Hepatitis C in Egypt


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A Presentation on the origins of the hepatitis C epidemic in Egypt.

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Hepatitis C in Egypt

  1. 1. The Tenth Plague of Egypt: Controlling Hepatitis C in the Land of the Nile
  2. 2. Gathering Information and Identifying Preliminary Issues <ul><li>Epidemiology </li></ul><ul><li>Egypt leads the world in hepatitis C infection cases (half of all cases in Africa) </li></ul><ul><li>30-40% seropositive for HCV in high risk areas (Nile Delta) </li></ul><ul><li>HCV is a major risk factor for hepatocellular carcinoma (HCC) </li></ul><ul><li>HCC accounts for 6% of all cancer and third leading cause of cancer-related deaths </li></ul><ul><li>HCV is currently Egypt’s leading health concern. </li></ul>
  3. 3. <ul><li>HCV </li></ul><ul><li>HCV is transmissible primarily through blood </li></ul><ul><li>Infects primarily hepatic tissue </li></ul><ul><li>Long latency and is carcinogenic </li></ul><ul><li>HCC </li></ul><ul><li>HCC is a form of liver cancer </li></ul><ul><li>Prognosis is very poor especially if induced by HCV </li></ul>Gathering Information and Identifying Preliminary Issues
  4. 4. Analysis: Emergence of HCV 1. Liver cirrhosis: historic problem 2. Primarily due to schistomiasis in rural areas 3. Aggressive public health campaigns in the 1960’s-1980’s (worm infections, vaccines etc.) 4. Most injections were administered using glass syringes that were reused due to limited resources. 5. Campaigns targeted mainly school children and residents of rural areas (Nile Delta)
  5. 5. Case in point <ul><li>Community based study conducted in 2001 found that </li></ul><ul><li>HCV incidences were high in 30+ (60%) year old compared to 10-19 (16%). </li></ul><ul><li>No risk factors identified </li></ul><ul><li>Overwhelming majority of patients had received injections of chemotherapeutic and vaccine agents. </li></ul><ul><li>Most cases came from the Nile Delta were most agents were administered. </li></ul><ul><li>Further studies implicated the spread of the virus through needle sharing during public health campaign period. </li></ul>
  6. 6. Analysis: Current Situation <ul><li>Today, 16% of all Egyptians are seropositive for HCV </li></ul><ul><li>50% of those infected have high enough viral load to be transmissible. </li></ul><ul><li>5 million are currently infected, 3.5 million are suffering from HCV-related complications </li></ul><ul><li>The virus continues to perpetuate as risk factors identified include: Blood transfusions, previous dental or hospital visits etc. </li></ul><ul><li>General distrust of public health entities in the country. </li></ul><ul><li>Access to QUALITY healthcare remains one of the biggest challenges for those suffering from HCV. </li></ul>
  7. 7. Recommendations: Theoretical Perspective 1. Model approach (small scale application first) 2. Multifaceted (Address all levels of the cycle) 3. Prioritized (reach the at risk first) 4. Efficient (utilize existing resources)
  8. 8. Recommendations: Action Plan 1. Phase Ia: Reform and Regulations Jan. 2008-2010 2. Phase Ib: National awareness campaign and prevention 2008-2010 (schools, mosques, hospitals etc.) 3. Phase IIa: Enforcement of Medical Standards 2010-Permenantly 4. Phase IIb: Enforcement of Public Policy 2010-2080 5. Phase III: Nationwide Implementation of the Program 2015-2080
  9. 9. Further Challenges <ul><li>Cultural Issues to consider </li></ul><ul><li>FMG </li></ul><ul><li>In home circumcision </li></ul><ul><li>Societal Issues to Consider </li></ul><ul><li>Drug abuse (needle sharing) </li></ul><ul><li>Vertical Transmission </li></ul><ul><li>Access to public health </li></ul>
  10. 10. Enduring Questions Why Hepatitis C in particular? Why Egypt in particular? Is Hepatitis C the only prevalent virus in Egypt?
  11. 11. Valuable Lesson Public health entities not only have the power to heal but the power to harm. It is a grave responsibility, one which careful planning, scrupulous execution and a sober understanding of the consequences.