Thursday, March 7, 2013

Testing for HCV and HCV prevention in Egypt

There is a strong misconception that testing people for HCV in Egypt is somehow going to result in the prevention of HCV transmission. This idea no doubt comes from the idea that testing is a screening tool for HCV infection and this information can somehow be used to prevent infection. For example in the US people are tested for TB and this can be used to control TB. Yes, but this only works in the US

The idea of testing for HCV as a tool for prevention is wrong. That is testing people for HCV will not prevent HCV transmission will not work. This is not a proven public health strategy. In fact, there is no publication that recommends testing for HCV as a prevention strategy.

In Egypt there is wide spread arbitrary testing for HCV especially by large businesses who will test persons applying for work. If they are positive they are refused employment. I know this is true for many of the big hotels because I ask employees and mangers who told me this. This is completely unjustified and should be made illegal.

People should go to there doctors if they feel ill or sick and if the doctor thinks this patient may have HCV then testing is appropriate.

Testing for HCV will not prevent HCV. It will only put people out of work.

Tuesday, July 5, 2011

Hepatitis C awareness programs in Egypt have no impact on the epidemic

New data generated by the Egyptian Demographic Health Survey which included a representative sample of the Egyptian population shows that:

The prevalence of hepatitis C virus (HCV) in those who have heard of HCV is the same as those who have not heard of HCV. (14.0% compared to 14.1%) See results of these data at

If the many public funded and privately funded HCV awareness projects in Egypt have had an impact on HCV, then it is logic that those who have heard of HCV would have a lower prevalence of HCV compared to those who have not.

The Egyptian awareness projects failure can be understood by understanding how this virus is transmitted from one person to another. This is a blood borne virus also known as a blood borne pathogen. The behavior of average people does not play a role in the transmission of these viruses. By far, blood borne pathogens are transmitted iatrogenically. This means by the practice of medical and dental care. Prevention of blood borne pathogens is primarily by strengthening and enforcing infection control measures. Egypt has a huge infection control problem and very little has been done to change this.

In fact the Egyptian National Committee for the control of HCV has not only done nothing by way of prevention of HCV but has actually obstructed prevention efforts.

Efforts are needed to change prevention from being directed at people to being directed at medical and dental care providers.

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Tuesday, August 17, 2010

Highest Rates of Hepatitis C Virus Transmission Found in Egypt

More than 500,000 new infections occur annually, according to new study

Honolulu, Doha, August 9, 2010 – The Arab Republic of Egypt has the highest rates of new hepatitis C virus (HCV) infection in the world, according to a new study published today in the prestigious Proceedings of the National Academy of Sciences. The study also estimates more than 500,000 new HCV infections occur in Egypt every year, likely signaling an epidemic in a country of more than 77 million people. This high rate of HCV transmission may be due to the lack of sufficient standard safety precautions in medical and dental facilities, the authors suggest.

“Nearly 7 out of every 1,000 Egyptians acquire HCV infections every year, suggesting intense ongoing transmission. This is the highest level of HCV transmission ever recorded at a national level for a blood borne infectious disease transmitted parenterally, that is, by use of non-sterile medical instruments,” said Dr. F. DeWolfe Miller, lead author of this study and professor of epidemiology at the Department of Tropical Medicine and Medical Microbiology and Pharmacology at the University of Hawaii.

Download a copy of this paper at
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Saturday, June 26, 2010

HCV in Egypt: HCV infection in newborne children

How many newborne children become infected in Egypt per year? More than anyother place in the world.

It is well documented that moms who have a positive test for HCV RNA are infected with the virus and have virus in their blood. There have been many studies to try and find out how many children born to these women will become infected at the time of birth.

The results from these studies vary. By far most children borne to mothers with HCV will not be or become infected. However, about 2% to 5% or more of the new born children will be infected. This is called HCV perinatal transmission. We do not know exactly how this occurs.

We can be certain about this: in Egypt more children are infected by perinatal transmission than anyplace else in the world. This is because of the HCV epidemic in Egypt. In Egypt, 14.7% have HCV antibody (this means infected previously by HCV) and 10% are chronically infected, have virus in their blood, and are infectious to others.

Since we know how many children are born in Egypt each year and how many of the mothers would be chronically infected, we can estimate how many new born children are being infected per year.

Given an Egyptian population of 77 million (other estimates are somewhat higher) and a birth rate of 22.12/1000, an estimated 3,410 newborne children will become infected with HCV. This is easily the highest population based rate of HCV infection in newborne children in the world.

This seems unavoidable. A HCV infected pregnant woman cannot take anti-HCV medication which is contraindicated for pregnancy. In fact, a woman in her childbearing years cannot be given HCV therapy unless it can be assured that she will not become pregnant.

This can be prevented. Prevention of HCV transmission or infection can be greatly improved in Egypt. This will prevent more people and therefore more moms from becoming infected with HCV in the first place.

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Monday, April 19, 2010

April 19, 2010
This graph shows the prevalence or the percent of people with hepatitis C in Egypt and in other parts of the world. The red column, Egypt, shows just how much higher HCV is in Egypt than anyplace place else in the world. There have been a number of explanations for this unusual epidemic, but what is important now is to prevent on going transmission of this virus in Egypt. That is, people in Egypt who do not have HCV are getting infected. This has lead to a lot of consternation about how people are being infected by HCV in Egypt. We know that HCV is a blood borne virus just like HIV that causes AIDS. We also know that unlike HIV, HCV is not spread by sex, at least not to any significant extent. The World Health Organization and the US Centers for Disease Control both agree that sex rarely if ever plays a role in the spread of HCV.

Blood Borne Virus

HCV is just one of many blood borne viruses. Preventing the spread of these viruses begins with health and dental care providers. For example, blood for transfusion has to be screened for HCV. In Egypt, all blood donors are screened for HCV and other important infections. HCV contaminated blood supply was a global problem before 1992. Before 1992, there was no laboratory method to test for HCV. Since 1992, blood transfusions in Egypt no longer play a role in infecting people and spreading the virus in the country.

Let’s try to understand how then an individual might become infected. First for infection to occur they would have to be exposed to blood. Specifically, they would have to be exposed to blood that had come from a person who was infected with HCV. Moreover, this blood would have to be on an object that could pierce or cut the skin or other membranes of the human body.

The most obvious place this can happen is within the health or dental care system. This is the place where an average ordinary Egyptian is most likely to be exposed to blood.

More about HCV transmission, exposure to blood, and how to prevent or protect yourself (if you are an Egyptian) from HCV infection in the next blog on HCV in Egypt.

Thursday, April 15, 2010

Hepatitis C virus in Egypt

Hepatitis C virus or HCV is an epidemic in Egypt. No where else in the world is there a HCV epidemic that effects a whole country. All other countries of the world, HCV is between 1 to 2 percent. There are a few exceptions where HCV is 3%. In Egypt however, HCV is 14.7%.