Seroprevalence and Risk Factors for Human Herpesvirus 8 Infection, Rural Egypt1
Identifieur interne : 001141 ( Pmc/Corpus ); précédent : 001140; suivant : 001142Seroprevalence and Risk Factors for Human Herpesvirus 8 Infection, Rural Egypt1
Auteurs : Sam M. Mbulaiteye ; Ruth M. Pfeiffer ; Bryan Dolan ; Victor C. W. Tsang ; John Noh ; Nabiel N. H. Mikhail ; Mohamed Abdel-Hamid ; Mohamed Hashem ; Denise Whitby ; G. Thomas Strickland ; James J. GoedertSource :
- Emerging Infectious Diseases [ 1080-6040 ] ; 2008.
Abstract
Seroprevalence and Risk Factors for Human Herpesvirus 8 Infection, Rural Egypt, Salivary and nosocomial transmission are possible.
Url:
DOI: 10.3201/eid1404.070935
PubMed: 18394276
PubMed Central: 2570936
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Seroprevalence and Risk Factors for Human Herpesvirus 8 Infection, Rural Egypt<xref ref-type="fn" rid="FN1"><sup>1</sup></xref></title><author><name sortKey="Mbulaiteye, Sam M" sort="Mbulaiteye, Sam M" uniqKey="Mbulaiteye S" first="Sam M." last="Mbulaiteye">Sam M. Mbulaiteye</name><affiliation><nlm:aff id="aff1">National Cancer Institute, Bethesda, Maryland, USA</nlm:aff></affiliation></author><author><name sortKey="Pfeiffer, Ruth M" sort="Pfeiffer, Ruth M" uniqKey="Pfeiffer R" first="Ruth M." last="Pfeiffer">Ruth M. Pfeiffer</name><affiliation><nlm:aff id="aff1">National Cancer Institute, Bethesda, Maryland, USA</nlm:aff></affiliation></author><author><name sortKey="Dolan, Bryan" sort="Dolan, Bryan" uniqKey="Dolan B" first="Bryan" last="Dolan">Bryan Dolan</name><affiliation><nlm:aff id="aff1">National Cancer Institute, Bethesda, Maryland, USA</nlm:aff></affiliation></author><author><name sortKey="Tsang, Victor C W" sort="Tsang, Victor C W" uniqKey="Tsang V" first="Victor C. W." last="Tsang">Victor C. W. Tsang</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Noh, John" sort="Noh, John" uniqKey="Noh J" first="John" last="Noh">John Noh</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Mikhail, Nabiel N H" sort="Mikhail, Nabiel N H" uniqKey="Mikhail N" first="Nabiel N. H." last="Mikhail">Nabiel N. H. Mikhail</name><affiliation><nlm:aff id="aff3">Assiut University, Cairo, Egypt</nlm:aff></affiliation></author><author><name sortKey="Abdel Hamid, Mohamed" sort="Abdel Hamid, Mohamed" uniqKey="Abdel Hamid M" first="Mohamed" last="Abdel-Hamid">Mohamed Abdel-Hamid</name><affiliation><nlm:aff id="aff4">National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt</nlm:aff></affiliation><affiliation><nlm:aff id="aff5">University of Maryland School of Medicine, Baltimore, Maryland, USA</nlm:aff></affiliation></author><author><name sortKey="Hashem, Mohamed" sort="Hashem, Mohamed" uniqKey="Hashem M" first="Mohamed" last="Hashem">Mohamed Hashem</name><affiliation><nlm:aff id="aff4">National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt</nlm:aff></affiliation><affiliation><nlm:aff id="aff5">University of Maryland School of Medicine, Baltimore, Maryland, USA</nlm:aff></affiliation></author><author><name sortKey="Whitby, Denise" sort="Whitby, Denise" uniqKey="Whitby D" first="Denise" last="Whitby">Denise Whitby</name><affiliation><nlm:aff id="aff6">National Cancer Institute-Frederick, Frederick, MD, USA</nlm:aff></affiliation></author><author><name sortKey="Strickland, G Thomas" sort="Strickland, G Thomas" uniqKey="Strickland G" first="G. Thomas" last="Strickland">G. Thomas Strickland</name><affiliation><nlm:aff id="aff5">University of Maryland School of Medicine, Baltimore, Maryland, USA</nlm:aff></affiliation></author><author><name sortKey="Goedert, James J" sort="Goedert, James J" uniqKey="Goedert J" first="James J." last="Goedert">James J. Goedert</name><affiliation><nlm:aff id="aff1">National Cancer Institute, Bethesda, Maryland, USA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">18394276</idno><idno type="pmc">2570936</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2570936</idno><idno type="RBID">PMC:2570936</idno><idno type="doi">10.3201/eid1404.070935</idno><date when="2008">2008</date><idno type="wicri:Area/Pmc/Corpus">001141</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001141</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Seroprevalence and Risk Factors for Human Herpesvirus 8 Infection, Rural Egypt<xref ref-type="fn" rid="FN1"><sup>1</sup></xref></title><author><name sortKey="Mbulaiteye, Sam M" sort="Mbulaiteye, Sam M" uniqKey="Mbulaiteye S" first="Sam M." last="Mbulaiteye">Sam M. Mbulaiteye</name><affiliation><nlm:aff id="aff1">National Cancer Institute, Bethesda, Maryland, USA</nlm:aff></affiliation></author><author><name sortKey="Pfeiffer, Ruth M" sort="Pfeiffer, Ruth M" uniqKey="Pfeiffer R" first="Ruth M." last="Pfeiffer">Ruth M. Pfeiffer</name><affiliation><nlm:aff id="aff1">National Cancer Institute, Bethesda, Maryland, USA</nlm:aff></affiliation></author><author><name sortKey="Dolan, Bryan" sort="Dolan, Bryan" uniqKey="Dolan B" first="Bryan" last="Dolan">Bryan Dolan</name><affiliation><nlm:aff id="aff1">National Cancer Institute, Bethesda, Maryland, USA</nlm:aff></affiliation></author><author><name sortKey="Tsang, Victor C W" sort="Tsang, Victor C W" uniqKey="Tsang V" first="Victor C. W." last="Tsang">Victor C. W. Tsang</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Noh, John" sort="Noh, John" uniqKey="Noh J" first="John" last="Noh">John Noh</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Mikhail, Nabiel N H" sort="Mikhail, Nabiel N H" uniqKey="Mikhail N" first="Nabiel N. H." last="Mikhail">Nabiel N. H. Mikhail</name><affiliation><nlm:aff id="aff3">Assiut University, Cairo, Egypt</nlm:aff></affiliation></author><author><name sortKey="Abdel Hamid, Mohamed" sort="Abdel Hamid, Mohamed" uniqKey="Abdel Hamid M" first="Mohamed" last="Abdel-Hamid">Mohamed Abdel-Hamid</name><affiliation><nlm:aff id="aff4">National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt</nlm:aff></affiliation><affiliation><nlm:aff id="aff5">University of Maryland School of Medicine, Baltimore, Maryland, USA</nlm:aff></affiliation></author><author><name sortKey="Hashem, Mohamed" sort="Hashem, Mohamed" uniqKey="Hashem M" first="Mohamed" last="Hashem">Mohamed Hashem</name><affiliation><nlm:aff id="aff4">National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt</nlm:aff></affiliation><affiliation><nlm:aff id="aff5">University of Maryland School of Medicine, Baltimore, Maryland, USA</nlm:aff></affiliation></author><author><name sortKey="Whitby, Denise" sort="Whitby, Denise" uniqKey="Whitby D" first="Denise" last="Whitby">Denise Whitby</name><affiliation><nlm:aff id="aff6">National Cancer Institute-Frederick, Frederick, MD, USA</nlm:aff></affiliation></author><author><name sortKey="Strickland, G Thomas" sort="Strickland, G Thomas" uniqKey="Strickland G" first="G. Thomas" last="Strickland">G. Thomas Strickland</name><affiliation><nlm:aff id="aff5">University of Maryland School of Medicine, Baltimore, Maryland, USA</nlm:aff></affiliation></author><author><name sortKey="Goedert, James J" sort="Goedert, James J" uniqKey="Goedert J" first="James J." last="Goedert">James J. Goedert</name><affiliation><nlm:aff id="aff1">National Cancer Institute, Bethesda, Maryland, USA</nlm:aff></affiliation></author></analytic><series><title level="j">Emerging Infectious Diseases</title><idno type="ISSN">1080-6040</idno><idno type="eISSN">1080-6059</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Seroprevalence and Risk Factors for Human Herpesvirus 8 Infection, Rural Egypt, Salivary and nosocomial transmission are possible.