Hepatitis C emerges as Egypt's top health crisis

When the government took measures against the waterborne parasite bilharzia, it infected millions with the potentially deadly virus hepatitis C.

A healthcare worker draws blood from a young boy to test for the virus hepatitis C at a clinic in Cairo.

CAIRO // It was about 25 years ago, but Mukhtar Ismail Abdu said he remembers it all quite clearly. One day during primary school, Mr Abdu and his fellows were herded into a clinic where they were injected with a tartar emetic drug - part of a nationwide rural public health campaign to prevent a water-borne parasite known as bilharzia, or schistosomiasis, a parasite that has been endemic to Egypt's Nile River valley since the time of the pharaohs. The treatment successfully reduced the rate of bilharzia infection to less than one per cent today from about 40 per cent in 1970, said Abdul Rahman Shahin, the spokesperson for Egypt's ministry of health. But Mr Abdu's needle, like those of millions of others, carried a hidden freeloader: the virus hepatitis C. "It was a time when everyone was injected by the same syringe, not like now when they use different syringes," said Mr Abdu, 41. "It bothers me because we were just schoolchildren." According to the ministry of health's last comprehensive study in 1996, some 15 to 20 per cent of Egyptians tested positive for hepatitis C antibodies. The study linked the epidemic directly to Egypt's otherwise laudable bilharzia treatment campaign, which ended only a few years before the hepatitis C virus was discovered in 1989. About one-third of Egyptians aged 50 and older - those who were more likely to have been injected with the tartar emetic shot during the therapy's heyday - tested positive for hepatitis C. "I can tell you that those who have [hepatitis] C now, a very high percentage of them are the kids who were given this tartar emetic in the late [19]60s and '70s and probably until the early '80s. Because they were all infected with [hepatitis] C," said Dr Shahin. Faced with what is thought to be the world's worst hepatitis C epidemic, Egypt's ministry of health embarked on yet another ambitious effort in 2006 to prevent and treat a growing incidence of cirrhosis and liver cancer caused by the virus. hepatitis C is now Egypt's worst public health crisis, said Manal El Sayed, a member of Egypt's National Committee for the Control of Viral Hepatitis. To fight the scourge, the ministry of health convened the National Committee for the Control of Viral Hepatitis in 2006, charging its seven-member board with evaluating the problem and halting the epidemic's spread. Before that, Egypt's broken public health system, stymied by the epidemic's daunting size, allowed the problem to metastasise for more than a decade. Only about half of Egyptians have health insurance, and the poorest people in rural areas were unable to pay for the costly Interferon protein therapy. "Before this programme, let me be very honest with you, nobody was given Interferon except those who could afford to pay for it because it was a very expensive therapy," said Dr Shahin. "The injection was bought by the minister of health at EGP 1,200 (Dh800) per injection." The Interferon regime requires 48 regular injections, bringing the total cost to nearly EGP 60,000. "Before this committee appeared, every doctor just gave whatever treatment he wanted, and they all gave different treatments" said Mr Abdu, who estimated that he earned about EGP600 each month as a day labourer before he started taking regular Interferon shots six months ago, which leave him too tired to work. "There was no good treatment at the time. We used to go to a doctor in Fayyoum who gave us capsules. They didn't treat the symptoms but the doctor said they would limit the spread of the virus in the body." These days, Mr Abdu travels once every two weeks to Cairo from his home in rural Fayyoum to get free medical care to treat both his hepatitis C and bilharzia, which he also contracted despite the ill-fated treatment years ago. Since the programme began three years ago, health officials have treated 40,000 people, more than 70 per cent of whom reacted positively to the medication, said Dr Shahin. By the end of this year, 20 specialised liver centres across the country will offer free treatment to 60,000 patients, said Dr Sayed, as well as liver transplants for advanced cases. But the spread of hepatitis C did not end with the injections. The blood-borne virus is 10 times more contagious than the human immunodeficiency virus (HIV), and can be transmitted by means as obvious as dirty needles or as unassuming as shower loofahs, toothbrushes or nail clippers. Preventing the disease's spread will require Egyptians to take a closer look at some of their more unsavoury habits, Dr Sayed said. "Now we have to focus much more on the non-infected people," she said, adding that "bad cultural habits" such as "mass tattooing, mass circumcisions, barber shops" can all act as vectors for disease. Tattoos are common among Egypt's Christian minority and circumcisions are done for both men and women, often under unsterile circumstances. The committee launched an awareness-raising campaign in 2007, which focused on universities in the hope that educated youth would spread the word about hepatitis C in their home villages. After targeting about 150,000 students in 11 universities, 80 per cent of rural Egyptians now say they have heard about hepatitis C, according to the committee's surveys. Given the extent of the disease, they are likely to have heard as much from their family, friends and neighbours as from any ministry-led health programme. Mr Abdu's double afflictions - hepatitis C and bilharzia - might have given him the demeanour of a man who was thrown out of the frying pan and into the fire. Yet Mr Abdu said he holds no grudge or anger, only the mild bitterness that comes from missed opportunities. His disease was discovered five years ago, after Mr Abdu submitted to routine medical tests that he hoped would qualify him to work as a labourer in Saudi Arabia. He saved for two years to afford the EGP7,000 Saudi visa and labour permit, but was rejected after testing positive for hepatitis C. But recent news has buoyed his spirits. After four months of therapy, Mr Abdu tested negative for Hepatitis C two months ago. He still has a year of therapy ahead of him, and he is eager to get back to work. "Sometimes I feel frustrated," he said. "I'm not accustomed to sitting at home. And work also trains the body." [e-mail]