The prevalence of hepatitis C virus infection in Egypt 2015: implications for future policy on prevention and treatment

Amr Kandeel, Mohamad Genedy, Samir El-Refai, Anna L Funk, Arnaud Fontanet, Maha Talaat, Amr Kandeel, Mohamad Genedy, Samir El-Refai, Anna L Funk, Arnaud Fontanet, Maha Talaat

Abstract

Background & aims: In 2015, a national Egyptian health issue survey was conducted to describe the prevalence of hepatitis C virus (HCV) infection. In this paper, we describe the HCV burden in 2015, compare the results with the national survey conducted in 2008, and discuss the implications of the new findings on prevention of HCV in Egypt.

Methods: A multistage probability sampling approach was used, similar to the national demographic survey conducted in 2008. More than 90% of sampled individuals complied with the interview and provided blood samples.

Results: In the 15-59-year age groups, the prevalence of HCV antibody was found to be 10.0% (95% CI 9.5-10.5) and that of HCV RNA to be 7.0% (95% CI 6.6-7.4). In children, 1-14 years old, the prevalence of HCV antibody and HCV RNA were 0.4% (95% CI 0.3-0.5) and 0.2% (95% CI 0.1-0.3) respectively. Approximately, 3.7 million persons have chronic HCV infection in the age group 15-59 in 2015. An estimated 29% reduction in HCV RNA prevalence has been seen since 2008, which is largely attributable to the ageing of the group infected 40-50 years ago during the mass schistosomiasis treatment campaigns. Prevention efforts may have also contributed to this decline, with an estimated 75% (95% CI 6-45) decrease in HCV incidence in the 0-19 year age groups over the past 20 years.

Conclusions: These findings can be used to shape future HCV prevention policies in Egypt.

Keywords: hepatitis C Egypt; incidence HCV; nation-wide surveys; prevalence HCV.

Conflict of interest statement

The authors do not have any disclosures to report.

© 2016 The Authors. Liver International Published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
(A) Age‐specific prevalence of hepatitis C virus (HCV) antibody‐positive persons in 2008 and 2015 (left), then shifted (by 7 years) 2008 and 2015 (right). (B) Age‐specific prevalence of HCV RNA‐positive persons in 2008 and 2015 (left), then shifted (by 7 years) 2008 and 2015 (right).
Figure 2
Figure 2
Prevalence of hepatitis C virus antibody in the 2008 and 2015 Egyptian Demographic and Health Surveys.