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article" xml:lang="EN"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Emerg Infect Dis</journal-id><journal-id journal-id-type="publisher-id">EID</journal-id><journal-title>Emerging Infectious Diseases</journal-title><issn pub-type="ppub">1080-6040</issn><issn pub-type="epub">1080-6059</issn><publisher><publisher-name>Centers for Disease Control and Prevention</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">18394276</article-id><article-id pub-id-type="pmc">2570936</article-id><article-id pub-id-type="publisher-id">07-0935</article-id><article-id pub-id-type="doi">10.3201/eid1404.070935</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Seroprevalence and Risk Factors for Human Herpesvirus 8 Infection, Rural Egypt<xref ref-type="fn" rid="FN1"><sup>1</sup></xref></article-title><alt-title alt-title-type="running-head">Human Herpesvirus 8 Infection, Egypt</alt-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Mbulaiteye</surname><given-names>Sam M.</given-names></name><xref ref-type="aff" rid="aff1">*</xref></contrib><contrib contrib-type="author"><name><surname>Pfeiffer</surname><given-names>Ruth M.</given-names></name><xref ref-type="aff" rid="aff1">*</xref></contrib><contrib contrib-type="author"><name><surname>Dolan</surname><given-names>Bryan</given-names></name><xref ref-type="aff" rid="aff1">*</xref></contrib><contrib contrib-type="author"><name><surname>Tsang</surname><given-names>Victor C.W.</given-names></name><xref ref-type="aff" rid="aff2">†</xref></contrib><contrib contrib-type="author"><name><surname>Noh</surname><given-names>John</given-names></name><xref ref-type="aff" rid="aff2">†</xref></contrib><contrib contrib-type="author"><name><surname>Mikhail</surname><given-names>Nabiel N.H.</given-names></name><xref ref-type="aff" rid="aff3">‡</xref></contrib><contrib contrib-type="author"><name><surname>Abdel-Hamid</surname><given-names>Mohamed</given-names></name><xref ref-type="aff" rid="aff4">§</xref><xref ref-type="aff" rid="aff5">¶</xref></contrib><contrib contrib-type="author"><name><surname>Hashem</surname><given-names>Mohamed</given-names></name><xref ref-type="aff" rid="aff4">§</xref><xref ref-type="aff" rid="aff5">¶</xref></contrib><contrib contrib-type="author"><name><surname>Whitby</surname><given-names>Denise</given-names></name><xref ref-type="aff" rid="aff6">#</xref></contrib><contrib contrib-type="author"><name><surname>Strickland</surname><given-names>G. Thomas</given-names></name><xref ref-type="aff" rid="aff5">¶</xref></contrib><contrib contrib-type="author"><name><surname>Goedert</surname><given-names>James J.</given-names></name><xref ref-type="aff" rid="aff1">*</xref></contrib><aff id="aff1"><label>*</label>National Cancer Institute, Bethesda, Maryland, USA</aff><aff id="aff2"><label> †</label>Centers for Disease Control and Prevention, Atlanta, Georgia, USA</aff><aff id="aff3"><label>‡</label>Assiut University, Cairo, Egypt</aff><aff id="aff4"><label>§</label>National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt</aff><aff id="aff5"><label>¶</label>University of Maryland School of Medicine, Baltimore, Maryland, USA</aff><aff id="aff6"><label>#</label>National Cancer Institute-Frederick, Frederick, MD, USA</aff></contrib-group><author-notes><corresp id="cor1">Address for correspondence: Sam M. Mbulaiteye, 6120 Executive Blvd, Executive Plaza South, Rm 7080, Rockville, MD 20852-7248, USA; email: <email xlink:href="mbulaits@mail.nih.gov">mbulaits@mail.nih.gov</email></corresp></author-notes><pub-date pub-type="ppub"><month>4</month><year>2008</year></pub-date><volume>14</volume><issue>4</issue><fpage>586</fpage><lpage>591</lpage><abstract abstract-type="toc"><p>Seroprevalence and Risk Factors for Human Herpesvirus 8 Infection, Rural Egypt, Salivary and nosocomial transmission are possible.</p></abstract><abstract><p>To determine whether human herpesvirus 8 (HHV-8) is associated with schistosomal and hepatitis C virus infections in Egypt, we surveyed 965 rural household participants who had been tested for HHV-8 and schistosomal infection (seroprevalence 14.2% and 68.6%, respectively, among those <15 years of age, and 24.2% and 72.8%, respectively, among those ≥15 years of age). Among adults, HHV-8 seropositivity was associated with higher age, lower education, dental treatment, tattoos, >10 lifetime injections, and hepatitis C virus seropositivity. In adjusted analyses, HHV-8 seropositivity was associated with dental treatment among men (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.1–5.2) and hepatitis C virus seropositivity among women (OR 3.3, 95% CI 1.4–7.9). HHV-8 association with antischistosomal antibodies was not significant for men (OR 2.1, 95% CI 0.3–16.4), but marginal for women (OR 1.5, 95% CI 1.0–2.5). Our findings suggest salivary and possible nosocomial HHV-8 transmission in rural Egypt.</p></abstract><kwd-group kwd-group-type="author" xml:lang="EN"><title>Keywords: </title><kwd>HHV-8</kwd><kwd>epidemiology</kwd><kwd>transmission</kwd><kwd>Africa</kwd><kwd>cancer</kwd><kwd>schistosomiasis</kwd><kwd>research</kwd></kwd-group></article-meta></front><body><p>Human herpesvirus 8 (HHV-8, also called Kaposi sarcoma [KS]–associated herpesvirus) is the infectious cause of KS (<xref ref-type="bibr" rid="R1"><italic>1</italic></xref>) and is prevalent in Africa (<xref ref-type="bibr" rid="R2"><italic>2</italic></xref>). HHV-8 seroepidemiology parallels imperfectly KS epidemiology (<xref ref-type="bibr" rid="R3"><italic>3</italic></xref>). Adult HHV-8 seropositivity is very high in eastern and central Africa (70%–90%), where KS is endemic, and lower in southern and northern Africa (10%–40%), including Egypt, where KS is more rare (<xref ref-type="bibr" rid="R4"><italic>4</italic></xref>). This variation may be due, in part, to socioeconomic or environmental factors (<xref ref-type="bibr" rid="R5"><italic>5</italic></xref>) influencing HHV-8 transmission or pathogenesis. HHV-8 is transmitted through contact with saliva (<xref ref-type="bibr" rid="R6"><italic>6</italic></xref><italic>–</italic><xref ref-type="bibr" rid="R8"><italic>8</italic></xref>), but sexual (<xref ref-type="bibr" rid="R9"><italic>9</italic></xref>) and blood-borne (<xref ref-type="bibr" rid="R10"><italic>10</italic></xref>) transmission also occur.