Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 8, 2015; 7(28): 2849-2858
Published online Dec 8, 2015. doi: 10.4254/wjh.v7.i28.2849
Epidemiology of hepatitis C virus exposure in Egypt: Opportunities for prevention and evaluation
F DeWolfe Miller, Mahmoud S Elzalabany, Sara Hassani, Diego F Cuadros
F DeWolfe Miller, Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, United States
Mahmoud S Elzalabany, Department of Internal Medicine, Ahmed Maher Teaching Hospital, Cairo 11638, Egypt
Sara Hassani, School of Medicine, Boston University, Boston, MA 02118, United States
Diego F Cuadros, Weill Cornell Medical College - Qatar, Qatar Foundation - Education City, PO Box 24144, Doha, Qatar
Author contributions: All authors contributed to the content of the review and editing manuscript drafts; Miller FD and Cuadros DF analyzed the data on injections; Miller FD wrote the manuscript.
Conflict-of-interest statement: Authors declare no conflicts of interests for this article.
Data sharing statement: The review is based on published work cited in the References. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: F DeWolfe Miller, MPH, PhD, FACE, Professor of Epidemiology, Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo Street, BSB 320C, Honolulu, HI 96813, United States. dewolfe@hawaii.edu
Telephone: +1-808-6921605 Fax: +1-808-6921979
Received: July 1, 2015
Peer-review started: July 6, 2015
First decision: September 22, 2015
Revised: October 24, 2015
Accepted: November 23, 2015
Article in press: November 25, 2015
Published online: December 8, 2015
Processing time: 156 Days and 3.1 Hours
Abstract

AIM: To critically evaluate the current epidemiology data on exposures, rather than infection, to hepatitis C virus (HCV) transmission and recommend epidemiologic strategies to fill gaps.

METHODS: Standard methods for identifying and evaluating relevant epidemiologic literature and available data were used.

RESULTS: There is a large body of literature on the epidemiology of HCV transmission in Egypt that collectively identifies ongoing iatrogenic exposures as the major driver for HCV transmission due to short comings in infection control and standard procedures. Additional epidemiologic studies on HCV transmission that requires the participation of human subject is unwarranted. Alternatively, very little literature was found on the epidemiology of exposure to HCV, infection control, and safe injection practices. The information that is available on patterns of HCV exposure shows high frequencies of inadequate infection control, problems in sterilization in health care facilities, low rates of hand washing, untrained personnel, lack of stated policies in facilities, HCV contamination of instruments and very large injection frequencies with low but very significant syringe and needle reuse. There is an important need to increase the number, size, and diversity of epidemiologic studies on HCV exposures, patterns of risk factors for infection, infection control, and safe injection practices. In addition to health care facilities evaluation, relevant knowledge attitude and practice studies are recommended.

CONCLUSION: Epidemiologic methods on HCV exposure can be used to characterize the magnitude of exposures to HCV infection, target interventions to reduce exposures, and provide the best method for evaluating interventions by demonstrating the reduction of exposure to HCV infection.

Keywords: Epidemiology; Hepatitis C virus; Egypt; Exposure; Prevention; Epidemic

Core tip: Much has been published on the epidemiology of hepatitis C virus epidemic in Egypt. The exposures that drive this epidemic are iatrogenic. This review focuses on what has been published on the epidemiology (patterns, distributions, and related factors) of the iatrogenic exposures. The review found that very little has been published on epidemiology of the exposures driving the epidemic. This is essential for developing effective interventions and evaluating prevention programs. Recommendations are given.