Monthly Archives: July 2015

Hepatitis C: The case of Egypt

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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.

Hepatitis C: Training for journalists

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Hepatitis viruses under an electron microscope

Hepatitis viruses under an electron microscope{credit}Image courtesy of U.S. Centers for Disease Control and Prevention{/credit}

Nearly 2.5% of people in the world is estimated to be infected with Hepatitis C – that’s a whopping 150 million people. And it’s more than most other infectious diseases, yet many people know little to nothing about the disease.

In addition to limited awareness of a disease that kills millions yearly, Hepatitis C receives narrow media coverage.

But for reporters to be able to cover the disease, properly, journalists need to know more about the virus and the disease. What are the different genotypes? Which new medications are there? Why is the disease burden so high around the world?

To mark World Hepatitis Day, the World Federation of Science Journalists (WFSJ) is launching a new online portal to educate and support journalists who are covering viral hepatitis all over the world. The portal should give reporters the appropriate tools, data sets and education to accurately cover the killer virus.

To produce this education plan, a steering committee of science journalists from around the world came together with experts, researchers, clinicians and patient advocacy groups representatives to identify the most important topics to cover; ranging from the global disease burden and its risks to health policy and the rapidly evolving hepatitis treatment landscape. I was part of this committee which met twice, then worked together online, to build the training programme.

The material is packaged into modules made available freely online, with each covering hepatitis C from a specific angle. Together they offer journalists different ways to tell the hepatitis C story.

Hepatitis C has been around for so long that it suffers from the same predicament that a condition like HIV/AIDS does: people feel it’s an old story that they don’t know how to keep telling.

But there is so much happening in the hepatitis C landscape to make the story both very fresh and very important. Through this portal, journalists will find tips on how to address said story, in a way that suits their community.

The portal’s steering committee worked on coming up with fresh angles and the portal is expected, still, to help journalists tie loose threads; for example, reporters on the virus should be able to explore questions related to drug policy, commercial use of hepatitis C drugs, accessibility and reach.

The portal also offers a database of experts, policymakers, researchers, clinicians and patient advocacy groups from around the world, with contact information readily available to all visitors of the portal. The experts speak different languages to suit the needs of journalists globally.

The second part of the programme will see the WFSJ use the material online to host face-to-face workshops for journalists on the ground in countries and regions where hepatitis C is most prevalent, such as Egypt and Pakistan.

The workshops will be held in several regions and in different languages to make sure that as many people as possible can benefit from them. In addition to field workshops, the portal will offer a series of online webinars by award-winning science journalists.

Tough times, tough measures for Kuwait

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Kuwait has greenligted the creation of a DNA database of all its 1.3 million citizens, and 2.9 million foreign residents – a surprising move that DNA privacy advocates deem “ill advised.”

Parliament, based on a government request, mandated the law earlier this month, allowing the country’s Interior Ministry to establish said database. Now, people who refuse to provide genetic samples for testing could be jailed or fined, according to this AFP report. Furnishing fake samples is punishable by a seven-year prison sentence.

The decision came in the wake of a suicide attack in a Shiite mosque in Kuwait’s capital that left 227 people wounded. The militant terror group known as the Islamic State (IS) has claimed responsibility.

The entire endeavor is expected to set back the Kuwaiti government some $400 million, dug out from the country’s emergency cash, something that Hellen Wallace, director of GeneWatch UK, genetic science watchdog, calls “a waste of resources.”

“It does not help to solve more crimes or prevent acts of terrorism, especially by suicide bombers who are not concerned about their identities being revealed after the event,” she tells Nature Middle East.

Wallace says that a DNA database reveals private information about biological relationships, for instance. “It also allows everyone on the database to be tracked by the government or any outsider who can infiltrate the system, because people leave their DNA wherever they go, such as on their coffee cup, not only at a crime scene.

“Finally, the risk of errors increases with large databases, as DNA evidence can be planted or contaminated, leading to false accusations and even false convictions for a crime.”

The UK and Portugal have previously mulled over building DNA databases of their populations but had an about face. The European Court of Human Rights, following a case in 2008, judged unanimously that the indefinite retention of innocent people’s DNA profiles, fingerprints and samples is unlawful, breaching Article 8 of the European convention on Human Rights, which is the “right to privacy.”

A 2014 study published in the Egyptian Journal of Forensic Sciences, and co-authored by Wallace, suggests that criminalizing all those who refuse to voluntarily provide their DNA will eventually lead to public distrust. The study says that certain questions should always be asked of databases worldwide, especially ones related to safeguards needed to prevent miscarriages of justice, and cross-border sharing of DNA information.

It also highlights the importance of involving the public in such a political debate, something that Kuwait – in its hurry to impose stricter security measures and help authorities make quicker arrests – has clearly sidestepped.

Reference:

Wallace, H.M. et al. Forensic DNA databases-Ethical and legal standards: a global review. Egyptian Journal of Forensic Science https://dx.doi.org/10.1016/j.ejfs.2014.04.002 (2014)