from infected healthcare workers to patients during the performance of invasive procedures appears to be very low. There have been two reports of HCV transmission attributed to healthcare workers performing such procedures, both involving HCV-infected cardiothoracic surgeons. In the one from Spain, the surgeon transmitted infection to five of his patients during a 6-year period, although the factors responsible for transmission were not identified.[138] In the second report from the United Kingdom, only a single episode of transmission was identified from among 277 patients of the surgeon (who was in training) during a 13-month period.[139]

In the United States, a retrospective investigation was performed of an HCV-infected plastic surgeon whose infection was diagnosed during a routine physical examination (CDC, unpublished data, 1999). HCV testing of 268 (85%) of the surgeon's patients was performed more than 6 months after their surgery, and no provider-to-patient transmission was detected. One other report of an HCV-infected healthcare worker from the United States involved a chronically infected outpatient surgical technician who did not perform exposure prone invasive procedures but who was addicted to narcotics and injected himself with patients' analgesic medications (L Sehulster, personal communication, 2000). Contamination of the medications resulted in HCV transmission to multiple patients.

Occupational Exposures

The proportion of all HCV infections attributed to occupational exposure is small and has shown little temporal or geographic variation. Although healthcare workers with exposure to blood are at risk for being infected with HCV and other bloodborne pathogens, the prevalence of HCV infection among healthcare workers appears to be no greater than that found in the general population of their native regions.[22] [140] [141] [142] [143] [144] [145] [146] [147] [148] Studies done in the United States indicate that this is true even for specialties with a high likelihood of percutaneous exposures to blood, including orthopedic, general, and oral surgeons.[150] [151] [152] [153]

Risk factors for HCV transmission in the occupational setting have not been well defined but appear to be primarily related to a history of accidental needlesticks.[142] Seroconversion after needlestick or sharps exposures averages 1.8% (range, 0-7%),[147] [149] [154] [155] and one study found that such transmission occurred only from hollow-bore needles.[147] Transmission of HCV from blood splashes to the conjunctiva have been described,[156] [157] but transmission via nonintact skin exposures has not been reported.

Perinatal Transmission

Perinatal exposures account for a small proportion of HCV infections, and there appears to be no geographic or temporal differences in the frequency of perinatal transmission. Data from the relatively large number of studies done to date indicate that perinatal transmission occurs exclusively from mothers who are HCV RNA positive at the time of delivery (Table [1]).[158] ^- [189] Of the 25 studies that followed infants for at least 12 months and included testing for HCV RNA, only one episode of transmission was reported from an anti-HCV-positive HCV RNA-negative mother,[162] and the detection method used in this study might not have had sufficient sensitivity to detect lower levels of virus. Thus, it would seem appropriate to evaluate the risk of perinatal transmission only among infants born to HCV RNA-positive mothers (Table [1]). A summary of such studies demonstrates an average risk for transmission of 6% (range, 0-42%) for infants born to HCV-positive mothers who are not infected with human immunodeficiency virus (HIV),[158] [159] [160] [161] [162] [163] [164] [165] [166] [167] [168] [169] [170] [172][SP171[RP [174] [175] [178] [179] [180] [181] [182] [184] [186] [187] [188] [189] and 17% (range, 8.5-44%) for infants born to mothers co-infected with HCV and HIV.[159] [162] [164] [167] [168] [173] [175] [176] [177] [185] [188] [189] Data on the relationship between risk of perinatal transmission and titer of HCV RNA are inconsistent. Studies of HCV/HIV-co-infected mothers more consistently have shown an association between virus titer and transmission. Only two studies of infants born to HCV-positive HIV-negative women reported an association with virus titer, and each reported a different level of HCV RNA related to transmission.[166] [174]

Available data are limited on the relationship between the risk for perinatal transmission of HCV and mode of delivery or type of feeding. Nevertheless, such data indicate no increased risk for transmission related to either vaginal delivery or breast-feeding (Table [1]). The average rate of HCV infection among infants born by vaginal delivery is 10% compared with 8.4% among infants born by cesarean section.[162] [175] [177] [184] [185] Similarly, the average infection rate is 5% among breast-fed infants compared with 8% among bottle-fed infants.[166] [168] [175] [180] [184] [188] [190]

Sexual Activity

The relative importance of sexual activity in the transmission of HCV remains controversial. Associations between sexual activity and infection with HCV have been reported from case-control studies of persons with acute hepatitis C, cross-sectional studies of groups with different types of sexual behaviors (heterosexuals and men who have sex with men [MSM] attending sexually transmitted disease [STD] clinics, female prostititutes), and a cross-sectional study of a representative sample of the general population.[61] [94] [95] [191] [192] [193] [194] [195] [196] [197] [198] [199] Although compared with other groups at risk for HCV infection, the prevalence of HCV infection among male and female heterosexuals and MSM attending STD clinics who denied injection drug use is relatively low (Table [2]). Factors associated with HCV infection in these populations include early age at first intercourse, greater numbers of sex partners, a history of other STDs, and failure to use a condom.[24] [25] [191] [192] [193] [194] [195] [196] [197] [199] [200] [201] [202] [203] [204] [205] [206] [207] [208] [209] [210] Among female prostitutes, sexual activities involving trauma have also been found to be associated with HCV infection.[211] In addition, evidence from one study indicates that male-to-female transmission of HCV may be more efficient than female-to-male,[191] a pattern characteristic of a sexual route of transmission.

Unlike STD populations, there is a striking variation between different geographic regions in the prevalence of infection reported among spouses (i.e., long term steady sex partners) of persons with chronic hepatitis C (Table [3]). In studies done in Western Europe and North America, the average anti-HCV positivity rate among spouses who report no other risk factor for infection is 1.3%.[79] [192] [212] [213] [214] [215] [216] [217] [218] [219] [220] [221] [222] In contrast, higher anti-HCV positivity rates among spouses have been reported from studies done in southern Europe (11%)[203] [223] [224] [225] [226] [227] [228] [229] [230] [231] [232] [233] [234] [235] and Asia (27%).[236] [237] [238] [239] [240] Some of these studies have reported a direct relationship between anti-HCV positivity and increasing years of marriage.[228] [229] [231] [239] However, it is likely that this relationship, as well as the high infection rates, is mostly the result of percutaneous exposures commonly experienced by both spouses in the past, because these studies were done in countries where it appears that contaminated equipment used in traditional and nontraditional medical procedures was the major source for HCV infection.

Similar differences by region in HCV prevalence rates have been found among nonsexual household contacts (Table [3]). In Western Europe and North America, the average anti-HCV prevalence rate among nonsexual household contacts is 0.7%[79] [213] [215] [217] [241] compared with about 4% among such contacts in southern Europe and Asia.[224] [226] [228] [229] [230] [231] [232] [233] [234] [235] [236] [237] [238] [239] [240] [243][SP241[RP[SP242[RP Thus, it is likely that transmission of HCV within households is uncommon in the absence of shared percutaneous exposures.

Only one study has found an association between HCV infection and MSM activity,[196] and at least in STD clinic settings, the prevalence rate of HCV infection among MSM generally has been similar to that of heterosexuals. Because sexual transmission of bloodborne viruses is recognized to be more efficient among MSM compared with heterosexual men and women, why HCV infection rates are not substantially higher among MSM compared with heterosexuals is unclear. This observation and the low prevalence of HCV infection observed among the long-term steady sex partners of persons with chronic HCV infection have raised doubts about the importance of sexual activity in the transmission of HCV. Unacknowledged percutaneous risk factors (i.e., illegal injection drug use) might contribute to increased risk for HCV infection among persons with high-risk sexual practices.

Nevertheless, the findings of existing studies support the conclusion that sexual transmission of HCV occurs but that the virus is inefficiently spread through this manner. Furthermore, in the United States, the low risk of transmitting HCV infection through sexual intercourse is not inconsistent with the results of both incidence and prevalence studies showing that high-risk sexual behavior accounts for 15-20% of HCV infections.[61] [65] Among acute hepatitis C cases reported during 1991-1997, 17% were attributed to sexual exposure in the absence of other risk factors; two thirds of these had an anti-HCV-positive sex partner and one third reported more than two partners in the 6 months before illness (CDC, unpublished data, 1999).[65] In the general population, 15% of prevalent infections could be attributed to sexual exposures in the absence of injection drug use.[61] Sex is a common behavior in the general population, a substantial proportion of the adult population in the United States has had multiple partners, and there are a large number of HCV chronically infected persons in the population. Although there are other types of exposures (e.g., transfusion from an HCV-infected donor) more likely to transmit HCV, they account for a much smaller proportion of infections because of the relatively small proportion of the current population in whom these exposures have occurred.

Other Potential Risk Factors

In the United States, a commonly recognized risk factor can be identified among most (90%) patients with acute or chronic hepatitis C. During 1991-1997, 60% of newly acquired infections were associated with injection drug use, 21% with high-risk sexual exposures (HCV-positive partner, multiple partners, history of STD), 4% with occupational exposures to blood, 3% with household exposure to an infected contact, and 3% to blood transfusion (all of which occurred before 1995) (CDC, unpublished data, 1999).

There are a variety of other percutaneous exposures for which a biologically plausible link with transmission of HCV can be postulated but about which there are insufficient data to assess their role as sources for HCV infection in either developed or developing countries. Reused contaminated instruments and objects during the performance of rituals or cosmetic services, such as tattooing, body piercing, commercial barbering, circumcision, and scarification, have the potential to transmit HCV and other bloodborne pathogens. However, the few studies conducted to date have either used inappropriate control groups or have been done in highly selected groups, resulting in conclusions that cannot be extrapolated to other populations.[77] [244] [245] [246] [247] [248] Thus, there are no studies demonstrating a causal link between these types of practices and HCV infection, and there are no data showing that persons with a history of exposures such as tattooing, body piercing, or being attended by a commercial barber are at increased risk for HCV infection based on these exposures alone.

In the United States, these types of exposures are rarely reported by persons with acute hepatitis C. Among patients reported with acute hepatitis C during the past 15 years who denied a history of injection drug use, only 1% reported tattooing or ear piercing and none reported a history of acupuncture.[75] However, the importance of some of these types of exposures as routes of transmission may differ according to the setting in which they occur. For example, although receiving a tattoo in a licensed commercial establishment may not be associated with an increased risk for HCV infection, when received in the setting of a correctional facility or in an unregulated commercial establishment, the risk associated with this type of exposure might be considerably greater. Similarly, although these types of exposures may not be significant sources for transmission in the United States or where the prevalence of infection is low and/or appropriate infection control standards are practiced, their role in other places or settings needs to be assessed.

PREVENTION AND CONTROL OF HCV INFECTION AND HCV-RELATED LIVER DISEASE

A comprehensive strategy for the prevention and control of HCV infection and HCV-related liver disease requires implementation of primary and secondary prevention activities,[1] [75] although the degree to which the components of such a program can be implemented in individual countries will depend on the capacity and resources available.

Primary Prevention

Because there is currently no vaccine and no effective postexposure prophylaxis for hepatitis C, the major emphasis of activities aimed at the primary prevention of HCV is on the counseling of uninfected persons at increased risk for HCV infection about ways to protect themselves from becoming infected and the counseling of infected persons so that they can reduce their risk of transmitting to others. Primary prevention efforts should also include education to reduce the risk for transmission of HCV in healthcare and other settings by modifying such practices as unsafe injections, emphasizing the importance of infection control, and reducing the risk of percutaneous exposures to blood in these settings. Finally, the implementation of donor screening and testing is needed to prevent transmission of HCV via blood transfusions, blood components, or plasma derivatives.

All countries should develop and implement programs for the primary prevention of new infections. To develop effective approaches to primary prevention, it is necessary to know the relative contribution of various sources of HCV infection. In countries where this information is not available, studies should be performed to facilitate prioritization of possible preventive measures and to allow the most appropriate use of available resources.[1]

In developing countries, where donor screening and testing policies for HCV and inactivation procedures for plasma-derived products have not been implemented and transfusions and organ transplants continue to be major sources for HCV infection, improving the safety of the blood supply should be the highest priority.[1] However, programs should also be initiated to reduce the extent to which HCV is transmitted as a result of inadequate sterilization or disinfection of medical, surgical and dental equipment, reuse of contaminated equipment, and unsafe injection practices. Such programs should include training regarding appropriate infection control practices and use of devices or products that prevent reuse or contamination of equipment. In addition, efforts should be made to modify injection practices of professionals and nonprofessionals and to educate practitioners of folk medicine, rituals, and cosmetic procedures about the risk for transmission of bloodborne pathogens from nonsterile instruments or objects used in these procedures.

In developed countries, primary prevention of illegal drug injecting, which remains the single most important mode for transmission of HCV in these countries, should be a high priority. In addition, although the relative importance of sexual activity as a route for HCV transmission is still unclear, it is known that persons with multiple sex partners are at risk for a variety of STDs and should be counseled regarding behavioral modification to reduce risk for all STDs, which may include HCV. Healthcare professionals should routinely obtain a history that inquires about use of illegal drugs and evidence of high-risk sexual practices to identify individuals for appropriate testing and counseling. Counseling and education, especially of adolescents, to prevent initiation of drug injecting or high-risk sexual practices is critical, but counseling should also be provided to those who already inject drugs or engage in high risk sexual behaviors about what they can do to minimize their risk of becoming infected or of transmitting infectious agents to others, including the need for vaccination against hepatitis B and, where appropriate, hepatitis A. Establishing needle exchange and other programs to increase access to sterile syringes and needles should also be considered.

Secondary Prevention

Countries with more developed economic, medical, and public health infrastructures should also develop programs to identify, counsel, and provide medical management for persons already infected to reduce their risk for developing chronic disease. The implementation of such programs is based on the identification of HCV-infected persons through routine screening of persons most likely to be infected with HCV with established protocols for providing counseling and medical management of those found to be infected. The decision on who to test should be based on various considerations, including whether there is a known epidemiologic link between a risk factor and acquiring HCV infection, the prevalence of the risk behavior or characteristic in the population, the prevalence of infection among those with a risk behavior or characteristic, and the need for persons with a recognized exposure to be evaluated for infection.

In the United States and Europe, routine testing is recommended for individuals in groups at increased risk for HCV infection and individuals with known exposure to HCV-infected blood,[75] [249] including

@nlf:• Anyone who ever injected illegal drugs;

@nl:• Persons who received plasma derived products known to transmit HCV infection that were not treated to inactivate viruses;

• Persons who have received blood products that might have been contaminated with HCV, including products prepared from blood that was either donated before the widespread use of second-generation EIA testing or came from a donor who later tested positive for HCV infection;

• Persons who have been on long-term hemodialysis;

• Healthcare workers after needlesticks, sharps, or mucosal exposures to HCV-positive blood;

• Children born to HCV-positive women.

It is important that all individuals found to be infected receive counseling on ways to reduce their risk for transmitting HCV to others.[75] They should be advised to not donate blood, body organs, other tissue, or semen; to not share toothbrushes, razors, or other personal care articles that might have blood on them; and to cover cuts and sores. Infected persons with a steady sex partner do not need to change sexual practices but should be advised to discuss with their partner the need for counseling and testing. The couple should be informed of available data regarding risk for HCV transmission by sexual activity to assist them in making decisions about precautions. They might decide to use barrier precautions if they want to lower the limited chance of spreading HCV to their partner. Infected persons should also be provided with information about ways to prevent further harm to their liver, primarily through the avoidance of alcohol and by vaccination against hepatitis A and, when appropriate, hepatitis B. As part of these programs, it is also critical that protocols are in place to ensure that infected individuals receive appropriate medical evaluation for chronic liver disease and possible treatment.

