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1
Tibbs CJ, 1995. Methods of transmission of hepatitis C. J Viral Hepat 2 :113–119.
-
2
Ackerman Z, Ackerman E, Paltiel O, 2000. Intrafamilial transmission of hepatitis C virus: a systematic review. J Viral Hepat 7 :93–103.
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3
Everhart JE, Di Bisceglic AM, Murray LM, Alter HJ, Melpolder JJ, Kuo G, Hoofnagle JA, 1990. Risk for non-A, non-B (type C) hepatitis through sexual or household contact with chronic carriers. Ann Intern Med 12 :544–545.
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4
Velasco M, Poniachik J, Alegria S, Brahm J, 2003. Familial transmission of hepatitis C virus infection in Chilean subjects. Rev Med Chil 131 :1123–1127.
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5
Akhtar S, Moatter T, 2004. Intra-household clustering of hepatitis C virus infection in Karachi, Pakistan. Trans R Soc Trop Med Hyg 98 :535–539.
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6
Merlo J, 2003. Multilevel analytical approaches in social epidemiology: measures of health variation compared with traditional measures of association. J Epidemiol Community Health 57 :550–552.
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7
Korn EL, Garubard BI, 1999. Analysis of Health Surveys. First edition. New York: John Wiley & Sons.
-
8
Akhtar S, Moatter T, Azam I, Rahbar MH, Adil S, 2002. Prevalence and risk factors for intrafamilial transmission of hepatitis C virus in Karachi, Pakistan. J Viral Hepat 9 :309–314.
-
9
Pasha O, Luby SP, Khan AJ, Shah SA, McCormick JB, Fisher-Hoch SP, 1999. Household members of hepatitis C virus-infected people in Hafizabad, Pakistan: infections by injections from health care providers. Epidemiol Infect 123 :515–518.
-
10
Demelia L, Vallebona E, Poma R, Sanna G, Masia G, Coppola RC, 1996. HCV transmission in family members of subjects with HCV related chronic liver disease. Eur J Epidemiol 12 :45–50.
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11
Saltoglu N, Tasova Y, Burgut R, Dundar IH, 1998. Sexual and non-sexual intrafamilial spread of hepatitis C virus: intrafamilial transmission of HCV. Eur J Epidemiol 14 :225–228.
-
12
Brusaferro S, Barbone F, Adrian P, 1999. A study on the role of the family and other risk factors in HCV transmission. Eur J Epidemiol 15 :125–132.
-
13
Duncan C, Jones K, Moon G, 1998. Context, composition and heterogeneity: using multilevel models in health research. Soc Sci Med 46 :97–117.
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14
Leyland AH, Goldstein H, 2001. Multilevel Modeling of Health Statistics. Chichester, United Kingdom: Wiley.
-
15
Larsen K, Petersen JH, Budtz-Jorgensen E, Endahl L, 2000. Interpreting parameters in the logistic regression model with random effects. Biometrics 56 :909–914.
-
16
Larsen K, Merlo J, 2005. Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol 161 :81–88.
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17
Rasbash J, Browne W, Goldstein H, Yang M, Plewis I, Healy M, Woodhouse G, Draper D, Langford I, Lewis T, 2002. A User’s Guide to MLwiN. Version 2.1. Centre of Multilevel Modelling, Institute of Education, University of London.
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18
Caporaso N, Ascione A, D’Antonio M, DiCostanzo GG, Galeota Lanza A, Tremolada F, Diodati G, Rumi MG, Parravicini ML, Pastore G, 1995. Prevalence of anti-HCV among spouses and offspring of anti-HCV positive subjects: an Italian multicentre study. Ital J Gastroenterol 27 :5–7.
-
19
Karmochkine M, Carrat F, Valleron AJ, Raguin G, 1998. Transmission modes of hepatitis C virus. Presse Med 27 :871–876.
-
20
Kim YS, Chi HS, Ahn Y, Lee H, Klag MJ, 1998. Lack of familial clustering of hepatitis C virus infection. Int J Epidemiol 27 :525–529.
-
21
Matyla-Radzewska A, Wysocki J, 2005. Natural course of infection in children and familial transmission of C viral hepatitis. Przegl Epidemiol 59 :475–481.
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22
Goldstein H, Browne W, Rasbash J, 2002. Multilevel modeling of medical data. Stat Med 21 :3291–3315.
| Past two years | Past Year | Past 30 Days | |
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| Abstract Views | 117 | 73 | 1 |
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MULTILEVEL MODELING OF INTRA-HOUSEHOLD SPREAD OF HEPATITIS C VIRUS INFECTION, KARACHI, PAKISTAN
SAEED AKHTAR
SAEED AKHTAR
Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Safat, Kuwait; Department of Community Health Sciences, Aga Khan University, Stadium Road, Karachi, Pakistan; Department of Pathology and Microbiology, Aga Khan University, Stadium Road, Karachi, Pakistan
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TARIQ MOATTER
TARIQ MOATTER
Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Safat, Kuwait; Department of Community Health Sciences, Aga Khan University, Stadium Road, Karachi, Pakistan; Department of Pathology and Microbiology, Aga Khan University, Stadium Road, Karachi, Pakistan
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Several epidemiologic studies have reported the existence of nonsexual intrafamilial hepatitis C virus (HCV) transmission. However, actual routes and their relative efficiency have been controversial. The objective of this study was to investigate whether contacts of HCV seropositive index patient living in the same household have similar probabilities of being HCV seropositive with respect to any of the household-level variables, after taking into account the independent effects of individual-level variables. We analyzed cross-sectional serological data on 341 nonsexual household contacts of 86 HCV-seropositive index thalassemic patients with a multilevel logistic regression model using household contacts at the first level and household characteristics at the second level. Prevalence of HCV seropositivity among household contacts who were tested was 20.5% (70/341). Multilevel analysis of household-level fixed effects indicated that contacts living in families wherein the index thalassemic patient was RNA positive—compared with those contacts living in families wherein the index thalassemic patient was RNA negative—had higher odds of being HCV positive (OR = 2.09; 95% CI: 1.02 to 4.28). Nonetheless, the effect of index patients’ RNA status on the contacts’ HCV serostatus was small in comparison with the unexplained between-cluster variation. The results of this study are pertinent for household members of HCV-infected patients; specifically, their close contact with objects that are contaminated with blood or perhaps saliva of the HCV-seropositive index patient may pose increased risk of HCV transmission. High household intercept variances in different analyses revealed that at there are still unrecognized nonsexual modes of HCV transmission at the household level that need further research.
