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Kandeel A, Fahim M, Abukamar S, BahaaEldin H, Abuelsood H, Samy S, Deghedy O, Sheta A, Naguib A, El Guindy N, Youssef A, Kamel R, Afifi S, El-Kassas M, Abdelghaffar K. Evidence for the elimination of viral hepatitis B and C in Egypt: Results of a nationwide survey in 2022. Liver Int 2024; 44:955-965. [PMID: 38291807 DOI: 10.1111/liv.15843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/15/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Viral hepatitis C (HCV) and B (HBV) were at the top of Egypt's most significant public health challenges, with an estimated 14.7% of its population having antibodies to HCV in 2008. Egypt issued an ambitious action plan in 2014 to eliminate viral hepatitis through strengthening infection control and improving patient care. In 2018, an extensive HCV mass screening campaign was conducted for the entire country's population with treating more than 4 million patients with antivirals. This study aimed to evaluate the current prevalence of viral hepatitis in Egypt after all these efforts. METHODS A cross-sectional household cluster survey was conducted in all 27 Egyptian governorates to obtain a representative sample of Egypt's population. Subjects aged 1-70 years were interviewed using a standardised questionnaire that included demographics, viral hepatitis knowledge, previous infection and risk factors data. Laboratory testing was performed for all subjects for anti-HCV and HBsAg using chemiluminescence. Subjects positive for anti-HCV were further tested for HCV-RNA by RT-PCR. Prevalence rates were calculated by demographic groups and compared to the demographic health survey 2015 results. RESULTS Of 20 881 subjects interviewed, 48.8% were males, 20.2% were children <15 years of age, and 53.7% were residents of rural areas. Of all subjects, 92 (0.4%) were HCV-infected, 1577 (7.6%) were anti-HCV positive and 177 (0.8%) were HBV-chronically infected, including one patient who had mixed HBV and HCV current infection. The prevalence of HCV-current and HBV chronic infections decreased by 93% and 20%, respectively, compared to 2015. CONCLUSIONS Egypt achieved the elimination of the viral hepatitis goal. To maintain low rates of viral hepatitis, community health education, in addition to maintaining infection control and blood safety programs, is essential.
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Affiliation(s)
- Amr Kandeel
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Manal Fahim
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Shimaa Abukamar
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Hala BahaaEldin
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Hanaa Abuelsood
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Sahar Samy
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Ola Deghedy
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Amany Sheta
- Central Public Health Laboratory, Ministry of Health and Population, Cairo, Egypt
| | - Amel Naguib
- Central Public Health Laboratory, Ministry of Health and Population, Cairo, Egypt
| | - Nancy El Guindy
- Central Public Health Laboratory, Ministry of Health and Population, Cairo, Egypt
| | - Amr Youssef
- Central Administration for Research and Health Development, Ministry of Health and Population, Cairo, Egypt
| | - Reham Kamel
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Salma Afifi
- Ministry of Health and Population, Cairo, Egypt
| | - Moahmed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
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El-Mokhtar MA, Elkhawaga AA, Ahmed MSH, El-Sabaa EMW, Mosa AA, Abdelmohsen AS, Moussa AM, Salama EH, Aboulfotuh S, Ashmawy AM, Seddik AI, Sayed IM, Ramadan HKA. High Incidence of Acute Liver Failure among Patients in Egypt Coinfected with Hepatitis A and Hepatitis E Viruses. Microorganisms 2023; 11:2898. [PMID: 38138042 PMCID: PMC10745896 DOI: 10.3390/microorganisms11122898] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
Hepatitis A virus (HAV) and Hepatitis E virus (HEV) are transmitted through the fecal-oral route. HAV outbreaks and one HEV outbreak have been reported in Egypt. However, the impact of HAV-HEV co-infection is not known. In this study, we assessed HEV markers in acute HAV-infected patients (n = 57) enrolled in Assiut University hospitals. We found that 36.8% of HAV-infected patients were also positive for HEV markers (anti-HEV IgM and HEV RNA), while 63.2% of the patients were HAV mono-infected. Demographic and clinical criteria were comparable in both HAV mono-infected patients and HAV-HEV co-infected patients. Although liver enzymes were not significantly different between the two groups, liver transaminases were higher in the co-infected patients. Six patients developed acute liver failure (ALF); five of them were HAV-HEV-co-infected patients. The relative risk of ALF development was 8.5 times higher in HAV-HEV co-infection compared to mono-infection. Three cases of ALF caused by HAV-HEV co-infection were reported in children (below 18 years) and two cases were reported in adults. All patients developed jaundice, coagulopathy, and encephalopathy; all were living in rural communities. In conclusion: HAV-HEV co-infection can be complicated by ALF. The risk of ALF development in HAV-infected patients is higher when coinfection with HEV is present.