ABBREVIATIONS

CDC Centers for Disease Control and Prevention

EIA enzyme immunoassay

HCV hepatitis C virus

HIV human immunodeficiency virus

MSM men who have sex with men

STD sexually transmitted disease

REFERENCES

• 1 WHO. Global surveillance and control of hepatitis C. Report of a WHO Consultation organized in collaboration with the Viral Hepatitis Prevention Board, Antwerp, Belgium.  J Viral Hepat . 1999;  6 35-47
  CrossrefPubMedSearch in Google Scholar
• 2 Dow B C, Coote I, Munru H. Confirmation of hepatitis C virus antibody in blood donors.  J Med Virol . 1993;  41 215-220
  PubMedSearch in Google Scholar
• 3 Mutimer D J, Harrison R F, O'Donnell K B. Hepatitis C virus infection in the asymptomatic British blood donor.  J Viral Hepat . 1995;  2 47-53
  PubMedSearch in Google Scholar
• 4 Atrah H I, Ala F A, Ahmed M M. Unexplained hepatitis C virus antibody seroconversion in established blood donors.  Transfusion . 1996;  36 339-343
  CrossrefPubMedSearch in Google Scholar
• 5 Mathiesen U L, Karlsson E, Foberg U. Also with a restrictive transfusion policy, screening with second-generation anti-hepatitis C virus enzyme-linked immunosorbent assay would have reduced posttransfusion hepatitis C after open-heart surgery.  Scand J Gastroenterol . 1993;  28 581-584
  PubMedSearch in Google Scholar
• 6 Nordoy I, Schrumpf E, Elgjo K. Liver disease in anti-hepatitis C virus-positive Norwegian blood donors.  Scand J Gastroenterol . 1994;  29 77-81
  PubMedSearch in Google Scholar
• 7 Hennig H, Haase D, Kirchner H. Prevalence of hepatitis C virus in blood donors and comparison of 4 different anti-HCV differentiation tests.  Beitr Infsuionsther Transfuisonsmed . 1996;  33 231-234
  PubMedSearch in Google Scholar
• 8 Riggert J, Schwartz D W, Uy A. Risk of hepatitis C virus (HCV) transmission by anti-HCV-negative blood components in Austria and Germany.  Ann Hematol . 1996;  72 35-39
  PubMedSearch in Google Scholar
• 9 Caspari G, Gerlich W H, Beyer J, Schmitt H. Non-specific and specific anti-HCV results correlated to age, sex, transaminase, rhesus blood group and follow-up in blood donors.  Arch Virol . 1997;  142 473-489
  CrossrefPubMedSearch in Google Scholar
• 10 Ranger S, Martin P, Roussane M C, Denis F. Prevalence of hepatitis C virus antibodies in the general population and in selected groups of patients in Limoges, France.  Gut . 1993;  34(2 Suppl) S50-S51
  PubMedSearch in Google Scholar
• 11 Kleinman S, Alter H, Busch M. Increased detection of hepatitis C virus (HCV)-infected blood donors by a multiple-antigen HCV enzyme immunoassay.  Transfusion . 1992;  32 805-813
  CrossrefPubMedSearch in Google Scholar
• 12 Murphy E L, Bryzman S, Williams A E. Demographic determinants of hepatitis C seroprevalence among blood donors.  JAMA . 1996;  275 996-1000
  PubMedSearch in Google Scholar
• 13 Zhang Y Y, Guo L S, Hao L J. Antibodies to hepatitis C virus and hepatitis C virus RNA in Chinese blood donors determined by ELISA, recombinant immunoblot assay and polymerase chain reaction.  Chin Med J . 1993;  106 171-174
  PubMedSearch in Google Scholar
• 14 Garcia Z, Taylor L, Ruano A. Evaluation of a pooling method for routine anti-HCV screening of blood donors to lower the cost burden on blood banks in countries under development.  J Med Virol . 1996;  49 218-222
  CrossrefPubMedSearch in Google Scholar
• 15 Pita-Ramirez L, Torres-Ortiz G E. Prevalence of viral antibodies and syphilis serology in blood donors from a hospital.  Rev Invest Clin . 1997;  49 475-480
  PubMedSearch in Google Scholar
• 16 Ayala Gaytan J J, Guerra Avalos J F, Brondo Mora P, Casillas Roma A. Prevalence of viral markers for hepatitis B, C and human immunodeficiency virus in volunteer blood donors in Northeast Mexico.  Rev Gastroenterol Mexico . 1997;  62 250-253
  PubMedSearch in Google Scholar
• 17 Guerrero-Romero J F, Castaneda A, Rodriguez-Moran M. Prevalence of risk factors associated with hepatitis C in blood donors in the municipality of Durango, Mexico.  Salud Publica Mex . 1996;  38 94-100
  PubMedSearch in Google Scholar
• 18 Munoz G, Velasco M, Thiers V. Prevalence and genotypes of hepatitis C virus in blood donors and in patients with chronic liver disease and hepatocarcinoma in a Chilean population.  Rev Med Chile . 1998;  126 1035-1042
  PubMedSearch in Google Scholar
• 19 Mison L M, Young I F, O'Donoghue M. Prevalence of hepatitis C virus and genotype distribution in an Australian volunteer blood donor population.  Transfusion . 1997;  37 73-78
  CrossrefPubMedSearch in Google Scholar
• 20 Triki H, Said N, Ben Salah A. Seroepidemiology of hepatitis B, C and delta viruses in Tunisia.  Trans R Soc Trop Med Hyg . 1997;  91 11-14
  CrossrefPubMedSearch in Google Scholar
• 21 Abid S, Fkih S, Khlass B. Screening and confirmation of anti-HCV antibodies in Tunisian blood donors.  Transfus Clin Biol . 1997;  4 221-226
  CrossrefPubMedSearch in Google Scholar
• 22 Soni P N, Tait D R, Kenoyer D G. Hepatitis C virus antibodies among risk groups in a South African area endemic for hepatitis B virus.  J Med Virol . 1993;  40 65-68
  PubMedSearch in Google Scholar
• 23 Vasconcelos H C, Yoshida C F, Vanderborght B O, Schatzmayr H G. Hepatitis B and C prevalences among blood donors in the south region of Brazil.  Mem Inst Oswaldo Cruz . 1994;  89 503-507
  PubMedSearch in Google Scholar
• 24 Edelenyi-Pinto M, Carvalho A P, Nogueira C. Prevalence of antibodies to hepatitis C virus in populations at low and high risk for sexually transmitted diseases in Rio de Janeiro.  Mem Inst Oswaldo Cruz . 1993;  88 305-307
  PubMedSearch in Google Scholar
• 25 Hadziyannis S J, Giannoulis G, Hadziyannis E. Hepatitis C virus infection in Greece and its role in chronic liver disease and hepatocellular carcinoma.  J Hepatol . 1993;  17(Suppl 3) S72-S77
  CrossrefPubMedSearch in Google Scholar
• 26 Mihaljevic I, Feldbauer J, Delajlija M, Grgicevic D. Antibodies to hepatitis C virus in Croatian blood donors and polytransfused patients.  Vox Sang . 1992;  63 236
  PubMedSearch in Google Scholar
• 27 Gloskowska-Moraczewska Z, Kacperska E, Seyfried H. Evaluation of screening and complementary tests for anti-HCV antibodies.  Acta Haematol Pol . 1993;  24 273-280
  PubMedSearch in Google Scholar
• 28 Lai M E, Mazzoleni A P, Farci P. Markers of hepatitis C virus infection in Sardinian blood donors: relationship with alanine aminotransferase levels.  J Med Virol . 1993;  41 282-288
  PubMedSearch in Google Scholar
• 29 Abdourakhamanov D T, Hasaev A S, Castro F J, Guardia J. Epidemiological and clinical aspects of hepatitis C virus infection in the Russian Republic of Daghestan.  Eur J Epidemiol . 1998;  14 549-553
  CrossrefPubMedSearch in Google Scholar
• 30 Barna T K, Ozsvar Z, Szendrenyi V, Gal G. Hepatitis C virus antibody in the serum of blood donors.  Orvosi Hetilap . 1996;  137 507-511
  PubMedSearch in Google Scholar
• 31 Al-Faleh F Z, Ramia S, Arif M. Profile of hepatitis C virus and the possible modes of transmission of the virus in the Gizan area of Saudi Arabia: a community-based study.  Ann Trop Med Parasitol . 1995;  89 431-437
  PubMedSearch in Google Scholar
• 32 El Guneid A M, Gunaid A A, O'Neill A M. Prevalence of hepatitis B, C and D virus markers in Yemeni patients with chronic liver disease.  J Med Virol . 1993;  40 330-333
  PubMedSearch in Google Scholar
• 33 Panigrahi A K, Panda S K, Dixit R K. Magnitude of hepatitis C virus infection in India: prevalence in healthy blood donors, acute and chronic liver diseases.  J Med Virol . 1997;  51 167-174
  CrossrefPubMedSearch in Google Scholar
• 34 Jaiswal S P, Chitnis D S, Naik G. Prevalence of anti-HCV antibodies in central India.  Indian J Med Res . 1996;  104 177-181
  PubMedSearch in Google Scholar
• 35 Irshad M, Acharya S K, Josha Y K. Prevalence of hepatitis C virus antibodies in the general population and in selected groups of patients in Delhi.  Indian J Med Res . 1995;  102 162-164
  PubMedSearch in Google Scholar
• 36 Frommel D, Tekle-Haimanot R, Berhe N. A survey of antibodies to hepatitis C virus in Ethiopia.  Am J Trop Med Hyg . 1993;  49 435-439
  PubMedSearch in Google Scholar
• 37 Wansbrough-Jones M H, Frimpong E, Cant B. Prevalence and genotype of hepatitis C virus infection in pregnant women and blood donors in Ghana.  Trans R Soc Trop Med Hyg . 1998;  92 496-499
  CrossrefPubMedSearch in Google Scholar
• 38 Lo B B, Meymouna M, Boulahi M A. Prevalence of serum markers of hepatitis B and C virus in blood donors of Nouakchott, Mauritania.  Bull Soc Pathol Exot . 1999;  92 83-84
  PubMedSearch in Google Scholar
• 39 Develoux M, Boni G, Aguessy Ahyi B. The prevalence of anti-hepatitis C antibodies in pregnant women and blood donors in Benin.  Bull Soc Pathol Exot . 1995;  88 115-116
  PubMedSearch in Google Scholar
• 40 Jeannel D, Fretz C, Traore Y. Evidence for high genetic diversity and long-term endemicity of hepatitis C virus genotrypes 1 and 2 in West Africa.  J Med Virol . 1998;  55 92-97
  CrossrefPubMedSearch in Google Scholar
• 41 Ilako F M, McLigeyo S O, Riyat M S. The prevalence of hepatitis C virus antibodies in renal patients, blood donors and patients with chronic liver disease in Kenya.  East Afr Med J . 1995;  72 362-364
  PubMedSearch in Google Scholar
• 42 Hayashi J, Furusyo N, Sawayama Y. Hepatitis G virus in the general population and in patients on hemodialysis.  Dig Dis Sci . 1998;  43 2143-2148
  CrossrefPubMedSearch in Google Scholar
• 43 Nakashima K, Kashiwagi S, Hayashi J. Prevalence of hepatitis C virus infection among female prostitutes in Fukuoka, Japan.  J Gastroenterol . 1996;  31 664-668
  PubMedSearch in Google Scholar
• 44 Sakugawa H, Nakasone H, Nakayoshi T. High proportion of false positive reactions among donors with anti-HCV antibodies in a low prevalence area.  J Med Virol . 1995;  46 334-338
  PubMedSearch in Google Scholar
• 45 Yamaguchi K, Kiyokawa H, Machida J. Seroepidemiology of hepatitis C virus infection in Japan and HCV infection in haemodialysis patients.  FEMS Microbiol Rev . 1994;  14 253-258
  CrossrefPubMedSearch in Google Scholar
• 46 Wang Y, Tao Q M, Zhao H Y. Hepatitis C virus RNA and antibodies among blood donors in Beijing.  J Hepatol . 1994;  21 634-640
  CrossrefPubMedSearch in Google Scholar
• 47 Wu X. Investigation on anti-HCV antibody in Shashi District.  Chin J Epidemiol . 1993;  14 331-333
  PubMedSearch in Google Scholar
• 48 Tang S. Seroepidemiological study on hepatitis C virus infection among blood donors from various regions in China.  Chin J Epidemiol . 1993;  14 271-274
  PubMedSearch in Google Scholar
• 49 Zhang Y Y, Hansson B G, Widell A, Nordenfelt E. Hepatitis C virus antibodies and hepatitis C virus RNA in Chinese blood donors determined by ELISA, recombinant immunoblot assay and polymerase chain reaction.  APMIS . 1992;  100 851-855
  PubMedSearch in Google Scholar
• 50 Duraisamy G, Zuridah H, Ariffin M Y. Prevalence of hepatitis C virus antibodies in blood donors in Malaysia.  Med J Mal . 1993;  48 313-316
  PubMedSearch in Google Scholar
• 51 Kuperan P, Choon A T, Ding S H, Lee G. Prevalence of antibodies to hepatitis C virus in relation to surrogate markers in a blood donor population in Singapore.  Southeast Asian J Trop Med Pub Health . 1993;  24(Suppl 1) 127-129
  PubMedSearch in Google Scholar
• 52 Apichartpiyakul C, Apichartpiyakul N, Urwijitaroon Y. Seroprevalence and subtype distribution of hepatitis C virus among blood donors and intravenous drug users in northern/northeastern Thailand.  Jpn J Infect Dis . 1999;  52 121-123
  PubMedSearch in Google Scholar
• 53 Songsivilai S, Jinathongthai S, Wongsena W. High prevalence of hepatitis C infection among blood donors in northeaster Thailand.  Am J Trop Med Hyg . 1997;  57 66-69
  PubMedSearch in Google Scholar
• 54 Sawanpanyalert P, Boonmar S, Maeda T. Risk factors for hepatitis C virus infection among blood donors in an HIV-epidemic area in Thailand.  J Epidemiol Commun Health . 1996;  50 174-177
  PubMedSearch in Google Scholar
• 55 Darmadi S, Soetjipto, Handajani R. Hepatitis C virus infection-associated markers in sera from blood donors in Surabaya, Indonesia.  Microbiol Immunol . 1996;  40 401-405
  PubMedSearch in Google Scholar
• 56 Soetjipto, Handajani R, Lusida M I. Differential prevalence of hepatitis C virus subtypes in healthy blood donors, patients on maintenance hemodialysis and patients with hepatocellular carcinoma in Surabaya, Indonesia.  J Clin Microbiol . 1996;  34 2875-2880
  PubMedSearch in Google Scholar
• 57 Saleh M G, Pereira L M, Tibbs C J. High prevalence of hepatitis C virus in the normal Libyan population.  Trans R Soc Trop Med Hyg . 1994;  88 292-294
  CrossrefPubMedSearch in Google Scholar
• 58 Bassily S, Hyams K C, Fouad R A. A high risk of hepatitis C infection among Egyptian blood donors: the role of parenteral drug abuse.  Am J Trop Med Hyg . 1995;  52 503-505
  PubMedSearch in Google Scholar
• 59 Darwish M A, Raouf T A, Rushdy P. Risk factor associated with a high seroprevalence of hepatitis C virus infection in Egyptian blood donors.  Am J Trop Med Hyg . 1993;  49 440-447
  PubMedSearch in Google Scholar
