Epidemiology , Prevention and Control programs of Hepatitis C in Egypt

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Epidemiology , Prevention and Control programs of
Hepatitis C in Egypt Mostafa K. Mohamed and
El-Said A. Aoun Egyptian Ministry of Health and
Population
WHO informal Consultation with VHPB Geneva,
Swittzerland 13-14 May 2002
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• Prevalence of HCV infection
• Incidence of new Infections or Seroconversions
• Notification Systems
• Prevenetion Programs
• Laboratory /Clinical Networks
• Role of Authorities
• Cost and Burden of disease

WHO informal Consultation with
VHPB Geneva, Swittzerland
13-14 May 2002
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Rural life
1996 62 Mil. Population 60 in Rural
Areas 2002 Population 70 Mil. Population Life
expectancy 66 y

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The Role of Parenteral Antischistosomal Therapy
in the Spread of Hepatitis C Virus in Egypt

• Christina Frank1, Mostafa K. Mohamed1,
• G. Thomas Strickland1, Daniel Lavanchy2,
• Ray R. Arthur2, Laurence S. Magder1, Taha El
  Khoby3,
• Yehia Abdel-Wahab3, El-Said A. Ohn3,
• Wagida Anwar3, Ismail Sallam3
• 1 HCP Project 2 World Health Organization
  3 Egyptian Ministry of Health and Population

THE LANCET Vol 355 March 11, 2000
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Comparison of Exposure Index and Prevalence
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Seroprevalence of Hepatitis C Among Egyptian
Workers 1996 and in the National Survey 1997-1998
60
55
47
50
47
46
41
38
40
36
35
35
35
34
34
32
27
30
27
23
18
20
13
13
10
10
9
8
10
6
0
lt05
10
15
20
25
30
35
40
45
50
55
60
gt60
National Survey gt 10000
Workers gt 5000
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Prevalence of HCV HBV and HBsAg in Egypt 1996
HBsAg HBV HCV Age Adjusted Rates/100
4.5 22.5 14.5 Total Egypt
5.2 24.9 18.9 Rural
3.7 19.5 9.1 Urban
5.0 23.9 16.4 Males
4.0 21 12.7 Females
Adjusted for ve predictive value of ELISA 98
specificity and 98 sensitivity).
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Etiology of Acute Viral Hepatitis in Egypt
1997-2000
Analysis of 1860 Acute hepatitis cases
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Hepatitis C Virus Infection in a Community in
the Nile DeltaSeroincidence and Risk
FactorsCenter for Field and Applied Research

• Mostafa K. Mohamed, Fatma Abdel-Aziz, Mohamed
  Abdel-Hamid, Nabiel N. Mikhail, Mostafa Habib ,
  Wagida Anwar , G. Thomas Strickland, Laurence S.
  Magder, Alan D. Fix, Ismail Sallam

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ALT among Village Residents and HCV 1999

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S1 EIA Negative S2 EIA Positive
87
Exclude 28
ve
ve
-ve
Seroconverter 5
Exclude 24
None 30
ve
Seroconverter 11
-ve
ve
Exclude 10
-ve
Seroconverter 9
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Over 2 years of follow-up, 2502/ 3394
seronegative (73.7) followed-up 25 had
valid anti-HCV seroconversion 11 had HCV
RNA seroconversions RNA Seroconversion Rate
2.7/1000 P.Y. 95 C.L. 1.1-4.3 /1000 P.Y.
Anti-HCV seroconversion Rate 6.2 /1000 P.Y.
95 C.L. 3.8 - 8.6 /1000 P.Y.
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Notification Systems

• Notification for Acute Jaundice National
  Surveillance in 110 Fever hospitals and referral
  hospitals
• A National Cancer Registry with HCC notification
  in 8 MOHP cancer centers and University Centers

Research on use of sentinel surveillance based on
blood banks for monitoring changes in community
prevalence by comparing ratios blood banks
prevalence with the surrounding communities in 6
geographical locations over 2 years.
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Prevenetion Programs

• 1- Blood Banks Screening of blood/blood
  products
• Central
  management , Reporting
• Provision of Lab Equipment
• Training, supplies,
  Monitoring
• 2- Central and Peripheral Infection Control
  Comittees
• 3- Development of Guidelines for Infection
  Control

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Prevenetion Programs Cont.
Training of Health Care personnel on
1- Safe Injection Practices 2-
Destruction of disposable needles 3- Proper
Disposal of contaminated invasive materials 4-
Proper sterilization of reusable material 5-
Universal precautions and barrier techniques 6-
Proper Counseling of Patients and their families
Public Education Use of Contaminated
materials
Reduce public use of injections
Unsafe practices
shaving/circumcision
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Laboratory /Clinical Networks

• NO Current Laboratory or Clinical Networks
• Blood Bank Serology reporting is
• The only network available
• Several Liver Disease Societies now collaborate
  for exchange of experiences but no common network
• Role of Authorities
• Cost and Burden of disease

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Role of Authorities

• There are many public calls on authorities
  including Peoples Assembly to
• Develop guidelines for patient management
• Act for control of transmission
• Provide Public support for provision of treatment
  of infected individuals
• Cost and Burden of disease

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Role of Authorities cont.

• MOHP Authorities are
• Supporting Research projects lead by the Ministry
  of Health and Universities in collaboration with
  International Agencies NIH CDC and WHO
• Physicians Syndicate authorities
• Organize meetings with national insurance
  authorities for developing guidelines for patient
  management
• News and Media Authorities
• Raising Awareness for prevention of infection

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Cost and Burden of Liver Disease
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Predicted Chronic Liver Disease in Egypt 1996
HCC 2 cirrhosis 15 CLD70 Total cases Age Groups N. in thousands
2780 13900 97.3 139 0-
3960 19800 138.6 198 5-
2380 11900 83.3 119 10-
3580 17900 125.3 179 15-
3320 16600 116.2 166 20-
8560 42800 299.6 428 25-
18160 90800 635.6 908 30-
21900 109500 766.5 1095 35-
18280 91400 639.8 914 40-
17480 87400 611.8 874 45-
11780 58900 412.3 589 50-
9380 46900 328.3 469 55-
8060 40300 282.1 403 60-
14220 71100 497.7 711 65-
143.840 719.200 5.034.400 7.192.000 Total
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Predicted Hepatocellular carcinoma in Egypt 1996
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Cost of STD. TTT ALL ALT 1.5N
X 30000 Cost of complication
Annually 10/100 ALT1.5N X 5000 Lost
Productivity Annually 20/100
ALT1.5N X 1500 Cost of YLL
Annually 3/100 ALT1.5N X 20000 Cost
of Alternative TTT Annually All ALT gt N
X 1000 TTT of All Cases with Viraemia will
prevent infection of new cases