References

    1. Gower E, Estes C, Blach S, Razavi‐Shearer K, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol 2014; 61: S45–57.
    1. Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: new estimates of age‐specific antibody to HCV seroprevalence. Hepatology 2013; 57: 1333–42.
    1. Perz JF, Armstrong GL, Farrington LA, Hutin YJ, Bell BP. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006; 45: 529–38.
    1. El‐Zanaty F, Way A. (2009). Egypt Demographic and Health Survey 2008. Cairo, Egypt: Ministry of Health,El‐Zanaty and Associates, and Macro International.
    1. Ministry of Health, Egypt , El‐Zanaty and Associates , Egypt and ICF International . (2015). Egypt Health Issues Survey 2015. Cairo, Egypt and Rockville, MD: Ministry of Health and ICF International.
    1. Newcombe RG. Interval estimation for the difference between independent proportions: comparison of eleven methods. Stat Med 1998; 17: 873–90.
    1. Armitage P, Berry G. Statistical Methods in Medical Research, 3rd edn London: Blackwell, 1994; 131.
    1. Gardner MJ, Altman DG. Confidence intervals rather than P values: estimation rather than hypothesis testing. BMJ (Clin Res Ed) 1986; 292: 746–50.
    1. Talaat M, El‐Sayed N, Kandeel A, et al Sentinel surveillance for patients with acute hepatitis in Egypt, 2001–04. East Mediterr Health J 2010; 16: 134–40.
    1. Centre for Disease Control and Prevention (CDC) . Establishment of a viral hepatitis surveillance system – Pakistan, 2009–2011. MMWR Morb Mortal Wkly Rep 2011; 60: 1385–90.
    1. MatheÏ C, Buntinx F, Van Damme P. Is the prevalence of hepatitis c virus (HCV) RNA in anti‐HCV–positive injection drug users positively correlated with age? J Infect Dis 2001; 184: 659–60.
    1. Thein HH, Yi Q, Dore GJ, Krahn MD. Estimation of stage‐specific fibrosis progression rates in chronic hepatitis C virus infection: a meta‐analysis and meta‐regression. Hepatology 2008; 48: 418–31.
    1. Breban R, Doss W, Esmat G, et al Towards realistic estimates of HCV incidence in Egypt. J Viral Hepat 2013; 20: 294–6.
    1. Frank C, Mohamed MK, Strickland GT, et al The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt. Lancet 2000; 355: 887–91.
    1. Habib M, Mohamed MK, Abdel‐Aziz F, et al Hepatitis C virus infection in a community in the Nile Delta: risk factors for seropositivity. Hepatology 2001; 33: 248–53.
    1. Medhat A, Shehata M, Magder LS, et al Hepatitis C in a community in Upper Egypt: risk factors for infection. Am J Trop Med Hyg 2002; 66: 633–8.
    1. Esmat G, Hashem M, El‐Raziky M, et al Risk factors for hepatitis C virus acquisition and predictors of persistence among Egyptian children. Liver Int 2012; 32: 449–56.
    1. Waked I, Doss W, El‐Sayed M, et al The current and future disease burden of chronic hepatitis C virus infection in Egypt. Arab J Gastroentero 2014; 15: 45–52.
    1. Ford N, Singh K, Cooke GS, et al Expanding access to treatment for hepatitis C in resource‐limited settings: lessons from HIV/AIDS. Clin Infect Dis 2012; 54: 1465–72.
    1. Centre for Disease Control and Prevention (CDC) . Progress toward prevention and control of hepatitis c virus infection – Egypt, 2001–2012. MMWR Morb Mortal Wkly Rep 2012; 61: 545–9.
    1. El Raziky M, Fathalah WF, Zakaria Z, et al Predictors of virological response in 3,235 chronic HCV Egyptian patients treated with peginterferon alpha‐2a compared with peginterferon alpha‐2b using statistical methods and data mining techniques. J Interferon Cytokine Res 2016; 36: 338–46.
    1. Deuffic‐Burban S, Schwarzinger M, Obach D, et al Should we await IFN‐free regimens to treat HCV genotype 1 treatment‐naive patients? A cost‐effectiveness analysis (ANRS 95141). Hepatology 2014; 61: 7–14.
    1. Lawitz E, Mangia A, Wyles D, et al Sofosbuvir for previously untreated chronic hepatitis C infection. N Engl J Med 2013; 368: 1878–87.
    1. Breban R, Arafa N, Leroy S, et al Effect of preventive and curative interventions on hepatitis C virus transmission in Egypt (ANRS 1211): a modelling study. Lancet Glob Health 2014; 2: e541–9.
    1. Negro F. Epidemiology of hepatitis C in Europe. Dig Liver Dis 2014; 46: S158–64.
    1. World Health Organization . Hepatitis C. WHO/CDS/CSR/LYO/2003.
    1. Espinosa M, Martn‐Malo A, Ojeda R, et al Marked reduction in the prevalence of hepatitis C virus infection in hemodialysis patients: causes and consequences. Am J Kidney Dis 2004; 43: 685–9.
    1. Abdel Aziz F, Habib M, Mohamed M, et al Hepatitis C virus infection in a community in the Nile Delta: population description and HCV prevalence. Hepatology 2000; 32: 111–5.
    1. Stoszek SK, Abdel‐Hamid M, Narooz S, et al Prevalence of and risk factors for hepatitis C in rural pregnant Egyptian women. Trans R Soc Trop Med Hyg 2006; 100: 102–7.
    1. El Gohary A, Hassan A, Nooman Z, et al High prevalence of hepatitis C virus among urban and rural population groups in Egypt. Acta Trop 1995; 59: 155–61.
    1. Ruane PJ, Ain D, Stryker R, et al Sofosbuvir plus ribavirin for the treatment of chronic genotype 4 hepatitis C virus infection in patients of Egyptian ancestry. J Hepatol 2015; 62: 1040–6.
    1. Obach D, Deuffic‐Burban S, Esmat G, et al Effectiveness and cost‐effectiveness of immediate versus delayed treatment of hepatitis C virus‐infected patients in a country with limited resources: the case of Egypt. Clin Infect Dis 2014; 58: 1064–71.
    1. Obach D, Yazdanpanah Y, Esmat G, et al How to optimize hepatitis C virus treatment impact on life years saved in resource‐constrained countries. Hepatology 2015; 62: 31–9.

Source: PubMed

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