</p><p>HHV-8 seroepidemiology in Egypt is incompletely described (<xref ref-type="bibr" rid="R3"><italic>3</italic></xref>,<xref ref-type="bibr" rid="R11"><italic>11</italic></xref>,<xref ref-type="bibr" rid="R12"><italic>12</italic></xref>). Egypt offers the opportunity to investigate how HHV-8 correlates in the general population with well-characterized hepatitis C virus (HCV) (<xref ref-type="bibr" rid="R13"><italic>13</italic></xref>) and schistosomal infections (<xref ref-type="bibr" rid="R14"><italic>14</italic></xref>). Hundreds of thousands of Egyptians were exposed to multiple intravenous injections during treatment campaigns to control schistosomiasis from the 1950s until 1982, which resulted in an epidemic of HCV (<xref ref-type="bibr" rid="R15"><italic>15</italic></xref>). Schistosomal infection has been reported to suppress the immune response to HCV, which could lead to more persistent infections in those who are co-infected (<xref ref-type="bibr" rid="R16"><italic>16</italic></xref>–<xref ref-type="bibr" rid="R20"><italic>20</italic></xref>). Whether a similar relationship exists with HHV-8 is not known. The rarity of KS in Egypt, despite its occurrence in organ transplant recipients (<xref ref-type="bibr" rid="R21"><italic>21</italic></xref>), suggests that schistosomal-induced immunosuppression may not increase KS risk substantially. We sought to test the hypothesis that schistosomal seropositivity is associated with HHV-8 seropositivity, which would support the concept that schistosomal-induced immunosuppression modulates susceptibility to HHV-8 infection.</p><sec sec-type="methods"><title>Methods</title><sec><title>Patient Selection and Serologic Testing for HHV-8 and Schistosomal Infections</title><p>We randomly selected residual frozen serum samples from 965 of ≈6,000 persons who had participated in the HCV and schistosomiasis epidemiologic, population–based, household survey in Assiut Governorate, in rural southern Egypt in 1992 (<xref ref-type="bibr" rid="R13"><italic>13</italic></xref>). Adults and parents of children <underline><</underline>15 years of age who had participated in the original survey gave informed consent and answered interviewer-administered questions about demographics, socioeconomic status, medical treatment, and parenteral exposures, including injections, transfusions, operations, dental treatment, and tattoos. Each participant gave a venous blood sample for serologic testing (<xref ref-type="bibr" rid="R13"><italic>13</italic></xref>). The proportion of children included in our study was slightly lower than in the original survey because serum samples from some children had been exhausted by tests for HCV and other hepatitis viruses. However, the included children were otherwise representative of the original survey population.</p><p>Anti–HHV-8 antibodies were measured by using an enzyme immunoassay to K8.1 glycoprotein (a lytic-phase antigen) as previously reported (<xref ref-type="bibr" rid="R22"><italic>22</italic></xref>,<xref ref-type="bibr" rid="R23"><italic>23</italic></xref>). Antischistosomal antibodies were measured by using enzyme-linked immunoelectrotransfer blots (EITB) to detect species-specific antibodies against microsomal glycoprotein antigens from <italic>Schistosoma hematobium</italic> and <italic>S. mansoni</italic> (98% sensitivity and 99% specificity) (<xref ref-type="bibr" rid="R24"><italic>24</italic></xref>). <italic>S. hematobium</italic> is the predominant species causing infection in Assiut Governorate; concurrent or single infection with <italic>S. mansoni</italic> among local inhabitants is rare (<xref ref-type="bibr" rid="R14"><italic>14</italic></xref>).</p></sec><sec><title>Statistical Methods</title><p>Because no standard for testing for HHV-8 infection exists, we previously based cutoff values for defining seropositivity on visual inspection of the distribution of the K8.1 assay optical density (OD) values (<xref ref-type="bibr" rid="R10"><italic>10</italic></xref>), assuming that there are seronegative and seropositive subpopulations. However, this approach is subjective. To more objectively define seropositivity, we applied mixture models to the OD data (<xref ref-type="bibr" rid="R25"><italic>25</italic></xref>). Briefly, the mixture model was based on the assumption that the OD value for each participant arises from either a seronegative or a seropositive subpopulation. The formulas and details on parameters for the statistical model are described elsewhere ([<xref ref-type="bibr" rid="R25"><italic>25</italic></xref>]; online Appendix, available from <ext-link ext-link-type="uri" xlink:href="http://www.cdc.gov/EID/content/14/4/586-app.htm">www.cdc.gov/EID/content/14/4/586-app.htm</ext-link>). We assumed that when the calculated posterior probability of seropositivity was <underline>></underline>0.5, then the person was seropositive. In sensitivity analyses (online Appendix, available from <ext-link ext-link-type="uri" xlink:href="http://www.cdc.gov/EID/content/14/4/586-app.htm">www.cdc.gov/EID/content/14/4/586-app.htm</ext-link>), we used alternative parameters of the model and also excluded persons with an intermediate posterior probability (range: 0.4–0.6).</p><p>After defining seropositivity, we used logistic regression models (PROC GENMOD, SAS 8.0; SAS, Cary, NC, USA) to calculate odds ratios (ORs) for HHV-8 associations with demographic, behavioral, and clinical risk factors. We used generalized estimation equations that accounted for correlations between persons living in the same household to calculate 95% confidence intervals (CIs) (<xref ref-type="bibr" rid="R26"><italic>26</italic></xref>). Because HHV-8 seropositivity is age dependent and modes of transmission may differ between children and adults, we performed univariate and multivariable analyses separately for children (<15 years of age) and adults (<underline>></underline>15 years of age). Because we postulated a priori that antischistosomal antibodies were associated with HHV-8, we included schistosomal status in all multivariable models. To adjust for potential confounding, we included in our multivariable models those variables that were associated with HHV-8 seropositivity at p<underline><</underline>0.1 in univariate analyses. Age was fitted with a trend whenever this resulted in a statistically significantly improved model fit; otherwise, it was fitted as a categoric variable with dummy values. Two-tailed p values (p<0.05) were considered statistically significant, while p values between 0.1 and 0.05 were suggestive of a trend.