• 60 Attia M A, Zekri A R, Goudsmit J. Diverse patterns of recognition of hepatitis C virus core and nonstructural antigens by antibodies present in Egyptian cancer patients and blood donors.  J Clin Microbiol . 1996;  34 2665-2669
  PubMedSearch in Google Scholar
• 61 Alter M J, Kruszon-Moran D, Nainan O V. Prevalence of hepatitis C virus infection in the United States, 1988-1994.  N Engl J Med . 1999;  341 556-562
  CrossrefPubMedSearch in Google Scholar
• 62 Lowe D, Cotton R. Hepatitis C: a review of Australia's response. Publications Production Unit, Commonwealth Department of Health and Aged Care, Commonwealth of Australia, Canberra, 1999
• 63 Farrell G C, Weltman M, Dingley J, Lin R. Epidemiology of hepatitis C virus infection in Australia.  Gastroenterol Jpn . 1993;  28(Suppl 5) 32-36
  PubMedSearch in Google Scholar
• 64 Armstrong G L, Alter M J, McQuillan G M. The past incidence of hepatitis C virus infection: implications for the future burden of chronic liver disease in the United States.  Hepatology . 2000;  31 777-782
  CrossrefPubMedSearch in Google Scholar
• 65 Alter M J. Epidemiology of hepatitis C.  Hepatology . 1997;  26 62S-65S
  CrossrefPubMedSearch in Google Scholar
• 66 Tanaka E, Kiyosawa K, Sodeyama T. Prevalence of antibody to hepatitis C virus in Japanese school children: comparison with adult blood donors.  Am J Trop Med Hyg . 1992;  46 460-464
  PubMedSearch in Google Scholar
• 67 Ishibasi M, Shinzawa H, Kuboki M, Tsuchida H, Takahashi T. Prevalence of inhabitants with anti-hepatitis C virus antibody in an area following an acute hepatitis C epidemic: age and area-related features.  J Epidemiol . 1996;  6 1-7
  PubMedSearch in Google Scholar
• 68 Guadagnino V, Stroffolini T, Rapicetta M. Prevalence, risk factors, and genotype distribution of hepatitis C virus infection in the general population: a community-based survey in Southern Italy.  Hepatology . 1997;  26 1006-1011
  PubMedSearch in Google Scholar
• 69 Stroffolini T, Menchinelli M, Taliani G. High prevalence of hepatitis C virus infection in a small central Italian town: lack of evidence of parenteral exposure.  Ital J Gastroenterol . 1995;  27 235-238
  PubMedSearch in Google Scholar
• 70 Abdel-Wahah M F, Zakaria S, Kamel M. High seroprevalence of hepatitis C infection among risk groups in Egypt.  Am J Trop Med Hyg . 1994;  51 563-567
  PubMedSearch in Google Scholar
• 71 Mohamed M K, Hussein M H, Massoud A A. Study of the risk factors for viral hepatitis C infection among Egyptians applying for work abroad.  J Egypt Public Health Assoc . 1996;  71 113-142
  PubMedSearch in Google Scholar
• 72 Villano S A, Vlahov D, Nelson K E, Lyles C M, Cohn S, Thomas D L. Incidence and risk factors for hepatitis C among injection drug users in Baltimore, Maryland.  J Clin Microbiol . 1997;  35 3274-3277
  PubMedSearch in Google Scholar
• 73 Garfein R S, Doherty M C, Monterroso E R, Thomas D L, Nelson K E, Vlahov D. Prevalence and incidence of hepatitis C virus infection among young adult injection drug users.  J Acquir Immune Defic Syndr Hum Retrovirol . 1998;  18(Suppl 1) S11-S19
  PubMedSearch in Google Scholar
• 74 Crofts N, Hopper J L, Bowden D S, Breschkin A M, Milner R, Locarnini S A. Hepatitis C virus infection among a cohort of Victorian injecting drug users.  Med J Aust . 1993;  159 237-241
  PubMedSearch in Google Scholar
• 75 Centers for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease.  MMWR Morb Mortal Wkly Rep . 1998;  47 1-33
  PubMedSearch in Google Scholar
• 76 Tanaka H, Tsukuma H, Hori Y. The risk of hepatitis C virus infection among blood donors in Osaka, Japan.  J Epidemiol . 1998;  8 292-296
  PubMedSearch in Google Scholar
• 77 Mele A, Sagliocca L, Manzillo G. Risk factors for acute non-A, non-B hepatitis and their relationship to antibodies for hepatitis C virus: a case-control study.  Am J Public Health . 1994;  84 1640-1643
  PubMedSearch in Google Scholar
• 78 Chiaramonte M, Stroffolini T, Lorenzoni U. Risk factors in community-acquired chronic hepatitis C virus infection: a case-control study in Italy.  J Hepatol . 1996;  24 129-134
  CrossrefPubMedSearch in Google Scholar
• 79 Conry-Cantilena C, VanRaden M, Gibble J. Routes of infection, viremia, and liver disease in blood donors found to have hepatitis C virus infection.  N Engl J Med . 1996;  334 1691-1696
  CrossrefPubMedSearch in Google Scholar
• 80 Lillienfeld A M, Lilienfeld D E. Foundations of Epidemiology.  New York: Oxford University Press 1980
  Search in Google Scholar
• 81 Conry-Cantilena C, Melpolder J C, Alter H J. Intranasal drug use among volunteer whole-blood donors: results of survey C.  Transfusion . 1998;  38 512-513
  CrossrefPubMedSearch in Google Scholar
• 82 Alter M J. Epidemiology of hepatitis C in the West.  Semin Liver Dis . 1995;  15 5-14
  PubMedSearch in Google Scholar
• 83 Aach R D, Stevens C E, Hollinger F B. Hepatitis C virus infection in post-transfusion hepatitis. An analysis with first- and second-generation assays.  N Engl J Med . 1991;  325 1325-1329
  PubMedSearch in Google Scholar
• 84 Elia G F, Magnani G, Belli L. Incidence of anti-hepatitis C virus antibodies in non-A, non-B post-transfusion hepatitis in an area of northern Italy.  Infection . 1991;  19 336-339
  CrossrefPubMedSearch in Google Scholar
• 85 Mattsson L, Grillner L, von Sydow M. Seroconversion to hepatitis C virus antibodies in patients with acute posttransfusion non-A, non-B hepatitis in Sweden.  Infection . 1991;  19 309-312
  CrossrefPubMedSearch in Google Scholar
• 86 Goncales Jr L F, Pedro de J R, Da Silva J L. Post-transfusional hepatitis in the city of Campinas SP, Brazil. I. Incidence, etiological agents and clinico-epidemiological aspects of hepatitis C.  Rev Inst Med Trop Sao Paulo . 1993;  35 53-62
  PubMedSearch in Google Scholar
• 87 Jullien A M, Courouce A M, Massari V. Impact of screening donor blood for alanine aminotransferase and antibody to hepatitis B core antigen on the risk of hepatitis C virus transmission.  Eur J Clin Microbiol Infect Dis . 1993;  12 668-672
  PubMedSearch in Google Scholar
• 88 Donahue J G, Munoz A, Ness P M. The declining risk of post-transfusion hepatitis C virus infection.  N Engl J Med . 1992;  327 369-373
  CrossrefPubMedSearch in Google Scholar
• 89 Nelson K E, Ahmed F, Ness P. Comparison of first and second generation ELISA screening tests in detecting HCV infections in transfused cardiac surgery patients [abstract]. Program and Abstracts of the International Symposium on Viral Hepatitis and Liver Disease, 1993, p. 50
• 90 Takano S, Nakamura K, Kawai S. Prospective assessment of donor blood screening for antibody to hepatitis C virus by first- and second-generation assays as a means of preventing posttransfusion hepatitis.  Hepatology . 1996;  23 708-712
  PubMedSearch in Google Scholar
• 91 Gonzalez A, Esteban J I, Madoz P. Efficacy of screening donors for antibodies to the hepatitis C virus to prevent transfusion-associated hepatitis: final report of a prospective trial.  Hepatology . 1995;  22 439-445
  CrossrefPubMedSearch in Google Scholar
• 92 Japanese Red Cross Non-A Non-B Hepatitis Research Group. Effect of screening for hepatitis C virus antibody and hepatitis B core antibody on incidence of post-transfusion hepatitis.  Lancet . 1991;  338 1040-1041
  CrossrefPubMedSearch in Google Scholar
• 93 Schreiber G B, Busch M P, Kleinman S H. The risk of transfusion-transmitted viral infections.  N Engl J Med . 1996;  334 1685-1690
  CrossrefPubMedSearch in Google Scholar
• 94 Alter M J, Coleman P J, Alexander W J. Importance of heterosexual activity in the transmission of hepatitis B and nonA, nonB hepatitis.  JAMA . 1989;  262 1201-1205
  CrossrefPubMedSearch in Google Scholar
• 95 Alter M J, Gerety R J, Smallwood L. Sporadic non-A, non-B hepatitis: frequency and epidemiology in an urban United States population.  J Infect Dis . 1982;  145 886-893
  CrossrefPubMedSearch in Google Scholar
• 96 Louie M, Low D E, Feinman S V. Prevalence of bloodborne infective agents among people admitted to a Canadian hospital.  Can Med Assoc J . 1992;  146 1331-1334
  PubMedSearch in Google Scholar
• 97 Kelen G D, Green G B, Purcell R H. Hepatitis B and hepatitis C in emergency department patients.  N Engl J Med . 1992;  326 1399-1404
  CrossrefPubMedSearch in Google Scholar
• 98 Barham W B, Figueroa R, Phillips I A, Hyams K C. Chronic liver disease in Peru: role of viral hepatitis.  J Med Virol . 1994;  42 129-132
  PubMedSearch in Google Scholar
• 99 Bile K, Aden C, Norder H. Important role of hepatitis C virus infection as a cause of chronic liver disease in Somalia.  Scand J Infect Dis . 1993;  25 559-564
  PubMedSearch in Google Scholar
• 100 Guyer B, Bradley D W, Bryan J A, Maynard J E. Non-A, non-B hepatitis among participants in a plasmapheresis stimulation program.  J Infect Dis . 1979;  139 634-40
  PubMedSearch in Google Scholar
• 101 Schvarcz R, Johansson B, Nystra;uom, Sönnerborg A. Nosocomial transmission of hepatitis C virus.  Infection . 1997;  25 74-77
  PubMedSearch in Google Scholar
• 102 Allander T, Gruber A, Naghavi M. Frequent patient-to-patient transmission of hepatitis C virus in a haematology ward.  Lancet . 1995;  345 603-607
  CrossrefPubMedSearch in Google Scholar
• 103 Widell A, Christensson B, Wiebe T. Epidemiologic and molecular investigation of outbreaks of hepatitis C virus infection on a pediatric oncology service.  Ann Intern Med . 1999;  130 130-134
  PubMedSearch in Google Scholar
• 104 Bronowicki J P, Venard V, Botte C. Patient to patient transmission of hepatitis C virus during colonoscopy.  N Engl J Med . 1997;  337 237-240
  CrossrefPubMedSearch in Google Scholar
• 105 Niu M T, Coleman P J, Alter M J. Multicenter study of hepatitis C virus infection in chronic hemodialysis patients and staff.  Am J Kidney Dis . 1993;  22 568-573
  CrossrefPubMedSearch in Google Scholar
• 106 Conlon P J, Walshe J J, Smyth E G. Lower prevalence of anti-hepatitis C antibody in dialysis and renal transplant patients in Ireland.  Irish J Med Sci . 1993;  162 145-147
  PubMedSearch in Google Scholar
• 107 Bukh J, Wantzin P, Krogsgaard K. High prevalence of hepatitis C virus (HCV) RNA in dialysis patients: failure of commercially available antibody tests to identify a significant number of patients with HCV infection.  J Infect Dis . 1993;  168 1343-1348
  CrossrefPubMedSearch in Google Scholar
• 108 Kolho E, Oksanen K, Honkanen E. Hepatitis C antibodies in dialysis patients and patients with leukaemia.  J Med Virol . 1993;  40 318-321
  PubMedSearch in Google Scholar
• 109 Nordenfelt E, Lofgren B, Widell A. Hepatitis C virus infection in hemodialysis patients in Southern Sweden: epidemiological, clinical, and diagnostic aspects.  J Med Virol . 1993;  40 266-270
  PubMedSearch in Google Scholar
• 110 Medin C, Allander T, Roll M. Seroconversion to hepatitis C virus in dialysis patients: a retrospective and prospective study.  Nephron . 1993;  65 40-45
  PubMedSearch in Google Scholar
• 111 Almroth G, Ekermo B, Franzen L, Hed J. Antibody responses to hepatitis C virus and its modes of transmission in dialysis patients.  Nephron . 1991;  59 232-235
  PubMedSearch in Google Scholar
• 112 Hardy N M, Sandroni S, Danielson S, Wilson W J. Antibody to hepatitis C virus increases with time on hemodialysis.  Clin Nephrol . 1992;  38 44-48
  PubMedSearch in Google Scholar
• 113 Zeldis J B, Depner T A, Kuramoto I K. The prevalence of hepatitis C virus antibodies among hemodialysis patients.  Ann Intern Med . 1990;  112 958-960
  CrossrefPubMedSearch in Google Scholar
• 114 Jeffers L J, Perez G O, DeMedina M D. Hepatitis C infection in two urban hemodialysis units.  Kidney Int . 1990;  38 320-322
  PubMedSearch in Google Scholar
• 115 Forseter G, Wormser G P, Adler S. Hepatitis C in the health care setting. Seroprevalence among hemodialysis staff and patients in suburban New York City.  Am J Infec Control . 1993;  21 5-8
  PubMedSearch in Google Scholar
• 116 Kallinowski B, Theilmann L, Gmelin K. Prevalence of antibodies to hepatitis C virus in hemodialysis patients.  Nephron . 1991;  59 236-238
  PubMedSearch in Google Scholar
• 117 Schlipkoter U, Roggendorf M, Ernst G. Hepatitis C virus antibodies in haemodialysis patients [letter].  Lancet . 1990;  335 1409
  CrossrefPubMedSearch in Google Scholar
• 118 Tokars J I, Alter M J, Favero M S. National surveillance of dialysis associated diseases in the United States, 1993.  ASAIO J . 1996;  42 219-229
  PubMedSearch in Google Scholar
• 119 Hayashi J, Yoshimura E, Nabeshima A. Seroepidemiology of hepatitis C virus infection in hemodialysis patients and the general population in Fukuoka and Okinawa, Japan.  J Gastroenterol . 1994;  29 276-281
  PubMedSearch in Google Scholar
• 120 Fujiyama S, Kawano S, Sato S. Changes in prevalence of anti-HCV antibodies associated with preventive measures among hemodialysis patients and dialysis staff.  Hepatogastroenterology . 1995;  42 162-165
  PubMedSearch in Google Scholar
• 121 Tsuyuguchi M. Prevalence of hepatitis C virus infection among chronic hemodialysis patients.  Hokkaido J Med Sci . 1994;  69 1178-1188
  PubMedSearch in Google Scholar
• 122 DiLallo D, Miceli M, Petrosillo N. Risk factors of hepatitis C virus infection in patients on hemodialysis: a multivariate analysis based on a dialysis register in Central Italy.  Eur J Epidemiol . 1999;  15 11-14
