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EGYPT: Viral Time Bomb Set to Explode
By Cam McGrath
CAIRO, May 5, 2009 (IPS) - It is a health crisis of alarming proportions. Up to nine million Egyptians have
been exposed to hepatitis C, and tens of thousands will die each year unless
they receive a liver transplant.
Health authorities are taking steps to stop the spread of the blood-borne
virus, but must also contend with higher liver failure mortality rates as the
disease advances in those infected decades ago.
"The prevalence of hepatitis C is not growing, but the impact of an outbreak
in the 1960s and 70s is appearing now as a clinical outcome," says Dr.
Mostafa Kamal Mohamed, professor of community medicine at Ain Shams
University in Cairo. "Liver disease has become the number one healthcare
priority for the country and will continue to be so for the next decade. About
70 percent of all liver deaths here are due to hepatitis C."
Egypt has the highest prevalence of hepatitis C in the world, the legacy of a
well-intended health campaign that went horribly wrong. In the 1960s, the
government turned to modern medicine in the hope of eradicating bilharzia,
a water-borne parasite that has plagued Egyptian farmers since the dawn of
time. In a tragic irony, the tartar-emetic injections given to Egyptians living
in rural areas cured their bilharzia, but spread another deadly disease among
the population, the hepatitis C virus (HCV).
"At that time, bilharzia treatment was administered intravenously," recalls Dr.
Refaat Kamel, a prominent surgeon and specialist in tropical diseases. "There
were no disposable syringes, so once the needle got infected, the disease
spread quickly from one person to another."
Millions of Egyptians were inadvertently infected with HCV before the World
Health Organisation (WHO) sponsored anti-bilharzia campaign was shut
down in 1982. Scientists only discovered the hepatitis C virus in 1987, and it
was another decade before they proved that its high prevalence in Egypt was
a consequence of the mass treatment campaign.
While Egyptian healthcare workers adopted disposable needles in the 1980s,
HCV continued to spread due to improper blood screening and poor hygiene
practices. "There is a laxity in precautions in Egypt," says Kamel. "People are
careless or ignorant where blood is involved, and this has facilitated the
transmission of HCV."
The results of a national survey released last month show that eight to nine
million Egyptians, more than 10 percent of the population, have been
exposed to hepatitis C, of which approximately 5.5 million are chronic
carriers. In some rural areas over half the adult population carries HCV
antibodies.
About 30 percent of people infected with HCV spontaneously clear the virus
from their system within six months, according to studies done in Egypt. The
rest develop chronic hepatitis, which in about a quarter of cases leads to
cirrhosis and liver failure in 20 to 30 years.
Egypt's viral time bomb is about to go off. Doctors estimate that some
30,000 Egyptians die each year of HCV-related liver failure - a figure that is
projected to climb as the disease progresses in those who contracted it
during the 1964-82 anti-bilharzia campaign. "We expect the number of
mortalities will peak in 2012," says Dr. Wahid Doss, head of the National
Committee for the Control of Viral Hepatitis (NCCVH), a government body
formed to fight the disease.
NCCVH is implementing an infection control programme in hospitals and
blood banks as part of a national strategy to reduce new HCV infections,
estimated at 70,000-140,000 cases a year. It is also spearheading a media
campaign to educate the public on the various routes of blood-to-blood
transmission. "Prevention is a big problem in Egypt - people are still being
infected with hepatitis C (due to risky behaviour)," says Doss. "For example,
if you go to a festival you will find people doing circumcisions or tattooing -
the same tool for 50 people."
Treatment options are limited for HCV carriers with end-stage liver disease.
Egypt's prohibition on cadaveric organ transplants and the strict criteria for
living donors limit the number of livers available for transplant. "A few
hundred donor transplants are carried out each year; tens of thousands are
needed," says Kamel. "Without transplants, all these people will die."
Limited organ availability is only one problem. A partial liver transplant can
cost up to 60,000 dollars plus another 10,000 dollars for
immunosuppression therapy - a sum far beyond the reach of most
Egyptians. The government has in some cases subsidised the cost of
transplant operations, but it cannot afford to foot the total bill. "No
government on earth could afford to cover the costs of all liver transplants,"
asserts Kamel.
Instead, the priority is to treat HCV infections where the disease has not yet
caused severe liver impairment. The standard therapy is a combination of
interferon and the antiviral drug ribavirin. A 48-week course costs 3,500
dollars, but is effective in only 30-50 percent of cases, and can have severe
side effects.
NCCVH has established 16 treatment centres around the country, which have
provided free interferon shots for 47,000 HCV patients since the programme
began two years ago. The government is spending more than 50 million
dollars a year on the subsidy package, but Doss argues that it is the most
sensible and cost-effective strategy. "You pay per patient now and you save
on a liver transplant 10 years later." (END)
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