</p></sec></sec><sec sec-type="results"><title>Results</title><p>None of the original household survey participants had a history of KS (<xref ref-type="bibr" rid="R13"><italic>13</italic></xref>). HHV-8 seroprevalence was lower among children compared with adults (14.3% vs. 24.2%, p<0.001). Among children, in unadjusted analyses, HHV-8 seroprevalence was higher in girls than boys (20% vs. 9%; OR 2.4, 95% CI 1.1–5.3). HHV-8 seroprevalence was not significantly elevated in children with a history of <underline>></underline>10 lifetime injections compared with those with <10 lifetime injections (18% vs. 11%, OR 1.8, 95% CI 0.8–3.8) nor among those with schistosomal antibodies (16% vs. 10%; OR 1.7, 95% CI 0.7–4.3). Age, education, dental treatment, tattoos, and HCV antibodies were unrelated to HHV-8 seropositivity among children. </p><p>Among adult men and women combined, unadjusted analyses showed that HHV-8 seropositivity was higher among older participants (<underline>></underline>45 years of age) compared with younger participants (15–24 years of age; OR 4.1, 95% CI 2.6–6.6); among those currently married (OR 1.9, 95% CI 1.2–3.0) or divorced, separated, or widowed (OR 3.3, 95% CI 1.7–6.4) versus never married; and among those with a history of dental treatment (OR 2.1, 95% CI 1.5–2.9), <underline>></underline>10 lifetime injections (OR 1.5, 95% CI 1.0–2.3), tattoos (OR 1.7, 95% CI 1.1–2.7), or HCV seropositivity (OR 1.8, 95% CI 1.0–3.3) compared with participants without these characteristics. Conversely, HHV-8 seropositivity was lower among adults who reported primary (OR 0.6, 95% CI 0.4–1.0) or higher level of formal education (OR 0.3, 95% CI 0.2–0.6) compared with participants without formal education.</p><p>Antischistosomal antibodies, which indicate past as well current infection, were detected among 72.8% of participants. Current infection, as indicated by ova in stool or urine samples, was noted for 4% of participants, all of whom had <italic>S. hematobium</italic>. <italic>S. mansoni</italic> was only recently introduced in Assiut Governorate and remains rare and focal in distribution (<xref ref-type="bibr" rid="R14"><italic>14</italic></xref>). Almost all participants who had <italic>S. mansoni</italic> antibodies were also positive for <italic>S. hematobium</italic>. Patterns of schistosomal seropositivity differed between women and men. Among women, antischistosomal antibody prevalence was inversely related with age (68.8% in those 15–24 years of age vs. 34.1% in those <underline>></underline>45 years of age; p<0.001); was lower in those who were widowed, divorced, or separated compared with those who were married or who had never married (38.8% vs. 63.4%; p = 0.003); but was unrelated to education (p = 0.36) or HCV seropositivity (p = 0 .12). Among men, antischistosomal antibody prevalence was unrelated to age (p = 0.61), marital status (p = 0.73), education (p = 0.64), or HCV seropositivity (p = 0.12).</p><p>In unadjusted sex-specific analyses (<xref ref-type="table" rid="T1">Tables 1</xref> and <xref ref-type="table" rid="T2">2</xref>), HHV-8 seropositivity was not associated with antischistosomal antibodies in women (OR 1.0, 95% CI 0.6–1.5); it was not significantly associated in men (OR 2.3, 95% CI 0.3–19.0), because only 9 men had no antischistosomal antibodies. The HHV-8 associations with age, formal education, marital status, and history of dental treatment among men and women combined were largely recapitulated in the sex-specific analyses, except for associations with having tattoos, <underline>></underline>10 lifetime injections, and HCV seropositivity, which were evident in women but not men (<xref ref-type="table" rid="T1">Tables 1</xref> and <xref ref-type="table" rid="T2">2</xref>). HHV-8 was significantly associated with cigarette smoking; cigarette smoking was only recorded for men.</p><table-wrap id="T1" position="float"><label>Table 1</label><caption><title>Prevalence and crude OR of association of HHV-8 seropositivity with demographic, behavioral, and clinical characteristics among male patients, Egypt*</title></caption><table frame="hsides" rules="groups"><col width="155" span="1"></col><col width="65" span="1"></col><col width="65" span="1"></col><col width="65" span="1"></col><col width="65" span="1"></col><col width="65" span="1"></col><thead><tr><th valign="bottom" align="left" scope="col" rowspan="1" colspan="1">Characteristic<hr></hr></th><th valign="bottom" align="center" scope="col" rowspan="1" colspan="1">n/N<hr></hr></th><th valign="bottom" align="center" scope="col" rowspan="1" colspan="1">%<hr></hr></th><th valign="bottom" align="center" scope="col" rowspan="1" colspan="1">OR<hr></hr></th><th valign="bottom" align="center" scope="col" rowspan="1" colspan="1">95% CI<hr></hr></th><th valign="bottom" align="center" scope="col" rowspan="1" colspan="1">p value†<hr></hr></th></tr><tr><th valign="top" align="left" scope="col" rowspan="1" colspan="1">Total</th><th valign="top" align="center" scope="col" rowspan="1" colspan="1">52/235</th><th valign="top" align="center" scope="col" rowspan="1" colspan="1">22.1</th><th valign="top" align="center" scope="col" rowspan="1" colspan="1">–</th><th valign="top" align="center" scope="col" rowspan="1" colspan="1">–</th><th valign="top" align="center" scope="col" rowspan="1" colspan="1">–</th></tr></thead><tbody><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Age group, y</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1"><0.001</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> 15–24</td><td valign="top" align="center" rowspan="1" colspan="1">8/96</td><td valign="top" align="center" rowspan="1" colspan="1">8.3</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> 25–34</td><td valign="top" align="center" rowspan="1" colspan="1">16/54</td><td valign="top" align="center" rowspan="1" colspan="1">29.6</td><td valign="top" align="center" rowspan="1" colspan="1">4.6</td><td valign="top" align="center" rowspan="1" colspan="1">2.0–11.0</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> 35–44</td><td valign="top" align="center" rowspan="1" colspan="1">10/30</td><td valign="top" align="center" rowspan="1" colspan="1">33.3</td><td valign="top" align="center" rowspan="1" colspan="1">5.5</td><td valign="top" align="center" rowspan="1" colspan="1">1.9–15.7</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"><underline>></underline>45<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">18/55<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">32.7<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">5.3<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">2.2–13.2<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Education</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.001</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> None</td><td valign="top" align="center" rowspan="1" colspan="1">19/50</td><td valign="top" align="center" rowspan="1" colspan="1">38.0</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Primary</td><td valign="top" align="center" rowspan="1" colspan="1">22/100</td><td valign="top" align="center" rowspan="1" colspan="1">22.0</td><td valign="top" align="center" rowspan="1" colspan="1">0.5</td><td valign="top" align="center" rowspan="1" colspan="1">0.2–1.0</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Secondary/postsecondary<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">11/85<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">12.9<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">0.2<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">0.1–0.6<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Job</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.001</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Student</td><td