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Epidemiology , Prevention and Control programs of Hepatitis C in Egypt Mostafa K. Mohamed and El-Said A. Aoun Egyptian Ministry of Health and Population. WHO informal Consultation with VHPB Geneva, Swittzerland 13-14 May 2002. Prevalence of HCV infection

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slide1

Epidemiology , Prevention and Control programs of Hepatitis C in Egypt

Mostafa K. Mohamed and El-Said A. Aoun

Egyptian Ministry of Health and Population

WHO informal Consultation with VHPB

Geneva, Swittzerland

13-14 May 2002

slide2

Prevalence of HCV infection

Incidence of new Infections or Seroconversions

Notification Systems

Prevenetion Programs

Laboratory /Clinical Networks

Role of Authorities

Cost and Burden of disease

WHO informal Consultation with VHPB Geneva, Swittzerland

13-14 May 2002

rural life
Rural life

1996 62 Mil. Population 60 % in Rural Areas

2002 Population 70 Mil. Population Life expectancy 66 y

the role of parenteral antischistosomal therapy in the spread of hepatitis c virus in egypt

The Role of Parenteral Antischistosomal Therapy in the Spread of Hepatitis C Virus in Egypt

Christina Frank1, Mostafa K. Mohamed1,

G. Thomas Strickland1, Daniel Lavanchy2,

Ray R. Arthur2, Laurence S. Magder1, Taha El Khoby3,

Yehia Abdel-Wahab3, El-Said A. Ohn3,

Wagida Anwar3, Ismail Sallam3

1 = HCP Project 2 = World Health Organization 3 = Egyptian Ministry of Health and Population

THE LANCET  Vol 355  March 11, 2000

slide6

Seroprevalence of Hepatitis C Among Egyptian Workers 1996 and in the National Survey 1997-1998

60

55

50

47

47

46

41

38

40

36

35

35

35

34

34

32

30

27

27

23

18

20

13

13

10

10

9

8

10

6

0

<05

10

15

20

25

30

35

40

45

50

55

60

>60

National Survey > 10000

Workers > 5000

slide8

Prevalence of HCV HBV and HBsAg in Egypt 1996

*Adjusted for +ve predictive value of ELISA 98% specificity and 98% sensitivity).

etiology of acute viral hepatitis in egypt 1997 2000

HCV

16

%

21

%

HBV

Median Age 26

Median Age 46

25

%

HAV

Median Age 12

Median Age 34

All -ve

Median Age 44

13

%

1

%

Mixed

HEV

24

%

Etiology of Acute Viral Hepatitis in Egypt 1997-2000

Analysis of 1860 Acute hepatitis cases

slide10

Hepatitis C Virus Infection in a Community in the Nile DeltaSeroincidence and Risk FactorsCenter for Field and Applied Research

Mostafa K. Mohamed, Fatma Abdel-Aziz, Mohamed Abdel-Hamid, Nabiel N. Mikhail, Mostafa Habib , Wagida Anwar , G. Thomas Strickland, Laurence S. Magder, Alan D. Fix, Ismail Sallam

slide13

S1 IMX

S2 PCR

S3 EIA

S2 IMX

S1 EIA Negative

S2 EIA Positive

87

Exclude

28

+ve

+ve

-ve

Exclude

24

Seroconverter

5

None

30

+ve

Seroconverter

11

-ve

+ve

Exclude

10

-ve

Seroconverter

9

slide14

Over 2 years of follow-up,

2502/ 3394 seronegative (73.7%) followed-up

25 had valid anti-HCV seroconversion

11 had HCV RNA seroconversions

RNA Seroconversion Rate 2.7/1000 P.Y.

95% C.L. 1.1-4.3 /1000 P.Y.

Anti-HCV seroconversion Rate 6.2 /1000 P.Y.

95% C.L. 3.8 - 8.6 /1000 P.Y.

slide15

95% CI for OR

Variable

OR

Lower CI

Upper CI

Significance

Kids Seroconversion

MOTHER HCV

6.8

1.4

32.8

.0171

FATHER HCV

.64

.20

2.0

.4503

INVASIVE Procedures

3.94

1.02

15.1

.0468

Frequent INJECTNS

1.44

.17

12.4

.7431

RAZOR Sharing

1.8

.28

11.4

.5424

AGE

.96

.87

1.1

.4334

SEX

.72

.26

2.0

.5225

slide16

Notification Systems

Notification for Acute Jaundice : National Surveillance in 110 Fever hospitals and referral hospitals

A National Cancer Registry with HCC notification in 8 MOHP cancer centers and University Centers

Research on use of sentinel surveillance based on blood banks for monitoring changes in community prevalenceby comparing ratios blood banks prevalence with the surrounding communities in 6 geographical locations over 2 years.

slide17

Prevenetion Programs

1- Blood Banks : Screening of blood/blood products

Central management , Reporting

Provision of Lab Equipment

Training, supplies, Monitoring

2- Central and Peripheral Infection Control Comittees

3- Development of Guidelines for Infection Control

slide18

Prevenetion Programs Cont.

  • Training of Health Care personnel on :
  • 1- Safe Injection Practices
  • 2- Destruction of disposable needles
  • 3- Proper Disposal of contaminated invasive materials
  • 4- Proper sterilization of reusable material
  • 5- Universal precautions and barrier techniques
  • 6- Proper Counseling of Patients and their families
  • Public Education :Use of Contaminated materials
  • Reduce public use of injections Unsafe practices shaving/circumcision
slide19

Laboratory /Clinical Networks

NO Current Laboratory or Clinical Networks

Blood Bank Serology reporting is

The only network available

Several Liver Disease Societies now collaborate for exchange of experiences but no common network

Role of Authorities

Cost and Burden of disease

slide20

Role of Authorities

There are many public calls on authorities including Peoples Assembly to

Develop guidelines for patient management

Act for control of transmission

Provide Public support for provision of treatment of infected individuals

Cost and Burden of disease

slide21

Role of Authorities cont.

MOHP Authorities are

Supporting Research projects lead by the Ministry of Health and Universities in collaboration with International Agencies NIH CDC and WHO

Physicians Syndicate authorities

Organize meetings with national insurance authorities for developing guidelines for patient management

News and Media Authorities

Raising Awareness for prevention of infection

slide25

Changes of Liver Disease Spectrum in Egypt over 70 Years

1930-1980 Schistosomiasis 30 % Hepato-Splenomegaly

1990

HCV 13%

1990-2000

HCV 14%

HCC

Liver Cirrhosis

Death

At Age 30-40’s

At Age 50-60’s

At Age 60-70’s

Liver Cell damage Portal Fibrosis, Portal Hypertension Variceal bleeding occurs in ~ 20% of HCV-infected individuals After 20 of Infection

Fatal in < 2 years In chronic HCV infection Patients

Occurs annually in 4% of Cirrhotic patients

Periportal Fibrosis, Portal Hypertension , variceal bleeding

occurs in ~ 80% of individuals After 15-20 of Infection

slide31

Cost of STD. TTT = ALL ALT 1.5N X 30000

Cost of complication = Annually 10/100 ALT1.5N X 5000

Lost Productivity = Annually 20/100 ALT1.5N X 1500

Cost of YLL = Annually 3/100 ALT1.5N X 20000

Cost of Alternative TTT = Annually All ALT > N X 1000

TTT of All Cases with Viraemia will prevent infection of new cases