  CrossrefPubMedSearch in Google Scholar
• 123 Covic A, Iancu L, Apetrei C. Hepatitis virus infection in haemodialysis patients from Moldavia.  Nephrol Dial Transplant . 1999;  14 40-45
  PubMedSearch in Google Scholar
• 124 Fabrizi F, Lunghi G, Pagliari B. Molecular epidemiology of hepatitis C virus infection in dialysis patients.  Nephron . 1997;  77 190-196
  PubMedSearch in Google Scholar
• 125 Halfon P, Khiri H, Feryn J M. Prospective virolocial follow-up of hepatitis C infection in a haemodialysis unit.  J Viral Hepat . 1998;  5 115-121
  CrossrefPubMedSearch in Google Scholar
• 126 Forns X, Fernandez-Llama P, Pons M. Incidence and risk factors of hepatitis C virus infection in a haemodialysis unit.  Nephrol Dial Transplant . 1997;  12 736-740
  PubMedSearch in Google Scholar
• 127 Fabrizi F, Martin P, Dixit V. Detection of de novo hepatitis C virus infection by polymerase chain in hemodialysis patients.  Am J Nephrol . 1999;  19 383-388
  CrossrefPubMedSearch in Google Scholar
• 128 Jadoul M, Cornu C, Van Ypersele de Strihou C, UCL Collaborative Group. Incidence and risk factors for hepatitis C seroconversion in hemodialysis: a prospective study.  Kidney Int . 1993;  44 1322-1326
  PubMedSearch in Google Scholar
• 129 Muller G Y, Zabaleta M E, Arminio A. Risk factors for dialysis-associated hepatitis C in Venezuela.  Kidney Int . 1992;  41 1055-1058
  PubMedSearch in Google Scholar
• 130 Irie Y, Hayashi H, Yokozeki K. Hepatitis C infection unrelated to blood transfusion in hemodialysis patients.  J Hepatol . 1994;  20 557-559
  CrossrefPubMedSearch in Google Scholar
• 131 Noguchi S, Sata M, Suzuki H, Mizokami M, Tanikawa K. Routes of transmission of hepatitis C virus in an epidemic rural area of Japan. Molecular epidemiologic study of hepatitis C virus infection.  Scand J Infect Dis . 1997;  29 23-28
  PubMedSearch in Google Scholar
• 132 Kiyosawa K, Tanaka E, Sodeyama T. Transmission of hepatitis C in an isolated area in Japan: community-acquired infection.  Gastroenterology . 1994;  196 1596-1602
  PubMedSearch in Google Scholar
• 133 Ito S, Ito M, Cho M-J, Shimotohno K, Tajima K. Massive sero-epidemiological survey of hepatitis C virus: clustering of carriers on the Southwest coast of Tsushima, Japan.  Jpn J Cancer Res . 1991;  82 1-3
  PubMedSearch in Google Scholar
• 134 Frank C, Mohamed M K, Strickland G T. The role of antischistosomal therapy in the spread of hepatitis C virus in Egypt.  Lancet . 2000;  355 887-891
  CrossrefPubMedSearch in Google Scholar
• 135 Hutin Y JF, Harpaz R, Drobeniuc, et al. Injections given in healthcare settings as a major source of hepatitis B virus infection in Moldova.  Int J Epidemiol . 1999;  28 782-786
  CrossrefPubMedSearch in Google Scholar
• 136 Luby S P, Qamruddin K, Shah A A. The relationship between therapeutic injections and high prevalence of hepatitis C infection in Hafizabad, Pakistan.  Epidemiol Infect . 1997;  119 349-356
  CrossrefPubMedSearch in Google Scholar
• 137 Centers for Disease Control and Prevention. Frequency of vaccine-related and therapeutic injections-Romania, 1998.  MMWR Morb Mortal Wkly Rep . 1999;  48 271-274
  PubMedSearch in Google Scholar
• 138 Esteban J I, Gomez J, Martell M. Transmission of hepatitis C virus by a cardiac surgeon.  N Engl J Med . 1996;  334 555-560
  CrossrefPubMedSearch in Google Scholar
• 139 Duckworth G J, Heptonstall J, Aitken C. Transmission of hepatitis C virus from a surgeon to a patient.  Commun Dis Public Health . 1999;  2 188-192
  PubMedSearch in Google Scholar
• 140 Blackmore T K, Stace N H, Maddocks P. Prevalence of antibodies to HCV in patients receiving renal replacement therapy, and in the staff caring for them.  Aust NZJ Med . 1992;  22 353-357
  PubMedSearch in Google Scholar
• 141 Thomas D L, Factor S H, Kelen G D. Viral hepatitis in health care personnel at The Johns Hopkins Hospital.  Arch Intern Med . 1993;  153 1705-1712
  CrossrefPubMedSearch in Google Scholar
• 142 Polish L B, Tong M J, Co R L. Risk factors for hepatitis C virus infection among health care personnel in a community hospital.  Am J Infect Control . 1993;  21 196-200
  CrossrefPubMedSearch in Google Scholar
• 143 Germanaud J, Barthez J P, Causse X. The occupational risk of hepatitis C infection among hospital employees.  Am J Public Health . 1994;  84 122
  PubMedSearch in Google Scholar
• 144 Campello C, Majori S, Poli A. Prevalence of HCV antibodies in health-care workers from northern Italy.  Infection . 1992;  20 224-226
  CrossrefPubMedSearch in Google Scholar
• 145 Nakashima K, Kashiwagi S, Hayashi J. Low prevalence of hepatitis C virus infection among hospital staff and acupuncturists in Kyushu, Japan.  J Infect . 1993;  26 17-25
  CrossrefPubMedSearch in Google Scholar
• 146 Struve J, Aronsson B, Frenning B. Prevalence of antibodies against hepatitis C virus infection among health care workers in Stockholm.  Scand J Gastroenterol . 1994;  29 360-362
  PubMedSearch in Google Scholar
• 147 Puro V, Petrosillo N, Ippolito G, Italian Study Group on Occupational Risk of HIV and Other Bloodborne Infections. Risk of hepatitis C seroconversion after occupational exposures in health care workers.  Am J Infect Control . 1995;  23 273-277
  CrossrefPubMedSearch in Google Scholar
• 148 Lodi G, Porter S R, Teo C G, Scully C. Prevalence of HCV infection in health care workers of a UK dental hospital.  Br Dental J . 1997;  183 329-332
  PubMedSearch in Google Scholar
• 149 Petrosilla N, Puro V, Ippolito G, Italian Study Group on Blood-borne Occupational Risk in Dialysis. Prevalence of hepatitis C antibodies in health-care workers.  Lancet . 1994;  343 1618-1620
  CrossrefPubMedSearch in Google Scholar
• 150 Cooper B W, Krusell A, Tilton R C. Seroprevalence of antibodies to hepatitis C virus in high-risk hospital personnel.  Infect Control Hosp Epidemiol . 1992;  13 82-85
  PubMedSearch in Google Scholar
• 151 Panlilio A L, Shapiro C N, Schable C A. Serosurvey of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection among hospital-based surgeons.  J Am Coll Surg . 1995;  180 16-24
  PubMedSearch in Google Scholar
• 152 Shapiro C N, Tokars J I, Chamberland M E, the American Academy of Orthopedic Surgeons Serosurvey Study Committee. Use of hepatitis B vaccine and infection with hepatitis B and C among orthopedic surgeons.  J Bone Joint Surg Am . 1996;  78 1791-1800
  PubMedSearch in Google Scholar
• 153 Thomas D L, Gruninger S E, Siew C, Joy E D, Quinn T C. Occupational risk of hepatitis C infections among general dentists and oral surgeons in North America.  Am J Med . 1996;  100 41-45
  CrossrefPubMedSearch in Google Scholar
• 154 Lanphear B P, Linnemann C C, Cannon C G. Hepatitis C virus infection in health care workers: risk of exposure and infection.  Infect Control Hosp Epidemiol . 1994;  15 745-750
  PubMedSearch in Google Scholar
• 155 Mitsui T, Iwano K, Masuko K. Hepatitis C virus infection in medical personnel after needlestick accident.  Hepatology . 1992;  16 1109-1114
  CrossrefPubMedSearch in Google Scholar
• 156 Sartori M, La Terra G, Aglietta M. Transmission of hepatitis C via blood splash into conjunctiva.  Scand J Infect Dis . 1993;  25 270-271
  PubMedSearch in Google Scholar
• 157 Ippolito G, Puro V, Petrosillo N, De Carli G, Micheloni G, Magliano E, Coordinating Centre of the Italian Study on Occupational Risk of HIV Infection. Simultaneous infection with HIV and hepatitis C virus following occupational conjunctival blood exposure.  JAMA . 1998;  280 28
  CrossrefPubMedSearch in Google Scholar
• 158 Aizaki H, Saito A, Kusakawa I. Mother-to-child transmission of a hepatitis C virus variant with an insertional mutation in its hypervariable region.  J Hepatol . 1996;  25 608-613
  CrossrefPubMedSearch in Google Scholar
• 159 Catalano D, Pollio F, Ercolano S. Maternal-fetal transmission of HCV.  Role of HIV as a risk factor. Min Ginecol . 1999;  51 117-119
  PubMedSearch in Google Scholar
• 160 Fischler B, Lindh G, Lindgren S. Vertical transmission of hepatitis C virus infection.  Scand J Infect Dis . 1996;  28 353-356
  CrossrefPubMedSearch in Google Scholar
• 161 Giacchino R, Picciotto A, Tasso L. Vertical transmission of hepatitis C.  Lancet . 1995;  345 1122-1123
  CrossrefPubMedSearch in Google Scholar
• 162 Granovsky M, Minkoff H L, Tess B H. Hepatitis C virus infection in the Mothers and Infants Cohort Study.  Pediatrics . 1998;  102 355-359
  CrossrefPubMedSearch in Google Scholar
• 163 Kudesia G, Ball G, Irving W L. Vertical transmission of hepatitis C.  Lancet . 1995;  345 1122-1125
  PubMedSearch in Google Scholar
• 164 Lam J PH, McOmish F, Burns S M. Infrequent vertical transmission of hepatitis C virus.  J Infect Dis . 1993;  167 572-576
  PubMedSearch in Google Scholar
• 165 Latt N, Collins E, Spencer J. Hepatitis C virus infection in pregnant injecting drug users-possible vertical tranmission to babies. Proceeding of National Methadone Conference, Sydney, 1994
• 166 Lin H H, Kao J H, Hsu H Y. Possible role of high-titer maternal viremia in perinatal transmission of hepatitis C virus.  J Infect Dis . 1994;  169 638-641
  PubMedSearch in Google Scholar
• 167 Maccabruni A, Bossi G, Caselli D. High efficiency of vertical transmission of hepatitis C virus among babies born to human immunodeficiency virus-negative women.  Pediatr Infect Dis J . 1995;  14 921-922
  PubMedSearch in Google Scholar
• 168 Manzini P, Saracco G, Cerchier A. Human Immunodeficiency virus infection as risk factor for mother-to-child hepatitis C virus tranmission; persistence of anti-hepatitis C virus in children is associated with the mother's anti-hepatitis C virus immunoblotting pattern.  Hepatology . 1995;  21 328-332
  CrossrefPubMedSearch in Google Scholar
• 169 Marcellin P, Bernuau J, Martinot-Peignoux M. Prevalence of hepatitis C virus infection in asymptomatic anti-HIV1 negative pregnant women and their children.  Dig Dis Sci . 1993;  38 2151-2155
  CrossrefPubMedSearch in Google Scholar
• 170 Mast E E, Hwang L Y, Seto D. Perinatal hepatitis C virus transmission: maternal risk factors and optimal timing of diagnosis.  Hepatology . 1999;  30(suppl., Part 2) 499A
  PubMedSearch in Google Scholar
• 171 Moriya T, Sasaki F, Mizui M. Transmission of hepatitis C virus from mother to infants: its frequency and risk factors revisited. Biomed Pharmacother .  1995;  49 59-64
  PubMedSearch in Google Scholar
• 172 Ni Y H, Lin H H, Chen P J. Temporal profile of hepatitis C virus antibody and genome in infants born to mother infected with hepatitis C virus but without human immunodeficiency virus coinfection.  J Hepatol . 1994;  20 641-645
  CrossrefPubMedSearch in Google Scholar
• 173 Novati R, Thiers V, D'Arminio Monforte A. Mother-to-child transmission of hepatitis C virus detected by nested polymerase chain reaction.  J Infect Dis . 1992;  165 720-723
  PubMedSearch in Google Scholar
• 174 Ohto H, Terazawa S, Sasaki N. Transmission of hepatitis C virus from mothers to infants.  N Engl J Med . 1994;  330 744-750
  CrossrefPubMedSearch in Google Scholar
• 175 Paccagnini S, Principi N, Massironi E. Perinatal transmission and manifestation of hepatitis C virus infection in a high risk population.  Pediatr Infect Dis J . 1995;  14 195-199
  PubMedSearch in Google Scholar
• 176 Palomba E, Manzini P, Fiammengo P. Natural history of perinatal hepatitis C virus infection.  Clin Infect Dis . 1996;  23 47-50
  PubMedSearch in Google Scholar
• 177 Papaevangelou V, Pollack H, Rochford G. Increased transmission of vertical hepatitis C virus (HCV) infection to human immunodeficiency virus (HIV)-infected infants of HIV- and HCV-coinfected women.  J Infect Dis . 1998;  178 1047-1052
  PubMedSearch in Google Scholar
• 178 Pipan C, Amici S, Astori G. Vertical transmission of hepatitis C virus in low-risk pregnant women.  Eur J Clin Microbiol Infect Dis . 1996;  14 116-120
  PubMedSearch in Google Scholar
• 179 Reinus J F, Leikin E L, Alter H J. Failure to detect vertical transmission of hepatitis C virus.  Ann Intern Med . 1992;  117 881-886
  PubMedSearch in Google Scholar
• 180 Resti M, Azzari C, Lega L. Mother-to-infant transmission of hepatitis C virus.  Acta Paediatr . 1995;  84 251-255
  PubMedSearch in Google Scholar
• 181 Roudot-Thoraval F, Pawlotsky J-M, Thiers V. Lack of mother-to-infant transmission of hepatitis C virus in human immunodeficiency virus-seronegative women: a prospective study with hepatitis C virus RNA testing.  Hepatology . 1993;  17 722-777
  PubMedSearch in Google Scholar
• 182 Sabatino G, Ramenghi L A, Di Marzio M, Pizzigallo E. Vertical transmission of hepatitis C virus: an epidemiological study on 2980 pregnant women in Italy.  Eur J Epidemiol . 1996;  12 443-447
  CrossrefPubMedSearch in Google Scholar
• 183 Soto B, Rodrigo L, Garcia Bengoechea M. Heterosexual transmission of HCV and the possible role of coexistent human immunodeficiency virus infection in the index case. A multicentre study of 432 pairings.  J Intern Med . 1994;  236 515-519
  PubMedSearch in Google Scholar
• 184 Spencer J D, Latt N, Beeby P J. Transmission of hepatitis C virus to infants of human immunodeficiency virus-negative intravenous drug-using mothers: rate of infection and assessment of risk factors for transmission.  J Viral Hepat . 1997;  4 395-409
