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Hepatitis C in Egypt

Summary

Cairo, May 2013 Suez Cement

Title

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Background
Worldwide, 130–170 million persons are living with chronic hepatitis C virus (HCV) infection , which, if left untreated, can result in cirrhosis and liver cancer. Egypt has the largest burden of HCV infection in the world, with a 10% prevalence of chronic HCV infection among persons aged 15–59 years (*). HCV transmission in Egypt is associated primarily with inadequate infection control during medical and dental care procedures. In response, the Egyptian Ministry of Health and Population (MOHP) in 2001 implemented a program to reduce health-care–associated HCV transmission and in 2008 launched a program to provide care and treatment. Infection control programs implemented in 2001 at MOHP facilities resulted in improvements in infection control practices and a decrease in the annual incidence of HCV infection among dialysis patients from 28% to 6%. Through June 2012, a total of 23 hepatitis treatment facilities had been established in Egypt, providing care and treatment to nearly 190,000 persons with chronic HCV infection. Despite these programs, Egypt continues to face an ongoing hepatitis C epidemic
* El-Zanaty F, Way A. Egypt demographic and health survey 2008. Cairo, Egypt: Ministry of Health, El-Zanaty and Associates, and Macro International; 2009. Available at http://www.measuredhs.com/pubs/pdf/fr220/fr220.pdf . Accessed July 18, 2012.

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Findings
Egypt has a population of 62 million and contains the highest prevalence of hepatitis C in the world. The national prevalence rate of HCV antibody positivity has been estimated to be between 10-13% (Mohamed MK. Epidemiology of HCV in Egypt 2004. The Afro-Arab Liver Journal, 2004, vol 3, No2, (July), pp 41-52). Since 30-40% of individuals clear the infection shortly after exposure based on national studies and village studies in Egypt, the estimated adjusted national prevalence rate of chronic hepatitis C infection is 7.8% or 5.3 million people in 2004 (American Journal of Gastroenterology 2006). Only one third of these individuals are estimated to have chronic liver disease (elevated ALT) and, furthermore, among these, one third are suffering from advanced liver disease. Further, with such a high background prevalence rate, transmission of hepatitis C through other non medical routes has become more significant. For example, tattooing, circumcision or other medical procedures performed by non-medical personnel are more frequent routes of infection in Egypt than elsewhere. In addition, household transmission, vertical transmission and sexual transmission are routes that are also under investigation.

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Treatments
As expected, the availability and cost of treatment for hepatitis C in Egypt is quite prohibitive. Although the most common methods of previous hepatitis C transmission (injection-based treatment for schistosomiasis and blood transfusions) have been addressed, the prevalence in those under age 20 is still approximately 5-8%, demonstrating the continued presence of significant hepatitis C transmission in modernday Egypt (Mohamed MK. Epidemiology of HCV in Egypt 2004. The Afro-Arab Liver Journal, 2004, vol 3, No2, (July), pp 41-52). Egypt is in need of additional training, funding and research in order to combat the hepatitis C epidemic.

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Treatments
The estimated cost of the care and treatment program for the Egyptian government is $80 million annually, which covers 40% of total costs of the program; the remaining 60% is paid by insurance companies and patients. Market competition has driven down the price of medications for a standard 48-week course of treatment; since program inception, medication costs have decreased from approximately $12,000 to

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