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The epidemic dynamics of hepatitis C virus subtypes 4a and 4d in Saudi Arabia
Ahmed A Al-Qahtani1,2, Guy Baele3, Nisreen Khalaf1
1Department of Infection and Immunity, King Faisal Specialist Hospital &Research Center, Riyadh, Saudi Arabia.
Insights
International travel, not domestic spread, drives Hepatitis C Virus (HCV) subtype 4a in Saudi Arabia. Targeting Egyptian immigrants and domestic campaigns can reduce HCV4a and HCV4d burdens.
Area of Science:
- Epidemiology
- Viral Evolution
- Public Health Genomics
Background:
- Viral genetic data offers insights into transmission dynamics beyond standard surveillance.
- Hepatitis C Virus (HCV) subtypes 4a (HCV4a) and 4d (HCV4d) represent significant public health concerns in Saudi Arabia.
Purpose of the Study:
- To elucidate the transmission dynamics of HCV4a and HCV4d epidemics in Saudi Arabia using viral genetic data.
- To introduce a novel method for assessing migration intensity between locations.
Main Methods:
- Bayesian statistical framework applied to a comprehensive dataset of newly generated and publicly available HCV sequences.
- Development and application of a novel analytical method for objective migration intensity assessment.
Main Results:
- International host mobility patterns were identified as the primary driver of the Saudi Arabian HCV4a epidemic.
- Within-country spread appears to play a lesser role in HCV4a transmission compared to international migration.
- Distinct transmission dynamics may be influencing the HCV4d epidemic, warranting further investigation.
Conclusions:
- Reducing the burden of HCV4a and HCV4d in Saudi Arabia requires a dual approach: prioritized screening and treatment of Egyptian immigrants alongside domestic prevention campaigns.
- Integrating evolutionary and epidemiological analyses provides valuable public health insights, even with limited metadata.
Abstract:
The relatedness between viral variants sampled at different locations through time can provide information pertinent to public health that cannot readily be obtained through standard surveillance methods. Here, we use virus genetic data to identify the transmission dynamics that drive the hepatitis C virus subtypes 4a (HCV4a) and 4d (HCV4d) epidemics in Saudi Arabia. We use a comprehensive dataset of newly generated and publicly available sequence data to infer the HCV4a and HCV4d evolutionary histories in a Bayesian statistical framework. We also introduce a novel analytical method for an objective assessment of the migration intensity between locations. We find that international host mobility patterns dominate over within country spread in shaping the Saudi Arabia HCV4a epidemic, while this may be different for the HCV4d epidemic. This indicates that the subtypes 4a and 4d burden can be most effectively reduced by combining the prioritized screening and treatment of Egyptian immigrants with domestic prevention campaigns. Our results highlight that the joint investigation of evolutionary and epidemiological processes can provide valuable public health information, even in the absence of extensive metadata information.
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