Hepatitis C in Arab world and Hepatitis C in Arab world and North AfricaNorth Africa
Dr. Khaled Mahmoud Abd ElazizDr. Khaled Mahmoud Abd Elaziz
Assistant professor of Public health Assistant professor of Public health & Preventive medicine & Preventive medicine
Faculty of Medicine -Ain Shams University Faculty of Medicine -Ain Shams University
DefinitionDefinitionPrevalence around the Arab countries and Prevalence around the Arab countries and
North AfricaNorth AfricaGenotypes Distribution of infectionGenotypes Distribution of infectionTransmission with blood transfusionTransmission with blood transfusionTransmission among health care workersTransmission among health care workers
Hepatitis C viral infectionHepatitis C viral infection
Hepatitis C virus (HCV) is a RNA virus known to infect humans and chimpanzees, causing similar disease in these 2 species. HCV is most often transmitted parentrally but is also transmitted vertically and sexually .HCV is up to 4 times more infectious than Human Immunodeficiency Virus.
Hepatitis C viral infectionHepatitis C viral infectionHCV is a leading cause of chronic liver disease in the world. The World Health Organization (WHO) estimates that 170 million people are infected with HCV globally and 3-4 million new infections occur each year, making it one of the leading public health problems in the world.
Hepatitis C viral infectionHepatitis C viral infection
With a prevalence of 5.3% and an estimated 32 million people infected with HCV, Sub Saharan Africa has the highest burden of the disease in the world. (Karoney 2013)
Hepatitis C viral infectionHepatitis C viral infection
WHO estimates 2.2% prevalence all over the world. It is estimated that 27% of the world burden of liver fibrosis and 25% of the HCC are due to hepatitis C viral infection
(Daw 2012)
Hepatitis C viral infection in arab Hepatitis C viral infection in arab countriescountries
Estimated 25 millions affected in the Arab world and without effective intervention the number will increase tremendously in the next two decades
(Daw 2012)
GenotypesGenotypes
There are 11 HCV genotypes: 1-11, with many subtypes: a, b, c, and about 100 different strains: 1,2,3 based on the sequence of the HCV genome Genotypes 1-3 are widely distributed globally, with genotypes 1a and 1 b accounting for 60% of infections worldwide. Genotype 4 is characteristic for the Middle East, Egypt and Central Africa.
Prevalence Countries Major genotypes
Minor
Low<1-1.9%
Lybia(1.2)Tunisia (0.4-0.7)
4/11b
2a,2b,2c2a,2c,1a
Moderate2-2.9%
Algeria (2%) NA NA
High3-3.9%
--- ---- -----
Very high>4%
Egypt,17.8(13-22)
Morocco 7%
41b
1a,1b2,2a2a,2c,1a
Prevalence of HCV infections in countries Prevalence of HCV infections in countries of North Africaof North Africa
Country Transmission
Egypt 40%
Lybia 20.5%
Algeria 63%
Tunisia 51%
Morrocco 76%
Transmission of HCV in hemodialysis Transmission of HCV in hemodialysis
Risk factor Low<5%
Moderate5-20%
High >20%
Blood transfusion
All countries
Hemodialysis All countries
Nosocomial transmissio
n
All countries
Health care workers
All countries
Risk factors for transmission of HCV Risk factors for transmission of HCV infection in North Africainfection in North Africa
Risk factor Low<5%
Moderate5-20%
High >20%
Invasive medical
procedure
All countries
Dental practice
Lybia, Tunisia Egypt, Algeria, Morocco
Hospital waste handling
Lybia, Tunisia Egypt, Algeria, Morocco
Intravenous Drug Abuse
All countries
Habiutal, high risk
behavior
Lybia, Tunisia Algeria, Egypt Morocco
Risk factors for transmission of HCV Risk factors for transmission of HCV infection in North Africainfection in North Africa
Habitual and community acquired Habitual and community acquired infectionsinfections
Around 50% of subjects deny any exposure to previous risk factors. We report that as community acquired infectionIt is likely that injections given in rural communities by both traditional and nontraditional health care providers are an important cause of HCV transmission, particularly in countries like Egypt, Morocco and Algeria,
Cases prevalence Suspected factors125
Tanta76% among cases HCV
Antibody40% PCR
family history, dental, minor
surgical procedures
150 Ain Shams
University
Only 66 done the testPrevalence 20%
Quality control and more
sensitive test for blood screening
strict pre transfusion blood testing
Transmission in cases with blood Transmission in cases with blood transfusion (children with B thalassemia)transfusion (children with B thalassemia)
Transmission within health care Transmission within health care settingsetting
Reported rates of HCV virus transmission to HCW exposed to HCV RNA positive patients inside hospitals range between 0 and 10%
Transmission within health care Transmission within health care settingsetting
A recent study done in Egypt to explore the transmission of HCV infection to HCWs.It included 597 health care workers that reported recent occupational blood born exposures.
Among the 73 HCWs enrolled in the prospective study,. Nine had evidence of transient viremia at one time point during follow-up, representing a cumulative incidence of 12.3% (95%CI, 5.8%–22.1%). Most(66.7%) HCWs had their viremic episode within 2 weeks after exposure.
The cumulative incidence of transient viremia was not significantly different between men and women. However, it was different according to the HCW’s age, with 35.7% (5/14) viremic HCWs among those aged below 24 years versus 6.8% (4/59)among HCWs aged 24 or above (p = 0.01). Also, the use of disinfectant after OBE was lower among HCWs who developed viremia than among those who did not (6.7% (3/45) and 26.3%(5/19), respectively; p =0.04).
HCWs of a general University hospital in Cairo were exposed to a highly viremic patient population. They experienced frequent occupational blood exposures, particularly in early stages of training. These exposures resulted in transient viremic episodes without established infection.
Mean viral load of index patientsdid not differ significantly between viremic and non viremicHCWs (5.1 and 4.8 logIU/ml, respectively, p= 0.36).
The first important finding of this study is the extremely high (37%) proportion of patients with HCV viremia among inpatients of a general hospital in Cairo.
Mounir et al 2013 (Diaa Marzouk)
Another study done in Al minia in upper egypt Abdel Wahab et al Journal of clinical virology
651 HCWS followed up for 18 months for seroconversion twice per year
Over all incidence of HCV sero convernsion 2.1/ 1000 person year
4.8% inicidence among subjects exposed to needle stick injuries.
Risk factors for acquiring HCV infection in referal center (liver institute) (central liver disease institute)
The prevalence of anti-HCV, hepatitis B surface antigen (HBsAg)and co-infection was 16.6%, 1.5% and 0.2%, respectively. Schistosoma mansoni antibodies were present in 35.1%. The anti-HCV rate increased sharplywith age and employment duration, but not among those with needlestick history.
After adjusting for other risk factors, the anti-HCV rate was higher among older HCWs[P < 0.001; risk ratio (RR) = 1.086, 95% CI 1.063–1.11], males (P = 0.002; RR = 1.911, 95% CI1.266–2.885) and those with rural residence (P < 0.001; RR = 2.876, 95% CI 1.830–4.52).Occupation (duration of employment or schistosomal antibody positivity) were not significant risk factors for anti-HCV positivity. In conclusion, although one in six HCWs had been infected with HCV, the infections were more likely tobe community-acquired and not occupationally related.
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