Rubella and tuberculosis are only the latest diseases to afflict the population, Reem Leila investigates In recent years, the masses seem to have lost confidence in the government's declarations about disease outbreaks and other health issues. And they have had many opportunities to test their suspicions with the outbreak of bird flu early last year, rubella (German measles) infections in recent weeks, the spread of the Hepatitis C virus (HCV) and cancer. Conventional wisdom among Egyptians states that if the Ministry of Health and Population (MOHP) issues a statement about an illness, be cautious and expect the worst. Indeed, the MOHP is facing a new medical challenge in the form of the deadly Tuberculosis (TB) disease which has been reported up and down the country. TB is spreading in Giza, Cairo and Qalioubya, as well as seven other governorates, namely Beheira, Fayoum, Kafr Al-Sheikh, Beni Sweif, Assiut, Sohag and Qena. TB infections have reportedly primarily hit poor areas due to malnutrition, pollution and lack of hygiene. By nature, TB is a contagious disease and like the common cold spreads through the air. Only people who have TB in their lungs are infectious, and when they cough, sneeze, talk or spit, TB germs, known as bacilli, are propelled into the air. According to Nasr El-Sayed, undersecretary of MOHP's Preventive Affairs, a person need only inhale a small amount of bacilli to be infected. Those infected will not necessarily become sick with TB since the immune system walls off the TB bacilli which, protected by a thick waxy coat, can lie dormant for years. When someone's immunity is weakened, the chances of becoming sick are greater, explained El-Sayed. "Currently, there are 26 TB patients for every 100,000 citizens," he stated. "Therefore, it has not turned into an epidemic yet." This means, that out of Egypt's population of 72 million, some 18,200 are suffering from the deadly disease. TB is responsible for two million deaths around the world every year, especially that it is no longer the poor people's disease; these deaths could be entirely prevented by applying measures that are both available and affordable. Along with the World Health Organisation (WHO), Egypt launched a national TB control programme to reduce mortality and morbidity of TB until it is no longer a public health problem. According to Hussein Gezairy, WHO regional director for the Eastern Mediterranean, the objectives are to achieve and sustain 70 per cent case detection and 85 per cent cure rate by using the Directly Observed Treatment Short course strategy (DOTS). DOTS was implemented in Egypt five years ago at a cost of more than $4 million. Gezairy stated that, "this strategy covers 97 per cent of the population in all of Egypt's governorates and rural areas." A few weeks ago, a health official stated that the bird flu virus is contained, despite continued human infections which reached 34 this week. "Bird flu is under control and vaccination campaigns are trying to cover the entire poultry population in Egypt," stated Abdel-Rahman Shaheen, MOHP official spokesman, and soon Egypt will be free of the deadly H5N1 virus. There are international fears that the bird flu virus has mutated into several strains, thus leading to a human-to- human infection. "It's going to stay in the country for at least three years until all fowl are vaccinated, which is almost impossible to happen in a short time. It will take some time," according to Hassan El-Bushra, a WHO regional advisor. El-Bushra added that Egypt is considered the biggest site of Avian Flu infections outside Asia. Egypt is faced with a double burden of disease, with a high prevalence of non-communicable diseases such as cancer and a scourge of transmissible diseases such as rubella, TB and HCV. All of these are often associated with poverty and unhygienic surroundings. Last month's rubella outbreak is believed to have infected thousands of students and adults across the country, causing panic and preventing children from going to school. Despite the mild nature of German measles, it seems to be turning into an epidemic. "Over 3,000 people were infected with rubella during the past three months," revealed El-Sayed. "But the curve of infections is decreasing, and within three days no more cases will be reported." While the MOHP is investigating why the disease suddenly appeared and spread across the country, El-Sayed confirmed that all other recent diseases were always present. "The media is exaggerating and highlighting old issues," he argued. MOHP has been working hard to deal with the challenges of chronic diseases such as HCV and cancer, and improve the health and well-being of citizens. It is believed that almost 10 per cent of Egyptians are infected with HCV, compared to less than five per cent in Sudan and only two per cent in the US. In some areas in Egypt, the rates are even higher. According to El-Sayed, the infection rate among 10-50 year-olds is 19.4 per cent in southern Egypt, 26.5 per cent in central Egypt and 28.4 per cent in northern Egypt. HCV is primarily spread through direct contact with infected human blood. El-Sayed explained that the transmission of HCV occurs via blood transfusions, the reuse of inadequately sterilised needles, syringes or other medical equipment, or through needle-sharing among drug users. Other modes of transmission such as social, cultural and behavioural practices using percutaneous procedures such as ear and body piercing, circumcision and tattooing can occur if inadequately sterilised equipment is used. "Unfortunately, there is no vaccine against Hepatitis C, but anti-viral drugs are used in the treatment," noted El-Sayed. "The cost is very high and is effective in about 30 to 50 per cent of patients." As for cancer, it can afflict anyone of any age or social status and represents a tremendous burden on patients, their families and the government. Cancer is one of the leading causes of death in the world, yet many of these deaths can be avoided. According to Mohamed Shaalan, a surgeon at the National Cancer Institute (NCI), over 40 per cent of all cancers can be prevented, while others can be detected early, treated and cured. In Egypt today, the number of cancer patients per year is estimated at 65,000. "Accumulated patients represent about three times the number of new cases," revealed Shaalan. Due to the increasing number of cancer patients, WHO is developing the Global WHO Cancer Control Strategy. Gezairy explained that the strategy aims at reducing the cancer burden and risk factors by means of planning and implementing cancer prevention and control strategies. This strategy is integrated into the overall WHO chronic diseases prevention and control framework. It aims to increase the percentage of life expectancy of cancer patients.