valign="top" align="center" rowspan="1" colspan="1">2/38</td><td valign="top" align="center" rowspan="1" colspan="1">5.3</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Not working</td><td valign="top" align="center" rowspan="1" colspan="1">6/31</td><td valign="top" align="center" rowspan="1" colspan="1">19.3</td><td valign="top" align="center" rowspan="1" colspan="1">4.3</td><td valign="top" align="center" rowspan="1" colspan="1">0.8–23.3</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Farmer</td><td valign="top" align="center" rowspan="1" colspan="1">25/87</td><td valign="top" align="center" rowspan="1" colspan="1">28.7</td><td valign="top" align="center" rowspan="1" colspan="1">7.3</td><td valign="top" align="center" rowspan="1" colspan="1">1.6–32.4</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Trade, service, production</td><td valign="top" align="center" rowspan="1" colspan="1">13/63</td><td valign="top" align="center" rowspan="1" colspan="1">20.6</td><td valign="top" align="center" rowspan="1" colspan="1">4.7</td><td valign="top" align="center" rowspan="1" colspan="1">1.1–20.0</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Technician/secretary<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">6/16<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">37.5<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">10.8<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">1.9–61.3<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Marital status</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.004</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Not married</td><td valign="top" align="center" rowspan="1" colspan="1">11/91</td><td valign="top" align="center" rowspan="1" colspan="1">12.1</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Married</td><td valign="top" align="center" rowspan="1" colspan="1">39/136</td><td valign="top" align="center" rowspan="1" colspan="1">28.7</td><td valign="top" align="center" rowspan="1" colspan="1">3.1</td><td valign="top" align="center" rowspan="1" colspan="1">1.4–6.5</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Separated/divorced/widowed<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">2/8<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">25.0<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">7.6<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">1.0–60.8<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Dental treatments</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1"><0.001</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> No</td><td valign="top" align="center" rowspan="1" colspan="1">16/128</td><td valign="top" align="center" rowspan="1" colspan="1">12.5</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Yes<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">36/107<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">33.6<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">3.5<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">1.8–7.1<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Tattoos</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.53</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> No</td><td valign="top" align="center" rowspan="1" colspan="1">50/220</td><td valign="top" align="center" rowspan="1" colspan="1">22.7</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Present<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">2/15<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">13.3<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">0.5<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">0.1–2.5<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">HCV serostatus</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.72</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Negative</td><td valign="top" align="center" rowspan="1" colspan="1">48/214</td><td valign="top" align="center" rowspan="1" colspan="1">22.4</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Positive<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">4/21<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">19.0<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">0.8<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">0.3–2.5<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Injections (lifetime)</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.74</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> <10</td><td valign="top" align="center" rowspan="1" colspan="1">20/72</td><td valign="top" align="center" rowspan="1" colspan="1">20.8</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"><underline>></underline>10<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">37/163<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">22.7<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">1.1<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">0.6–2.1<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Smoking</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.02</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Never</td><td valign="top" align="center" rowspan="1" colspan="1">23/138</td><td valign="top" align="center" rowspan="1" colspan="1">16.7</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Ever<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">29/97<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">29.9<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">2.1<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">1.1–4.0<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Goza‡</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.77</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Never</td><td valign="top" align="center" rowspan="1" colspan="1">42/193</td><td valign="top" align="center" rowspan="1" colspan="1">21.8</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Ever<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">10/42<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">23.8<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">1.1<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">0.5–2.4<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Schistosomiasis</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.43</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Negative</td><td valign="top" align="center" rowspan="1" colspan="1">1/9</td><td valign="top" align="center" rowspan="1" colspan="1">11.1</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Positive</td><td valign="top" align="center" rowspan="1" colspan="1">51/226</td><td valign="top" align="center" rowspan="1" colspan="1">31.0</td><td valign="top" align="center" rowspan="1" colspan="1">2.3</td><td valign="top" align="center" rowspan="1" colspan="1">0.3–19.0</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr></tbody></table><table-wrap-foot><p>*OR, odds ratio; HHV-8, human herpesvirus 8; CI, confidence interval; Ref, referrent; HCV, hepatitis C virus.