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Affiliation(s)
- Mohamed A. El-Mokhtar
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos P.O. Box 36, Lebanon
| | - Amal A. Elkhawaga
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mona Sedky Hussein Ahmed
- Molecular Biology Researches & Studies Institute (MBRSI), Assiut University, Assiut 71515, Egypt
| | - Ehsan M. W. El-Sabaa
- Microbiology and Immunology Department, Faculty of Pharmacy, Assiut University, Assiut 71515, Egypt
| | - Aliaa A. Mosa
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Ahmed Shawkat Abdelmohsen
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Abdelmajeed M. Moussa
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Aswan University, Aswan 81528, Egypt
| | - Eman H. Salama
- Department of Clinical Pathology, Faculty of Medicine, Sohag University, Sohag 82524, Egypt
| | - Sahar Aboulfotuh
- Department of Clinical Pathology, Faculty of Medicine, Sohag University, Sohag 82524, Egypt
| | - Ahmed M. Ashmawy
- Department of Internal Medicine, Gastroenterology and Hepatology Unit, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Ahmed Ismail Seddik
- Pediatric Department, Faculty of Medicine, Aswan University, Aswan 81528, Egypt
| | - Ibrahim M. Sayed
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Haidi Karam-Allah Ramadan
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
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Abdel-Gawad M, Nour M, El-Raey F, Nagdy H, Almansoury Y, El-Kassas M. Gender differences in prevalence of hepatitis C virus infection in Egypt: a systematic review and meta-analysis. Sci Rep 2023; 13:2499. [PMID: 36781919 PMCID: PMC9925441 DOI: 10.1038/s41598-023-29262-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/01/2023] [Indexed: 02/15/2023] Open
Abstract
Egypt is the country with the highest known hepatitis C virus (HCV) prevalence worldwide. The origin of gender differences in HCV prevalence is not usually well understood. This systematic review and meta-analysis aimed to review and evaluate the gender differences in HCV infection rates amongst Egyptians. Such data would be important to support prevention and control programs aiming to minimize HCV-related morbidity and mortality. PubMed, Scopus, and Web of Science (WOS) were searched for relevant articles published from 1st January 2011 to 13th December 2021, using the search terms (HCV OR "hepatitis C" OR hepacivirus) AND (prevalence OR seroprevalence OR epidemiology OR incidence OR magnitude). At first, retrieved articles were screened, and then relevant data were extracted and analyzed. Descriptive statistics were used for data analysis. Out of 616 studies from databases, only 30 were included after the full-text screening, with 193,621 included participants: 97,597 male and 96,024 female. The overall seroprevalence of HCV antibodies in all included studies was 0.02 (CI - 0.23 to 0.28), with no significant difference between males and females. However, HCV RNA positivity was significantly more prevalent in males than females in adults and the general population (after excluding high-risk groups). In children, no statistically significant differences between males and females were found in the seroprevalence of HCV antibodies nor in the prevalence of PCR positivity. HCV RNA positivity is significantly higher in males than females in adults, while there are no gender differences in children.
