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Ali L, Eldessouki R. Assessment of safe injection awareness and practices among healthcare providers at primary health care facilities. J Egypt Public Health Assoc 2023; 97:29. [PMID: 36600149 PMCID: PMC9813316 DOI: 10.1186/s42506-022-00123-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/22/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Unsafe injection necessitates some preventive steps including promoting and assuring the execution of safe injection administration and waste disposal methods. The present study aimed to assess the awareness and practices of safe injection among health care providers working at all primary health care (PHC) facilities in Fayoum governorate, Egypt. Also, it assessed the awareness, readiness, and response related to needle stick injuries (NSIs). METHODS A cross-sectional observational study conducted from September to December 2019 at all working PHC facilities in Fayoum Governorate, Egypt, resulted in enrolling 685 health care providers, and observation of 520 injection processes. Data were collected by a combination of staff interviews and structured observation of different injection processes using the WHO revised C tool. RESULTS Safe injection and post-exposure NSI policies and procedures was implemented in 96.5% of the PHC facilities. Compliance to hand wash before preparing a procedure was 56.7%. Immediate disposal of used needles was 76.2% in observed injections. Hepatitis B vaccination rate among participants was 87.2%. Most participants 87.6% admitted the existence of a NSI reporting system but only 38.8% of those who had experienced NSI event reported. The rate of NSI was 14%. CONCLUSIONS Fayoum PHC facilities have good awareness level among providers and broadly accepted compliance with injection practices as per the WHO tool. Most injection-safety aspects were satisfactory, and implemented measures to face NSI were in place. Appropriate timely actions are required to maintain the fair awareness and improve injections practices in the PHC facilities.
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Affiliation(s)
- Lamia Ali
- grid.411170.20000 0004 0412 4537Department of Public Health and Community Medicine, Faculty of Medicine, Fayoum University, Faiyum, Egypt
| | - Randa Eldessouki
- grid.411170.20000 0004 0412 4537Department of Public Health and Community Medicine, Faculty of Medicine, Fayoum University, Faiyum, Egypt
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Elbahrawy A, Ibrahim MK, Eliwa A, Alboraie M, Madian A, Aly HH. Current situation of viral hepatitis in Egypt. Microbiol Immunol 2021; 65:352-372. [PMID: 33990999 DOI: 10.1111/1348-0421.12916] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/02/2021] [Accepted: 05/11/2021] [Indexed: 12/12/2022]
Abstract
An estimated 8-10 million people suffer from viral hepatitis in Egypt. Hepatitis A virus (HAV) and hepatitis E virus (HEV) are the major causes of viral hepatitis in Egypt as 50% or more of the Egyptian population are already exposed to HAV infection by the age of 15. In addition, over 60% of the Egyptian population test seropositive for anti-HEV in the first decade of life. HEV mainly causes self-limiting hepatitis; however, cases of fulminant hepatitis and liver failure were reported in Egypt. Hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV) are the main causes of chronic hepatitis, liver cirrhosis, and liver cancer (hepatocellular carcinoma [HCC]) in Egypt. Globally, Egypt had the highest age-standardized death rate due to cirrhosis from 1990 to 2017. The prevalence rate of HBV (1.3%-1.5%) has declined after national infantile immunization. Coinfection of HBV patients with HDV is common in Egypt because HDV antibodies (IgG) vary in range from 8.3% to 43% among total HBV patients. After the conduction of multiple national programs to control HCV infection, a lower rate of HCV prevalence (4.6%) was recently reported. Data about the incidence of HCV after treatment with direct antiviral agents (DAAs) are lacking. An HCC incidence of 29/1000/year in cirrhotic patients after DAA treatment is reported. A higher rate of infiltrative pattern among HCC patients after DAA treatment is also recognized. Viral hepatitis is one of the major public health concerns in Egypt that needs more attention and funding from health policymakers.
