In the Arab world, and worldwide, one of the most affected countries when it comes to hepatitis C virus (HCV) is Egypt – in fact, it’s estimated that 14.7% of the North African country’s population is carrying the virus and up to 100,000 new infections occur each year.
Seven months before the world celebrates World Hepatitis Day today, Tuesday, a new study revealed that between 3,000 an 5,000 Egyptian children could be infected by the virus through mother-to-child transmission, probably during pregnancy, childbirth or somewhere in the postpartum period. The transmission could contribute to up to 50% of new cases in children under five.
A feature story published by Nature Middle East in October last year explored the possible causes of one of the most widely spread epidemics in Egypt, and it turns out, medical care – or the lack thereof – is responsible, with most transmissions happening due to healthcare hygiene breaches. Hospitals and clinics are by far the largest suppliers of the virus. Wahid Doss, the head of the Egyptian National Committee for the Control of Viral Hepatitis and dean of the Ministry of Health’s affiliated Liver Institute, told our writer Louise Sarant that “[around] 60% of patients who undergo kidney dialysis will have contracted HCV within the year, because the machines are not sterilized properly. Same goes for blood transfusions, which are very risky.”
In 2011, Nature Middle East’s chief editor Mohammed Yahia wrote that “not only is the Egyptian HCV problem one of size, but the genotype of the virus in circulation is one that is not commonly found in the rest of the world. If it is not controlled, there’s no guarantee that it will be confined to Egypt.”
Egypt — and the Middle East more generally — is a stronghold for genotype 4. The prolonged 72-weeks treatment available for hepatitis C – which involves a weekly injection and a daily capsule dose – only has a 60-65% success rate for this genotype. While the preferred treatment regimen – a costly 48-week course of interferon and the antiviral drug ribavirin – is usually only effective in 30-50% of cases.
By contrast, about 75% of HCV infections in Europe and the United States are of genotype 1. Naturally, most prominent research in the West targeted the latter, and not the former.
But perhaps things are changing; already scientists in the region are starting to pay some attention to the virus and its possible new treatments.
Last year, two Egyptian scientists sent sample crystals of two proteins of the hepatitis C virus to space for analysis, in their search for possible cure. The proteins are HCV genome 4, and the researchers, working at the German Aerospace Center (DLR), said they were hoping to understand the behavior of this specific type located heavily in Egypt.
Separately, researchers in Qatar collaborated with Harvard Medical School to develop a therapeutic cocktail that combines antiviral agents and cholestrol-lowering drugs, commonly known as statin, to ease the burden of hepatitis C complications. This statin therapy, announced in April, can complement treatment by slowing the progress of liver fibrosis and reducing the risks of liver cancer in virus-infected patients.
Research aside, in a chronic case like Egypt, prevention remains the saving factor in this affair. And it’s not an easy feat; it involves an overhaul of hospital practices, measures like proper sterilization across health facilities, more investment in awareness and educational programmes aimed at curbing the virus’ spread, in addition to easing access to treatments, especially in rural areas.