[back] Dirty needles
Dirty Needles Kill One Million
From 1964 to 1982 the World Health Organization sponsored a massive
program of tartar-emetic injections in Egypt to wipe out parasitic
bilharzia, and Egyptian healthcare workers unfortunately re-used
unsterilized hypodermic needles again and again and again and again.
At the time, nobody knew exactly what was being transmitted by
all those dirty needles, but when Hepatitis C was eventually
identified, Egypt was reeking with it.
5,500,000 Egyptians have developed chronic hepatitis,
which eventually causes liver failure and death in about 25%
of infected individuals.
As you might expect in a country where sterilization of medical
instruments was more or less unknown only 25 years ago, “treatment
options” are primitive for Egyptians suffering from Hepatitis C, and
even if a giant pharmaceutical corporation in faraway America
developed a miracle cure for Hepatitis C tomorrow, most Egyptians
probably couldn’t afford it.
Viral Time Bomb Set to Explode
By Cam McGrath
CAIRO, May 5 (IPS) - It is a health crisis of alarming proportions. Up to
nine million Egyptians have been exposed to hepatitis C, and tens of thousands
will die each year unless they receive a liver transplant.
Health authorities are taking steps to stop the spread of the blood-borne virus,
but must also contend with higher liver failure mortality rates as the disease
advances in those infected decades ago.
"The prevalence of hepatitis C is not growing, but the impact of an outbreak in
the 1960s and 70s is appearing now as a clinical outcome," says Dr. Mostafa
Kamal Mohamed, professor of community medicine at Ain Shams University in Cairo.
"Liver disease has become the number one healthcare priority for the country and
will continue to be so for the next decade. About 70 percent of all liver deaths
here are due to hepatitis C."
Egypt has the highest prevalence of hepatitis C in the world, the legacy of a
well-intended health campaign that went horribly wrong. In the 1960s, the
government turned to modern medicine in the hope of eradicating bilharzia, a
water-borne parasite that has plagued Egyptian farmers since the dawn of time.
In a tragic irony, the tartar-emetic injections given to Egyptians living in
rural areas cured their bilharzia, but spread another deadly disease among the
population, the hepatitis C virus (HCV).
"At that time, bilharzia treatment was administered intravenously," recalls Dr.
Refaat Kamel, a prominent surgeon and specialist in tropical diseases. "There
were no disposable syringes, so once the needle got infected, the disease spread
quickly from one person to another."
Millions of Egyptians were inadvertently infected with HCV before the World
Health Organisation (WHO) sponsored anti-bilharzia campaign was shut down in
1982. Scientists only discovered the hepatitis C virus in 1987, and it was
another decade before they proved that its high prevalence in Egypt was a
consequence of the mass treatment campaign.
While Egyptian healthcare workers adopted disposable needles in the 1980s, HCV
continued to spread due to improper blood screening and poor hygiene practices.
"There is a laxity in precautions in Egypt," says Kamel. "People are careless or
ignorant where blood is involved, and this has facilitated the transmission of
The results of a national survey released last month show that eight to nine
million Egyptians, more than 10 percent of the population, have been exposed to
hepatitis C, of which approximately 5.5 million are chronic carriers. In some
rural areas over half the adult population carries HCV antibodies.
About 30 percent of people infected with HCV spontaneously clear the virus from
their system within six months, according to studies done in Egypt. The rest
develop chronic hepatitis, which in about a quarter of cases leads to cirrhosis
and liver failure in 20 to 30 years.
Egypt's viral time bomb is about to go off. Doctors estimate that some 30,000
Egyptians die each year of HCV-related liver failure - a figure that is
projected to climb as the disease progresses in those who contracted it during
the 1964-82 anti-bilharzia campaign. "We expect the number of mortalities will
peak in 2012," says Dr. Wahid Doss, head of the National Committee for the
Control of Viral Hepatitis (NCCVH), a government body formed to fight the
NCCVH is implementing an infection control programme in hospitals and blood
banks as part of a national strategy to reduce new HCV infections, estimated at
70,000-140,000 cases a year. It is also spearheading a media campaign to educate
the public on the various routes of blood-to-blood transmission. "Prevention is
a big problem in Egypt - people are still being infected with hepatitis C (due
to risky behaviour)," says Doss. "For example, if you go to a festival you will
find people doing circumcisions or tattooing - the same tool for 50 people."
Treatment options are limited for HCV carriers with end-stage liver disease.
Egypt's prohibition on cadaveric organ transplants and the strict criteria for
living donors limit the number of livers available for transplant. "A few
hundred donor transplants are carried out each year; tens of thousands are
needed," says Kamel. "Without transplants, all these people will die."
Limited organ availability is only one problem. A partial liver transplant can
cost up to 60,000 dollars plus another 10,000 dollars for immunosuppression
therapy - a sum far beyond the reach of most Egyptians. The government has in
some cases subsidised the cost of transplant operations, but it cannot afford to
foot the total bill. "No government on earth could afford to cover the costs of
all liver transplants," asserts Kamel.
Instead, the priority is to treat HCV infections where the disease has not yet
caused severe liver impairment. The standard therapy is a combination of
interferon and the antiviral drug ribavirin. A 48-week course costs 3,500
dollars, but is effective in only 30-50 percent of cases, and can have severe
NCCVH has established 16 treatment centres around the country, which have
provided free interferon shots for 47,000 HCV patients since the programme began
two years ago. The government is spending more than 50 million dollars a year on
the subsidy package, but Doss argues that it is the most sensible and
cost-effective strategy. "You pay per patient now and you save on a liver
transplant 10 years later." (END/2009)