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Affiliation(s)
- Muhammad Abdel-Gawad
- Hepatology, Gastroenterology, and Infectious Diseases Department, Assiut Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Mohamed Nour
- Department of Public Health and Community Medicine, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
- Faculty of Public Health and Health Informatics, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Fathiya El-Raey
- Hepatogastroenterology and Infectious Diseases Department, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Hanaa Nagdy
- Internal Medicine Department, College of Medicine, Arab Academy for Science and Technology and Maritime Transport, Alexandria, Egypt
| | - Yahya Almansoury
- Internal Medicine Department, Gastroenterology and Hepatology Division, South Valley University, Qena, Egypt
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Ain Helwan, Cairo, 11795, Egypt.
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Badur S, Öztürk S, AbdelGhany M, Khalaf M, Lagoubi Y, Ozudogru O, Hanif K, Saha D. Hepatitis A in the Eastern Mediterranean Region: a comprehensive review. Hum Vaccin Immunother 2022; 18:2073146. [PMID: 35617508 PMCID: PMC9621081 DOI: 10.1080/21645515.2022.2073146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/10/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION With 583 million inhabitants, the Eastern Mediterranean Region (EMR) is a worldwide hub for travel, migration, and food trade. However, there is a scarcity of data on the epidemiology of the hepatitis A virus (HAV). METHODS The MEDLINE and grey literature were systematically searched for HAV epidemiological data relevant to the EMR region published between 1980 and 2020 in English, French, or Arabic. RESULTS Overall, 123 publications were extracted. The proportion of HAV cases among acute viral hepatitis cases was high. HAV seroprevalence rate ranged from 5.7% to 100.0% and it was decreasing over time while the average age at infection increased. CONCLUSION In the EMR, HAV remains a significant cause of acute viral hepatitis. The observed endemicity shift will likely increase disease burden as the population ages. Vaccinating children and adopting sanitary measures are still essential to disease prevention; vaccinating at-risk groups might reduce disease burden even further.
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Yassin NA, El-Houchi SZ, Abd El-Shafy SF, Soliman NS, Elmonem MA, El-Koofy N. Frequency of Hepatitis A virus as a cause of anicteric hepatitis in children under 5 years: a common yet under-recognized cause. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2022. [DOI: 10.1186/s43054-022-00134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Hepatitis A is the most common form of acute viral hepatitis in developing countries. In children < 6 years of age, most infections are asymptomatic, and if illness does occur, it is usually anicteric. This study aimed to determine the frequency of HAV in Egyptian children under 5 years presenting with gastroenteritis-like manifestations and to associate the frequency of HAV with social, demographic, and various risk factors.
Results
Among 450 children aged from 6 months to 5 years of both sexes, presenting with gastroenteritis-like manifestations and anicteric hepatitis, 200/450 children had elevated transaminases (ALT, AST) and were recruited in the study. A total number of 24 (12%) out of 200 children were found to have HAV IgM antibodies. Lower maternal and paternal education, poor sanitary and hygienic conditions, crowding, contaminated water, and lack of sanitary facilities were significantly higher in HAV-positive group (p-value < 0.05). ALT and AST were significantly higher in HAV IgM-positive group (p-value < 0.01).
Conclusion
HAV infection is common in Egyptian children with gastroenteritis-like manifestations and anicteric hepatitis. Hepatitis A is a vaccine-preventable disease.
