HEPATITIS c Virus prevention IN eGYPT                               Reducing Transmission by Reducing Exposure
Prevention Iatrogenic Infection Incidence
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New publication on the incidence of  HCV new infections in Egypt -> read about it PNAS                                                    

1. Kamel, M.A., Ghaffar, Y.A., Wasef, M.A., Wright, M., Clark, L.C., Miller, F.D., 1992. High HCV prevalence in Egyptian Blood donors. Lancet. 340(8816): p. 427.

The investigators were lead by Dr. Moamena Kamel, a professor of clinical pathology at the Cairo University, Facility of Medicine. The other Egyptian physicians were leading liver specialists. Dr. F. DeWolfe Miller, Professor of Epidemiology at the University of Hawaii, designed the study, conducted the analysis of data, and drafted the report. This report was a ground breaking discovery of the HCV epidemic in Egypt.

2. Christina Frank, Mostafa K Mohamed, G Thomas Strickland, Daniel Lavanchy, Ray R Arthur, Laurence S Magder, Taha El Khoby, Yehia Abdel-Wahab, El Said Aly Ohn, Wagida Anwar, Ismail Sallam. 2000. The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt.  Lancet 2000; 355: 887–891

This study suggested that the epidemic of HCV in Egypt was started by the injections given for bilharzia in Egypt started more that 60 years ago and ending with the development of a safer oral drug more than 25 years ago. This and other studies have had a negative public health impact in Egypt. Because treatment with injections ended 25 years ago, many believe that the TRANSMISSION of HCV ended. This is not the case. See the incidence of new cases of HCV.

3.  M. Karmochkine, F Carrat, O Dos Santos, and others. A case-control study of risk factors for hepatitis C infection in patients with unexplained routes of infection. Journal of Viral Hepatitis 13(11): 775-782. November 2006.

 see: http://www.hivandhepatitis.com/hep_c/news/2007/121206_c.html 

This study suggests that Iatrogenic Infections which are very important in Egypt also play a role in the transmission of HCV in other developed countries as well. In fact there was a recent iatrogenic exposure to over 40,000 patients in Las Vagas, NV. U.S.A.

Summarized Results from this report are:

Among the 66 items considered, multivariate analysis identified 15 independent risk factors for HCV infection: 

Iatrogenic inpatient exposures
admission to a medical facility (OR 2.1);
digestive endoscopy (OR 1.9);
admission to a surgical ward (OR 1.7);
surgical abortion (OR 1.7).>

Out-patient treatments:
Cutaneous ulcer or wound care (OR 10.1);
diathermy (OR 3.0);
gamma globulin administration (OR 1.7);
intravenous injections (OR = 1.7);

varicose vein sclerotherapy (OR 1.6);
acupuncture (OR 1.5);
intramuscular injections (OR 1.4).http://www2.hawaii.edu/%7Edewolfe/Iatrogenic.html

Lifestyle factors:
intranasal cocaine use (OR 4.5);
engaging in contact sports (OR 2.3);
beauty treatments (OR 2.0);
professional pedicure or manicure (OR 1.7). 

These factors explained 73% of community-acquired HCV infections. 


In conclusion, the authors wrote, "for patients with unexplained routes of HCV infection, our data incriminate previously unidentified risk factors (abortions, some dermatological procedures, outpatient injections, contact sports, beauty treatments, professional pedicure/manicure) and confirm those already recognized (hospitalization, digestive endoscopy, acupuncture and intra-nasal cocaine use)."

These results suggest that prevention education materials and programs should include a broader range of exposures and activities that may put individuals at risk for contracting HCV. They also emphasize the need for universal precautions and sterile procedures in medical settings.

4. Mohamed, M. K.et al. Intrafamilial transmission of hepatitis C in Egypt. Hepatology. 42: 683-7. 2000.

This publication was an important contribution to understanding HCV transmission in Egypt. Many, including those in the medical profession, considered that since the PAT campaigns had been stopped more than 25 years ago, then the transmission of HCV had also stopped (see reference 2 above). This report shows that in areas of Egypt with high HCV prevalence, incidence (the number of new cases per year) was also high (6.8/1000 per year).


The conclusion is that HCV transmission is ongoing in Egypt and has not ended as many in the medical profession believe.

This report also suggests that there is transmission of HCV within household or family members. This is an unexpected and unlikely finding. The transmission of HCV virus is low even when exposed directly to for example a needle contaminated with blood from a person known to have HCV viremia. We know this from studies of accidental needle stick injury.

This report did not demonstrate exactly how HCV transmission occurred within the family. Only indirect evidence was given. Also the absolute numbers of new incident cases in the study was small, 28 cases in one village and 5 in the other village. Therefore the analysis was based on small numbers. It is not possible to rule out that exposure and infection of family members did not occur outside the household and confounded by health care provider.

The results from this single prospective study have not been confirmed by other prospective studies. Even if there were household transmission, the attributable risk of this exposure to the total exposure of HCV infection in Egypt was not given. The results consequently in Egypt have been blown out of proportion relative to the more substantial data on transmission of HCV by iatrogenic exposures both in Egypt and elsewhere in the world. This has had a negative impact on focusing prevention messages and measures on the more widely spread iatrogenic exposures and efforts to reduce these exposures. Reducing iatrogenic exposures is essential even if there is household transmission.

Finally, this report potentially stigmatizes family members who may find themselves tested positive for HCV. This is unnecessary and unfortunate. 

5. Saleh, DA et al. Incidence and risk factors for hepatitis C infection in a cohort of women in rural Egypt. Transactions of the Royal Society of Tropical Medicine and Hygiene (2008)

This very recent report estimates incidence of HCV in rural women at 0.5% per year.

6.  El-Zanaty F, Way A. Egypt Demographic and Health Survey 2008. Egyptian: Ministry of Health. El-Zanaty and Associates, and Macro International. Cairo. p 431, 2009.  Egypt Demographic Health Survey: Final Report - June 2009.

This study completed the first representative national sample of HCV antibody and HCV RNA.  The final estimated prevalence of HCV antibody was 14.7%. See  Figure 1