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Affiliation(s)
- Ashraf Elbahrawy
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Marwa K Ibrahim
- Department of Microbial Biotechnology, Division of Genetic Engineering and Biotechnology Research, National Research Centre, Giza, Egypt.,Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ahmed Eliwa
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Ali Madian
- Department of Internal Medicine, Al-Azhar University, Assiut, Egypt
| | - Hussein Hassan Aly
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
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Soliman G, Elzalabany MS, Hassanein T, Miller FD. Mass screening for hepatitis B and C in Southern Upper Egypt. BMC Public Health 2019; 19:1326. [PMID: 31640639 PMCID: PMC6805514 DOI: 10.1186/s12889-019-7640-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023] Open
Abstract
Background It is well documented that Egypt has the highest prevalence of hepatitis C virus (HCV) infection in the world. The recent development of highly effective direct acting antiviral drugs (DAAs), has opened the possibility of treating and curing HCV infection in the Egyptian population on a large scale. Methods A screening demonstration project was implemented in southern Egypt in and around the city of Luxor. Free screening and if indicated, treatment, was offered to those 16 years or older for anti-HCV antibodies (anti-HCV) and hepatitis B surface antigen (HBsAg) using third generation enzyme immunoassays (Enzygnost® Anti-HCV and HbsAg). Statistical methods included estimation of odds ratios (OR) and 95% confidence intervals (95% CI). Results There was a large turnout of 67,042 persons who were screened in a 12-month period starting in June 2016. Thirty-one thousand nine hundred sixty-four males (47.7%) and 35,074 females (52.3%) were screened with a mean age of 43.6 ± 14.3 years. Nine thousand seven hundred one patients (14.5%) were positive for anti-HCV and 2950 (4.4%) for HBsAg. Prevalence of anti-HCV was significantly higher in males than females (19.67% vs.9.73% OR = 2.27; CI 2.2 to 2.4; p < 0.001) and the same for HBsAg (6.2% vs. 2.8% OR = 2.3; CI 2.2 to 2.5; p < 0.001). The prevalence of anti-HCV was significantly associated with age (p < 0.001), ranging from between 1 and 4% in individuals below the age of 40 years, then increased steadily to 42% at age 60 followed by a precipitous decline in age specific prevalence. Conclusions The results showed unanticipated patterns in the Luxor area of anti-HCV and HBsAg by age and gender in contrast to previous reports on this unique HCV epidemic in Egypt. Moreover, the level and rate of turnout, cost, and other logistical issues, provided essential information for effective planning, design, and evaluation methods for larger national mass screening and treatment programs.
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Affiliation(s)
- Gamal Soliman
- Tropical Medicine, Gastroenterology and Hepatology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | | | - F DeWolfe Miller
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
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Abo-Amer YEE, Abd-Elsalam S, Eldosoky H, ELShenawy AK, Awny S, Elagawy W, Abgeegy ME, Elsergany HF, Elashry H, Negm MS. Declining prevalence of hepatitis C virus among university students in one of the main governorates in Egypt. Infect Drug Resist 2018; 11:2435-2441. [PMID: 30538509 PMCID: PMC6254504 DOI: 10.2147/idr.s183462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background and aims Egypt is considered to have the highest rate of hepatitis C virus (HCV) prevalence worldwide. However, HCV prevalence is currently declining due to the improvement of health education programs, improved environmental sanitation, and the introduction of novel treatment regimens. The aim of this work was to determine the HCV seroprevalence among Menoufia University students. Methods The current study included 48,972 students from Menoufia University, Egypt. Blood sample was obtained from every patient for HCV seromarker testing. In anti-HCV-positive subjects, quantitative PCR for HCV RNA was done. Results Overall, HCV antibody prevalence rate was 1%. This prevalence was higher in females (304/27,421; 1.1%) than in males (194/21,371; 0.9%). HCV-RNA PCR was positive in 355/48,972 (0.7%); the percentage of HCV PCR positive among the anti-HCV-positive was 71.3% (355/498 patients), with a higher prevalence among females than in males but without statistical significance. In addition, rural areas showed more prevalent HCV seroprevalence than urban areas. Conclusion These prevalence rates for HCV infection are lower than that previously reported in the same age group denoting a new evidence for the reduction of prevalence and a hope for successful eradication of HCV in the forthcoming years.
