cqvip:Goals: To determine whether the smallpox vaccination program has significantly contributed to the widespread prevalence of hepatitis C infection in Pakistan. Background: Hepatitis C virus has become a worldwide pandemic and has especially devastated developing nations such as Pakistan. There continues to be an increa se in fatalities due to hepatitis C-related cirrhosis in Pakistan. Study: We st udied 523 volunteers in the city of Lahore to determine whether the smallpox vac cination program, which ran from 1964 to 1982 in Pakistan, may be responsible fo r the national surge in hepatitis C viral infection,perhaps because of repetitiv e use of vaccination devices without proper sterilization or to contaminated vac cine contents. Results:There was a significantly higher likelihood of hepatitis C antibody seroprevalence in individuals vaccinated for smallpox versus nonvacci nated individuals (21.0%vs. 4.6%, P < 0.001,age-adjusted odds ratio, 3.39; 95 %confidence interval, 1.36-8.46). Subjects with positive hepatitis C serology were also more likely to have a history of transfusions (19.2%vs. 9.0%,P = 0.0 1), but anti-HCV positive serology was not significantly associated with a hist ory of surgery or dental procedures. Following adjustment for age, sex, and hist ory of other conditions,including transfusion, the association between prior sma llpox vaccination and hepatitis C antibody seroprevalence remained strong and hi ghly significant (multivariate adjusted odds ratio,6.11; 95%confidence interval , 2.58-14.51). Conclusion: These results suggest that the widespread prevalence of hepatitis C infection in Pakistan may be an unintended consequence of the co untry’s smallpox vaccination program and that blood transfusion is also a signi ficant risk factor.
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