There is a large geographic variation in the distribution of the hepatitis C virus (HCV) in Egypt according to a new study by researchers at Weill Cornell Medical College in Qatar.
Egypt has the highest infection level of the disease in the world, with 14.7% of the population carrying HCV, but it is still not clear why this is the case. Treatment campaigns for bilharzia – a disease caused by parasitic worms – during the 1960s and 1970s, using parenteral antischistosomal therapy (PAT), contributed to the epidemic through wide–scale sharing of needles and syringes.
However, these campaigns can explain only about 10% of HCV infections in this country. It is probable that most HCV infections in Egypt are linked to exposures in medical care settings. These are some of the findings of the study, which has been published in the prestigious journal Hepatology.
Dr. Diego Cuadros, lead author of the study and postdoctoral associate at the Infectious Disease Epidemiology Group at WCMC-Q, explained what the research involved.
“We implemented a novel methodology with the aim of characterizing the geographical clusters of HCV infection and PAT exposure all over Egypt,” he said. “We were able to identify six clusters of high HCV infection levels and three clusters of low HCV infection levels. We were also able to identify five clusters of high PAT exposure and four clusters of low PAT exposure. We further conducted different kinds of analyses on these clusters to identify the drivers of this unusual epidemic in this specific country,” he added.
What the study found, contrary to expectation, was a rather weak association between HCV infection and previous PAT exposure.
Dr. Laith Abu Raddad, principal investigator of the study and associate professor of public health in the Infectious Disease Epidemiology Group at WCMC-Q, said, “This suggested that bilharzia treatment campaigns explained only a small fraction of HCV infections in Egypt. Most infections in this country occurred due to other modes of transmission, and probably linked to medical care. Our analyses also suggested that there must be considerable ongoing HCV transmission in Egypt today.”
Dr. Cuadros said, “The results could help formulate more efficient treatment plans. There is a growing pipeline of highly effective – but expensive – treatments for HCV. However, a targeted approach focused on the settings of most intense HCV transmission, as identified by the study, will probably be more cost-effective than a broad one at the national level.”
The work described in the study was funded by a Junior Scientist Research Experience Program (JSREP) grant (JSREP 3-014-3-007) from the Qatar National Research Fund (QNRF) and by the Biomedical Research Program (BMRP) of Qatar Foundation (QF), which supports the research effort at WCMC-Q. The JSREP program was recently launched by QNRF with the aim of supporting junior scientists to initiate their own research careers.
Key scientific findings of the study
•There are six clusters of high HCV infection levels and three clusters of low HCV infection levels in Egypt. By far, this is the largest HCV epidemic in the world. There must be considerable ongoing HCV transmission in Egypt today.
•Treatment campaigns for bilharzia, through wide–scale sharing of needles and syringes, contributed to this epidemic, but cannot explain except about 10% of HCV infections. Most HCV infections in Egypt are probably linked to exposures in medical care settings.
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