Egypt has one of the highest HCV prevalence rates in the world. About one in every 10 persons has the virus. A survey on the prevalence of the hepatitis C virus (HCV) in Egypt is being conducted by the National Committee for the Control and Prevention of Viral Hepatitis, a government body formed last year to tackle the disease. The results of an ongoing national survey will be released later this year, will tell how much of a problem the disease still is in the country.

A similar survey in 1996 showed that 10-12 percent of the population had HCV, with 70,000-140,000 new infections each year, according to Manal Hamdy al-Sayed, Professor of Paediatrics at Cairo's Ain Shams University and a member of the Committee. Al-Sayed was part of a team which formulated an action plan to fight the disease and combat rising mortality.
It is widely believed that mass vaccinations of Egypt's rural population against schistosomiasis (bilharzia) in the 1960s and 1970s, which did not follow rigorous hygiene standards, are responsible for the current rates of hepatitis C. Bilharzia, a water-borne disease, was at one time endemic in Egypt.
Hazem al-Qadi, a Cairo endoscopist who has been working with HCV patients for over 20 years, said the high rate has resulted from the use of non-disposable syringes. The current infection rate remains surprising, since disposable syringes have been available since 1980.
Raising awareness
Al-Sayed blames the high HCV rates on bad hygiene habits, the population's ignorance of the virus and lack of a vaccine against the virus.
"It can come from children playing with scissors, teenage boys borrowing someone's razor to shave or even a toothbrush," she said. "They don't have any manifestations, they don't feel anything, and it is often discovered by accident."
Reda Mohamed (name changed by request), a 50-year-old villager who lives just outside Cairo, discovered she had hepatitis C two years ago when she began feeling ill, and decided to do a blood test. She is unsure how she got infected.
"I had a lot of surgery done before, and I have had many blood transfusions, so it may have come from that," Reda said. "My body began feeling heavy, I could not really move and my colour turned yellow."
The government has promoted screening of high-risk groups - including healthcare professionals - who are at risk from needle injuries and those who are undergoing repeated blood transfusion treatment.
The committee is currently gearing up for an awareness campaign within universities in order to increase awareness among future doctors and nurses, and within the general population. Screening could also help families discover they have a family member with HCV and prevent further infections in the household, al-Sayed said. The committee will conduct voluntary screenings in villages throughout the year since village dwellers are considered most at risk.
"They don't want to face reality and we're now trying to change this thinking," she said. "Detecting it as early as possible will lead to early control of virus."
Ten percent of hospital patients have HVC
Medical practices have improved greatly since the 1970s, but the virus is still a problem because maintaining good infection control programmes in hospitals is difficult when at least 10 percent of patients carry the virus.
However, last week saw the creation of the Advisory Board for Infection Control, and the board will put in place a hospital programme to prevent infection among patients and staff.
"One out of every 10 patients has the virus," al-Sayed said, "So sometimes it is very, very hard to strictly prevent transmission from one patient to another."
No symptoms for many years
HCV enters the blood stream and then the liver, and the individual usually shows no symptoms for many years, al-Qadi said. When they do appear, they include the vomiting of blood, internal bleeding, jaundice and fatigue. In Egypt, 91 percent of carriers have genotype four, he said, which is more difficult to treat than the genotypes common to Europe - one, two and three. HCV is combated using a drug called Interferon, but the behaviour of genotype four is unpredictable, and can show resistance to the drug.
Rates of the virus in different areas may correlate with the extent of the bilharzia problem in Egypt at the time of the vaccinations in the 1960s and 1970s, al-Sayed said. Rates vary from six percent in Alexandria to as high as 70 percent in some rural areas.
"Before 1980 syringes were not plastic, they were glass - so the syringe was boiled in order to disinfect it," al-Qadi said. "Now, if you are in a village and you are injecting 100 farmers right after each other, the doctors wouldn't boil the syringe after every one, they would just use it again."
Subsidised treatment
So as to offset the prohibitive cost of treating someone with HCV (about US$4,500 a year per patient), the government, through the National Committee for the Control and Prevention of Viral Hepatitis, subsidised the treatment of 12,000 people during 2007. This is compared to the 1,000 treated throughout 2006 - before the committee was created to raise awareness, complete a new national survey and set up liver centres for the treatment of virus carriers. Ten centres have been created so far, and the committee will create another five this year.
The committee will take its next steps after the new survey is completed, al-Sayed said. The government spent 200 million Egyptian pounds (about US$37 million) on HCV treatments last year, and is expecting to pay the same amount in the coming years.