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AM Mastromatteo^{*}, GL Rapaccini^{*}, S Ursino^{*}, G Capelli^{*}, L Puglisi^{*}, GB Gasbarrini^{*} and GC Vanini^{*}. ^{*}Institute of Internal Medicine Catholic University, Rome; ^{*}Institute of Hygiene Catholic University, Rome

Several epidemiological studies have shown the existence of other ways of transmission of the hepatitis C virus (HCV) besides the parenteral one, but the mechanisms involved are not yet clear. The aim of this study is to evaluate the prevalence of HCV infection in family contacts of infected patients and to analyse the epidemiological risk factors and the possible transmission routes, with particular regard to saliva, associated with intrafamiliar transmission of HCV. Material and

We studied 138 relatives of 45 patients (index cases) affected by C virus related chronic hepatitis: 45 spouses, 89 children, 4 cohabitants. The index cases were chosen for socioeconomical condition, geographical area, marital status and age. To assess the risk factors for the infection an anonymous questionnaire was provided to each subject. All the studied subjects underwent physical examination, serology for anti HCV antibodies (Elisa 2°, Riba 3°) and ALT values. The subjects were tested for the presence of HCV RNA both in blood serum and in saliva by nested PCR amplification of the 5'UTR region. The genotype was studied using specific primers of the core region. The statistical analysis of data was made with K Cohen Test. Results: The questionnaires have confirmed a role for the following risk factors: transfusion, sexual contact, contaminated needle injury and dental surgery. No one of the index cases was intravenous drug user or haemodialysis patient. Antibodies to HCV were detected in 8/138 (5.7%) of the family members of the index cases. Of the positive contacts 4 (44%) were positive for serum HCV-RNA: spouses 2, children 1, cohabitant 1. Of antibodies negative contacts 3(2.3%) were positive to HCV-RNA (spouses). In total the 11.1% of the analysed spouses was infected. Comparative genetic analysis was used to confirm the correlation between the index cases and the affected relatives. The genotype 1b was predominant in the studied population. HCV-RNA was found in 44% examined saliva and 39% of these were found serum HCV-RNA negative. A significant correlation existed between the detectability of HCV-RNA in saliva and in serum(K 0.4435, Z 7.98, Pr>Z 0.000: Agreement 76.61% and the expected agreement 57.96%)

We observed an high risk of infection between relatives of the index cases, in particular spouses. We found HCV-RNA also in saliva of serum PCR-negative patients. The epidemiological data on the intrafamiliar spread of HCV may be underestimated by the existence of infected relatives serum negative but saliva positive for the presence of the virus. In general, the whole of these observations suggests a possible major role of biological fluids in the intrafamiliar spread of HCV.

Source: American Association for the Study of Liver Diseases - 1996 Annual Meeting

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