https://orcid.org/0000-0001-8616-5874
The widespread hepatitis C virus (HCV) infection in Egypt has resulted from the implementation of mass population anti-schistosomal treatment (1950s–80s) by the Egyptian Ministry of Health with the advice and support of the World Health Organization (WHO). Accordingly, Egypt has the highest rate of HCV infection globally. Incidence rates have been estimated at 2.4 per 1000 person-years (close to 170 000 new infections annually).
In 2008, an Egyptian demographic health survey revealed that 15% of the population is seropositive, 10% are chronically infected and 90% of patients are infected with Genotype 4. In 2013, only 7.3% of the population had viremic HCV.1 Whilst about 30% of patients may be able to get rid of the virus on their own, the majority of patients who develop chronic HCV are the chief health burden.2 In Egypt, Genotype 4 is the most prevalent HCV RNA genotype, causing more than 85% of all HCV cases in the country.
The Egyptian National Committee for the Control of Viral Hepatitis was founded in 2006, and its goal was to cure 20% of Egypt’s HCV patients by the end of 2012 by devising a strategy for viral hepatitis control. However, the Egyptian Ministry of Health’s strong focus on treatment rather than infection prevention and education was a significant flaw in the plan. Between 2014 and 2018, and with more funding and assistance from the WHO and other organizations, the Egyptian Ministry of Health presented a new national strategy to contain the HCV pandemic in Egypt, named ‘The Plan of Action for the Prevention, Care, and Treatment of Viral Hepatitis 2014–2018’. Over 2 million people (around 40% of the total HCV-infected population) were treated with sofosbuvir plus daclatasvir without cost for 12 or 24 weeks, with cure rates above 90%. Egypt launched the biggest disease screening programme in its history on 29 July 2018, treating the largest number of patients worldwide (a target population of 62.5 million and screening coverage of 79.4%) using extremely successful oral and less intrusive direct-acting antiviral agents (DAAs). In the Egyptian context, effective DAAs have demonstrated up to 90% efficiency against HCV Genotype 4, with outstanding sustained virological response results.3 Over 7 months, 49.6 million people were screened as part of Egypt’s effective national HCV screening and treatment initiative.
On 9 October 2023, Egypt proved that hepatitis C can be cured efficiently in large-scale real-life programmes after conducting the largest national programme for HCV treatment in the world, eradicating HCV in Egypt for the first time and serving as a paradigm for other resource-limited countries with high rates of HCV. Egypt became the first country to achieve ‘gold tier’ status on the path to the elimination of hepatitis C as per WHO criteria4 by diagnosing 87% of people living with HCV and providing 93% of those diagnosed with curative treatment, meaning that it is well on its way towards reaching all elimination targets before 2030 (Figure 1). In just over a decade, Egypt has successfully reduced its prevalence of hepatitis C from 10 to 0.38% (<0.5%), moving from one of the highest rates in the world to one of the lowest.
Egypt’s journey in eradicating HCV— Timeline of events from the country with the highest prevalence of HCV to achieving WHO ‘gold tier’.
Travel is linked to higher rates of sharing syringes, needles, and equipment used for drug preparation, higher rates of heavy drinking and polysubstance use, and more partners for injection and sex. Community-acquired HCV is believed to be linked to wound contamination or sharing personal articles like toothbrushes, razors, scissors, and nail clippers. Parenteral exposure to contaminated blood through injecting drug use, blood transfusions, unsafe injections, medical procedures (such as dental treatment), piercings, acupuncture, or tattooing is typically the cause of HCV transmission. Although the risk of catching the virus is believed to be minimal in travellers, there is little information on HCV acquisition linked to travel.
Over the past decades, there has been an increase in international travel, putting more tourists at risk of HCV infection. The risk of contracting HCV varies significantly by the traveller’s activities, length of stay, and destination. Travellers frequently engage in high-risk, unsafe behaviours that increase their chance of contracting HCV.5 Since immigrants and travellers travel to and from highly endemic countries, chronic HCV infection is more prevalent in these mobile populations.6 Accordingly, surveys have approximated that the risk of contracting viral hepatitis amongst travellers is 1.8 in 10 000 for HCV.5,7 Although there is a high prevalence of HCV infection in various immigrant populations, travellers from Egypt now have largely received the required healthcare to break HCV transmission and spread its genotypes.8
Most importantly, Egypt is a major tourist destination, and this step in eliminating the HCV problem in Egypt, particularly Genotype 4, which is not internationally circulated, wipes out the potential threat of further spread.9 Nowadays, travellers to Egypt are safe to receive certain community and unconventional medical services, such as public shaving, acupuncture, and routine healthcare, especially in the era of pandemics, such as COVID-19 and Mpox, or accidental food poisonings. From this standpoint, Egypt has provided a real example for low- and middle-income countries in eliminating the HCV and achieving the goals of WHO by 2030, enabling Egypt to be a safer place on the global travel map.
Ethics approval
Not applicable.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Author contributions
AbdulRahman A. Saied (Conceptualization, Data curation, Formal analysis, writing—original draft) and Asmaa A. Metwally, Zeinab Kamal and Ali B. Roomi (Writing—review and editing). All authors read and approved the final version.
Conflict of interest: None declared.
Data availability
Data are contained within the manuscript.