  CrossrefPubMedSearch in Google Scholar
• 185 Thomas D A, Villano S A, Riester K A. Perinatal transmission of hepatitis C virus from human immunodeficiency virus type 1-infected mothers. Women and Infants Transmission Study.  J Infect Dis . 1998;  177 1480-1488
  PubMedSearch in Google Scholar
• 186 Uehara S, Abe Y, Saito T. The incidence of vertical transmission of HCV.  Tohoku J Exp Med . 1993;  171 195-202
  PubMedSearch in Google Scholar
• 187 Wejstal R, Anders W, Mansson A S. Mother-to-infant transmission of hepatitis C virus.  Ann Intern Med . 1992;  117 887-890
  PubMedSearch in Google Scholar
• 188 Zanetti A R, Tanzi E, Paccagnini S. Mother-to-infant transmission of hepatitis C virus.  Lancet . 1995;  345 289-291
  CrossrefPubMedSearch in Google Scholar
• 189 Zuccotti G V, Ribero M L, Giovannini M. Effect of hepatitis C genotype on mother-to-infant transmission of virus.  J Pediatr . 1995;  127 278-280
  PubMedSearch in Google Scholar
• 190 Mast E E, Alter M J. Hepatitis C.  Semin Pediatr Infect Dis . 1997;  8 17-22
  PubMedSearch in Google Scholar
• 191 Thomas D L, Zenilman J M, Alter H J. Sexual transmission of hepatitis C virus among patients attending Baltimore sexually transmitted diseases clinics-an analysis of 309 sex partnerships.  J Infect Dis . 1995;  171 768-775
  PubMedSearch in Google Scholar
• 192 Osmond D H, Charlebois E, Sheppard H W. Comparison of risk factors for hepatitis C and hepatitis B virus infection in homosexual men.  J Infect Dis . 1993;  167 66-71
  PubMedSearch in Google Scholar
• 193 Corona R, Prignano G, Mele A. Heterosexual and homosexual transmission of hepatitis C virus: relation with hepatitis B virus and human immunodeficiency virus type 1.  Epidemiol Infect . 1991;  107 667-672
  PubMedSearch in Google Scholar
• 194 Quaranta J F, Delaney S R, Alleman S. Prevalence of antibody to hepatitis C virus (HCV) in HIV-1-infected patients (Nice SEROCO cohort).  J Med Virol . 1994;  42 29-32
  PubMedSearch in Google Scholar
• 195 Weinstock H S, Bolan G, Reingold A L, Polish L B. Hepatitis C virus infection among patients attending a clinic for sexually transmitted diseases.  JAMA . 1993;  269 392-394
  CrossrefPubMedSearch in Google Scholar
• 196 Thomas D L, Cannon R O, Shapiro C N. Hepatitis C, hepatitis B, and human immunodeficiency virus infections among non-intravenous drug-using patients attending clinics for sexually transmitted diseases.  J Infect Dis . 1994;  169 990-995
  PubMedSearch in Google Scholar
• 197 van Doornum J J G, Hooykaas C, Cuypers M T. Prevalence of hepatitis C virus infections among heterosexuals with multiple partners.  J Med Virol . 1991;  35 22-27
  PubMedSearch in Google Scholar
• 198 Mast E E, Darrow W W, Witte J. Hepatitis C virus infection among prostitutes: evidence for sexual transmission and protective efficacy of condoms [abstract]. Program and Abstracts of the Third International Symposium on HCV, Strasbourg, 1991, p. 95
• 199 Gutierrez P, Orduna A, Bratos M A. Prevalence of anti-hepatitis C virus antibodies in positive FTA-ABS non-drug abusing female prostitutes in Spain.  Sex Trans Dis . 1992;  19 39-40
  PubMedSearch in Google Scholar
• 200 Daikos G L, Lai S, Fischl M A. Hepatitis C virus infection in a sexually active inner city population. The potential for heterosexual transmission.  Infection . 1994;  22 72-76
  CrossrefPubMedSearch in Google Scholar
• 201 Hershow R C, Kalish L A, Sha B. Hepatitis C virus infection in Chicago women with or at risk for HIV infection: evidence for sexual transmission.  Sex Trans Dis . 1998;  25 527-532
  PubMedSearch in Google Scholar
• 202 Mesquita P E, Hernandez Granato F C, Castelo A. Risk factors associated with hepatitis C virus (HCV) infection among prostitutes and their clients in the city of Santos, Sao Paulo state, Brazil.  J Med Virol . 1997;  51 338-343
  CrossrefPubMedSearch in Google Scholar
• 203 Lissen E, Alter H J, Abad M A. Hepatitis C virus infection among sexually promiscuous groups and the hetersexual partners of hepatitis C virus infected index cases.  Eur J Clin Microbiol Infect Dis . 1993;  12 827-831
  PubMedSearch in Google Scholar
• 204 Tedder R S, Gilson R J, Briggs M. Hepatitis C virus: evidence for sexual transmission.  BMJ . 1991;  302 1299-1302
  PubMedSearch in Google Scholar
• 205 Donahue J G, Nelson K E, Munoz A. Antibody to HCV among cardiac surgery patients, homosexual men, and intravenous drug users in Baltimore, Maryland.  Am J Epidemiol . 1991;  134 1206-1211
  PubMedSearch in Google Scholar
• 206 Hyams K C, Phillips I A, Tejada A. Three year incidence study of retroviral and viral hepatitis transmission in a Peruvian prostitute population.  J AIDS . 1993;  6 1353-1357
  PubMedSearch in Google Scholar
• 207 Osella A R, Massa M A, Joekes S. Hepatitis B and C virus sexual transmission among homosexual men.  Am J Gastroenterol . 1998;  93 49-52
  CrossrefPubMedSearch in Google Scholar
• 208 Gasparini V, Chiaramonte M, Moschen M E. Hepatitis C virus infection in homosexual men: A seroepidemiological study in gay clubs in north-east Italy.  Eur J Epidemiol . 1991;  7 665-669
  PubMedSearch in Google Scholar
• 209 Westh H, Worm A M, Jensen B L. HCV antibodies in homosexual men and intravenous drug users in Denmark.  Infection . 1993;  21 115-117
  CrossrefPubMedSearch in Google Scholar
• 210 Sonnerborg A, Abebe A, Strannegard O. HCV infection in individuals with or without human immunodeficiency virus type 1 infection.  Infection . 1990;  18 347-351
  CrossrefPubMedSearch in Google Scholar
• 211 Williams C L, Mast E E, Coleman P J. Risk factors for sexual transmission of hepatitis C virus among non injecting-drug-using female prostitutes in the United States [abstract]. 36th Annual Meeting of the Infectious Disease Society of America, Denver, CO, 1998
• 212 Bresters D, Mauser-Bunschoten E P, Reesink H W. Sexual transmission of hepatitis C virus.  Lancet . 1993;  342 210-211
  CrossrefPubMedSearch in Google Scholar
• 213 Meisel H, Reip A, Faltus B. Transmission of hepatitis C virus to children and husbands by women infected with contaminated anti-D immunoglobulin.  Lancet . 1995;  345 1209-1211
  CrossrefPubMedSearch in Google Scholar
• 214 David X R, Blanc P, Pageaux G P. Familial transmission of HCV.  Gastroenterol Clin Biol . 1995;  19 150-155
  PubMedSearch in Google Scholar
• 215 Deny P, Roulot D, Asselot C. Low rate of hepatitis C virus (HCV) transmission within the family.  J Hepatol . 1992;  14 409-410
  PubMedSearch in Google Scholar
• 216 Wyld R, Robertson J R, Brettle R P. Absence of hepatitis C virus transmission but frequent transmission of HIV-1 from sexual contact with doubly-infected individuals.  J Infect . 1997;  35 163-166
  CrossrefPubMedSearch in Google Scholar
• 217 Sachithanandan S, Fielding J F. Low rate of HCV transmission from women infected with contaminated anti-D immunoglobulin to their family contacts.  Ital J Gastroenterol Hepatol . 1997;  29 47-50
  PubMedSearch in Google Scholar
• 218 Pachucki C T, Lentino J R, Schaaff D. Low prevalence of sexual transmission of hepatitis C virus in sex partners of seropositive intravenous drug users.  J Infect Dis . 1991;  164 820-821
  PubMedSearch in Google Scholar
• 219 Eyster M E, Alter H J, Aledort L M. Heterosexual co-transmission of hepatitis C virus (HCV) and human immunodeficiency virus (HIV).  Ann Intern Med . 1991;  115 764-768
  PubMedSearch in Google Scholar
• 220 Gordon S C, Patel A H, Kulesza G W. Lack of evidence for the heterosexual transmission of hepatitis C.  Am J Gastroenterol . 1992;  87 1849-1851
  PubMedSearch in Google Scholar
• 221 Tong M J, Lai P PC, Hwang S H. Evaluation of sexual transmission in patients with chronic hepatitis C infection.  Clin Diagn Virol . 1995;  3 39-47
  CrossrefPubMedSearch in Google Scholar
• 222 Scully L J, Mitchel S, Gill P. Clinical and epidemiologic characteristics of hepatitis C in a gastroenterology/hepatology practice in Ottawa.  Can Med Assoc J . 1993;  148 1173-1177
  PubMedSearch in Google Scholar
• 223 Diaz Morant V, De La Mata M, Costan G. A low prevalence of antibodies to the hepatitis C virus in stable heterosexual couples.  Gastroenterol Hepatol . 1995;  18 111-113
  PubMedSearch in Google Scholar
• 224 Garcia Bengoechea M, Cortes A, Lopez P. Intrafamilial spread of HCV infection.  Scand J Infect Dis . 1994;  26 15-18
  PubMedSearch in Google Scholar
• 225 Soto B, Rodrigo L, Garcia Bengoechea M. Heterosexual transmission of HCV and the possible role of coexistent human immunodeficiency virus infection in the index case. A multicentre study of 432 pairings.  J Intern Med . 1994;  236 515-519
  PubMedSearch in Google Scholar
• 226 Napoli N, Fiore G, Vella F. Prevalence of antibodies to hepatitis C virus among family members of patients with chronic hepatitis C.  Eur J Epidemiol . 1993;  9 629-632
  PubMedSearch in Google Scholar
• 227 Gabrielli C, Zannini A, Corradini R. Spread of HCV among sexual partners of HCVAb positive intravenous drug users.  J Infect . 1994;  29 17-22
  CrossrefPubMedSearch in Google Scholar
• 228 Coltorti M, Caporaso N, Morisco F. Prevalence of HCV infection in the household contacts of patients with HCV-related chronic liver disease.  Infection . 1994;  22 183-186
  CrossrefPubMedSearch in Google Scholar
• 229 Guadagnino V, Stroffolini T, Foca A. Hepatitis C virus infection in family setting.  Eur J Epidemiol . 1998;  14 229-232
  CrossrefPubMedSearch in Google Scholar
• 230 Brusaferro S, Barbone F, Andrian P. A study on the role of the family and other risk factors in HCV transmission.  Eur J Epidemiol . 1999;  15 125-132
  CrossrefPubMedSearch in Google Scholar
• 231 Caporaso N, Ascione A, Stroffolini T. Spread of hepatitis C virus within families.  J Viral Hepat . 1998;  5 67-72
  CrossrefPubMedSearch in Google Scholar
• 232 Mondello P, Patti S, Vitale M G. Anti-HCV antibodies in household contacts of patients with cirrhosis of the liver-preliminary results.  Infection . 1992;  20 51-52
  CrossrefPubMedSearch in Google Scholar
• 233 Bellobuono A, Zanella A, Petrini G. Intrafamilial spread of hepatitis C virus.  Transfusion . 1991;  31 475
  PubMedSearch in Google Scholar
• 234 Scaraggi F A, Lomuscio S, Perricci A. Intrafamilial and sexual transmission of hepatitis C virus.  Lancet . 1993;  342 1300-1301
  PubMedSearch in Google Scholar
• 235 Saltoglu N, Tasova Y, Burgut R, Dundar I H. Sexual and non-sexual intrafamilial spread of hepatitis C virus: intrafamilial transmission of HCV.  Eur J Epidemiol . 1998;  14 225-228
  CrossrefPubMedSearch in Google Scholar
• 236 Oshita M, Hayashi N, Kasahara A. Prevalence of HCV in family members of patients with hepatitis C.  J Med Virol . 1993;  41 251-255
  PubMedSearch in Google Scholar
• 237 Setoguchi Y, Kajihara S, Hara T. Analysis of nucleotide sequences of HCV isolates from husband-wife pairs.  J Gastroenterol Hepatol . 1994;  9 468-471
  PubMedSearch in Google Scholar
• 238 Nakashima K, Ikematsu H, Hayashi J. Intrafamilial transmission of hepatitis C virus among the population of an endemic area of Japan.  JAMA . 1995;  274 1459-1461
  CrossrefPubMedSearch in Google Scholar
• 239 Kao J H, Chen P J, Yang P M. Intrafamilial transmission of HCV: The important role of infections between spouses.  J Infect Dis . 1994;  170 1128-1133
  PubMedSearch in Google Scholar
• 240 Kim Y S, Chi H S, Ahn Y O. Lack of familial clustering of hepatitis C virus infection.  Int J Epidemiol . 1998;  27 525-529
  CrossrefPubMedSearch in Google Scholar
• 241 Brackmann S A, Gerritzen A, Oldenburg J. Search for intrafamilial transmission of HCV in hemophilia patients.  Blood . 1993;  81 1077-1082
  PubMedSearch in Google Scholar
• 242 Camarero C, Martos I, Delgado R. Horizontal transmission of hepatitis C virus in households of infected children.  J Pediatr . 1993;  123 98-99
  PubMedSearch in Google Scholar
• 243 Vegnente A, Iorio R, Saviano A. Lack of intrafamilial transmission of hepatitis C virus in family members of children with chronic hepatitis C infection.  Pediatr Infect Dis J . 1994;  886-889
  PubMedSearch in Google Scholar
• 244 Kaldor J M, Archer G T, Buring M L. Risk factors for hepatitis C virus infection in blood donors: a case-control study.  Med J Australia . 1992;  157 227-230
  PubMedSearch in Google Scholar
• 245 Sun D X, Zhang F G, Geng Y Q. Hepatitis C transmission by cosmetic tattooing in women.  Lancet . 1996;  347 541
  PubMedSearch in Google Scholar
• 246 Tumminelli F, Marcellin P, Rizzo S. Shaving as a potential source of hepatitis C virus infection.  Lancet . 1995;  345 658
  PubMedSearch in Google Scholar
• 247 Mele A, Corona R, Tosti M E. Beauty treatments and risk of parenterally transmitted hepatitis: results from the hepatitis surveillance system in Italy.  Scand J Infect Dis . 1995;  27 441-444
  PubMedSearch in Google Scholar
• 248 Balasekaran R, Bulterys M, Jamal M. A case-control study of risk factors for sporadic hepatitis C virus infection in the southwestern United States.  Am J Gastroenterol . 1999;  94 1341-1346
  CrossrefPubMedSearch in Google Scholar
• 249 EASL International Consensus Conference on Hepatitis C. Consensus statement.  J Hepatol . 1999;  30 956-961
  CrossrefPubMedSearch in Google Scholar