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Affiliation(s)
- Yousry Esam-Eldin Abo-Amer
- Hepatology, Gastroenterology and Infectious Diseases Department, Mahala Hepatology Teaching Hospital, Gharbia, Egypt
| | | | - Hazim Eldosoky
- Clinical Pathology Department, Student Hospital, Menoufia University, Menoufia, Egypt
| | - Amira K ELShenawy
- Public Health and Community Medicine Department, Tanta University, Tanta, Egypt
| | - Shereen Awny
- Internal Medicine Department, Tanta University, Tanta, Egypt
| | - Waleed Elagawy
- Tropical Medicine Department, National Hepatology and Tropical Medicine Research Institute in Cairo, Cairo, Egypt
| | - Mohamed El Abgeegy
- Tropical Medicine Department, National Hepatology and Tropical Medicine Research Institute in Cairo, Cairo, Egypt
| | - Heba Fadl Elsergany
- Tropical Medicine Department, National Hepatology and Tropical Medicine Research Institute in Cairo, Cairo, Egypt
| | - Heba Elashry
- Tropical Medicine Department, Tanta University, Tanta, Egypt,
| | - Manal Saad Negm
- Internal Medicine Department, Tanta University, Tanta, Egypt
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Alsalawy NF, Darwish RK, Kamal MM, ElTaweel AE, Shousha HI, Elbaz TM. Evaluation of trail receptor 1 (DR4) polymorphisms C626G and A683C as risk factors of hepatocellular carcinoma. J Med Virol 2017; 90:490-496. [PMID: 28975649 DOI: 10.1002/jmv.24964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/06/2017] [Indexed: 01/05/2023]
Abstract
Tumor necrosis factor related apoptosis-inducing ligand (TRAIL) plays an important role in many cancers including hepatocellular carcinoma (HCC). The aim of this study is to investigate the association of the DR4 polymorphisms C626G (Thr209Arg, rs20575) and A683C (Glu228Ala, rs20576) with the occurrence of HCC in Egyptian patients chronically infected with HCV. The study included 80 patients with HCV-related HCC (group 1) and 80 patients with HCV-related liver cirrhosis (group 2) who are naïve to treatment. Clinical and laboratory data were recorded. Genotyping of TRAIL receptor DR4 polymorphism C626G rs20575 and A683C rs20576 SNP was done by Real-Time PCR using taqman probes technology. The mean age of HCC patients was 57.6 ± 8.4 years with 62 patients (77.5%) were males. While group 2 mean age was 49.5 ± 10.29 years with 50% were males. The frequency distribution of rs20575 genotypes showed a statistically significant difference between the two studied groups (P = 0.02), the carriers of the C allele were 2.01 times more likely to develop HCC than the carriers of the G allele (P = 0.003), while no significant difference in rs20576 genotypes distribution was found between the studied groups (P = 0.680). On combining the carriers of C allele of rs20575 and the carriers of A allele of rs20576, a significant difference was detected (P > 0.001) with 2.85 higher risk of HCC development in patients who carried both genetic risk alleles simultaneously. The significant difference in DR4 polymorphisms among HCC and cirrhotic patients suggests their role as potential risk factors of HCC development.
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Affiliation(s)
- Naglaa F Alsalawy
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rania K Darwish
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Manal M Kamal
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed E ElTaweel
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hend I Shousha
- Department of Endemic Hepatogastroenterolog, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tamer M Elbaz
- Department of Endemic Hepatogastroenterolog, Faculty of Medicine, Cairo University, Cairo, Egypt
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Elbahrawy A, Elwassief A, Abdallah AM, Kasem A, Mostafa S, Makboul K, Ali MS, Alashker A, Eliwa AM, Shahbah H, Othman MA, Morsy MH, Abdelbaseer MA, Abdelhafeez H. Hepatitis C Virus Exposure Rate among Health-care Workers in Rural Lower Egypt Governorates. J Transl Int Med 2017; 5:164-168. [PMID: 29085789 DOI: 10.1515/jtim-2017-0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Studies on hepatitis C virus (HCV) in Egypt supported a strong role for various exposures in the health-care setting. In this study, we attempted to estimate the frequency of HCV exposure among Egyptian health-care workers (HCWs). METHODS Five hundred and sixty-four (564) HCWs were included in this study. Two hundred and fifty-eight (45.74%) were health-care providers and 306 (54.25%) were non-health-care providers. All HCWs completed both the study questionnaire and provided a blood sample for anti-HCV testing by third-generation enzyme-linked immunosorbent assay. Subsequently, anti-HCV-positive samples were tested for HCV RNA using nested polymerase chain reaction (PCR). RESULTS The mean age of included HCWs was 33.0 ± 9.8 years; of them, 319 (56.56%) were males and 245 (43.44%) were females. The mean duration of health-care work was 9.3 ± 6.7 years. The frequency of antibody against hepatitis C virus (anti-HCV) among included HCWs was 8.7% (n = 49). Old age and prolonged duration of health-care work were significantly associated with anti-HCV seropositivity. Forty (81.63%) of 49 with anti-HCV-positive HCWs had positive hepatitis C viremia. The frequency of HCV RNA positivity increased with age. The frequency of eradicated past infection among nurses (36.85%) was markedly higher than that (6.7%) detected in non-health-care providers. CONCLUSION High rate of HCV infection is detected in Egyptian HCWs in rural Lower Egypt governorates. Health-care providers seem to eradicate HCV infection more frequently than non-health-care providers. National screening and treatment of infected HCWs are recommended.
