National strategy to cut prevalence below 5%, a media campaign to be launched CAIRO: US and Egyptian scientists participating at the 14th annual AUC Research Conference warned against the impact of economic, social and psychological problems caused by the high prevalence of Hepatitis C (HCV) in Egypt. Egypt, along with Magnolia and Bolivia, is amongst the worst hit by the virus and has the world s highest prevalence rate ranging from 12 to 15 percent and up to 18 percent of the population in rural areas. Dr. F. DeWolfe Miller, head of the Public Health Sciences and Epidemiology at the University of Hawaii, gave the keynote speech at this year s conference. He referred to a study conducted by The Lancet Medical Journal in 2000, in cooperation with the World Health Organization and the Egyptian Ministry of Health that traced the prevalence of the virus in Egypt to mass treatment campaigns implemented to fight Schistosomiasis, a condition caused by a parasite in the blood acquired through swimming in contaminated irrigation canals in rural areas. He said the mass anti-Schistosomal injection treatment campaign carried out between the 1950s and 1980s, long before the exposure to blood was clearly understood and before disposable syringes were available, was the cause of the high prevalence of HCV in Egypt. Miller described, in a lecture entitled The Epidemiology of Hepatitis C in Egypt, the medical challenges that HCV poses due to its high replication and mutation rate is comparable to that of the HIV virus which causes AIDS. He said this small, only recently imaged virus, also poses huge challenges when it comes to detection and prevention of its spread from an infected person to others mainly through blood contact, as the virus has an incubation period of three to 20 weeks before the infected person starts showing symptoms of the disease. There are a number of windows of opportunity for an infected person to transmit the virus without even knowing it, as the appearance of the virus in the blood could occur long before any manifestation of symptoms . also determining if a person is infected based on an antibodies test may not be possible as antibodies may not appear until after the virus is already in the blood, said Miller, who has been working on HCV in Egypt since 1975. Miller, who co-discovered the epidemic in Egypt, recounted how the world s biggest Hepatitis epidemic was discovered in Egypt in the early 1980s. This was after a microbiologist conducting research on local and foreign labor groups in Saudi Arabia found an unusually high number of Egyptian workers testing positive for HCV. Since that time, much has been done by the health authorities in Egypt to remove blood tainted with the virus from the blood supply used for blood transfusion, and I can attest that procedures taken by the Vacsera [the main health body in charge of vaccination and serums] in Egypt are very, very, very good, he said. Egyptian scientists taking part in the three-day conference that started on April 28, called for amending legislation to allowing cadaveric liver transplants, or organ transplant from recently dead healthy donors. They criticized the fact that Egyptian law only allows living donor transplants, and pinned hopes on a national campaign to prevent the transmission of the disease and cut its prevalence in Egypt to less than five percent. Panelist Gamal Esmat, a professor of tropical medicine at the Faculty of Medicine and director of the Hematology Research Unit at Cairo University, told The Daily Star Egypt that the five-year national strategy aims to prevent the iatrogenic transmission of the disease by focusing on medical behavior to ensure safe medical procedures are followed by dentists. There are also plans for a national survey to assess the impact of the disease and its transmission on the socio-economic level. We started a treatment applicability program to attempt to eliminate the reservoir of virus in infected people in Cairo, Alexandria and Assiut to prevent the spread of the infection. Esmat also pointed out that the national strategy will launch a community study to minimize the risk factors of contracting HCV from barbers, body art, such as tattoos, and body piercing, through a media and awareness campaign. We hope by the end of these five years to succeed in reducing the prevalence of HCV from more than 10 percent to less than five percent. Another panelist, Dr. Amr Helmy, a professor of Surgery at The National Liver Institute, in Egypt's Menufiya University, called for changing the law to allow cadaveric liver transplants from a dead donor to a living receptor, as surgery remains the gold standard for treatment of Hepatitis C in its advanced stages, marked by extensive morbidity and liver damage on the cellular level. The obstacle to the success of the surgical solution to the epidemic are ethical, legal, financial, and social rather than medical, he said. Helmy noted that while an elective transplant from a living donor, usually a family member, to a hepatitis patient has the advantage of being a clean transplant, the procedure is still marred by disadvantages such as limited eligibility, the risk of donor mortality, psychological and social limitations, in addition to the absence of a clear understanding of the long-term health impacts on the donor, as the first ever procedure of this kind was only carried out in 1990. On the other hand, limitations to cadaveric transplants are the lack of legislation, lack of equipped rescue units, trained mobile medical teams, and advanced communications and transfer systems, he added. HCV: Facts and Figures . Nearly 200 million or two percent of the global population are infected with HCV; Egypt has the world s highest prevalence of more than 12 percent of the population. . Prevalence in developed countries does not exceed two percent, while it ranges from three to four percent in India and China. . HVC is blood borne; at highest risk are drug users who share needles, those who have had a blood transfusion or an organ transplant before 1992. . Body piercing, tattooing, acupuncture, and dental procedures can transmit the virus. . Sexual contact has not been fully established as a sure transmission route. . Hepatitis A and E are self-limiting and are transmitted through contaminated food or water. . Diagnosis and the interpretation of blood tests is complex; over 80 percent of Hepatitis C patients have no symptoms. . The cost of a live donor liver transplant in private hospitals increased from LE 80,000 in 1991 to LE 400,000. Cost of the procedure in government, charity, or university hospitals currently stands at LE 150,000. . Egypt spends LE 1.3 billion annually to treat diabetes and cancer. However, diabetes and cancer patients have lower chances for full productive lives after treatment compared to Hepatitis patients who receive a live transplant. For the same amount of funding allotted to diabetes and cancer, 1,000 liver transplant procedures could be performed each year.
