Global HCV

The former U.S. Surgeon General, C. Everett Koop, MD said about the global HCV epidemic, "We stand at the precipice of a grave threat to our public health... It affects people from all walks of life, in every state, in every country. And unless we do something about it soon, it will kill more people than AIDS." visit his web page at http://www.epidemic.org/. Dr. Koop went on to say, "Without rapid intervention to contain the spread of the disease, the death rate from hepatitis C will surpass that from AIDS by the turn of the century and will only get worse."

It is estimated that globally over 200 million people are infected with HCV. One of the problems in recognizing this epidemic is that it is a "silent” epidemic. That is to say, most people who are infected do not know they are infected and have not reached the stage of the infection when clinical symptoms of liver failure begin to show. To complicate this is the difficulty of treatment. Treatment is very expensive, has low efficacy, and has severe side effects causing many to abandon treatment.

This is clearly an important infectious disease. Moreover, HCV has essentially "fallen under the radar". Unlike malaria, HIV, TB and other infectious diseases, HCV has not been identified by any of the major foundations, world governments, or other global funding institutions as a significant public health problem. The Prevention of Hepatitis C Viral Infection In Egypt project is deadicated to prevention of HCV infection.

Egypt has the largest epidemic of hepatitis C in the world.

The hepatitis C virus (HCV) epidemic in Egypt is unique in the world and well documented in the international medical scientific literature (see References). The percentage of Egyptians with HCV is 14.7%. This is ten times greater than any other country in the world. The prevalence of HCV in Western countries is less than 2%.

Almost 99% of the people in Egypt, estimated at over 80 million, live within the Nile Valley and the Nile Delta, which constitutes less than 4 percent of Egypt´s total area. Nearly half live in urban areas.

The prevalence of HCV varies throughout the country. The northern Nile Delta appears to have the highest prevalence, ~28%. The much smaller population of Upper Egypt, in the south, seems to have the lowest HCV prevalence, ~ 16%.

The epidemic was first reported in the international medical literature in the journal Lancet, by Kamel et al. in 1992 (click on References). This was the first year that a laboratory test (serologic assay) for HCV became globally available. Before this study no one really knew what the situation was in Egypt. Reports had been coming in from many countries, all in the 1% to 3% range. Egypt has a very large blood donation and transfusion system. The investigators designed a study based on first time blood donors. The report was based on the analysis of blood specimens from 2,164 apparently healthy first time donors. 10.6% tested positive. This discovery had huge implications. The first was the issue of the blood supply and its safety. The HCV test was new and there were no policies in place to mandate HCV testing of blood donation. The Lancet report and other reports that soon followed, of course, changed altogether how the Egyptian system of blood banks were operated throughout the country.

The study continued and in all collected and examined over 17,000 specimens. The additional specimens did not change the overall prevalence. The investigator's interpretation was that the prevalence was an underestimate for the general population. This is because the blood donors were apparently healthy first time donors. However, recently published data provided a very clear pattern of prevalence and age. See Figure 1 [click here].

Many are now suffering advanced liver disease. However, thousands even 10s of thousands of young people and children are infected each year.