In the fight against hepatitis C, directing preventive and curative interventions towards sufferers of chronic diseases requiring regular medical care would be an effective means of reducing transmission of the hepatitis C virus (HCV) in Egypt, and undoubtedly also in other countries with limited resources. This theory has arisen from a mathematical modeling study carried out as part of the ANRS 1211 study, conducted jointly by scientists at the Institut Pasteur, the CNAM and their fellow scientists in Egypt. These results were published in The Lancet Global Health on August 28, 2014.
Paris, August 28, 2014
WHO estimates the number of people infected with the hepatitis C virus worldwide at 150 million, and the annual number of deaths caused by this virus at 350,000. Egypt has the world's highest prevalence of HCV, with 15% of the adult population infected. Over the last year, new antiviral treatments have made it possible to cure over 90% of patients. These treatments are highly effective, and could even have an impact on viral transmission by reducing the reservoir of infected patients within the population. What, then, are the most effective prevention and treatment strategies in terms of reducing hepatitis C transmission in Egypt?
Within the framework of the ANRS 1211 study, scientists from the Emerging Diseases Epidemiology Unit (EDEU) at the Institut Pasteur, led by Professor Arnaud Fontanet, have been using data on viral hepatitis infections gathered over a ten-year period in collaboration with the Egyptian teams of the ANRS FRENSH (France REcherche Nord & Sud Sida-HIV, Hépatites) research site on viral hepatitis in Cairo.
The primary finding of the work carried out by Institut Pasteur and CNAM scientists is that the main viral transmission route in Egypt is via percutaneous medical treatments (for example injections) conducted under non-sterile conditions. Over 50% of these medical treatments are concentrated in only 5% of the population, for the most part patients with chronic diseases (cardiovascular, metabolic or rheumatological diseases) who have frequent recourse to the healthcare system.
This epidemiological situation has been characterized using a mathematical model developed by Romulus Breban (EDEU, Institut Pasteur). Breban explains, "Our modeling study shows that patients who are frequent users of the healthcare system are the first ones to be infected. They then become the main source of infection to others exposed to the same medical procedures, and thus contribute to the continued spread of HCV in Egypt".
The mathematical model subsequently showed that, in comparison with a non-targeted approach, prioritizing preventive and therapeutic actions by targeting the 5% of highly exposed patients would be an efficient way of reducing viral transmission. "Detecting patients suffering from chronic diseases, educating medical staff as well as patients in safe injection procedures and instigating treatment for sufferers of chronic diseases who also have HCV are three key stages in the implementation of an effective strategy for limiting the epidemic in Egypt," explained Professor Arnaud Fontanet (Institut Pasteur, CNAM).
These results are important for healthcare policy makers in Egypt and, more generally, in countries with limited resources, which, with the advent of increasingly costly new treatments, will be forced to adapt their national healthcare strategies accordingly.
Illustration: Histological section of liver infected by hepatitis C. © Institut Pasteur
This project is backed by the ANRS and the Labex IBEID.
Modelling the impact of preventive and curative interventions on HCV transmission in a high prevalence setting: the case of Egypt (ANRS 1211). The Lancet Global Health – August 28, 2014.
R. Breban 1, N. Arafa 2, S. Leroy 1, A. Mostafa 2, I. Bakr 2, L. Tondeur 1, M.A. Hamid 3,4, W. Doss 5, G. Esmat 5, M.K. Mohamed 2 and A. Fontanet 1,6.
(1) Institut Pasteur, Epidemiology of Emerging Diseases Unit, Paris, France
(2) Ain Shams University, Cairo, Egypt
(3) National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
(4) Minia University, Egypt
(5) Cairo University, Egypt
(6) CNAM (French National Conservatory of Arts and Trades), Paris, France
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