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El-Ghitany EM, Ashour A, Fekry MM, Elrewany E, Farghaly AG, Omran EA. Seroprevalence of Hepatitis A, B and C Among a Sample of Refugees in Egypt: An Exploratory Survey. J Epidemiol Glob Health 2022; 12:430-440. [PMID: 36107333 PMCID: PMC9723078 DOI: 10.1007/s44197-022-00060-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Estimating the prevalence of infectious diseases, including viral hepatitis, among refugees is important for evaluating their health needs and predicting the burden on the health system of the host country. This study aimed at estimating the seroprevalence of viral hepatitis among refugees in Egypt. METHODS This cross-sectional study involved a heterogeneous group of 501 refugees. Enzyme-linked immunosorbent assays were used to detect IgG antibodies against hepatitis A virus (HAV), B virus (HBV) surface antigen (anti-HBsAg), C virus (HCV), and HBV surface antigen (HBsAg). RESULTS Anti-HAV was the most prevalent marker (n = 482, 96.2%), followed by anti-HBs (n = 142, 28.3%) and HBsAg (n = 21, 4.2%), while only four refugees (0.8%) had positive anti-HCV IgG. Anti-HBs was higher in males (p < 0.05). Older refugees and non-working subjects had significantly higher seropositive rates of anti-HAV (p = 0.051 and p = 0.023, respectively), while students and those below 15 years of age had higher rates of anti-HBs (p < 0.05). Positive HBsAg results were associated with history of hepatitis (p < 0.001). Obese participants were more likely to be positive for HBsAg (p = 0.025) and anti-HBs (p < 0.05). Sudanese refugees had significantly higher rates of anti-HAV antibodies (p = 0.049), while Yemini refugees had significantly higher rates for HBsAg (p = 0.019) positivity. Residents of Dakahlia had significantly higher rates of anti-HAV (p = 0.008) and anti-HBs (p < 0.05). None of the studied risk factors was significantly associated with anti-HCV. CONCLUSION Refugees in Egypt have poor immunity against HBV with intermediate to high HBV and low HCV prevalence rates. Despite that 65% of refugees received the HAV vaccine, almost all had IgG anti-HAV, denoting previous infection.
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Affiliation(s)
- Engy Mohamed El-Ghitany
- grid.7155.60000 0001 2260 6941Department of Tropical Health, High Institute of Public Health, Alexandria University, 165 El-Horreya Avenue–El-Ibrahimia, Alexandria, Egypt
| | - Ayat Ashour
- grid.7155.60000 0001 2260 6941Department of Family Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Marwa M. Fekry
- grid.7155.60000 0001 2260 6941Department of Microbiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Ehab Elrewany
- grid.7155.60000 0001 2260 6941Department of Tropical Health, High Institute of Public Health, Alexandria University, 165 El-Horreya Avenue–El-Ibrahimia, Alexandria, Egypt
| | - Azza Galal Farghaly
- grid.7155.60000 0001 2260 6941Department of Tropical Health, High Institute of Public Health, Alexandria University, 165 El-Horreya Avenue–El-Ibrahimia, Alexandria, Egypt
| | - Eman A. Omran
- grid.7155.60000 0001 2260 6941Department of Microbiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Owada K, Sarkar J, Rahman MK, Khan SA, Islam A, Hassan MM, Soares Magalhães RJ. Epidemiological Profile of a Human Hepatitis E Virus Outbreak in 2018, Chattogram, Bangladesh. Trop Med Infect Dis 2022; 7:tropicalmed7080170. [PMID: 36006262 PMCID: PMC9415847 DOI: 10.3390/tropicalmed7080170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/24/2022] Open
Abstract
Hepatitis E virus (HEV) is a waterborne zoonotic disease that can result in a high fatality rate in pregnant women and infants. In 2018, a large HEV outbreak emerged in Chattogram, Bangladesh, resulting in 2800 cases and a significant public health response to mitigate the transmission. While the source of the outbreak remained poorly understood, authorities suggested that possible risk factors for HEV infection included contamination of water supply, exacerbated by concurrent severe flooding events in the community. A cross-sectional study was conducted to investigate the distribution and risk factors for HEV seroprevalence between January and December 2018 in the Chattogram city area. A total of 505 blood samples were collected from symptomatic patients of 10 hospitals who met the case definition for an HEV infection. Standard ELISA tests were performed in all patients to identify anti-HEV antibodies. The size and location of HEV seroprevalence clusters within Chattogram were investigated using SaTScan. We investigated the association between risk of HEV infection and individual and environmentally lagged risk factors using Bernoulli generalised linear regression models. Our results indicate an overall HEV seroprevalence of 35% with significant variation according to sex, source of drinking water, and boiling of drinking water. A positive cross-correlation was found between HEV exposure and precipitation, modified normalised difference water index (MNDWI), and normalised difference vegetation index (NDVI). Our model indicated that risk of infection was associated with sex, age, source of drinking water, boiling of water, increased precipitation, and increased MNDWI. The results from this study indicate that source and boiling of drinking water and increased precipitation were critical drivers of the 2018 HEV outbreak. The communities at highest risk identified in our analyses should be targeted for investments in safe water infrastructure to reduce the likelihood of future HEV outbreaks in Chattogram.