†p value for age group and education is test for trend; otherwise, p value is test for heterogeneity
‡Goza is a method of tobacco smoking in which tobacco smoke passes through a water pipe.</p></table-wrap-foot></table-wrap><table-wrap id="T2" position="float"><label>Table 2</label><caption><title>Prevalence and crude OR of association of HHV-8 seropositivity with demographic, behavioral, and clinical characteristics among female patients, Egypt*</title></caption><table frame="hsides" rules="groups"><col width="155" span="1"></col><col width="65" span="1"></col><col width="65" span="1"></col><col width="65" span="1"></col><col width="65" span="1"></col><col width="65" span="1"></col><thead><tr><th valign="bottom" align="left" scope="col" rowspan="1" colspan="1">Characteristic<hr></hr></th><th valign="bottom" align="center" scope="col" rowspan="1" colspan="1">n/N<hr></hr></th><th valign="bottom" align="center" scope="col" rowspan="1" colspan="1">%<hr></hr></th><th valign="bottom" align="center" scope="col" rowspan="1" colspan="1">OR<hr></hr></th><th valign="bottom" align="center" scope="col" rowspan="1" colspan="1">95% CI<hr></hr></th><th valign="bottom" align="center" scope="col" rowspan="1" colspan="1">p value†<hr></hr></th></tr><tr><th valign="top" align="left" scope="col" rowspan="1" colspan="1">Total</th><th valign="top" align="center" scope="col" rowspan="1" colspan="1">125/495</th><th valign="top" align="center" scope="col" rowspan="1" colspan="1">25.3</th><th valign="top" align="center" scope="col" rowspan="1" colspan="1">–</th><th valign="top" align="center" scope="col" rowspan="1" colspan="1">–</th><th valign="top" align="center" scope="col" rowspan="1" colspan="1">–</th></tr></thead><tbody><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Age group, y</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1"><0.001</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> 15–24</td><td valign="top" align="center" rowspan="1" colspan="1">23/148</td><td valign="top" align="center" rowspan="1" colspan="1">15.5</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> 25–34</td><td valign="top" align="center" rowspan="1" colspan="1">21/106</td><td valign="top" align="center" rowspan="1" colspan="1">19.8</td><td valign="top" align="center" rowspan="1" colspan="1">1.4</td><td valign="top" align="center" rowspan="1" colspan="1">0.7–2.7</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> 35–44</td><td valign="top" align="center" rowspan="1" colspan="1">31/115</td><td valign="top" align="center" rowspan="1" colspan="1">27.0</td><td valign="top" align="center" rowspan="1" colspan="1">2.0</td><td valign="top" align="center" rowspan="1" colspan="1">1.1–3.6</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"><underline>></underline>45<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">50/126<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">39.7<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">3.6<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">2.1–6.3<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Education</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1"><0.001</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> None</td><td valign="top" align="center" rowspan="1" colspan="1">88/307</td><td valign="top" align="center" rowspan="1" colspan="1">28.7</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Primary</td><td valign="top" align="center" rowspan="1" colspan="1">34/154</td><td valign="top" align="center" rowspan="1" colspan="1">32.7</td><td valign="top" align="center" rowspan="1" colspan="1">0.7</td><td valign="top" align="center" rowspan="1" colspan="1">0.4–1.1</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Secondary/postsecondary<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">4/38<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">22.5<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">0.3<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">0.1–0.8<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Job</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.11</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Other‡</td><td valign="top" align="center" rowspan="1" colspan="1">2/21</td><td valign="top" align="center" rowspan="1" colspan="1">9.5</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Housewife<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">121/470<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">25.7<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">3.3<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">0.8–14.3<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Dental treatments</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.02</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> No</td><td valign="top" align="center" rowspan="1" colspan="1">49/239</td><td valign="top" align="center" rowspan="1" colspan="1">20.5</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Yes<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">77/260<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">29.6<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">1.6<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">1.1–2.5<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Tattoos</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.006</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> No</td><td valign="top" align="center" rowspan="1" colspan="1">93/410</td><td valign="top" align="center" rowspan="1" colspan="1">22.7</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Present<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">33/89<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">37.1<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">2.0<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">1.2–3.3<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">HCV serostatus</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.006</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Negative</td><td valign="top" align="center" rowspan="1" colspan="1">112/470</td><td valign="top" align="center" rowspan="1" colspan="1">23.8</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Positive<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">14/29<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">48.3<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">3.0<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">1.4–6.5<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Injections (lifetime)</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.03</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> <10</td><td valign="top" align="center" rowspan="1" colspan="1">23/128</td><td valign="top" align="center" rowspan="1" colspan="1">18.0</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"><underline>></underline>10<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">103/371<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">27.8<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">1.7<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">1.1–2.9<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Schistosomiasis</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.94</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Negative</td><td valign="top" align="center" rowspan="1" colspan="1">48/189</td><td valign="top" align="center" rowspan="1" colspan="1">25.4</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Positive</td><td valign="top" align="center" rowspan="1" colspan="1">76/303</td><td valign="top" align="center" rowspan="1" colspan="1">25.1</td><td valign="top" align="center" rowspan="1" colspan="1">1.0</td><td valign="top" align="center" rowspan="1" colspan="1">0.6–1.5</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr></tbody></table><table-wrap-foot><p>*OR, odds ratio; HHV-8, human herpesvirus 8; CI, confidence interval; Ref, referrent; HCV, hepatitis C virus.
