Hepatitis C in Arab world andHepatitis C in Arab world and
North AfricaNorth Africa
Dr. Khaled Mahmoud Abd ElazizDr. Khale...
DefinitionDefinition
Prevalence around the Arab countries andPrevalence around the Arab countries and
North AfricaNorth Af...
Hepatitis C viral infectionHepatitis C viral infection
Hepatitis C virus (HCV) is a RNA virus
known to infect humans and c...
Hepatitis C viral infectionHepatitis C viral infection
HCV is a leading cause of chronic liver
disease in the world.
The W...
Hepatitis C viral infectionHepatitis C viral infection
With a prevalence of 5.3% and an
estimated 32 million people infect...
Hepatitis C viral infectionHepatitis C viral infection
WHO estimates 2.2% prevalence all over
the world. It is estimated t...
Hepatitis C viral infection in arabHepatitis C viral infection in arab
countriescountries
Estimated 25 millions affected i...
GenotypesGenotypes
There are 11 HCV genotypes: 1-11, with
many subtypes: a, b, c, and about 100
different strains: 1,2,3 b...
Prevalence Countries Major
genotypes
Minor
Low
<1-1.9%
Lybia(1.2)
Tunisia (0.4-0.7)
4/1
1b
2a,2b,2c
2a,2c,1a
Moderate
2-2....
Country Transmission
Egypt 40%
Lybia 20.5%
Algeria 63%
Tunisia 51%
Morrocco 76%
Transmission of HCV in hemodialysisTransmi...
Risk factor Low
<5%
Moderate
5-20%
High
>20%
Blood
transfusion
All countries
Hemodialysis All countries
Nosocomial
transmi...
Risk factor Low
<5%
Moderate
5-20%
High
>20%
Invasive
medical
procedure
All countries
Dental
practice
Lybia, Tunisia Egypt...
Habitual and community acquiredHabitual and community acquired
infectionsinfections
Around 50% of subjects deny any exposu...
Cases prevalence Suspected factors
125
Tanta
76% among cases HCV
Antibody
40% PCR
family history,
dental, minor
surgical
p...
Transmission within health careTransmission within health care
settingsetting
Reported rates of HCV virus transmission to
...
Transmission within health careTransmission within health care
settingsetting
A recent study done in Egypt to explore the
...
 Among the 73 HCWs enrolled in
the prospective study,. Nine had
evidence of transient viremia at one
time point during fo...
The cumulative incidence of transient viremia
was not significantly different between men
and women. However, it was diffe...
 HCWs of a general University hospital
in Cairo were exposed to a highly
viremic patient population. They
experienced fre...
 Mean viral load of index patientsdid not
differ significantly between viremic and non
viremicHCWs (5.1 and 4.8 logIU/ml,...
 Another study done in Al minia in upper
egypt Abdel Wahab et al Journal of clinical
virology
 651 HCWS followed up for ...
 Risk factors for acquiring HCV infection in
referal center (liver institute) (central liver
disease institute)
 The pre...
 After adjusting for other risk factors, the anti-
HCV rate was higher among older HCWs[P <
0.001; risk ratio (RR) = 1.08...
THANK YOU
Hepatitis c in arab world and na khaled
Hepatitis c in arab world and na khaled
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Hepatitis c in arab world and na khaled

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Hepatitis c in arab world and na khaled

