Epidemiology of Hepatitis C Virus Infection in Egypt

Abstract

Hepatitis C virus constitutes an epidemic in Egypt having the highest prevalence in the world of 14.7%. The reasons behind this unique epidemic may be dated back to iatrogenic role of parenteral antischistosomal therapy campaigns to control endemic schistosomiasis. Other routes of infection are contributing to the ongoing HCV transmission. The prevalent genotype in Egypt is type 4 (73%), the origin, evolution, and dynamics are difficult to determine. Risk factors for acquiring HCV infection include: History of antischistosomal injection treatment before 1986, old age, male gender, and residence in rural areas. Other risk factors include; injection therapy, blood transfusion prior to 1994, exposure to various facility-based medical procedures, and occupational transmission among health care workers. In community settings, a set of risk factors, mostly related to prevailing social and cultural conditions, are responsible for maintaining the high rates of HCV transmission. Chronic HCV is the main cause of liver cirrhosis and liver cancer in Egypt and, indeed, one of the top five leading causes of death. It kills an estimated 40,000 Egyptians a year. When talking about children, current HCV seroprevalenceis high, approximately 5-8%. It is to be emphasized that HCV infection is not always benign in the childhood period in Egypt. It has been shown that blood transfusion, surgical procedures, dental treatment, male circumcision and age above 10 years are important risk factors associated with anti-HCV antibody prevalence. In addition, vertical transmissions, and household transmission have been documented as routes of transmission. Occult HCV infection is defined as elevated liver function tests and negative HCV antibodies in serum, while HCV RNA is detectable in liver tissue and peripheral polymorphonuclear cells (PBMCs). Interest in occult HCV has emerged recently in Egypt. Studies at a national level are being carried out, but no results have yet been released. Many small scale studies have been performed among particular patient groups, which have highlighted the importance of this disease entity.