Contrary to the widely-held perception
that this rate of occurrence reflects merely the limited
safety measures during anti-bilharzia campaigns, HCV
incidence likely continues at alarming levels due to limitations in
the implementation and enforcement of stringent standard precautions
in public and private medical and dental facilities.
Highest Rates of Hepatitis C Virus Transmission Found in Egypt
© 2010 Al Bawaba
The Arab Republic of Egypt has the highest rates of
new hepatitis C virus (HCV) infection in the world, according to a
new study published today in the prestigious Proceedings of the
National Academy of Sciences. The study also estimates more than
500,000 new HCV infections occur in Egypt every year, likely
signaling an epidemic in a country of more than 77 million people.
This high rate of HCV transmission may be due to the lack of
sufficient standard safety precautions in medical and dental
facilities, the authors suggest.
“Nearly 7 out of every 1,000 Egyptians acquire HCV
infections every year, suggesting intense ongoing transmission. This
is the highest level of HCV transmission ever recorded at a national
level for a blood borne infectious disease transmitted parenterally,
that is, by use of non-sterile medical instruments,” said Dr. F.
DeWolfe Miller, lead author of this study and professor of
epidemiology at the Department of Tropical Medicine and Medical
Microbiology and Pharmacology at the University of Hawaii.
Although the high prevalence of hepatitis C in Egypt
has been well established for many years, and linked in part to
limited safety measures during anti-bilharzia campaigns, published
estimates of prevalence from different Egyptian communities failed
to provide a nationwide picture of the magnitude of ongoing HCV
infection transmission. To estimate the rate of new HCV cases of
infection in Egypt, the authors of the study performed epidemiologic
modeling of data from a range of studies, including a 2008 national
HCV survey with a representative sample and well-documented study
“The study opened our eyes to a disease burden
similar in scale and challenge to the HIV problem in sub-Saharan
Africa: Millions of cases of an infection for which there is no
vaccine, no effective treatment, and where case management is so
expensive that it is beyond the reach of most patients,” said Dr.
Laith J. Abu-Raddad, co-author of the study and assistant professor
of public health at the Infectious Disease Epidemiology Group at the
Weill Cornell Medical College–Qatar.
The study necessitates not only further analysis of
HCV transmission in Egypt but also justifies the immediate increase
of resources to strengthen public health measures aimed at reducing
the transmission of HCV in clinical and non-clinical settings,
according to the authors. Failure to address this problem will
result in a massive disease burden in the nation in terms of HCV
infection complications, including active liver disease, liver
failure, or liver cancer.
“There is only one way to deal with the HCV
challenge in this country: HCV prevention,” warned Dr. Miller.
“Effective and stronger HCV prevention programs are urgently needed
in Egypt. Failure to act could swamp the public health system over
the coming decades with millions of cases of HCV disease
complications with an economic and social cost that this nation does
not have the means to confront.”
Key scientific findings of the study
• Nearly 7 out of each 1,000 Egyptians acquire HCV
infection every year for a total of 537,000 new HCV infections every
year. This is by far the largest ever recorded rate of occurrence of
HCV at a national level of all countries in the world.
• One in every 10 Egyptians is a carrier of the HCV
infection, which means that there are at least 4,459,000 persons
infected with HCV who are infectious to others. This is the largest
reservoir of HCV infection in the world.
• Contrary to the widely-held perception that this
rate of occurrence reflects merely the limited safety measures
during anti-bilharzia campaigns, HCV incidence likely continues at
alarming levels due to limitations in the implementation and
enforcement of stringent standard precautions in public and private
medical and dental facilities.
UNIVERSITY OF MARYLAND
SCHOOL OF MEDICINE STUDY LINKS HEPATITIS C SPREAD IN EGYPT TO INJECTION CAMPAIGNS
Mar 12, 2008 Researchers at the University of Maryland School of Medicine have
concluded that a high prevalence of hepatitis C infection in Egypt can be
traced to mass treatment campaigns to fight a common illness in that
country decades ago. The study, conducted in cooperation with the World
Health Organization and the Egyptian Ministry of Health and Population, is
published in this week's issue of The Lancet.