REFERENCES

• 1 WHO. Global surveillance and control of hepatitis C. Report of a WHO Consultation organized in collaboration with the Viral Hepatitis Prevention Board, Antwerp, Belgium.  J Viral Hepat . 1999;  6 35-47
  CrossrefPubMedSearch in Google Scholar
• 2 Dow B C, Coote I, Munru H. Confirmation of hepatitis C virus antibody in blood donors.  J Med Virol . 1993;  41 215-220
  PubMedSearch in Google Scholar
• 3 Mutimer D J, Harrison R F, O'Donnell K B. Hepatitis C virus infection in the asymptomatic British blood donor.  J Viral Hepat . 1995;  2 47-53
  PubMedSearch in Google Scholar
• 4 Atrah H I, Ala F A, Ahmed M M. Unexplained hepatitis C virus antibody seroconversion in established blood donors.  Transfusion . 1996;  36 339-343
  CrossrefPubMedSearch in Google Scholar
• 5 Mathiesen U L, Karlsson E, Foberg U. Also with a restrictive transfusion policy, screening with second-generation anti-hepatitis C virus enzyme-linked immunosorbent assay would have reduced posttransfusion hepatitis C after open-heart surgery.  Scand J Gastroenterol . 1993;  28 581-584
  PubMedSearch in Google Scholar
• 6 Nordoy I, Schrumpf E, Elgjo K. Liver disease in anti-hepatitis C virus-positive Norwegian blood donors.  Scand J Gastroenterol . 1994;  29 77-81
  PubMedSearch in Google Scholar
• 7 Hennig H, Haase D, Kirchner H. Prevalence of hepatitis C virus in blood donors and comparison of 4 different anti-HCV differentiation tests.  Beitr Infsuionsther Transfuisonsmed . 1996;  33 231-234
  PubMedSearch in Google Scholar
• 8 Riggert J, Schwartz D W, Uy A. Risk of hepatitis C virus (HCV) transmission by anti-HCV-negative blood components in Austria and Germany.  Ann Hematol . 1996;  72 35-39
  PubMedSearch in Google Scholar
• 9 Caspari G, Gerlich W H, Beyer J, Schmitt H. Non-specific and specific anti-HCV results correlated to age, sex, transaminase, rhesus blood group and follow-up in blood donors.  Arch Virol . 1997;  142 473-489
  CrossrefPubMedSearch in Google Scholar
• 10 Ranger S, Martin P, Roussane M C, Denis F. Prevalence of hepatitis C virus antibodies in the general population and in selected groups of patients in Limoges, France.  Gut . 1993;  34(2 Suppl) S50-S51
  PubMedSearch in Google Scholar
• 11 Kleinman S, Alter H, Busch M. Increased detection of hepatitis C virus (HCV)-infected blood donors by a multiple-antigen HCV enzyme immunoassay.  Transfusion . 1992;  32 805-813
  CrossrefPubMedSearch in Google Scholar
• 12 Murphy E L, Bryzman S, Williams A E. Demographic determinants of hepatitis C seroprevalence among blood donors.  JAMA . 1996;  275 996-1000
  PubMedSearch in Google Scholar
• 13 Zhang Y Y, Guo L S, Hao L J. Antibodies to hepatitis C virus and hepatitis C virus RNA in Chinese blood donors determined by ELISA, recombinant immunoblot assay and polymerase chain reaction.  Chin Med J . 1993;  106 171-174
  PubMedSearch in Google Scholar
• 14 Garcia Z, Taylor L, Ruano A. Evaluation of a pooling method for routine anti-HCV screening of blood donors to lower the cost burden on blood banks in countries under development.  J Med Virol . 1996;  49 218-222
  CrossrefPubMedSearch in Google Scholar
• 15 Pita-Ramirez L, Torres-Ortiz G E. Prevalence of viral antibodies and syphilis serology in blood donors from a hospital.  Rev Invest Clin . 1997;  49 475-480
  PubMedSearch in Google Scholar
• 16 Ayala Gaytan J J, Guerra Avalos J F, Brondo Mora P, Casillas Roma A. Prevalence of viral markers for hepatitis B, C and human immunodeficiency virus in volunteer blood donors in Northeast Mexico.  Rev Gastroenterol Mexico . 1997;  62 250-253
  PubMedSearch in Google Scholar
• 17 Guerrero-Romero J F, Castaneda A, Rodriguez-Moran M. Prevalence of risk factors associated with hepatitis C in blood donors in the municipality of Durango, Mexico.  Salud Publica Mex . 1996;  38 94-100
  PubMedSearch in Google Scholar
• 18 Munoz G, Velasco M, Thiers V. Prevalence and genotypes of hepatitis C virus in blood donors and in patients with chronic liver disease and hepatocarcinoma in a Chilean population.  Rev Med Chile . 1998;  126 1035-1042
  PubMedSearch in Google Scholar
• 19 Mison L M, Young I F, O'Donoghue M. Prevalence of hepatitis C virus and genotype distribution in an Australian volunteer blood donor population.  Transfusion . 1997;  37 73-78
  CrossrefPubMedSearch in Google Scholar
• 20 Triki H, Said N, Ben Salah A. Seroepidemiology of hepatitis B, C and delta viruses in Tunisia.  Trans R Soc Trop Med Hyg . 1997;  91 11-14
  CrossrefPubMedSearch in Google Scholar
• 21 Abid S, Fkih S, Khlass B. Screening and confirmation of anti-HCV antibodies in Tunisian blood donors.  Transfus Clin Biol . 1997;  4 221-226
  CrossrefPubMedSearch in Google Scholar
• 22 Soni P N, Tait D R, Kenoyer D G. Hepatitis C virus antibodies among risk groups in a South African area endemic for hepatitis B virus.  J Med Virol . 1993;  40 65-68
  PubMedSearch in Google Scholar
• 23 Vasconcelos H C, Yoshida C F, Vanderborght B O, Schatzmayr H G. Hepatitis B and C prevalences among blood donors in the south region of Brazil.  Mem Inst Oswaldo Cruz . 1994;  89 503-507
  PubMedSearch in Google Scholar
• 24 Edelenyi-Pinto M, Carvalho A P, Nogueira C. Prevalence of antibodies to hepatitis C virus in populations at low and high risk for sexually transmitted diseases in Rio de Janeiro.  Mem Inst Oswaldo Cruz . 1993;  88 305-307
  PubMedSearch in Google Scholar
• 25 Hadziyannis S J, Giannoulis G, Hadziyannis E. Hepatitis C virus infection in Greece and its role in chronic liver disease and hepatocellular carcinoma.  J Hepatol . 1993;  17(Suppl 3) S72-S77
  CrossrefPubMedSearch in Google Scholar
• 26 Mihaljevic I, Feldbauer J, Delajlija M, Grgicevic D. Antibodies to hepatitis C virus in Croatian blood donors and polytransfused patients.  Vox Sang . 1992;  63 236
  PubMedSearch in Google Scholar
• 27 Gloskowska-Moraczewska Z, Kacperska E, Seyfried H. Evaluation of screening and complementary tests for anti-HCV antibodies.  Acta Haematol Pol . 1993;  24 273-280
  PubMedSearch in Google Scholar
• 28 Lai M E, Mazzoleni A P, Farci P. Markers of hepatitis C virus infection in Sardinian blood donors: relationship with alanine aminotransferase levels.  J Med Virol . 1993;  41 282-288
  PubMedSearch in Google Scholar
• 29 Abdourakhamanov D T, Hasaev A S, Castro F J, Guardia J. Epidemiological and clinical aspects of hepatitis C virus infection in the Russian Republic of Daghestan.  Eur J Epidemiol . 1998;  14 549-553
  CrossrefPubMedSearch in Google Scholar
• 30 Barna T K, Ozsvar Z, Szendrenyi V, Gal G. Hepatitis C virus antibody in the serum of blood donors.  Orvosi Hetilap . 1996;  137 507-511
  PubMedSearch in Google Scholar
• 31 Al-Faleh F Z, Ramia S, Arif M. Profile of hepatitis C virus and the possible modes of transmission of the virus in the Gizan area of Saudi Arabia: a community-based study.  Ann Trop Med Parasitol . 1995;  89 431-437
  PubMedSearch in Google Scholar
• 32 El Guneid A M, Gunaid A A, O'Neill A M. Prevalence of hepatitis B, C and D virus markers in Yemeni patients with chronic liver disease.  J Med Virol . 1993;  40 330-333
  PubMedSearch in Google Scholar
• 33 Panigrahi A K, Panda S K, Dixit R K. Magnitude of hepatitis C virus infection in India: prevalence in healthy blood donors, acute and chronic liver diseases.  J Med Virol . 1997;  51 167-174
  CrossrefPubMedSearch in Google Scholar
• 34 Jaiswal S P, Chitnis D S, Naik G. Prevalence of anti-HCV antibodies in central India.  Indian J Med Res . 1996;  104 177-181
  PubMedSearch in Google Scholar
• 35 Irshad M, Acharya S K, Josha Y K. Prevalence of hepatitis C virus antibodies in the general population and in selected groups of patients in Delhi.  Indian J Med Res . 1995;  102 162-164
  PubMedSearch in Google Scholar
• 36 Frommel D, Tekle-Haimanot R, Berhe N. A survey of antibodies to hepatitis C virus in Ethiopia.  Am J Trop Med Hyg . 1993;  49 435-439
  PubMedSearch in Google Scholar
• 37 Wansbrough-Jones M H, Frimpong E, Cant B. Prevalence and genotype of hepatitis C virus infection in pregnant women and blood donors in Ghana.  Trans R Soc Trop Med Hyg . 1998;  92 496-499
  CrossrefPubMedSearch in Google Scholar
• 38 Lo B B, Meymouna M, Boulahi M A. Prevalence of serum markers of hepatitis B and C virus in blood donors of Nouakchott, Mauritania.  Bull Soc Pathol Exot . 1999;  92 83-84
  PubMedSearch in Google Scholar
• 39 Develoux M, Boni G, Aguessy Ahyi B. The prevalence of anti-hepatitis C antibodies in pregnant women and blood donors in Benin.  Bull Soc Pathol Exot . 1995;  88 115-116
  PubMedSearch in Google Scholar
• 40 Jeannel D, Fretz C, Traore Y. Evidence for high genetic diversity and long-term endemicity of hepatitis C virus genotrypes 1 and 2 in West Africa.  J Med Virol . 1998;  55 92-97
  CrossrefPubMedSearch in Google Scholar
• 41 Ilako F M, McLigeyo S O, Riyat M S. The prevalence of hepatitis C virus antibodies in renal patients, blood donors and patients with chronic liver disease in Kenya.  East Afr Med J . 1995;  72 362-364
  PubMedSearch in Google Scholar
• 42 Hayashi J, Furusyo N, Sawayama Y. Hepatitis G virus in the general population and in patients on hemodialysis.  Dig Dis Sci . 1998;  43 2143-2148
  CrossrefPubMedSearch in Google Scholar
• 43 Nakashima K, Kashiwagi S, Hayashi J. Prevalence of hepatitis C virus infection among female prostitutes in Fukuoka, Japan.  J Gastroenterol . 1996;  31 664-668
  PubMedSearch in Google Scholar
• 44 Sakugawa H, Nakasone H, Nakayoshi T. High proportion of false positive reactions among donors with anti-HCV antibodies in a low prevalence area.  J Med Virol . 1995;  46 334-338
  PubMedSearch in Google Scholar
• 45 Yamaguchi K, Kiyokawa H, Machida J. Seroepidemiology of hepatitis C virus infection in Japan and HCV infection in haemodialysis patients.  FEMS Microbiol Rev . 1994;  14 253-258
  CrossrefPubMedSearch in Google Scholar
• 46 Wang Y, Tao Q M, Zhao H Y. Hepatitis C virus RNA and antibodies among blood donors in Beijing.  J Hepatol . 1994;  21 634-640
  CrossrefPubMedSearch in Google Scholar
• 47 Wu X. Investigation on anti-HCV antibody in Shashi District.  Chin J Epidemiol . 1993;  14 331-333
  PubMedSearch in Google Scholar
• 48 Tang S. Seroepidemiological study on hepatitis C virus infection among blood donors from various regions in China.  Chin J Epidemiol . 1993;  14 271-274
  PubMedSearch in Google Scholar
• 49 Zhang Y Y, Hansson B G, Widell A, Nordenfelt E. Hepatitis C virus antibodies and hepatitis C virus RNA in Chinese blood donors determined by ELISA, recombinant immunoblot assay and polymerase chain reaction.  APMIS . 1992;  100 851-855
  PubMedSearch in Google Scholar
• 50 Duraisamy G, Zuridah H, Ariffin M Y. Prevalence of hepatitis C virus antibodies in blood donors in Malaysia.  Med J Mal . 1993;  48 313-316
  PubMedSearch in Google Scholar
• 51 Kuperan P, Choon A T, Ding S H, Lee G. Prevalence of antibodies to hepatitis C virus in relation to surrogate markers in a blood donor population in Singapore.  Southeast Asian J Trop Med Pub Health . 1993;  24(Suppl 1) 127-129
  PubMedSearch in Google Scholar
• 52 Apichartpiyakul C, Apichartpiyakul N, Urwijitaroon Y. Seroprevalence and subtype distribution of hepatitis C virus among blood donors and intravenous drug users in northern/northeastern Thailand.  Jpn J Infect Dis . 1999;  52 121-123
  PubMedSearch in Google Scholar
• 53 Songsivilai S, Jinathongthai S, Wongsena W. High prevalence of hepatitis C infection among blood donors in northeaster Thailand.  Am J Trop Med Hyg . 1997;  57 66-69
  PubMedSearch in Google Scholar
• 54 Sawanpanyalert P, Boonmar S, Maeda T. Risk factors for hepatitis C virus infection among blood donors in an HIV-epidemic area in Thailand.  J Epidemiol Commun Health . 1996;  50 174-177
  PubMedSearch in Google Scholar
• 55 Darmadi S, Soetjipto, Handajani R. Hepatitis C virus infection-associated markers in sera from blood donors in Surabaya, Indonesia.  Microbiol Immunol . 1996;  40 401-405
  PubMedSearch in Google Scholar
• 56 Soetjipto, Handajani R, Lusida M I. Differential prevalence of hepatitis C virus subtypes in healthy blood donors, patients on maintenance hemodialysis and patients with hepatocellular carcinoma in Surabaya, Indonesia.  J Clin Microbiol . 1996;  34 2875-2880
  PubMedSearch in Google Scholar
• 57 Saleh M G, Pereira L M, Tibbs C J. High prevalence of hepatitis C virus in the normal Libyan population.  Trans R Soc Trop Med Hyg . 1994;  88 292-294
  CrossrefPubMedSearch in Google Scholar
• 58 Bassily S, Hyams K C, Fouad R A. A high risk of hepatitis C infection among Egyptian blood donors: the role of parenteral drug abuse.  Am J Trop Med Hyg . 1995;  52 503-505
  PubMedSearch in Google Scholar
• 59 Darwish M A, Raouf T A, Rushdy P. Risk factor associated with a high seroprevalence of hepatitis C virus infection in Egyptian blood donors.  Am J Trop Med Hyg . 1993;  49 440-447
  PubMedSearch in Google Scholar
• 60 Attia M A, Zekri A R, Goudsmit J. Diverse patterns of recognition of hepatitis C virus core and nonstructural antigens by antibodies present in Egyptian cancer patients and blood donors.  J Clin Microbiol . 1996;  34 2665-2669
  PubMedSearch in Google Scholar
• 61 Alter M J, Kruszon-Moran D, Nainan O V. Prevalence of hepatitis C virus infection in the United States, 1988-1994.  N Engl J Med . 1999;  341 556-562
  CrossrefPubMedSearch in Google Scholar
• 62 Lowe D, Cotton R. Hepatitis C: a review of Australia's response. Publications Production Unit, Commonwealth Department of Health and Aged Care, Commonwealth of Australia, Canberra, 1999
• 63 Farrell G C, Weltman M, Dingley J, Lin R. Epidemiology of hepatitis C virus infection in Australia.  Gastroenterol Jpn . 1993;  28(Suppl 5) 32-36
  PubMedSearch in Google Scholar
• 64 Armstrong G L, Alter M J, McQuillan G M. The past incidence of hepatitis C virus infection: implications for the future burden of chronic liver disease in the United States.  Hepatology . 2000;  31 777-782
  CrossrefPubMedSearch in Google Scholar
• 65 Alter M J. Epidemiology of hepatitis C.  Hepatology . 1997;  26 62S-65S
  CrossrefPubMedSearch in Google Scholar
• 66 Tanaka E, Kiyosawa K, Sodeyama T. Prevalence of antibody to hepatitis C virus in Japanese school children: comparison with adult blood donors.  Am J Trop Med Hyg . 1992;  46 460-464
  PubMedSearch in Google Scholar
• 67 Ishibasi M, Shinzawa H, Kuboki M, Tsuchida H, Takahashi T. Prevalence of inhabitants with anti-hepatitis C virus antibody in an area following an acute hepatitis C epidemic: age and area-related features.  J Epidemiol . 1996;  6 1-7
  PubMedSearch in Google Scholar
• 68 Guadagnino V, Stroffolini T, Rapicetta M. Prevalence, risk factors, and genotype distribution of hepatitis C virus infection in the general population: a community-based survey in Southern Italy.  Hepatology . 1997;  26 1006-1011
  PubMedSearch in Google Scholar
• 69 Stroffolini T, Menchinelli M, Taliani G. High prevalence of hepatitis C virus infection in a small central Italian town: lack of evidence of parenteral exposure.  Ital J Gastroenterol . 1995;  27 235-238
  PubMedSearch in Google Scholar
• 70 Abdel-Wahah M F, Zakaria S, Kamel M. High seroprevalence of hepatitis C infection among risk groups in Egypt.  Am J Trop Med Hyg . 1994;  51 563-567
  PubMedSearch in Google Scholar
• 71 Mohamed M K, Hussein M H, Massoud A A. Study of the risk factors for viral hepatitis C infection among Egyptians applying for work abroad.  J Egypt Public Health Assoc . 1996;  71 113-142
  PubMedSearch in Google Scholar
• 72 Villano S A, Vlahov D, Nelson K E, Lyles C M, Cohn S, Thomas D L. Incidence and risk factors for hepatitis C among injection drug users in Baltimore, Maryland.  J Clin Microbiol . 1997;  35 3274-3277
  PubMedSearch in Google Scholar
• 73 Garfein R S, Doherty M C, Monterroso E R, Thomas D L, Nelson K E, Vlahov D. Prevalence and incidence of hepatitis C virus infection among young adult injection drug users.  J Acquir Immune Defic Syndr Hum Retrovirol . 1998;  18(Suppl 1) S11-S19
  PubMedSearch in Google Scholar
• 74 Crofts N, Hopper J L, Bowden D S, Breschkin A M, Milner R, Locarnini S A. Hepatitis C virus infection among a cohort of Victorian injecting drug users.  Med J Aust . 1993;  159 237-241
  PubMedSearch in Google Scholar
• 75 Centers for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease.  MMWR Morb Mortal Wkly Rep . 1998;  47 1-33
  PubMedSearch in Google Scholar
• 76 Tanaka H, Tsukuma H, Hori Y. The risk of hepatitis C virus infection among blood donors in Osaka, Japan.  J Epidemiol . 1998;  8 292-296
  PubMedSearch in Google Scholar
• 77 Mele A, Sagliocca L, Manzillo G. Risk factors for acute non-A, non-B hepatitis and their relationship to antibodies for hepatitis C virus: a case-control study.  Am J Public Health . 1994;  84 1640-1643
  PubMedSearch in Google Scholar
• 78 Chiaramonte M, Stroffolini T, Lorenzoni U. Risk factors in community-acquired chronic hepatitis C virus infection: a case-control study in Italy.  J Hepatol . 1996;  24 129-134
  CrossrefPubMedSearch in Google Scholar
• 79 Conry-Cantilena C, VanRaden M, Gibble J. Routes of infection, viremia, and liver disease in blood donors found to have hepatitis C virus infection.  N Engl J Med . 1996;  334 1691-1696
  CrossrefPubMedSearch in Google Scholar
• 80 Lillienfeld A M, Lilienfeld D E. Foundations of Epidemiology.  New York: Oxford University Press 1980
  Search in Google Scholar
• 81 Conry-Cantilena C, Melpolder J C, Alter H J. Intranasal drug use among volunteer whole-blood donors: results of survey C.  Transfusion . 1998;  38 512-513