†p value for age group and education is test for trend; otherwise, p value is test for heterogeneity.
‡Job category for women: “Other” includes women who are students, are not working, or have technical or scientific jobs.</p></table-wrap-foot></table-wrap><p>In a multivariable analysis, HHV-8 seropositivity was higher among girls than boys (OR 2.6, 95% CI 1.2–5.8) and marginally associated with antischistosomal antibodies (OR 2.2, 95% CI 0.8–5.6). Among adult men, HHV-8 seropositivity was independently associated with older age and history of dental treatment but not with schistosomal antibodies (OR 2.3, 95% CI 0.3–16.1; <xref ref-type="table" rid="T3">Table 3</xref>). Among women, HHV-8 seropositivity was associated with older age, HCV seropositivity, and marginally with antischistosomal antibodies (OR 1.5, 95% CI 1.0–2.5; p = 0.07).</p><table-wrap id="T3" position="float"><label>Table 3</label><caption><title>Adjusted OR of association of HHV-8 seropositivity with demographic and clinical variables among adults, Egypt*</title></caption><table frame="hsides" rules="groups"><col width="104" span="1"></col><col width="60" span="1"></col><col width="60" span="1"></col><col width="60" span="1"></col><col width="11" span="1"></col><col width="62" span="1"></col><col width="62" span="1"></col><col width="62" span="1"></col><thead><tr><th rowspan="2" valign="bottom" align="left" scope="col" colspan="1">Characteristic</th><th valign="bottom" colspan="3" align="center" scope="colgroup" rowspan="1">Men<hr></hr></th><th rowspan="2" valign="bottom" align="left" scope="col" colspan="1"></th><th valign="bottom" colspan="3" align="center" scope="colgroup" rowspan="1">Women<hr></hr></th></tr><tr><th valign="bottom" colspan="1" align="center" scope="colgroup" rowspan="1">OR</th><th valign="bottom" align="center" scope="col" rowspan="1" colspan="1">95% CI</th><th valign="bottom" align="center" scope="col" rowspan="1" colspan="1">p value</th><th valign="bottom" colspan="1" align="center" scope="colgroup" rowspan="1">OR</th><th valign="bottom" align="center" scope="col" rowspan="1" colspan="1">95% CI</th><th valign="bottom" align="center" scope="col" rowspan="1" colspan="1">p value</th></tr></thead><tbody><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Age group, y†</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.002</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> 15–24</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> 25–34</td><td valign="top" align="center" rowspan="1" colspan="1">1.6</td><td valign="top" align="center" rowspan="1" colspan="1">1.2–2.2</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.8</td><td valign="top" align="center" rowspan="1" colspan="1">0.4–1.6</td><td valign="top" align="center" rowspan="1" colspan="1">0.53</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> 35–44</td><td valign="top" align="center" rowspan="1" colspan="1">2.6</td><td valign="top" align="center" rowspan="1" colspan="1">1.4–4.9</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">1.5</td><td valign="top" align="center" rowspan="1" colspan="1">0.8–2.9</td><td valign="top" align="center" rowspan="1" colspan="1">0.15</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"><underline>></underline>45<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">4.3<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">1.7–11.0<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td><td valign="top" align="left" rowspan="1" colspan="1"><hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">3.1<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">1.5–6.4<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1"><0.001<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Dental treatments‡</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.04</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> No</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Yes<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">2.3<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">1.1–4.9<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td><td valign="top" align="left" rowspan="1" colspan="1"><hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">HCV serostatus‡</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.007</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Negative</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Positive<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td><td valign="top" align="left" rowspan="1" colspan="1"><hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">3.3<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">1.4–7.9<hr></hr></td><td valign="top" align="center" rowspan="1" colspan="1">–<hr></hr></td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1">Schistosomiasis§</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.47</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">0.07</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Negative</td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">Ref</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr><tr><td valign="top" align="left" scope="row" rowspan="1" colspan="1"> Positive</td><td valign="top" align="center" rowspan="1" colspan="1">2.3</td><td valign="top" align="center" rowspan="1" colspan="1">0.3–16.1</td><td valign="top" align="center" rowspan="1" colspan="1">–</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="center" rowspan="1" colspan="1">1.5</td><td valign="top" align="center" rowspan="1" colspan="1">1.0–2.5</td><td valign="top" align="center" rowspan="1" colspan="1">–</td></tr></tbody></table><table-wrap-foot><p>*OR, odds ratio; HHV-8, human herpesvirus 8; CI, confidence interval; Ref, referrent; HCV, hepatitis C virus.
†p value is for age group fitted with trend among men; p values for heterogeneity for categories given for women (see Statistical Methods).
‡Missing values in sex-specific analyses mean the variable was not significant and was excluded from final multivariable model.