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Affiliation(s)
- Kei Owada
- Queensland Alliance for One Health Sciences, School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia
| | - Joyantee Sarkar
- One Health Institute, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | - Md. Kaisar Rahman
- School of Veterinary Medicine, Texas Tech University, Amarillo, TX 79106, USA
- EcoHealth Alliance, New York, NY 10018, USA
| | - Shahneaz Ali Khan
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
| | | | - Mohammad Mahmudul Hassan
- Queensland Alliance for One Health Sciences, School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia
- One Health Institute, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
- Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh
- Correspondence: (M.M.H.); (R.J.S.M.)
| | - Ricardo J. Soares Magalhães
- Queensland Alliance for One Health Sciences, School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia
- Children’s Health and Environment Program, UQ Children’s Health Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
- Correspondence: (M.M.H.); (R.J.S.M.)
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Raslan E, AbdAllah M, Soliman S. The prevalence and determinants of hepatitis B among Egyptian adults: a further analysis of a country-representative survey. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-022-00207-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hepatitis B virus (HBV) infection is a major worldwide healthcare problem with subsequent serious complications including cirrhosis and hepatocellular carcinoma (HCC). Hence, taking cognizance of HBV impact is critical for future planning of its control and prevention.
Objectives
To assess the prevalence of HBV in Egypt, analyse the demographic characteristics of HBV-infected patients and examine the common routes of its transmission.
Methods
This is a cross-sectional study of data from the Egyptian Health Issues Survey (EHIS), which employed a nationally representative sample of 16,004 individuals. The survey participants were categorized into two groups: group A, HBV positive, and group B, HBV negative. Comparative analysis was performed to identify demographic features and define possible risk factors.
Results
The total number of participants included in the study was 16,004. The mean age (± SD) was 33.5 (± 12.4) years. The prevalence of HBV was 1.52%. Demographic analysis showed that HBV was more prevalent among males, married people, people with jobs and smokers (P = 0.0011, 0.002, < 0.001 and 0.0036) respectively. Employing an adjusted multivariate logistic regression model, we observed an increased likelihood of HBV infection in married adults who received cupping without blood and who did not know if they had schistosomiasis injection therapy.
Conclusion
The application of special screening programs to highly susceptible patients and treatment optimization is recommended for the elimination of HBV. EHIS indicates the likely success of the previous Egyptian control plan for viral hepatitis through reducing several risk factors.
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Artenie A, Luhmann N, Lim AG, Fraser H, Ward Z, Stone J, MacGregor L, Walker JG, Trickey A, Marquez LK, Abu-Raddad LJ, Ayoub HH, Walsh N, Hickman M, Martin NK, Easterbrook P, Vickerman P. Methods and indicators to validate country reductions in incidence of hepatitis C virus infection to elimination levels set by WHO. Lancet Gastroenterol Hepatol 2022; 7:353-366. [PMID: 35122713 PMCID: PMC10644895 DOI: 10.1016/s2468-1253(21)00311-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/22/2022]
Abstract
One of the main goals of the 2016 Global Health Sector Strategy on viral hepatitis is the elimination of hepatitis C virus (HCV) as a public health problem by 2030, defined as an 80% reduction in incidence and 65% reduction in mortality relative to 2015. Although monitoring HCV incidence is key to validating HCV elimination, use of the gold-standard method, which involves prospective HCV retesting of people at risk, can be prohibitively resource-intensive. Additionally, few countries collected quality data in 2015 to enable an 80% decrease by 2030 to be calculated. Here, we first review different methods of monitoring HCV incidence and discuss their resource implications and applicability to various populations. Second, using mathematical models developed for various global settings, we assess whether trends in HCV chronic prevalence or HCV antibody prevalence or scale-up levels for HCV testing, treatment, and preventative interventions can be used as reliable alternative indicators to validate the HCV incidence target. Third, we discuss the advantages and disadvantages of an absolute HCV incidence target and suggest a suitable threshold. Finally, we propose three options that countries can use to validate the HCV incidence target, depending on the available surveillance infrastructure.