  CrossrefPubMedSearch in Google Scholar
• 82 Alter M J. Epidemiology of hepatitis C in the West.  Semin Liver Dis . 1995;  15 5-14
  PubMedSearch in Google Scholar
• 83 Aach R D, Stevens C E, Hollinger F B. Hepatitis C virus infection in post-transfusion hepatitis. An analysis with first- and second-generation assays.  N Engl J Med . 1991;  325 1325-1329
  PubMedSearch in Google Scholar
• 84 Elia G F, Magnani G, Belli L. Incidence of anti-hepatitis C virus antibodies in non-A, non-B post-transfusion hepatitis in an area of northern Italy.  Infection . 1991;  19 336-339
  CrossrefPubMedSearch in Google Scholar
• 85 Mattsson L, Grillner L, von Sydow M. Seroconversion to hepatitis C virus antibodies in patients with acute posttransfusion non-A, non-B hepatitis in Sweden.  Infection . 1991;  19 309-312
  CrossrefPubMedSearch in Google Scholar
• 86 Goncales Jr L F, Pedro de J R, Da Silva J L. Post-transfusional hepatitis in the city of Campinas SP, Brazil. I. Incidence, etiological agents and clinico-epidemiological aspects of hepatitis C.  Rev Inst Med Trop Sao Paulo . 1993;  35 53-62
  PubMedSearch in Google Scholar
• 87 Jullien A M, Courouce A M, Massari V. Impact of screening donor blood for alanine aminotransferase and antibody to hepatitis B core antigen on the risk of hepatitis C virus transmission.  Eur J Clin Microbiol Infect Dis . 1993;  12 668-672
  PubMedSearch in Google Scholar
• 88 Donahue J G, Munoz A, Ness P M. The declining risk of post-transfusion hepatitis C virus infection.  N Engl J Med . 1992;  327 369-373
  CrossrefPubMedSearch in Google Scholar
• 89 Nelson K E, Ahmed F, Ness P. Comparison of first and second generation ELISA screening tests in detecting HCV infections in transfused cardiac surgery patients [abstract]. Program and Abstracts of the International Symposium on Viral Hepatitis and Liver Disease, 1993, p. 50
• 90 Takano S, Nakamura K, Kawai S. Prospective assessment of donor blood screening for antibody to hepatitis C virus by first- and second-generation assays as a means of preventing posttransfusion hepatitis.  Hepatology . 1996;  23 708-712
  PubMedSearch in Google Scholar
• 91 Gonzalez A, Esteban J I, Madoz P. Efficacy of screening donors for antibodies to the hepatitis C virus to prevent transfusion-associated hepatitis: final report of a prospective trial.  Hepatology . 1995;  22 439-445
  CrossrefPubMedSearch in Google Scholar
• 92 Japanese Red Cross Non-A Non-B Hepatitis Research Group. Effect of screening for hepatitis C virus antibody and hepatitis B core antibody on incidence of post-transfusion hepatitis.  Lancet . 1991;  338 1040-1041
  CrossrefPubMedSearch in Google Scholar
• 93 Schreiber G B, Busch M P, Kleinman S H. The risk of transfusion-transmitted viral infections.  N Engl J Med . 1996;  334 1685-1690
  CrossrefPubMedSearch in Google Scholar
• 94 Alter M J, Coleman P J, Alexander W J. Importance of heterosexual activity in the transmission of hepatitis B and nonA, nonB hepatitis.  JAMA . 1989;  262 1201-1205
  CrossrefPubMedSearch in Google Scholar
• 95 Alter M J, Gerety R J, Smallwood L. Sporadic non-A, non-B hepatitis: frequency and epidemiology in an urban United States population.  J Infect Dis . 1982;  145 886-893
  CrossrefPubMedSearch in Google Scholar
• 96 Louie M, Low D E, Feinman S V. Prevalence of bloodborne infective agents among people admitted to a Canadian hospital.  Can Med Assoc J . 1992;  146 1331-1334
  PubMedSearch in Google Scholar
• 97 Kelen G D, Green G B, Purcell R H. Hepatitis B and hepatitis C in emergency department patients.  N Engl J Med . 1992;  326 1399-1404
  CrossrefPubMedSearch in Google Scholar
• 98 Barham W B, Figueroa R, Phillips I A, Hyams K C. Chronic liver disease in Peru: role of viral hepatitis.  J Med Virol . 1994;  42 129-132
  PubMedSearch in Google Scholar
• 99 Bile K, Aden C, Norder H. Important role of hepatitis C virus infection as a cause of chronic liver disease in Somalia.  Scand J Infect Dis . 1993;  25 559-564
  PubMedSearch in Google Scholar
• 100 Guyer B, Bradley D W, Bryan J A, Maynard J E. Non-A, non-B hepatitis among participants in a plasmapheresis stimulation program.  J Infect Dis . 1979;  139 634-40
  PubMedSearch in Google Scholar
• 101 Schvarcz R, Johansson B, Nystra;uom, Sönnerborg A. Nosocomial transmission of hepatitis C virus.  Infection . 1997;  25 74-77
  PubMedSearch in Google Scholar
• 102 Allander T, Gruber A, Naghavi M. Frequent patient-to-patient transmission of hepatitis C virus in a haematology ward.  Lancet . 1995;  345 603-607
  CrossrefPubMedSearch in Google Scholar
• 103 Widell A, Christensson B, Wiebe T. Epidemiologic and molecular investigation of outbreaks of hepatitis C virus infection on a pediatric oncology service.  Ann Intern Med . 1999;  130 130-134
  PubMedSearch in Google Scholar
• 104 Bronowicki J P, Venard V, Botte C. Patient to patient transmission of hepatitis C virus during colonoscopy.  N Engl J Med . 1997;  337 237-240
  CrossrefPubMedSearch in Google Scholar
• 105 Niu M T, Coleman P J, Alter M J. Multicenter study of hepatitis C virus infection in chronic hemodialysis patients and staff.  Am J Kidney Dis . 1993;  22 568-573
  CrossrefPubMedSearch in Google Scholar
• 106 Conlon P J, Walshe J J, Smyth E G. Lower prevalence of anti-hepatitis C antibody in dialysis and renal transplant patients in Ireland.  Irish J Med Sci . 1993;  162 145-147
  PubMedSearch in Google Scholar
• 107 Bukh J, Wantzin P, Krogsgaard K. High prevalence of hepatitis C virus (HCV) RNA in dialysis patients: failure of commercially available antibody tests to identify a significant number of patients with HCV infection.  J Infect Dis . 1993;  168 1343-1348
  CrossrefPubMedSearch in Google Scholar
• 108 Kolho E, Oksanen K, Honkanen E. Hepatitis C antibodies in dialysis patients and patients with leukaemia.  J Med Virol . 1993;  40 318-321
  PubMedSearch in Google Scholar
• 109 Nordenfelt E, Lofgren B, Widell A. Hepatitis C virus infection in hemodialysis patients in Southern Sweden: epidemiological, clinical, and diagnostic aspects.  J Med Virol . 1993;  40 266-270
  PubMedSearch in Google Scholar
• 110 Medin C, Allander T, Roll M. Seroconversion to hepatitis C virus in dialysis patients: a retrospective and prospective study.  Nephron . 1993;  65 40-45
  PubMedSearch in Google Scholar
• 111 Almroth G, Ekermo B, Franzen L, Hed J. Antibody responses to hepatitis C virus and its modes of transmission in dialysis patients.  Nephron . 1991;  59 232-235
  PubMedSearch in Google Scholar
• 112 Hardy N M, Sandroni S, Danielson S, Wilson W J. Antibody to hepatitis C virus increases with time on hemodialysis.  Clin Nephrol . 1992;  38 44-48
  PubMedSearch in Google Scholar
• 113 Zeldis J B, Depner T A, Kuramoto I K. The prevalence of hepatitis C virus antibodies among hemodialysis patients.  Ann Intern Med . 1990;  112 958-960
  CrossrefPubMedSearch in Google Scholar
• 114 Jeffers L J, Perez G O, DeMedina M D. Hepatitis C infection in two urban hemodialysis units.  Kidney Int . 1990;  38 320-322
  PubMedSearch in Google Scholar
• 115 Forseter G, Wormser G P, Adler S. Hepatitis C in the health care setting. Seroprevalence among hemodialysis staff and patients in suburban New York City.  Am J Infec Control . 1993;  21 5-8
  PubMedSearch in Google Scholar
• 116 Kallinowski B, Theilmann L, Gmelin K. Prevalence of antibodies to hepatitis C virus in hemodialysis patients.  Nephron . 1991;  59 236-238
  PubMedSearch in Google Scholar
• 117 Schlipkoter U, Roggendorf M, Ernst G. Hepatitis C virus antibodies in haemodialysis patients [letter].  Lancet . 1990;  335 1409
  CrossrefPubMedSearch in Google Scholar
• 118 Tokars J I, Alter M J, Favero M S. National surveillance of dialysis associated diseases in the United States, 1993.  ASAIO J . 1996;  42 219-229
  PubMedSearch in Google Scholar
• 119 Hayashi J, Yoshimura E, Nabeshima A. Seroepidemiology of hepatitis C virus infection in hemodialysis patients and the general population in Fukuoka and Okinawa, Japan.  J Gastroenterol . 1994;  29 276-281
  PubMedSearch in Google Scholar
• 120 Fujiyama S, Kawano S, Sato S. Changes in prevalence of anti-HCV antibodies associated with preventive measures among hemodialysis patients and dialysis staff.  Hepatogastroenterology . 1995;  42 162-165
  PubMedSearch in Google Scholar
• 121 Tsuyuguchi M. Prevalence of hepatitis C virus infection among chronic hemodialysis patients.  Hokkaido J Med Sci . 1994;  69 1178-1188
  PubMedSearch in Google Scholar
• 122 DiLallo D, Miceli M, Petrosillo N. Risk factors of hepatitis C virus infection in patients on hemodialysis: a multivariate analysis based on a dialysis register in Central Italy.  Eur J Epidemiol . 1999;  15 11-14
  CrossrefPubMedSearch in Google Scholar
• 123 Covic A, Iancu L, Apetrei C. Hepatitis virus infection in haemodialysis patients from Moldavia.  Nephrol Dial Transplant . 1999;  14 40-45
  PubMedSearch in Google Scholar
• 124 Fabrizi F, Lunghi G, Pagliari B. Molecular epidemiology of hepatitis C virus infection in dialysis patients.  Nephron . 1997;  77 190-196
  PubMedSearch in Google Scholar
• 125 Halfon P, Khiri H, Feryn J M. Prospective virolocial follow-up of hepatitis C infection in a haemodialysis unit.  J Viral Hepat . 1998;  5 115-121
  CrossrefPubMedSearch in Google Scholar
• 126 Forns X, Fernandez-Llama P, Pons M. Incidence and risk factors of hepatitis C virus infection in a haemodialysis unit.  Nephrol Dial Transplant . 1997;  12 736-740
  PubMedSearch in Google Scholar
• 127 Fabrizi F, Martin P, Dixit V. Detection of de novo hepatitis C virus infection by polymerase chain in hemodialysis patients.  Am J Nephrol . 1999;  19 383-388
  CrossrefPubMedSearch in Google Scholar
• 128 Jadoul M, Cornu C, Van Ypersele de Strihou C, UCL Collaborative Group. Incidence and risk factors for hepatitis C seroconversion in hemodialysis: a prospective study.  Kidney Int . 1993;  44 1322-1326
  PubMedSearch in Google Scholar
• 129 Muller G Y, Zabaleta M E, Arminio A. Risk factors for dialysis-associated hepatitis C in Venezuela.  Kidney Int . 1992;  41 1055-1058
  PubMedSearch in Google Scholar
• 130 Irie Y, Hayashi H, Yokozeki K. Hepatitis C infection unrelated to blood transfusion in hemodialysis patients.  J Hepatol . 1994;  20 557-559
  CrossrefPubMedSearch in Google Scholar
• 131 Noguchi S, Sata M, Suzuki H, Mizokami M, Tanikawa K. Routes of transmission of hepatitis C virus in an epidemic rural area of Japan. Molecular epidemiologic study of hepatitis C virus infection.  Scand J Infect Dis . 1997;  29 23-28
  PubMedSearch in Google Scholar
• 132 Kiyosawa K, Tanaka E, Sodeyama T. Transmission of hepatitis C in an isolated area in Japan: community-acquired infection.  Gastroenterology . 1994;  196 1596-1602
  PubMedSearch in Google Scholar
• 133 Ito S, Ito M, Cho M-J, Shimotohno K, Tajima K. Massive sero-epidemiological survey of hepatitis C virus: clustering of carriers on the Southwest coast of Tsushima, Japan.  Jpn J Cancer Res . 1991;  82 1-3
  PubMedSearch in Google Scholar
• 134 Frank C, Mohamed M K, Strickland G T. The role of antischistosomal therapy in the spread of hepatitis C virus in Egypt.  Lancet . 2000;  355 887-891
  CrossrefPubMedSearch in Google Scholar
• 135 Hutin Y JF, Harpaz R, Drobeniuc, et al. Injections given in healthcare settings as a major source of hepatitis B virus infection in Moldova.  Int J Epidemiol . 1999;  28 782-786
  CrossrefPubMedSearch in Google Scholar
• 136 Luby S P, Qamruddin K, Shah A A. The relationship between therapeutic injections and high prevalence of hepatitis C infection in Hafizabad, Pakistan.  Epidemiol Infect . 1997;  119 349-356
  CrossrefPubMedSearch in Google Scholar
• 137 Centers for Disease Control and Prevention. Frequency of vaccine-related and therapeutic injections-Romania, 1998.  MMWR Morb Mortal Wkly Rep . 1999;  48 271-274
  PubMedSearch in Google Scholar
• 138 Esteban J I, Gomez J, Martell M. Transmission of hepatitis C virus by a cardiac surgeon.  N Engl J Med . 1996;  334 555-560
  CrossrefPubMedSearch in Google Scholar
• 139 Duckworth G J, Heptonstall J, Aitken C. Transmission of hepatitis C virus from a surgeon to a patient.  Commun Dis Public Health . 1999;  2 188-192
  PubMedSearch in Google Scholar
• 140 Blackmore T K, Stace N H, Maddocks P. Prevalence of antibodies to HCV in patients receiving renal replacement therapy, and in the staff caring for them.  Aust NZJ Med . 1992;  22 353-357
  PubMedSearch in Google Scholar
• 141 Thomas D L, Factor S H, Kelen G D. Viral hepatitis in health care personnel at The Johns Hopkins Hospital.  Arch Intern Med . 1993;  153 1705-1712
  CrossrefPubMedSearch in Google Scholar
• 142 Polish L B, Tong M J, Co R L. Risk factors for hepatitis C virus infection among health care personnel in a community hospital.  Am J Infect Control . 1993;  21 196-200
  CrossrefPubMedSearch in Google Scholar
• 143 Germanaud J, Barthez J P, Causse X. The occupational risk of hepatitis C infection among hospital employees.  Am J Public Health . 1994;  84 122
  PubMedSearch in Google Scholar
• 144 Campello C, Majori S, Poli A. Prevalence of HCV antibodies in health-care workers from northern Italy.  Infection . 1992;  20 224-226
  CrossrefPubMedSearch in Google Scholar
• 145 Nakashima K, Kashiwagi S, Hayashi J. Low prevalence of hepatitis C virus infection among hospital staff and acupuncturists in Kyushu, Japan.  J Infect . 1993;  26 17-25
  CrossrefPubMedSearch in Google Scholar
• 146 Struve J, Aronsson B, Frenning B. Prevalence of antibodies against hepatitis C virus infection among health care workers in Stockholm.  Scand J Gastroenterol . 1994;  29 360-362
  PubMedSearch in Google Scholar
• 147 Puro V, Petrosillo N, Ippolito G, Italian Study Group on Occupational Risk of HIV and Other Bloodborne Infections. Risk of hepatitis C seroconversion after occupational exposures in health care workers.  Am J Infect Control . 1995;  23 273-277
  CrossrefPubMedSearch in Google Scholar
• 148 Lodi G, Porter S R, Teo C G, Scully C. Prevalence of HCV infection in health care workers of a UK dental hospital.  Br Dental J . 1997;  183 329-332
  PubMedSearch in Google Scholar
• 149 Petrosilla N, Puro V, Ippolito G, Italian Study Group on Blood-borne Occupational Risk in Dialysis. Prevalence of hepatitis C antibodies in health-care workers.  Lancet . 1994;  343 1618-1620
  CrossrefPubMedSearch in Google Scholar
• 150 Cooper B W, Krusell A, Tilton R C. Seroprevalence of antibodies to hepatitis C virus in high-risk hospital personnel.  Infect Control Hosp Epidemiol . 1992;  13 82-85
  PubMedSearch in Google Scholar
• 151 Panlilio A L, Shapiro C N, Schable C A. Serosurvey of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection among hospital-based surgeons.  J Am Coll Surg . 1995;  180 16-24
  PubMedSearch in Google Scholar
• 152 Shapiro C N, Tokars J I, Chamberland M E, the American Academy of Orthopedic Surgeons Serosurvey Study Committee. Use of hepatitis B vaccine and infection with hepatitis B and C among orthopedic surgeons.  J Bone Joint Surg Am . 1996;  78 1791-1800
  PubMedSearch in Google Scholar
• 153 Thomas D L, Gruninger S E, Siew C, Joy E D, Quinn T C. Occupational risk of hepatitis C infections among general dentists and oral surgeons in North America.  Am J Med . 1996;  100 41-45
  CrossrefPubMedSearch in Google Scholar
• 154 Lanphear B P, Linnemann C C, Cannon C G. Hepatitis C virus infection in health care workers: risk of exposure and infection.  Infect Control Hosp Epidemiol . 1994;  15 745-750
  PubMedSearch in Google Scholar
• 155 Mitsui T, Iwano K, Masuko K. Hepatitis C virus infection in medical personnel after needlestick accident.  Hepatology . 1992;  16 1109-1114
  CrossrefPubMedSearch in Google Scholar
• 156 Sartori M, La Terra G, Aglietta M. Transmission of hepatitis C via blood splash into conjunctiva.  Scand J Infect Dis . 1993;  25 270-271
  PubMedSearch in Google Scholar
• 157 Ippolito G, Puro V, Petrosillo N, De Carli G, Micheloni G, Magliano E, Coordinating Centre of the Italian Study on Occupational Risk of HIV Infection. Simultaneous infection with HIV and hepatitis C virus following occupational conjunctival blood exposure.  JAMA . 1998;  280 28
  CrossrefPubMedSearch in Google Scholar
• 158 Aizaki H, Saito A, Kusakawa I. Mother-to-child transmission of a hepatitis C virus variant with an insertional mutation in its hypervariable region.  J Hepatol . 1996;  25 608-613
  CrossrefPubMedSearch in Google Scholar
• 159 Catalano D, Pollio F, Ercolano S. Maternal-fetal transmission of HCV.  Role of HIV as a risk factor. Min Ginecol . 1999;  51 117-119
  PubMedSearch in Google Scholar
• 160 Fischler B, Lindh G, Lindgren S. Vertical transmission of hepatitis C virus infection.  Scand J Infect Dis . 1996;  28 353-356
  CrossrefPubMedSearch in Google Scholar
• 161 Giacchino R, Picciotto A, Tasso L. Vertical transmission of hepatitis C.  Lancet . 1995;  345 1122-1123
  CrossrefPubMedSearch in Google Scholar
• 162 Granovsky M, Minkoff H L, Tess B H. Hepatitis C virus infection in the Mothers and Infants Cohort Study.  Pediatrics . 1998;  102 355-359
  CrossrefPubMedSearch in Google Scholar
• 163 Kudesia G, Ball G, Irving W L. Vertical transmission of hepatitis C.  Lancet . 1995;  345 1122-1125
  PubMedSearch in Google Scholar
• 164 Lam J PH, McOmish F, Burns S M. Infrequent vertical transmission of hepatitis C virus.  J Infect Dis . 1993;  167 572-576
  PubMedSearch in Google Scholar
• 165 Latt N, Collins E, Spencer J. Hepatitis C virus infection in pregnant injecting drug users-possible vertical tranmission to babies. Proceeding of National Methadone Conference, Sydney, 1994