Author Notes
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1
Tibbs CJ, 1995. Methods of transmission of hepatitis C. J Viral Hepat 2 :113–119.
-
2
Ackerman Z, Ackerman E, Paltiel O, 2000. Intrafamilial transmission of hepatitis C virus: a systematic review. J Viral Hepat 7 :93–103.
-
3
Everhart JE, Di Bisceglic AM, Murray LM, Alter HJ, Melpolder JJ, Kuo G, Hoofnagle JA, 1990. Risk for non-A, non-B (type C) hepatitis through sexual or household contact with chronic carriers. Ann Intern Med 12 :544–545.
-
4
Velasco M, Poniachik J, Alegria S, Brahm J, 2003. Familial transmission of hepatitis C virus infection in Chilean subjects. Rev Med Chil 131 :1123–1127.
-
5
Akhtar S, Moatter T, 2004. Intra-household clustering of hepatitis C virus infection in Karachi, Pakistan. Trans R Soc Trop Med Hyg 98 :535–539.
-
6
Merlo J, 2003. Multilevel analytical approaches in social epidemiology: measures of health variation compared with traditional measures of association. J Epidemiol Community Health 57 :550–552.
-
7
Korn EL, Garubard BI, 1999. Analysis of Health Surveys. First edition. New York: John Wiley & Sons.
-
8
Akhtar S, Moatter T, Azam I, Rahbar MH, Adil S, 2002. Prevalence and risk factors for intrafamilial transmission of hepatitis C virus in Karachi, Pakistan. J Viral Hepat 9 :309–314.
-
9
Pasha O, Luby SP, Khan AJ, Shah SA, McCormick JB, Fisher-Hoch SP, 1999. Household members of hepatitis C virus-infected people in Hafizabad, Pakistan: infections by injections from health care providers. Epidemiol Infect 123 :515–518.
-
10
Demelia L, Vallebona E, Poma R, Sanna G, Masia G, Coppola RC, 1996. HCV transmission in family members of subjects with HCV related chronic liver disease. Eur J Epidemiol 12 :45–50.
-
11
Saltoglu N, Tasova Y, Burgut R, Dundar IH, 1998. Sexual and non-sexual intrafamilial spread of hepatitis C virus: intrafamilial transmission of HCV. Eur J Epidemiol 14 :225–228.
-
12
Brusaferro S, Barbone F, Adrian P, 1999. A study on the role of the family and other risk factors in HCV transmission. Eur J Epidemiol 15 :125–132.
-
13
Duncan C, Jones K, Moon G, 1998. Context, composition and heterogeneity: using multilevel models in health research. Soc Sci Med 46 :97–117.
-
14
Leyland AH, Goldstein H, 2001. Multilevel Modeling of Health Statistics. Chichester, United Kingdom: Wiley.
-
15
Larsen K, Petersen JH, Budtz-Jorgensen E, Endahl L, 2000. Interpreting parameters in the logistic regression model with random effects. Biometrics 56 :909–914.
-
16
Larsen K, Merlo J, 2005. Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol 161 :81–88.
-
17
Rasbash J, Browne W, Goldstein H, Yang M, Plewis I, Healy M, Woodhouse G, Draper D, Langford I, Lewis T, 2002. A User’s Guide to MLwiN. Version 2.1. Centre of Multilevel Modelling, Institute of Education, University of London.
-
18
Caporaso N, Ascione A, D’Antonio M, DiCostanzo GG, Galeota Lanza A, Tremolada F, Diodati G, Rumi MG, Parravicini ML, Pastore G, 1995. Prevalence of anti-HCV among spouses and offspring of anti-HCV positive subjects: an Italian multicentre study. Ital J Gastroenterol 27 :5–7.
-
19
Karmochkine M, Carrat F, Valleron AJ, Raguin G, 1998. Transmission modes of hepatitis C virus. Presse Med 27 :871–876.
-
20
Kim YS, Chi HS, Ahn Y, Lee H, Klag MJ, 1998. Lack of familial clustering of hepatitis C virus infection. Int J Epidemiol 27 :525–529.
-
21
Matyla-Radzewska A, Wysocki J, 2005. Natural course of infection in children and familial transmission of C viral hepatitis. Przegl Epidemiol 59 :475–481.
-
22
Goldstein H, Browne W, Rasbash J, 2002. Multilevel modeling of medical data. Stat Med 21 :3291–3315.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 117 | 73 | 1 |
| Full Text Views | 216 | 7 | 0 |
| PDF Downloads | 53 | 7 | 0 |