Egypt's Hepatitis C Crisis Traced to Old Public Health Program

by Larry Roberts

Hepatitis C virus was apparently transmitted through the contamination of reusable needles and syringes used in the treatment of schistosomiasis, a condition caused by a parasite in the blood. Researchers say the treatment campaigns may account for the world's largest transmission of blood-borne pathogens resulting from medical intervention.

Hundreds of thousands of Egyptians received the treatment, called parenteral antischistosomal therapy (PAT), from the 1950's to the 1980's. Today, drugs for schistosomiasis are administered in pill form.

"They were given the only available form of treatment for a serious disease, but the treatment was administered with reusable injection equipment, as was the standard in those times," says Christina Frank, a doctoral candidate at the University of Maryland School of Medicine and author of the study. "Doctors meant well, but they were unaware of the dangers associated with inadequate sterilization procedures."

Frank and her colleagues reviewed historical public health records and statistics to determine whether there was a connection between the PAT injections and the hepatitis C rate in different age groups. Researchers found a significant association between exposure to PAT and Hepatitis C infection. A drop in the hepatitis C rate coincided with the gradual replacement of PAT injections with oral medications in the mid-1970's and early 1980's.

The investigators concluded that PAT played a major role in the spread of hepatitis C throughout Egypt. In part because of the high number of people who were infected, the risk of transmission remains high in the Egyptian population today. It is believed that at least 15 percent of the Egyptian population has been infected with hepatitis C. Liver disease caused by chronic hepatitis C infection is a significant health problem in Egypt today.

"The treatment campaigns were conducted with the best of intentions, using accepted sterilization techniques of the time," says Frank. "Testing for hepatitis C only became available in the early 1990's, years after PAT injection campaigns had ended."

"This situation is somewhat paradoxical," says Thomas Strickland M.D., Ph.D., professor of Epidemiology at the University of Maryland School of Medicine, and the director of the USAID-supported Hepatitis C Prevention Project that coordinated the study.

"Egypt's extensive and dedicated nationwide control program for schistosomiasis was the cause of the current high prevalence of hepatitis C in the country," says Dr. Strickland. "The practice of mass treatment with PAT before the danger of exposure to blood was so well known, and before the availability of disposable syringes and needles, provided a very potent means for transmission of blood-borne infections."

The study, conducted in cooperation with the World Health Organization and the Egyptian Ministry of Health and Population, was published last month in The Lancet.