The study suggests that the hepatitis C virus was transmitted through the
contamination of reusable needles and syringes used in the treatment of
schistosomiasis, a condition caused by a parasite in the blood.
Researchers say the treatment campaigns may account for the world's
largest transmission of blood-borne pathogens resulting from medical
Hundreds of thousands of Egyptians received the treatment, called
parenteral antischistosomal therapy (PAT), from the 1950's to the 1980's.
Today, drugs for schistosomiasis are administered in pill form.
"They were given the only available form of treatment for a serious
disease, but the treatment was administered with reusable injection
equipment, as was the standard in those times," says Christina Frank,
a doctoral candidate at the University of Maryland School of Medicine and
author of the study. "Doctors meant well, but they were unaware of
the dangers associated with inadequate sterilization procedures."
Frank and her colleagues reviewed historical public health records and
statistics to determine whether there was a connection between the PAT
injections and the hepatitis C rate in different age groups. Researchers
found a significant association between exposure to PAT and Hepatitis C
infection. A drop in the hepatitis C rate coincided with the gradual
replacement of PAT injections with oral medications in the mid-1970's and
The investigators concluded that PAT played a major role in the spread of
hepatitis C throughout Egypt. In part because of the high number of people
who were infected, the risk of transmission remains high in the Egyptian
population today. It is believed that at least 15% of the Egyptian
population has been infected with hepatitis C. Liver disease caused by
chronic hepatitis C infection is a significant health problem in Egypt
"The treatment campaigns were conducted with the best of intentions,
using accepted sterilization techniques of the time," says Frank.
"Testing for hepatitis C only became available in the early 1990's,
years after PAT injection campaigns had ended."
"This situation is somewhat paradoxical," says Thomas Strickland
M.D., Ph.D., professor of Epidemiology at the University of Maryland
School of Medicine, and the director of the USAID-supported Hepatitis C
Prevention Project that coordinated the study.
"Egypt's extensive and dedicated nationwide control program for
schistosomiasis was the cause of the current high prevalence of hepatitis
C in the country," says Dr. Strickland. "The practice of mass
treatment with PAT before the danger of exposure to blood was so well
known, and before the availability of disposable syringes and needles,
provided a very potent means for transmission of blood-borne
role of parenteral antischistosomal therapy in the spread of hepatitis C
virus in Egypt.
2000 Mar 11;355(9207):887-91
C, Mohamed MK, Strickland GT, Lavanchy D, Arthur RR, Magder LS, El Khoby
T, Abdel-Wahab Y, Aly Ohn ES, Anwar W, Sallam I
of Maryland, School of Medicine, Department of Epidemiology and
Medicine, Baltimore, USA.
The population of Egypt has a heavy burden of liver disease, mostly due to
chronic infection with hepatitis C virus (HCV). Overall prevalence of
antibody to HCV in the general population is around 15-20%.The risk factor
for HCV transmission that specifically sets Egypt apart from other
countries is a personal history of parenteral antischistosomal therapy
(PAT). A review of the Egyptian PAT mass-treatment campaigns, discontinued
only in the 1980s, show a very high potential for transmission of
blood-borne pathogens. We examine the relative importance of PAT in the
spread of HCV in Egypt. METHODS: The degree of exposure to PAT by cohort
was estimated from 1961-86 Ministry of Health data. A cohort-specific
exposure index for PAT was calculated and compared with cohort-specific
HCV prevalence rates in four regions.
FINDINGS: HCV prevalence was
calculated for 8499 Egyptians aged 10-50 years. A significant association
between seroprevalence of antibodies to HCV and the exposure index (1.31
[95% CI 1.08-1.59]; p=0.007) was identified across four different regions.
In all regions cohort-specific HCV prevalence was lowest in children and
young adults than in older cohorts. These lower prevalence rates coincided
with the gradual and final replacement of PAT with oral
antischistosomal drugs at different points in time in the four regions.
INTERPRETATION: The data suggest that PAT had a major role in the spread
of HCV throughout Egypt. This intensive transmission established a large
reservoir of chronic HCV infection, responsible for the high prevalence of
HCV infection and current high rates of transmission. Egypt's mass
campaigns of PAT may represent the world's largest iatrogenic transmission
of blood-borne pathogens.
10752705, UI: 20214379