Five million infected with Hepatitis C

At least five million people in Egypt are infected with the hepatitis C virus (HCV), a new committee formed by the country’s government to tackle the disease has said. It added that action must be taken now to combat rising mortality.

“The annual infection rate is more than 70,000 new cases, of which at least 35,000 would have chronic hepatitis C,” said Dr Manal el-Sayed, Professor of Paediatrics at Cairo’s Ain Shams University and member of the National Hepatitis Committee which is currently formulating an action plan to fight the disease.

Hepatitis C is a lethal virus which can cause liver cirrhosis and cancer. Egypt has one of the highest prevalence rates of the virus in the world, say specialists. An estimated 10-15 percent of the population, some 8-10 million people, are carrying hepatitis C antibodies, meaning that they either have or at one time had the virus. Five million of those are actively infected, according to government figures.

No vaccine is available for HCV although it can be treated with a combination of drugs if detected early enough.

Egypt’s very high prevalence of HCV is largely the legacy of government campaigns prior to 1980 to treat rural populations for schistosomiasis (or bilharzia), a water-borne disease which at one time was endemic in Egypt. The treatment campaigns, which involved repeated injections, did not follow rigorous hygiene standards, and as such spread blood-borne HCV throughout the population.

As it may take up to 30 years for a patient to display symptoms of HCV or for the disease to become active, the full extent of the problem has only recently become known.

“The main risk factor [for HCV now], according to all the studies done in Egypt, is treatment in the past for schistosomiasis,” said Dr Amr Kandeel, Director of the Communicable Disease Department at the Egyptian Ministry of Health and Population.

“At that time, the Ministry treated people in the villages without using disposable syringes,” he added.

New infections

In addition to cases among the older population, new infections are still being recorded, due to poor medical practices and behavioural factors. Deaths from liver disease are, therefore, expected to increase in Egypt within the next 20 years.

“If we consider that by the year 2020 we are going to have so many patients who are having liver failure and liver cancer, treating them now is more effective than leaving them to that outcome,” said el-Sayed.

Egypt’s hepatitis committee is now making plans to prevent and treat hepatitis C. Treatment of HCV is usually done with a drug called Interferon. However, the most typical type of HCV in Egypt has about a 40 percent resistance to the drug. Although research is ongoing, no more effective treatment is yet available.

Nevertheless, the committee has succeeded in brokering a deal with the manufacturers of Interferon to supply the drug to Ministry of Health hospitals for one third of the usual price, and treatment under the committee’s programme has begun in selected centres.

Even with the cost of Interferon reduced, the financial burden of Egypt’s HCV problem is huge. The committee estimates that of the five million people actively infected with the virus, around one million currently need treatment. A year’s treatment for a person with signs of liver damage from HCV costs around LE 25,000 (about US $4,500) – a sum few can afford.

In January this year, the committee began fundraising activities with the help of NGOs and international organisations including USAID, the World Health Organisation and UNICEF. The committee hopes to be able to provide free treatment to those most in need.

“We would also like to appeal to the international community to help with this campaign by whatever means possible,” said el-Sayed.

Due to the cost and difficulty of treating chronic HCV patients, promoting awareness to prevent the disease, and detecting those infected before they develop liver damage are critical factors.

Screening the population

“We are going to promote screening for high-risk populations – including healthcare professionals who are at risk from needle injuries, and those who are undergoing repeated blood transfusion treatment,” said el-Sayed.

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 Egyptian Ministry of Health is co-operating through its National Infection Control Programme, which began in 2003.

Those at risk of new HCV infections in Egypt are not just those in medical contact with existing patients, however. The children and relatives of individuals affected during the schistosomiasis campaign are also a high-risk group, as widespread behavioural practices – such as the re-use of syringes, sharing of toothbrushes and even circumcision – all increase the risk of contracting blood-borne viruses such as HIV and Hepatitis C.

And although the circumcision of girls is officially banned in Egypt, the practice still continues, placing girls who are being circumcised at a very high risk of contracting HCV.

“Sometimes there is a sort of celebration for mass circumcision in certain communities. Girls are at a higher risk because it is a very bloody procedure. However, female circumcision has dramatically decreased, with more awareness and a ban by law,” said el-Sayed.

As part of its Unite for Children, Unite Against Aids campaign, UNICEF Egypt has also been trying to raise awareness of the more common dangers of contracting HCV. Changing people’s behaviour and attitudes toward blood safety is key, according to Wessam el-Beih, UNICEF’s Unite Against Aids Egypt co-ordinator.

“Many people share razors and re-use syringes. They see no harm in just washing them and using them again. So there is a big behavioural component to the plan,” she said.

jb/ar/ed

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