• 166 Lin H H, Kao J H, Hsu H Y. Possible role of high-titer maternal viremia in perinatal transmission of hepatitis C virus.  J Infect Dis . 1994;  169 638-641
  PubMedSearch in Google Scholar
• 167 Maccabruni A, Bossi G, Caselli D. High efficiency of vertical transmission of hepatitis C virus among babies born to human immunodeficiency virus-negative women.  Pediatr Infect Dis J . 1995;  14 921-922
  PubMedSearch in Google Scholar
• 168 Manzini P, Saracco G, Cerchier A. Human Immunodeficiency virus infection as risk factor for mother-to-child hepatitis C virus tranmission; persistence of anti-hepatitis C virus in children is associated with the mother's anti-hepatitis C virus immunoblotting pattern.  Hepatology . 1995;  21 328-332
  CrossrefPubMedSearch in Google Scholar
• 169 Marcellin P, Bernuau J, Martinot-Peignoux M. Prevalence of hepatitis C virus infection in asymptomatic anti-HIV1 negative pregnant women and their children.  Dig Dis Sci . 1993;  38 2151-2155
  CrossrefPubMedSearch in Google Scholar
• 170 Mast E E, Hwang L Y, Seto D. Perinatal hepatitis C virus transmission: maternal risk factors and optimal timing of diagnosis.  Hepatology . 1999;  30(suppl., Part 2) 499A
  PubMedSearch in Google Scholar
• 171 Moriya T, Sasaki F, Mizui M. Transmission of hepatitis C virus from mother to infants: its frequency and risk factors revisited. Biomed Pharmacother .  1995;  49 59-64
  PubMedSearch in Google Scholar
• 172 Ni Y H, Lin H H, Chen P J. Temporal profile of hepatitis C virus antibody and genome in infants born to mother infected with hepatitis C virus but without human immunodeficiency virus coinfection.  J Hepatol . 1994;  20 641-645
  CrossrefPubMedSearch in Google Scholar
• 173 Novati R, Thiers V, D'Arminio Monforte A. Mother-to-child transmission of hepatitis C virus detected by nested polymerase chain reaction.  J Infect Dis . 1992;  165 720-723
  PubMedSearch in Google Scholar
• 174 Ohto H, Terazawa S, Sasaki N. Transmission of hepatitis C virus from mothers to infants.  N Engl J Med . 1994;  330 744-750
  CrossrefPubMedSearch in Google Scholar
• 175 Paccagnini S, Principi N, Massironi E. Perinatal transmission and manifestation of hepatitis C virus infection in a high risk population.  Pediatr Infect Dis J . 1995;  14 195-199
  PubMedSearch in Google Scholar
• 176 Palomba E, Manzini P, Fiammengo P. Natural history of perinatal hepatitis C virus infection.  Clin Infect Dis . 1996;  23 47-50
  PubMedSearch in Google Scholar
• 177 Papaevangelou V, Pollack H, Rochford G. Increased transmission of vertical hepatitis C virus (HCV) infection to human immunodeficiency virus (HIV)-infected infants of HIV- and HCV-coinfected women.  J Infect Dis . 1998;  178 1047-1052
  PubMedSearch in Google Scholar
• 178 Pipan C, Amici S, Astori G. Vertical transmission of hepatitis C virus in low-risk pregnant women.  Eur J Clin Microbiol Infect Dis . 1996;  14 116-120
  PubMedSearch in Google Scholar
• 179 Reinus J F, Leikin E L, Alter H J. Failure to detect vertical transmission of hepatitis C virus.  Ann Intern Med . 1992;  117 881-886
  PubMedSearch in Google Scholar
• 180 Resti M, Azzari C, Lega L. Mother-to-infant transmission of hepatitis C virus.  Acta Paediatr . 1995;  84 251-255
  PubMedSearch in Google Scholar
• 181 Roudot-Thoraval F, Pawlotsky J-M, Thiers V. Lack of mother-to-infant transmission of hepatitis C virus in human immunodeficiency virus-seronegative women: a prospective study with hepatitis C virus RNA testing.  Hepatology . 1993;  17 722-777
  PubMedSearch in Google Scholar
• 182 Sabatino G, Ramenghi L A, Di Marzio M, Pizzigallo E. Vertical transmission of hepatitis C virus: an epidemiological study on 2980 pregnant women in Italy.  Eur J Epidemiol . 1996;  12 443-447
  CrossrefPubMedSearch in Google Scholar
• 183 Soto B, Rodrigo L, Garcia Bengoechea M. Heterosexual transmission of HCV and the possible role of coexistent human immunodeficiency virus infection in the index case. A multicentre study of 432 pairings.  J Intern Med . 1994;  236 515-519
  PubMedSearch in Google Scholar
• 184 Spencer J D, Latt N, Beeby P J. Transmission of hepatitis C virus to infants of human immunodeficiency virus-negative intravenous drug-using mothers: rate of infection and assessment of risk factors for transmission.  J Viral Hepat . 1997;  4 395-409
  CrossrefPubMedSearch in Google Scholar
• 185 Thomas D A, Villano S A, Riester K A. Perinatal transmission of hepatitis C virus from human immunodeficiency virus type 1-infected mothers. Women and Infants Transmission Study.  J Infect Dis . 1998;  177 1480-1488
  PubMedSearch in Google Scholar
• 186 Uehara S, Abe Y, Saito T. The incidence of vertical transmission of HCV.  Tohoku J Exp Med . 1993;  171 195-202
  PubMedSearch in Google Scholar
• 187 Wejstal R, Anders W, Mansson A S. Mother-to-infant transmission of hepatitis C virus.  Ann Intern Med . 1992;  117 887-890
  PubMedSearch in Google Scholar
• 188 Zanetti A R, Tanzi E, Paccagnini S. Mother-to-infant transmission of hepatitis C virus.  Lancet . 1995;  345 289-291
  CrossrefPubMedSearch in Google Scholar
• 189 Zuccotti G V, Ribero M L, Giovannini M. Effect of hepatitis C genotype on mother-to-infant transmission of virus.  J Pediatr . 1995;  127 278-280
  PubMedSearch in Google Scholar
• 190 Mast E E, Alter M J. Hepatitis C.  Semin Pediatr Infect Dis . 1997;  8 17-22
  PubMedSearch in Google Scholar
• 191 Thomas D L, Zenilman J M, Alter H J. Sexual transmission of hepatitis C virus among patients attending Baltimore sexually transmitted diseases clinics-an analysis of 309 sex partnerships.  J Infect Dis . 1995;  171 768-775
  PubMedSearch in Google Scholar
• 192 Osmond D H, Charlebois E, Sheppard H W. Comparison of risk factors for hepatitis C and hepatitis B virus infection in homosexual men.  J Infect Dis . 1993;  167 66-71
  PubMedSearch in Google Scholar
• 193 Corona R, Prignano G, Mele A. Heterosexual and homosexual transmission of hepatitis C virus: relation with hepatitis B virus and human immunodeficiency virus type 1.  Epidemiol Infect . 1991;  107 667-672
  PubMedSearch in Google Scholar
• 194 Quaranta J F, Delaney S R, Alleman S. Prevalence of antibody to hepatitis C virus (HCV) in HIV-1-infected patients (Nice SEROCO cohort).  J Med Virol . 1994;  42 29-32
  PubMedSearch in Google Scholar
• 195 Weinstock H S, Bolan G, Reingold A L, Polish L B. Hepatitis C virus infection among patients attending a clinic for sexually transmitted diseases.  JAMA . 1993;  269 392-394
  CrossrefPubMedSearch in Google Scholar
• 196 Thomas D L, Cannon R O, Shapiro C N. Hepatitis C, hepatitis B, and human immunodeficiency virus infections among non-intravenous drug-using patients attending clinics for sexually transmitted diseases.  J Infect Dis . 1994;  169 990-995
  PubMedSearch in Google Scholar
• 197 van Doornum J J G, Hooykaas C, Cuypers M T. Prevalence of hepatitis C virus infections among heterosexuals with multiple partners.  J Med Virol . 1991;  35 22-27
  PubMedSearch in Google Scholar
• 198 Mast E E, Darrow W W, Witte J. Hepatitis C virus infection among prostitutes: evidence for sexual transmission and protective efficacy of condoms [abstract]. Program and Abstracts of the Third International Symposium on HCV, Strasbourg, 1991, p. 95
• 199 Gutierrez P, Orduna A, Bratos M A. Prevalence of anti-hepatitis C virus antibodies in positive FTA-ABS non-drug abusing female prostitutes in Spain.  Sex Trans Dis . 1992;  19 39-40
  PubMedSearch in Google Scholar
• 200 Daikos G L, Lai S, Fischl M A. Hepatitis C virus infection in a sexually active inner city population. The potential for heterosexual transmission.  Infection . 1994;  22 72-76
  CrossrefPubMedSearch in Google Scholar
• 201 Hershow R C, Kalish L A, Sha B. Hepatitis C virus infection in Chicago women with or at risk for HIV infection: evidence for sexual transmission.  Sex Trans Dis . 1998;  25 527-532
  PubMedSearch in Google Scholar
• 202 Mesquita P E, Hernandez Granato F C, Castelo A. Risk factors associated with hepatitis C virus (HCV) infection among prostitutes and their clients in the city of Santos, Sao Paulo state, Brazil.  J Med Virol . 1997;  51 338-343
  CrossrefPubMedSearch in Google Scholar
• 203 Lissen E, Alter H J, Abad M A. Hepatitis C virus infection among sexually promiscuous groups and the hetersexual partners of hepatitis C virus infected index cases.  Eur J Clin Microbiol Infect Dis . 1993;  12 827-831
  PubMedSearch in Google Scholar
• 204 Tedder R S, Gilson R J, Briggs M. Hepatitis C virus: evidence for sexual transmission.  BMJ . 1991;  302 1299-1302
  PubMedSearch in Google Scholar
• 205 Donahue J G, Nelson K E, Munoz A. Antibody to HCV among cardiac surgery patients, homosexual men, and intravenous drug users in Baltimore, Maryland.  Am J Epidemiol . 1991;  134 1206-1211
  PubMedSearch in Google Scholar
• 206 Hyams K C, Phillips I A, Tejada A. Three year incidence study of retroviral and viral hepatitis transmission in a Peruvian prostitute population.  J AIDS . 1993;  6 1353-1357
  PubMedSearch in Google Scholar
• 207 Osella A R, Massa M A, Joekes S. Hepatitis B and C virus sexual transmission among homosexual men.  Am J Gastroenterol . 1998;  93 49-52
  CrossrefPubMedSearch in Google Scholar
• 208 Gasparini V, Chiaramonte M, Moschen M E. Hepatitis C virus infection in homosexual men: A seroepidemiological study in gay clubs in north-east Italy.  Eur J Epidemiol . 1991;  7 665-669
  PubMedSearch in Google Scholar
• 209 Westh H, Worm A M, Jensen B L. HCV antibodies in homosexual men and intravenous drug users in Denmark.  Infection . 1993;  21 115-117
  CrossrefPubMedSearch in Google Scholar
• 210 Sonnerborg A, Abebe A, Strannegard O. HCV infection in individuals with or without human immunodeficiency virus type 1 infection.  Infection . 1990;  18 347-351
  CrossrefPubMedSearch in Google Scholar
• 211 Williams C L, Mast E E, Coleman P J. Risk factors for sexual transmission of hepatitis C virus among non injecting-drug-using female prostitutes in the United States [abstract]. 36th Annual Meeting of the Infectious Disease Society of America, Denver, CO, 1998
• 212 Bresters D, Mauser-Bunschoten E P, Reesink H W. Sexual transmission of hepatitis C virus.  Lancet . 1993;  342 210-211
  CrossrefPubMedSearch in Google Scholar
• 213 Meisel H, Reip A, Faltus B. Transmission of hepatitis C virus to children and husbands by women infected with contaminated anti-D immunoglobulin.  Lancet . 1995;  345 1209-1211
  CrossrefPubMedSearch in Google Scholar
• 214 David X R, Blanc P, Pageaux G P. Familial transmission of HCV.  Gastroenterol Clin Biol . 1995;  19 150-155
  PubMedSearch in Google Scholar
• 215 Deny P, Roulot D, Asselot C. Low rate of hepatitis C virus (HCV) transmission within the family.  J Hepatol . 1992;  14 409-410
  PubMedSearch in Google Scholar
• 216 Wyld R, Robertson J R, Brettle R P. Absence of hepatitis C virus transmission but frequent transmission of HIV-1 from sexual contact with doubly-infected individuals.  J Infect . 1997;  35 163-166
  CrossrefPubMedSearch in Google Scholar
• 217 Sachithanandan S, Fielding J F. Low rate of HCV transmission from women infected with contaminated anti-D immunoglobulin to their family contacts.  Ital J Gastroenterol Hepatol . 1997;  29 47-50
  PubMedSearch in Google Scholar
• 218 Pachucki C T, Lentino J R, Schaaff D. Low prevalence of sexual transmission of hepatitis C virus in sex partners of seropositive intravenous drug users.  J Infect Dis . 1991;  164 820-821
  PubMedSearch in Google Scholar
• 219 Eyster M E, Alter H J, Aledort L M. Heterosexual co-transmission of hepatitis C virus (HCV) and human immunodeficiency virus (HIV).  Ann Intern Med . 1991;  115 764-768
  PubMedSearch in Google Scholar
• 220 Gordon S C, Patel A H, Kulesza G W. Lack of evidence for the heterosexual transmission of hepatitis C.  Am J Gastroenterol . 1992;  87 1849-1851
  PubMedSearch in Google Scholar
• 221 Tong M J, Lai P PC, Hwang S H. Evaluation of sexual transmission in patients with chronic hepatitis C infection.  Clin Diagn Virol . 1995;  3 39-47
  CrossrefPubMedSearch in Google Scholar
• 222 Scully L J, Mitchel S, Gill P. Clinical and epidemiologic characteristics of hepatitis C in a gastroenterology/hepatology practice in Ottawa.  Can Med Assoc J . 1993;  148 1173-1177
  PubMedSearch in Google Scholar
• 223 Diaz Morant V, De La Mata M, Costan G. A low prevalence of antibodies to the hepatitis C virus in stable heterosexual couples.  Gastroenterol Hepatol . 1995;  18 111-113
  PubMedSearch in Google Scholar
• 224 Garcia Bengoechea M, Cortes A, Lopez P. Intrafamilial spread of HCV infection.  Scand J Infect Dis . 1994;  26 15-18
  PubMedSearch in Google Scholar
• 225 Soto B, Rodrigo L, Garcia Bengoechea M. Heterosexual transmission of HCV and the possible role of coexistent human immunodeficiency virus infection in the index case. A multicentre study of 432 pairings.  J Intern Med . 1994;  236 515-519
  PubMedSearch in Google Scholar
• 226 Napoli N, Fiore G, Vella F. Prevalence of antibodies to hepatitis C virus among family members of patients with chronic hepatitis C.  Eur J Epidemiol . 1993;  9 629-632
  PubMedSearch in Google Scholar
• 227 Gabrielli C, Zannini A, Corradini R. Spread of HCV among sexual partners of HCVAb positive intravenous drug users.  J Infect . 1994;  29 17-22
  CrossrefPubMedSearch in Google Scholar
• 228 Coltorti M, Caporaso N, Morisco F. Prevalence of HCV infection in the household contacts of patients with HCV-related chronic liver disease.  Infection . 1994;  22 183-186
  CrossrefPubMedSearch in Google Scholar
• 229 Guadagnino V, Stroffolini T, Foca A. Hepatitis C virus infection in family setting.  Eur J Epidemiol . 1998;  14 229-232
  CrossrefPubMedSearch in Google Scholar
• 230 Brusaferro S, Barbone F, Andrian P. A study on the role of the family and other risk factors in HCV transmission.  Eur J Epidemiol . 1999;  15 125-132
  CrossrefPubMedSearch in Google Scholar
• 231 Caporaso N, Ascione A, Stroffolini T. Spread of hepatitis C virus within families.  J Viral Hepat . 1998;  5 67-72
  CrossrefPubMedSearch in Google Scholar
• 232 Mondello P, Patti S, Vitale M G. Anti-HCV antibodies in household contacts of patients with cirrhosis of the liver-preliminary results.  Infection . 1992;  20 51-52
  CrossrefPubMedSearch in Google Scholar
• 233 Bellobuono A, Zanella A, Petrini G. Intrafamilial spread of hepatitis C virus.  Transfusion . 1991;  31 475
  PubMedSearch in Google Scholar
• 234 Scaraggi F A, Lomuscio S, Perricci A. Intrafamilial and sexual transmission of hepatitis C virus.  Lancet . 1993;  342 1300-1301
  PubMedSearch in Google Scholar
• 235 Saltoglu N, Tasova Y, Burgut R, Dundar I H. Sexual and non-sexual intrafamilial spread of hepatitis C virus: intrafamilial transmission of HCV.  Eur J Epidemiol . 1998;  14 225-228
  CrossrefPubMedSearch in Google Scholar
• 236 Oshita M, Hayashi N, Kasahara A. Prevalence of HCV in family members of patients with hepatitis C.  J Med Virol . 1993;  41 251-255
  PubMedSearch in Google Scholar
• 237 Setoguchi Y, Kajihara S, Hara T. Analysis of nucleotide sequences of HCV isolates from husband-wife pairs.  J Gastroenterol Hepatol . 1994;  9 468-471
  PubMedSearch in Google Scholar
• 238 Nakashima K, Ikematsu H, Hayashi J. Intrafamilial transmission of hepatitis C virus among the population of an endemic area of Japan.  JAMA . 1995;  274 1459-1461
  CrossrefPubMedSearch in Google Scholar
• 239 Kao J H, Chen P J, Yang P M. Intrafamilial transmission of HCV: The important role of infections between spouses.  J Infect Dis . 1994;  170 1128-1133
  PubMedSearch in Google Scholar
• 240 Kim Y S, Chi H S, Ahn Y O. Lack of familial clustering of hepatitis C virus infection.  Int J Epidemiol . 1998;  27 525-529
  CrossrefPubMedSearch in Google Scholar
• 241 Brackmann S A, Gerritzen A, Oldenburg J. Search for intrafamilial transmission of HCV in hemophilia patients.  Blood . 1993;  81 1077-1082
  PubMedSearch in Google Scholar
• 242 Camarero C, Martos I, Delgado R. Horizontal transmission of hepatitis C virus in households of infected children.  J Pediatr . 1993;  123 98-99
  PubMedSearch in Google Scholar
• 243 Vegnente A, Iorio R, Saviano A. Lack of intrafamilial transmission of hepatitis C virus in family members of children with chronic hepatitis C infection.  Pediatr Infect Dis J . 1994;  886-889
  PubMedSearch in Google Scholar
• 244 Kaldor J M, Archer G T, Buring M L. Risk factors for hepatitis C virus infection in blood donors: a case-control study.  Med J Australia . 1992;  157 227-230
  PubMedSearch in Google Scholar
• 245 Sun D X, Zhang F G, Geng Y Q. Hepatitis C transmission by cosmetic tattooing in women.  Lancet . 1996;  347 541
  PubMedSearch in Google Scholar
• 246 Tumminelli F, Marcellin P, Rizzo S. Shaving as a potential source of hepatitis C virus infection.  Lancet . 1995;  345 658
  PubMedSearch in Google Scholar
• 247 Mele A, Corona R, Tosti M E. Beauty treatments and risk of parenterally transmitted hepatitis: results from the hepatitis surveillance system in Italy.  Scand J Infect Dis . 1995;  27 441-444
  PubMedSearch in Google Scholar
• 248 Balasekaran R, Bulterys M, Jamal M. A case-control study of risk factors for sporadic hepatitis C virus infection in the southwestern United States.  Am J Gastroenterol . 1999;  94 1341-1346
  CrossrefPubMedSearch in Google Scholar
• 249 EASL International Consensus Conference on Hepatitis C. Consensus statement.  J Hepatol . 1999;  30 956-961
  CrossrefPubMedSearch in Google Scholar