Due to the increasing number of patients infected with hepatitis C, a promising national programme has swung into action. Reem Leila reports The Ministry of Health and Population (MOHP) has come up with the National Hepatitis Programme (NHP), supervised by the newly created National Hepatitis Committee (NHC), in order to combat the escalating mortality rate from hepatitis C. According to Manal El-Sayed, a member of the NHC, the annual infection rate is more than 70,000 new cases per year, of which at least half suffer chronic hepatitis C. "HCV is a direct cause for liver cancer and cirrhosis. Unfortunately, there is no known vaccine for this virus although a patient can recover from the infection with a combination of drugs if treated early," El-Sayed said. The World Health Organisation (WHO) has declared the Hepatitis C Virus (HCV) a global health problem, with approximately three per cent of the world's population -- a percentage ranging from between 170-200 million people -- infected with the virus. In the US, approximately three million people are chronically infected, many of whom are still undiagnosed. Hepatitis C was discovered worldwide only in 1987. In Egypt the situation is worse. With a population of 73 million people, Egypt has the highest rate of HCV infection in the world. As estimated by MOHP, 13 per cent, or nearly eight million Egyptians, have the virus. Egypt's very high prevalence of HCV is due to the government's campaign during the 1970s to treat rural villagers from bilharzia, a disease which at one time was prevalent in Egypt. The treatment campaigns, which involved repeated injections with metal syringes instead of disposable needles, did not follow strict hygiene standards. Accordingly, it spread the HCV, which is transmitted via blood, throughout the population. Abdel-Rahman Shahin, official MOHP spokesman, stated that it may take up to 30 years for HCV symptoms to appear in a patient or for the disease to become active. "The main risk factor for HCV now, according to all the studies done in Egypt, is treatment in the past for bilharzia," said Shahin. "In the past, the ministry treated people in rural areas without using disposable syringes as is the current procedure. They were using glass syringes," he added. In addition to cases among the older population, there are still recurring infections due to poor medical practices of some people and health workers in poor, slum and deserted areas. Deaths from liver disease are, therefore, expected to increase in Egypt within the next 20 years. "Supposedly by the year 2020 we will have so many patients who suffer liver failure and liver cancer that treating them now will be more effective than leaving them to face their destiny," El-Sayed said. The NHC is currently drawing up plans to treat this aggressive virus. Treatment of the virus is usually done with the drug Interferon. However, the most typical type of HCV in Egypt is about 40 per cent resistant to the drug. Although research is ongoing, no more effective treatment is available. Nevertheless, the committee has succeeded in striking a deal with the suppliers of Interferon to provide the ministry with the required drug for one-third of the usual price, and treatment under the committee's programme has begun in 10 centres throughout the country. "The cost of the drug has decreased from LE1,300 to LE480. Soon it will be LE250," stated Shahin. The decrease is due to the production of an Egyptian version of Interferon which will be marketed by the beginning of 2008. But even with the cost of Interferon reduced, the financial burden of Egypt's HCV problem is huge. The committee estimates that of the eight million people actively infected with the virus, around one million currently need treatment. Wahid Dous, director of Cairo's National Liver Institute (NLI), believes that a year's treatment for a person with signs of liver damage from HCV costs around LE25,000 which only a few can afford; the NLI will pay for those who cannot. "The NHP will help us in screening patients at high risk status as well as other cases. Accordingly we will set up a credible data base to help us know the actual dimensions of the problem in Egypt," said Dous. The hepatitis committee has stressed the need for good infection control programmes in hospitals, and among healthcare professionals, to stem the transmission of the virus. The MOHP is cooperating through its National Infection Control Programme which began in 2003. The NHP is also helping seriously ill patients undergo liver transplants. Dous says there are no actual figures concerning those who need urgent surgery. He cited the example of 13 patients on the list who are ready to undergo surgery but cannot because of a lack of funds. The operation costs LE200,000, well beyond the means of the average Egyptian. During the past year the NHP paid the entire cost of the surgery for three patients. Four other patients underwent the operation but the NHP paid only LE50,000; the remainder was paid by the patients themselves. "The NHP has created a fund in coordination with Egypt's grand mufti, to collect donations for those who need financial support," added Dous.