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Affiliation(s)
- Adelina Artenie
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
| | - Niklas Luhmann
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, WHO, Geneva, Switzerland
| | - Aaron G Lim
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Zoe Ward
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Jack Stone
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Louis MacGregor
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Josephine G Walker
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Adam Trickey
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Lara K Marquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | | | - Houssein H Ayoub
- Department of Mathematics, Statistics, and Physics, Qatar University, Doha, Qatar
| | - Nick Walsh
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, WHO, Geneva, Switzerland
| | - Matthew Hickman
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Philippa Easterbrook
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, WHO, Geneva, Switzerland
| | - Peter Vickerman
- Department of Population Health Sciences and National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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10
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Hepatitis A and E in the Mediterranean: A systematic review. Travel Med Infect Dis 2022; 47:102283. [DOI: 10.1016/j.tmaid.2022.102283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/05/2022] [Accepted: 02/23/2022] [Indexed: 11/23/2022]
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11
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Elbahrawy A, Ibrahim MK, Eliwa A, Alboraie M, Madian A, Aly HH. Current situation of viral hepatitis in Egypt. Microbiol Immunol 2021; 65:352-372. [PMID: 33990999 DOI: 10.1111/1348-0421.12916] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/02/2021] [Accepted: 05/11/2021] [Indexed: 12/12/2022]
Abstract
An estimated 8-10 million people suffer from viral hepatitis in Egypt. Hepatitis A virus (HAV) and hepatitis E virus (HEV) are the major causes of viral hepatitis in Egypt as 50% or more of the Egyptian population are already exposed to HAV infection by the age of 15. In addition, over 60% of the Egyptian population test seropositive for anti-HEV in the first decade of life. HEV mainly causes self-limiting hepatitis; however, cases of fulminant hepatitis and liver failure were reported in Egypt. Hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) are the main causes of chronic hepatitis, liver cirrhosis, and liver cancer (hepatocellular carcinoma [HCC]) in Egypt. Globally, Egypt had the highest age-standardized death rate due to cirrhosis from 1990 to 2017. The prevalence rate of HBV (1.3%-1.5%) has declined after national infantile immunization. Coinfection of HBV patients with HDV is common in Egypt because HDV antibodies (IgG) vary in range from 8.3% to 43% among total HBV patients. After the conduction of multiple national programs to control HCV infection, a lower rate of HCV prevalence (4.6%) was recently reported. Data about the incidence of HCV after treatment with direct antiviral agents (DAAs) are lacking. An HCC incidence of 29/1000/year in cirrhotic patients after DAA treatment is reported. A higher rate of infiltrative pattern among HCC patients after DAA treatment is also recognized. Viral hepatitis is one of the major public health concerns in Egypt that needs more attention and funding from health policymakers.