  1. 1. Hepatitis C in Arab world andHepatitis C in Arab world and North AfricaNorth Africa Dr. Khaled Mahmoud Abd ElazizDr. Khaled Mahmoud Abd Elaziz Assistant professor of Public healthAssistant professor of Public health & Preventive medicine& Preventive medicine Faculty of Medicine -Ain Shams UniversityFaculty of Medicine -Ain Shams University
  2. 2. DefinitionDefinition Prevalence around the Arab countries andPrevalence around the Arab countries and North AfricaNorth Africa Genotypes Distribution of infectionGenotypes Distribution of infection Transmission with blood transfusionTransmission with blood transfusion Transmission among health care workersTransmission among health care workers
  3. 3. Hepatitis C viral infectionHepatitis C viral infection Hepatitis C virus (HCV) is a RNA virus known to infect humans and chimpanzees, causing similar disease in these 2 species. HCV is most often transmitted parentrally but is also transmitted vertically and sexually .HCV is up to 4 times more infectious than Human Immunodeficiency Virus.
  4. 4. Hepatitis C viral infectionHepatitis C viral infection HCV is a leading cause of chronic liver disease in the world. The World Health Organization (WHO) estimates that 170 million people are infected with HCV globally and 3-4 million new infections occur each year, making it one of the leading public health problems in the world.
  5. 5. Hepatitis C viral infectionHepatitis C viral infection With a prevalence of 5.3% and an estimated 32 million people infected with HCV, Sub Saharan Africa has the highest burden of the disease in the world. (Karoney 2013)
  6. 6. Hepatitis C viral infectionHepatitis C viral infection WHO estimates 2.2% prevalence all over the world. It is estimated that 27% of the world burden of liver fibrosis and 25% of the HCC are due to hepatitis C viral infection (Daw 2012)
  7. 7. Hepatitis C viral infection in arabHepatitis C viral infection in arab countriescountries Estimated 25 millions affected in the Arab world and without effective intervention the number will increase tremendously in the next two decades (Daw 2012)
  8. 8. GenotypesGenotypes There are 11 HCV genotypes: 1-11, with many subtypes: a, b, c, and about 100 different strains: 1,2,3 based on the sequence of the HCV genome Genotypes 1-3 are widely distributed globally, with genotypes 1a and 1 b accounting for 60% of infections worldwide. Genotype 4 is characteristic for the Middle East, Egypt and Central Africa.
  9. 9. Prevalence Countries Major genotypes Minor Low <1-1.9% Lybia(1.2) Tunisia (0.4-0.7) 4/1 1b 2a,2b,2c 2a,2c,1a Moderate 2-2.9% Algeria (2%) NA NA High 3-3.9% --- ---- ----- Very high >4% Egypt,17.8(13- 22) Morocco 7% 4 1b 1a,1b2,2a 2a,2c,1a Prevalence of HCV infections in countriesPrevalence of HCV infections in countries of North Africaof North Africa
  10. 10. Country Transmission Egypt 40% Lybia 20.5% Algeria 63% Tunisia 51% Morrocco 76% Transmission of HCV in hemodialysisTransmission of HCV in hemodialysis
  11. 11. Risk factor Low <5% Moderate 5-20% High >20% Blood transfusion All countries Hemodialysis All countries Nosocomial transmissio n All countries Health care workers All countries Risk factors for transmission of HCVRisk factors for transmission of HCV infection in North Africainfection in North Africa
  12. 12. Risk factor Low <5% Moderate 5-20% High >20% Invasive medical procedure All countries Dental practice Lybia, Tunisia Egypt, Algeria, Morocco Hospital waste handling Lybia, Tunisia Egypt, Algeria, Morocco Intravenous Drug Abuse All countries Habiutal, high risk behavior Lybia, Tunisia Algeria, Egypt Morocco Risk factors for transmission of HCVRisk factors for transmission of HCV infection in North Africainfection in North Africa
  13. 13. Habitual and community acquiredHabitual and community acquired infectionsinfections Around 50% of subjects deny any exposure to previous risk factors. We report that as community acquired infection It is likely that injections given in rural communities by both traditional and nontraditional health care providers are an important cause of HCV transmission, particularly in countries like Egypt, Morocco and Algeria,
  14. 14. Cases prevalence Suspected factors 125 Tanta 76% among cases HCV Antibody 40% PCR family history, dental, minor surgical procedures 150 Ain Shams University Only 66 done the test Prevalence 20% Quality control and more sensitive test for blood screening strict pre transfusion blood testing Transmission in cases with bloodTransmission in cases with blood transfusion (children with B thalassemia)transfusion (children with B thalassemia)
  15. 15. Transmission within health careTransmission within health care settingsetting Reported rates of HCV virus transmission to HCW exposed to HCV RNA positive patients inside hospitals range between 0 and 10%
  16. 16. Transmission within health careTransmission within health care settingsetting A recent study done in Egypt to explore the transmission of HCV infection to HCWs. It included 597 health care workers that reported recent occupational blood born exposures.
  17. 17.  Among the 73 HCWs enrolled in the prospective study,. Nine had evidence of transient viremia at one time point during follow-up, representing a cumulative incidence of 12.3% (95%CI, 5.8%– 22.1%). Most(66.7%) HCWs had their viremic episode within 2 weeks after exposure.
  18. 18. The cumulative incidence of transient viremia was not significantly different between men and women. However, it was different according to the HCW’s age, with 35.7% (5/14) viremic HCWs among those aged below 24 years versus 6.8% (4/59)among HCWs aged 24 or above (p = 0.01). Also, the use of disinfectant after OBE was lower among HCWs who developed viremia than among those who did not (6.7% (3/45) and 26.3%(5/19), respectively; p =0.04).
  19. 19.  HCWs of a general University hospital in Cairo were exposed to a highly viremic patient population. They experienced frequent occupational blood exposures, particularly in early stages of training. These exposures resulted in transient viremic episodes without established infection.
  20. 20.  Mean viral load of index patientsdid not differ significantly between viremic and non viremicHCWs (5.1 and 4.8 logIU/ml, respectively, p= 0.36).  The first important finding of this study is the extremely high (37%) proportion of patients with HCV viremia among inpatients of a general hospital in Cairo.  Mounir et al 2013 (Diaa Marzouk)
  21. 21.  Another study done in Al minia in upper egypt Abdel Wahab et al Journal of clinical virology  651 HCWS followed up for 18 months for seroconversion twice per year  Over all incidence of HCV sero convernsion 2.1/ 1000 person year  4.8% inicidence among subjects exposed to needle stick injuries.
  22. 22.  Risk factors for acquiring HCV infection in referal center (liver institute) (central liver disease institute)  The prevalence of anti-HCV, hepatitis B surface antigen (HBsAg)and co-infection was 16.6%, 1.5% and 0.2%, respectively. Schistosoma mansoni antibodies were present in 35.1%. The anti-HCV rate increased sharplywith age and employment duration, but not among those with needlestick history.
  23. 23.  After adjusting for other risk factors, the anti- HCV rate was higher among older HCWs[P < 0.001; risk ratio (RR) = 1.086, 95% CI 1.063– 1.11], males (P = 0.002; RR = 1.911, 95% CI1.266–2.885) and those with rural residence (P < 0.001; RR = 2.876, 95% CI 1.830– 4.52).Occupation (duration of employment or schistosomal antibody positivity) were not significant risk factors for anti-HCV positivity. In conclusion, although one in six HCWs had been infected with HCV, the infections were more likely tobe community-acquired and not occupationally related.
  24. 24. THANK YOU

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