1. Hepatitis C in Arab world andHepatitis C in Arab world and
North AfricaNorth Africa
Dr. Khaled Mahmoud Abd ElazizDr. Khaled Mahmoud Abd Elaziz
Assistant professor of Public healthAssistant professor of Public health
& Preventive medicine& Preventive medicine
Faculty of Medicine -Ain Shams UniversityFaculty of Medicine -Ain Shams University

2. DefinitionDefinition
Prevalence around the Arab countries andPrevalence around the Arab countries and
North AfricaNorth Africa
Genotypes Distribution of infectionGenotypes Distribution of infection
Transmission with blood transfusionTransmission with blood transfusion
Transmission among health care workersTransmission among health care workers

3. 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.

4. Hepatitis C viral infectionHepatitis C viral infection
HCV 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.

7. 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)

8. 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)

9. Hepatitis C viral infection in arabHepatitis 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)

10. 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.

11. Prevalence Countries Major
genotypes
Minor
Low
<1-1.9%
Lybia(1.2)
Tunisia (0.4-0.7)
4/1
1b
2a,2b,2c
2a,2c,1a
Moderate
2-2.9%
Algeria (2%) NA NA
High
3-3.9%
--- ---- -----
Very high
>4%
Egypt,17.8(13-
22)
Morocco 7%
4
1b
1a,1b2,2a
2a,2c,1a
Prevalence of HCV infections in countriesPrevalence of HCV infections in countries
of North Africaof North Africa

12. Country Transmission
Egypt 40%
Lybia 20.5%
Algeria 63%
Tunisia 51%
Morrocco 76%
Transmission of HCV in hemodialysisTransmission of HCV in hemodialysis

13. Risk factor Low
<5%
Moderate
5-20%
High
>20%
Blood
transfusion
All countries
Hemodialysis All countries
Nosocomial
transmissio
n
All countries
Health care
workers
All countries
Risk factors for transmission of HCVRisk factors for transmission of HCV
infection in North Africainfection in North Africa

14. Risk factor Low
<5%
Moderate
5-20%
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 HCVRisk factors for transmission of HCV
infection in North Africainfection in North Africa

15. Habitual and community acquiredHabitual and community acquired
infectionsinfections
Around 50% of subjects deny any exposure
to previous risk factors. We report that as
community acquired infection
It 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,

16. Cases prevalence Suspected factors
125
Tanta
76% among cases HCV
Antibody
40% PCR
family history,
dental, minor
surgical
procedures
150
Ain Shams
University
Only 66 done the test
Prevalence 20%
Quality control
and more
sensitive test
for blood
screening
strict pre transfusion
blood testing
Transmission in cases with bloodTransmission in cases with blood
transfusion (children with B thalassemia)transfusion (children with B thalassemia)

17. Transmission within health careTransmission 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%

18. Transmission within health careTransmission 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.

19.  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.

20. 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).

21.  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.

22.  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)

23.  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.

24.  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.

25.  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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