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Affiliation(s)
- Ashraf Elbahrawy
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Marwa K Ibrahim
- Department of Microbial Biotechnology, Division of Genetic Engineering and Biotechnology Research, National Research Centre, Giza, Egypt.,Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ahmed Eliwa
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Ali Madian
- Department of Internal Medicine, Al-Azhar University, Assiut, Egypt
| | - Hussein Hassan Aly
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
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Shiha G, Soliman R, Mikhail NNH, Easterbrook P. Reduced incidence of hepatitis C in 9 villages in rural Egypt: Progress towards national elimination goals. J Hepatol 2021; 74:303-311. [PMID: 32931878 DOI: 10.1016/j.jhep.2020.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 08/01/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Egypt has a major HCV burden and a well established treatment programme, with an ambitious goal of HCV elimination. Our aim was to assess the impact of a comprehensive HCV prevention, test and treat programme on the incidence of new HCV infections in 9 villages in rural Egypt. METHODS An HCV "educate, test and treat" project was implemented in 73 villages across 7 governorates in Egypt between 06/2015 and 06/2018. In 2018, in 9 of the villages we re-tested individuals who originally tested HCV antibody (HCV-Ab) and HBsAg negative using rapid diagnostic tests (RDTs); confirmatory HCV RNA testing was performed for positive cases. The incidence rate per 1,000 person-years (py) was calculated, and risk factors for incident HCV infections assessed through an interviewer-administered questionnaire in 1:3 age- and gender-matched cases and controls. RESULTS Out of 20,490 individuals who originally tested HCV-Ab negative in the 9 villages during the 2015-2016 implementation of the "educate, test and treat" programme, 19,816 (96.7%) were re-tested in 2018. Over a median of 2.4 years (IQR 2.1-2.7), there were 19 new HCV infections all of which were HCV RNA positive (incidence rate 0.37/1,000 py) (95% CI 0.24-0.59). Compared to a previous estimate of incidence in the Nile Delta region (2.4/1,000 py) from 2006, there was a substantial reduction in overall incidence of new HCV infections. Exposures through surgery (odds ratio 51; 95% CI 3.5-740.1) and dental procedures (odds ratio 23.8; 95% CI 2.9-194.9) were significant independent predictors of incident infections. CONCLUSIONS This is the first study to show a substantial reduction in incidence of new HCV infections in a sample of the general population in Egypt following attainment of high testing and treatment coverage. New infections were significantly associated with healthcare-associated exposures. LAY SUMMARY Egypt has a major national HCV testing and treatment programme with the goal of eliminating HCV infection. We assessed the impact of a comprehensive HCV prevention, test and treat programme in 73 villages that achieved high coverage of testing and treatment on the subsequent incidence of new HCV infections in nine of the villages. We re-tested people who were previously HCV antibody negative and found that the rate of new HCV infections was greatly reduced compared to previous estimates. We also found that exposure through surgery and dental procedures were associated with these new infections. This highlights the importance of continued strengthening of infection control and prevention measures, alongside treatment scale-up.
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Affiliation(s)
- Gamal Shiha
- Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, El-Mansoura, Egypt; Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Egypt.
| | - Reham Soliman
- Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, El-Mansoura, Egypt; Tropical Medicine Department, Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Nabiel N H Mikhail
- Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, El-Mansoura, Egypt; Biostatistics and Cancer Epidemiology Department, South Egypt Cancer Institute, Assiut University, Egypt
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
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The Course of Hepatitis C Infection and Response to Anti-viral Therapy in Patients with Thalassemia major and Hepatitis C Infection: A Longitudinal, Prospective Study. Mediterr J Hematol Infect Dis 2019; 11:e2019060. [PMID: 31700585 PMCID: PMC6827603 DOI: 10.4084/mjhid.2019.060] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 09/19/2019] [Indexed: 02/06/2023] Open
Abstract
