Challenge of hepatitis C in Egypt and hepatitis B in Mauritania

Table 1 Risk factors of the transmission of hepatitis C in Egypt through the healthcare system and proposed interventions

Risk factors	Proposed interventions
Needle stick injuries or other injuries	Institute infection control and occupational health programs in all healthcare facilities to reduce occupational exposure, protect against needle stick, and other healthcare related injuries Adequate education and training of healthcare providers Use of safety-engineered devices, such as needleless intravenous medication systems, blunted suture needles Use of needle disposal containers
Surgical or invasive interventions, dental procedures	Appropriate sterilization of surgical and dental instruments Good aseptic techniques practiced during invasive procedures Provide personal protective equipment, such as gloves, gowns, face/eye shields, to be used during procedures with anticipated blood exposure
Exposure to medical equipment, hemodialysis machines and procedures	Strict infection control and prevention policies Universal precautions should be used when caring for all patients
Injection and IV insertion	Use of self-sheathing needles, needleless connectors, needleless intravenous medication system, and needle disposal containers
Blood transfusion from poorly screened individuals (false negative anti-HCV)	Universal screening of all donors
Organ donation	Universal screening of all donors

HCV: Hepatitis C virus.

Table 2 Direct-acting antiviral regimens available to treat hepatitis C virus genotype 4

1Combination regimen[43,44]	Duration (wk)
Sofosbuvir-ledipasvir	12
Sofosbuvir-velpatasvir	12
Glecaprevir-pibrentasvir	8 (without cirrhosis)
	12 (with cirrhosis)
Sofosbuvir-velpatasvir-voxilaprevir	12
Ombitasvir-paritaprevir-ritonavir ± ribavirin	12
Elbasvir-grazoprevir ± ribavirin	12-16
Elbasvir-grazoprevir	12 (treatment naïve)
Elbasvir-grazoprevir + ribavirin	16 (treatment experienced)
Sofosbuvir + ribavirin	24
Sofosbuvir + daclatasvir ± ribavirin	12
Sofosbuvir + simeprivir ± ribavirin	12-24

¹The information from the table is from the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL) hepatitis C virus guidelines.

Table 3 Risk factors of transmission of hepatitis B in Mauritania and proposed interventions

Risk factors	Proposed interventions
Direct contact with infected blood and or handling blood or body fluids (job exposure)	Rigorous adherence to standard precautions in healthcare settings Completely avoid sharing needles or re-using disposable devices Education of healthcare providers and patients Hepatitis B vaccinations and assessment of response to vaccine (hepatitis B surface antibody) Use of safety-engineered devices and needless infusion systems Use of sharp object disposal containers Strict infection control measures upon cleaning and reusing medical equipment Appropriate screening of blood donors Post-exposure prophylaxis Antiviral therapy
Sharing needles or other equipment (such as cotton, spoons, and water) to inject drugs
Hemodialysis
Intimate contact with a person with HBV	Hepatitis B vaccination Avoid sharing toothbrushes, razors, etc.
Multiple sex partners or having unprotected sex with someone who is infected with the virus	Hepatitis B vaccination Protected sexual intercourse
Mother-to-Child transmission	Screening pregnant women Antiviral therapy to pregnant women with high DNA levels Passive-active immunization of newborns of mothers with HBV Universal vaccination of newborns
Body piercings, tattoos or acupuncture	Avoid body piercing and tattoos Strict infection control and prevention policies
IV drug users	Avoid sharing syringes and needles

HBV: Hepatitis B virus.