Abstract
In Sweden, infection with hepatitis C virus (HCV) has been a notifiable disease since 1990, when diagnostic methods became available. Blood donor screening indicated that about 0.5% of the Swedish population (9 millions) had been HCV infected. Here we present the Swedish hepatitis C epidemic based on data from all the HCV notifications 1990-2006. During this time about 42,000 individuals (70% men) were diagnosed and reported as HCV infected. The majority (80%) were born in 1950 or later, with a high percentage (60%) born in the 1950s and 1960s. Younger people, 15-24 years old at notification, were reported on the same level each year. The main reported routes of HCV transmission were intravenous drug use in 65%, blood transfusions/products in 6%, and sexual in 2%, though unknown or not stated in 26%. Approximately 6,000 of all notified individuals have died during the study period. To conclude, the Swedish HCV epidemic is highly related to the increase of intravenous drug use in the late 1960s and 1970s, with a high proportion of people now chronically infected for more than 25 years, resulting in an increase of severe liver complications in form of cirrhosis and hepatocellular carcinoma. Furthermore the unchanged number of notifications of newly infected younger people indicates an ongoing HCV epidemic.
Highlights
Hepatitis C virus (HCV) infection is a global problem affecting about 140 million individuals, corresponding to an estimated global prevalence of 2.2% [1]
In this study we present the data on HCV infection, based on the national database of communicable diseases with all diagnosed and notified HCVinfected individuals in Sweden
Out of a total of 42,153 HCV notifications during the study period, more complete clinical information was reported for 41,026 individuals
Summary
Hepatitis C virus (HCV) infection is a global problem affecting about 140 million individuals, corresponding to an estimated global prevalence of 2.2% [1]. In Sweden (which has a population of 9 million), the prevalence of HCV infection was estimated in the beginning of the 1990s, when blood donor screening (introduced in 1991) revealed that 0.2-0.5% of Swedish blood donors had antibodies to HCV infection (anti-HCV) [3,4], and a study of a middle-aged urban population in southern Sweden showed that 0.4% were anti-HCV positive [5]. It has been suggested that the initial spread of HCV infection in southern Europe was iatrogenic and started over 50 years ago, leading to high infection prevalence in older people [2]. In a Swedish study, analyses of stored frozen serum samples from patients with acute hepatitis in 1969-1972 revealed that 52% of the intravenous drug users in the study were anti-HCV positive at that time [10]. In the 1990s, it was found that over 90% of Swedish IDUs were antiHCV positive by the age of 26 to 30 years [11], and even occasional
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