Background The course of hepatitis C infection (HCV) in patients with thalassemia has not been adequately studied, and management has not been optimized. The current prospective longitudinal study assessed the clinical course, outcome, progression, and management of recently acquired HCV in patients with transfusion-dependent thalassemia major versus acute HCV without thalassemia. Methods A well-characterized cohort of patients with thalassemia and recent HCV infection or recent HCV without thalassemia were enrolled and prospectively followed. The blood transfusion needs and chelating agents were determined. Liver functions tests, HCV-RNA, iron, and ferritin levels were measured. Patients with chronic HCV evolution received treatment for HCV. The fibrosis progression rate was determined in chronic HCV patients with or without thalassemia by paired liver biopsies or serial transient elastography (TE), or serum markers of liver fibrosis. Liver iron content (LIC) was assessed by R2 MRI. Results Self-limited acute HCV was observed in 17% of patients with acute HCV and thalassemia versus 35% of patients without thalassemia (P=0.031). The fibrosis progression rates were significantly higher in patients with chronic HCV and thalassemia compared to those with chronic HCV alone (1.14±0.48) and (0.35±0.14) (P<0.0001), respectively. A direct linear correlation was observed between the fibrosis progression rate and each of LIC (R=+0.67; P=0.01) and ferritin (R=0.77; P<0.01). In patients with chronic HCV and thalassemia, the sustained virologic response (SVR) to pegylated interferon-based therapy and direct antiviral agents (DAAS) were 33% and 82% respectively (P<0.0001), while in chronic HCV patients without thalassemia, the SVR rates to PEG-IFN/RBV and DAAs were 51% and 92% respectively. Five patients with concomitant HCV and thalassemia died during the study due to cardiac causes (n=3) and liver cancer (n=2). Conclusions Patients with acute HCV and thalassemia have low rates of spontaneous resolution of HCV infection, and the majority develop chronic HCV. Direct-acting antiviral combinations are associated with high SVR rates and low adverse event in treatment naïve and experienced patients with chronic HCV and thalassemia. Liver fibrosis is accelerated in thalassemia patients with chronic HCV; therefore, early diagnosis, treatment with DAAs, adequate iron chelation, and non-invasive monitoring liver status are recommended to prevent cirrhosis and hepatocellular carcinoma.
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Soliman G, Elzalabany MS, Hassanein T, Miller FD. Mass screening for hepatitis B and C in Southern Upper Egypt. BMC Public Health 2019; 19:1326. [PMID: 31640639 PMCID: PMC6805514 DOI: 10.1186/s12889-019-7640-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023] Open
Abstract
Background It is well documented that Egypt has the highest prevalence of hepatitis C virus (HCV) infection in the world. The recent development of highly effective direct acting antiviral drugs (DAAs), has opened the possibility of treating and curing HCV infection in the Egyptian population on a large scale. Methods A screening demonstration project was implemented in southern Egypt in and around the city of Luxor. Free screening and if indicated, treatment, was offered to those 16 years or older for anti-HCV antibodies (anti-HCV) and hepatitis B surface antigen (HBsAg) using third generation enzyme immunoassays (Enzygnost® Anti-HCV and HbsAg). Statistical methods included estimation of odds ratios (OR) and 95% confidence intervals (95% CI). Results There was a large turnout of 67,042 persons who were screened in a 12-month period starting in June 2016. Thirty-one thousand nine hundred sixty-four males (47.7%) and 35,074 females (52.3%) were screened with a mean age of 43.6 ± 14.3 years. Nine thousand seven hundred one patients (14.5%) were positive for anti-HCV and 2950 (4.4%) for HBsAg. Prevalence of anti-HCV was significantly higher in males than females (19.67% vs.9.73% OR = 2.27; CI 2.2 to 2.4; p < 0.001) and the same for HBsAg (6.2% vs. 2.8% OR = 2.3; CI 2.2 to 2.5; p < 0.001). The prevalence of anti-HCV was significantly associated with age (p < 0.001), ranging from between 1 and 4% in individuals below the age of 40 years, then increased steadily to 42% at age 60 followed by a precipitous decline in age specific prevalence. Conclusions The results showed unanticipated patterns in the Luxor area of anti-HCV and HBsAg by age and gender in contrast to previous reports on this unique HCV epidemic in Egypt. Moreover, the level and rate of turnout, cost, and other logistical issues, provided essential information for effective planning, design, and evaluation methods for larger national mass screening and treatment programs.
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Affiliation(s)
- Gamal Soliman
- Tropical Medicine, Gastroenterology and Hepatology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | | | - F DeWolfe Miller
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
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