Egypt steps up efforts against hepatitis C

July 2014

“Just about every family in Egypt is touched by hepatitis C,” says Dr Henk Bekedam, WHO Representative in the country. The bloodborne virus, which is highly infectious, kills an estimated 40 000 Egyptians a year and at least 1 in 10 of the population aged 15 to 59 is infected.

Egypt’s hepatitis C epidemic dates back decades when glass syringes used during a mass vaccination campaign were not properly sterilized between use, explains Dr Manal Hamdy El-Sayed from Egypt’s National Viral Hepatitis Committee. “This reservoir of infection was sustained for years because there was no awareness and no efforts to control the spread,” she says.

Part of the problem is that hepatitis symptoms can take a long time to show. “Most people do not know they are infected, as they often do not have symptoms until they develop serious liver disease, which can be years later,” says Stefan Wiktor from WHO’s Global Hepatitis Programme.

“The good news is that Egypt reached agreement on 15 July to access new oral hepatitis C treatments that promise higher cure rates at significantly reduced cost."

Dr Henk Bekedam, WHO Representative in the country

Hepatitis is today recognised by people at all levels in Egypt as a major challenge, Dr Bekedam notes. There are 26 specialized centres and 350 000 people have been treated in the past 6 years. Yet despite these efforts, the virus is still spreading, with some 165 000 new infections each year.

“The good news is that Egypt reached agreement on 15 July to access new oral hepatitis C treatments that promise higher cure rates at significantly reduced cost. This is less than a year after these treatments, which are less toxic and have fewer side-effects than existing medications, were cleared by the Food and Drug Administration for the US market,” Dr Bekedam says.

The eventual aim, according to Dr Hamdy El-Sayed, is to treat 300 000 people a year.

Strong emphasis on prevention

Egypt’s fragmented health system has made it difficult to maintain and reinforce national standards in health, Dr Bekedam says. But the national hepatitis plan for 2013-2018, drawn up by the National Viral Hepatitis Committee, the Ministry of Health and supported by health partners, places a strong emphasis on prevention.

As part of the plan, WHO is helping the Government to set up a national system to collect hepatitis data to understand trends and adapt responses where needed. WHO has also played a central role in coordinating support from international partners, which also include the US Centers for Disease Control, USAID, and the Pasteur Institute.

With 8 out of 10 new infections occurring in hospitals and clinics, Egypt is working to improve training on infection control for doctors and nurses. The aim is to stamp out unsafe medical practices such as reusing needles and other medical devices that should be discarded after use.

But raising standards will also require further resources, Dr Hamdy El-Sayed stresses. “A dentist in a poor rural area will probably spend more on sterilising his equipment than he earns from treating a patient,” she says.

Public awareness is also vitally important and the authorities are developing a communications campaign, with UNICEF and WHO support, to educate people about the need to avoid unnecessary injections and to insist that health workers use sterile syringes and needles.