§Schistosomiasis seropositivity was included in models even when not significant because we hypothesized a priori that it was associated with HHV-8 seropositivity (see online Appendix, available from <ext-link ext-link-type="uri" xlink:href="http://www.cdc.gov/EID/content/14/4/586-app.htm">www.cdc.gov/EID/content/14/4/586-app.htm</ext-link>).</p></table-wrap-foot></table-wrap></sec><sec sec-type="discussion"><title>Discussion</title><p>We report HHV-8 seroepidemiology in a rural population in Egypt in which correlates of schistosomal and HCV were previously characterized (<xref ref-type="bibr" rid="R13"><italic>13</italic></xref><italic>,</italic><xref ref-type="bibr" rid="R14"><italic>14</italic></xref>). As in other populations, HHV-8 seropositivity in Egypt rose with increasing age (<xref ref-type="bibr" rid="R3"><italic>3</italic></xref><italic>,</italic><xref ref-type="bibr" rid="R5"><italic>5</italic></xref>). In subgroups, we found associations of HHV-8 seropositivity with history of dental therapy, lifetime injections, tattoos, and HCV seropositivity.</p><p>Previous studies of HHV-8 in Egypt (<xref ref-type="bibr" rid="R11"><italic>11</italic></xref>,<xref ref-type="bibr" rid="R12"><italic>12</italic></xref>) reported a seroprevalence of ≈40%, which is ≈2× the prevalence we observed. Those studies were hospital based, were conducted in urban areas, and detected anti-HHV-8 antibodies with lytic immunofluorescence assays; all of these factors may have contributed to higher prevalence estimates. Despite these differences, the patterns in our associations support their validity. First, we detected HHV-8 antibodies in children, consistent with earlier reports and nonsexual HHV-8 spread in Egypt (<xref ref-type="bibr" rid="R11"><italic>11</italic></xref>). Second, HHV-8 seroprevalence increased with age, in accord with the general pattern of HHV-8 observed in other populations (<xref ref-type="bibr" rid="R5"><italic>5</italic></xref>). Among men, HHV-8 seropositivity was significantly associated with dental treatment, which may be a marker for transmission through saliva- or blood-contaminated dental instruments. Our HHV-8 associations with a history of <underline>></underline>10 lifetime injections, tattoos, and HCV seropositivity also point to possible blood-borne transmission and agree with other studies (<xref ref-type="bibr" rid="R10"><italic>10</italic></xref>,<xref ref-type="bibr" rid="R27"><italic>27</italic></xref>,<xref ref-type="bibr" rid="R28"><italic>28</italic></xref>). Sexual transmission might be suggested by our HHV-8 association with marital status, but this association did not persist after adjustment for age. Rather than ongoing transmission among adults, higher HHV-8 seropositivity in older persons may be due to a birth-cohort effect, i.e., reflecting periods of elevated HHV-8 transmission risk in the past. In this regard, the widespread use of intravenous injections for schistosomiasis treatment and control programs from 1950 to 1982 would be consistent with a birth-cohort effect for high HHV-8 seroprevalence among our older participants. However, most populations, including those with no similar historical programs, have higher HHV-8 seroprevalence among older persons, which suggests that ongoing HHV-8 transmission among adults is a more likely explanation.</p><p>We found a 2-fold higher HHV-8 seroprevalence in persons who also had schistosomal antibodies. In multivariable analyses, the CI for this association was 1.0–2.5 among women, but it was wide among children (0.8–5.6) and especially among men (0.3–16.1). Chance association and serologic cross-reactivity between HHV-8 and schistosomal antibodies are possible explanations, but schistosomal antibodies may be a valid marker for exposure to injections in the historical anti-schistosomal program; these findings are consistent with parenteral transmission of HHV-8 as discussed above. Another possibility is that anti-schistosomal antibodies may be a marker for contact with surface water sources or walking barefoot, which are also risk factors for HHV-8 seropositivity and KS (<xref ref-type="bibr" rid="R5"><italic>5</italic></xref>,<xref ref-type="bibr" rid="R7"><italic>7</italic></xref>,<xref ref-type="bibr" rid="R29"><italic>29</italic></xref>). No biologic explanation has been advanced for these environmental correlations with HHV-8 and KS. Our study suggests that perhaps contact with surface water or walking barefoot is a marker of exposure to and potential infection with <italic>Schistosoma</italic> or other water-related parasites. Infection with such parasites could influence the natural history of HHV-8 by shifting the immune response from a T helper 1 (Th1)–type response, which is central to controlling viral infections, to a Th2-dominant response (<xref ref-type="bibr" rid="R30"><italic>30</italic></xref>), which is less effective against viral infections. If this model is correct, schistosomal infection could increase susceptibility to HHV-8 infection at relatively low exposure to the virus. In parallel, Th2-dominant hosts may fail to effectively control HHV-8 infection and thus shed infectious virions in saliva more frequently and at higher levels, resulting in higher HHV-8 transmission. If our findings are confirmed, they could drive investigations of environmental characteristics, including exposures to volcanic soil or plants (<xref ref-type="bibr" rid="R31"><italic>31</italic></xref>), to explain variation in HHV-8 infection and possibly KS.</p><p>Our study has several limitations. First, current HHV-8 serologic assays have imperfect specificity and sensitivity (<xref ref-type="bibr" rid="R32"><italic>32</italic></xref>), which could have contributed to the lower HHV-8 seroprevalence observed. Except for the possible cross-reactivity mentioned above, serologic misclassification is likely to be random, which would attenuate associations toward the null. Second, our HCV and schistosomal antibody assays cannot distinguish current from resolved infections, diminishing the strength of observed associations as well. Third, with our cross-sectional design, we cannot determine the temporality of associations. This limitation may be particularly relevant to our findings of HHV-8 with antischistosomal antibodies. The antischistosomal programs surely reduced the prevalence and load of schistosoma eggs, but they may also have contributed to HHV-8 transmission through injections. Finally, we studied only ≈15% of the participants in the original survey, which limited our statistical power to estimate some associations. </p><p>The strengths of our study include our state-of-the-art serologic methods, our model-based approach to estimating infection risk, and our well-characterized general population with detailed socioeconomic and clinical data.HHV-8 seropositivity was associated with older age, dental therapy, lifetime injections, and HCV and schistosomiasis seropositivity. These findings suggest salivary and possible nosocomial HHV-8 transmission in rural Egypt and a potential biologic explanation for geographic variation of HHV-8 seropositivity and KS.</p></sec><sec sec-type="supplementary-material"><title>Supplementary Material</title><supplementary-material content-type="local-data" id="SD1"><caption><title>Appendix</title></caption><media xlink:href="07-0935_app.pdf" xlink:type="simple" id="N0x1f86cd0N0x381a350" position="anchor" mimetype="application" mime-subtype="pdf"></media></supplementary-material></sec></body><back><fn-group><fn fn-type="citation"><p><italic>Suggested citation for this article</italic>: Mbulaiteye SM, Pfeiffer RM, Dolan B, Tsang VCW, Noh J, Mikhail NNH, et al. Seroprevalence and risk factors for human herpesvirus 8 infection, rural Egypt. Emerg Infect Dis [serial on the Internet]. 2008 April [<italic>date cited</italic>]. Available from <ext-link ext-link-type="uri" xlink:href="http://www.cdc.gov/EID/content/14/4/586.htm">http://www.cdc.gov/EID/content/14/4/586.htm</ext-link></p></fn><fn id="FN1"><label>1</label><p>Results were presented, in part, at the 9th International Workshop on Kaposi’s Sarcoma–associated Herpesvirus (KSHV) and Related Agents, Cape Cod, Massachusetts, USA, July 12–15, 2006.</p></fn></fn-group><bio><p>Dr Mbulaiteye is a tenure-track investigator in the Infections and Immunoepidemiology Branch (formerly Viral Epidemiology Branch), Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA. 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