Changing personal habits essential in combating spread of disease PARIS: On the second day of the 12th International Symposium in Viral Hepatitis and Liver Disease, hepatitis C (HCV) held center stage, with the symposium attempting to shed light on Egypt's widespread problem with this form of hepatitis. Egypt currently possesses the highest reported prevalence of HCV in the world, according to the findings of a study conducted by a team of foreign and Egyptian doctors in a presentation entitled, "Intra-familial transmission of HCV infection in a rural area from Egypt at the conference. According to the study, HCV is highly prevalent in Egypt due to the spread of HCV through massive anti 'schistosomal' (known in Egyptian laymen terms as bilharzia) campaigns in the past. More alarmingly, HCV prevalence remains high even now, the ways in which the virus is spreading are unknown. However, many Egyptian doctors dispute this idea, stating that the means of transmission and contraction have been identified. "Hepatitis C is spread through the blood, not through intercourse or pregnancy, Dr. Gamal Esmat, professor of hepatology at Cairo University and president-elect of the International Association for the Study of Liver Disease, tells The Daily Star Egypt. "This is a very important point, because lots of people want to get divorced, thinking that the virus can be spread through these two means. But again, there is no evidence of that. What is perhaps the most important point is that so far there is no cure, which means that those who have contracted it must live with it. This situation only gets worse for Egypt, where one out of seven people have HCV. "Twelve to 15 percent of the Egyptian general population have HCV, says Esmat. "When you go to a barber shop in France, (where 1 in 100 have HCV) you don't have to worry that you may contract HCV, because your chances are very low. But in Egypt, this is a very real possibility, says Esmat. According to Esmat, the problem also lies in the culture, where the sharing of personal toiletries is a normal practice. "Friends and family sometimes share the same nail clippers, towels and razors. They then blot blood from cuts on towels that are used by the family before being washed, states Esmat. While many conjure up images of blood transfusions in a hospital when they think of ways in which to contract HCV, the greater danger of transmission lies in everyday habits. "People don't think about their actions, because most of the time they are unaware that they can contract HCV this way. The problem lays in lack of awareness, explains Esmat. HCV began its descent on Egypt between the 1940s and 1980s, when people were being vaccinated for schistosomal. According to Esmat, the vaccine for schistosomal was given with a hypodermic needle, which wasn't being sterilized from individual to individual. "You have to remember, this was in the '40s, when sterilization and the hepatitis virus were fairly unknown. We only discovered hepatitis in 1998, and traced it back to the vaccine for bilharzia, but by then it had spread, says Esmat. According to the intra-familial transmission of HCV infection study, unsafe injections and transfusions are considered to be the major sources of HCV transmission in developing countries. However, these classical methods do not account for the substantial proportion of HCV infections in Egypt. In order to investigate modes of transmission within families, the study surveyed families in rural governorates around the Nile Delta, where HCV infection is high. According to the results of the study, which included 3,994 subjects, 1,947 of which were male and 2,047 were female between the ages of 4 to 88, the overall HCV prevalence was 12.3 percent, with no significant difference between genders. The study also found that HCV prevalence increased from 0.8 percent in children less than 10 years of age, to 31 percent in adults over 40. Major risk factors of HCV included blood transfusions and invasive medical procedures. Furthermore, the study's findings strongly support the existence of HCV transmission within family units, and that a large portion of the present HCV infections in these families occurs from parents to their children and between siblings. "Egypt has a big reservoir of hepatitis C, says Esmat. According to him, the aim is to eradicate the disease, and the best way to do this is through awareness. "We have to make people aware of their habits, of changing the culture of sharing personal items. We need to overhaul the research and facilities for hepatitis, says Esmat. In the meantime, there is only one treatment in the world for HCV, he states, and that is interferon. "It's very expensive and it has side effects like the depression of the production of white blood cells and blood platelets in the body, all of which make it not the most exemplary treatment. But it's the only thing we've got. All those claiming natural remedies involving herbs cure HCV are delusional. None of these natural remedies work, he says. "We all have interferon in our bodies, but now it is being created genetically to combat HCV, said Dr. Hunter, professor of gastroenterology and hepatology at Cairo University. "All government entities and public health facilities in Egypt administer this treatment to the public, so that even those living in the poorest communities have access to treatment. The private sector also assists their employees by including this treatment in their health care plans, says Esmat. However, according to the Hepatology Review's latest published report, interferon's effectiveness is limited due to the drug's short shelf life. "Every 48 hours, we have to inject interferon in the body because the body gets rid of the vaccine within two days. That is why pharmaceuticals are now using pegylated interferon, a cheap material used because it has a big molecule, which allows the vaccine to latch onto the body for longer, explains Hunter. According to Hunter, in order to combat the short shelf life of interferon, pegylated interferon was created and is the most effective drug available against HCV, but it is only 50 percent effective and many patients relapse after taking the course. Furthermore, unlike interferon, pegylated interferon is not subsidized because it is too expensive (interferon injection costs approximately LE 80 and are taken every two days, while pegylated interferon costs LE 1,400 an injection, taken once a week). HCV currently infects more than 170 million people worldwide. Chronic infection develops in 80 percent of infected patients and is a major cause of chronic liver disease, according to the Hepatology Review's report.