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Affiliation(s)
- Ashraf Elbahrawy
- Department of Internal Medicine, Al-Azhar School of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Elwassief
- Department of Internal Medicine, Al-Azhar School of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Arafat Kasem
- Department of Internal Medicine, Al-Azhar School of Medicine, Al-Azhar University, Cairo, Egypt
| | - Sadek Mostafa
- Department of Internal Medicine, Al-Azhar School of Medicine, Al-Azhar University, Cairo, Egypt
| | - Khaled Makboul
- Department of Internal Medicine, Al-Azhar School of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Salah Ali
- Department of Internal Medicine, Al-Azhar School of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Alashker
- Department of Internal Medicine, Al-Azhar School of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Maher Eliwa
- Department of Internal Medicine, Al-Azhar School of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hossam Shahbah
- Department of Internal Medicine, Al-Azhar School of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Abdellah Othman
- Department of Internal Medicine, Al-Azhar School of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Hanafy Morsy
- Department of Microbiology, Faculty of Science, Al-Azhar University, Cairo, Egypt
| | - Mohamed Ali Abdelbaseer
- Department of Clinical Pathology, Al-Azhar School of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hafez Abdelhafeez
- Department of Internal Medicine, Al-Azhar School of Medicine, Al-Azhar University, Cairo, Egypt
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Gürtler LG, Eberle J. Aspects on the history of transmission and favor of distribution of viruses by iatrogenic action: perhaps an example of a paradigm of the worldwide spread of HIV. Med Microbiol Immunol 2017; 206:287-293. [PMID: 28434128 PMCID: PMC5511299 DOI: 10.1007/s00430-017-0505-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/13/2017] [Indexed: 02/07/2023]
Abstract
Transmission of infectious agents might be associated with iatrogenic actions of charitable help in health care. An example is the vaccination against yellow fever in USA that transmitted hepatitis B virus. Another example is injections of praziquantel for treatment and cure of schistosomiasis in Central and Northern Africa, with a focus in Egypt that has spread hepatitis C virus. There is no indication that human T-lymphotropic virus type 1 was spread by injection treatment for African trypanosomiasis, syphilis and treponematosis, but these treatments might have contributed to the early spread of human immunodeficiency virus type 1 (HIV-1) in Central Africa. Slave trade contributed as well to the spread of viruses from Africa to the Americas; it was stopped in 1850. Until that date HIV-1 was not transported to the Americas. By analysis of nucleic acid sequence data it can be concluded that the continental spread of HCV and HIV-1 might have started around 1920 with an exponential phase from 1940 to 1970. Further iatrogenic actions that promoted the spread of HCV and HIV-1 might be vaccinations to prevent deadly diseases. The successful vaccination was followed by diminution of the infectious agent in the population such as small pox, yellow fever and measles. Measurements to reduce the spread of plague and cholera were further benefits increasing survival of diseased subjects in a population. Thus, the reduction of exposure to deadly infectious agents might have given a chance to HIV-1 infected subjects to survive and for HIV-1 to be distributed around the world starting from Central Africa in the 1950s.
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Affiliation(s)
- Lutz G. Gürtler
- Max von Pettenkofer Institute, National Reference Centre for Retroviruses, Ludwig-Maximilians-University of München, Pettenkofer Str 9A, 80336 Munich, Germany
| | - Josef Eberle
- Max von Pettenkofer Institute, National Reference Centre for Retroviruses, Ludwig-Maximilians-University of München, Pettenkofer Str 9A, 80336 Munich, Germany
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Hepatitis C Virus in North Africa: An Emerging Threat. ScientificWorldJournal 2016; 2016:7370524. [PMID: 27610403 PMCID: PMC5004010 DOI: 10.1155/2016/7370524] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/21/2016] [Accepted: 07/19/2016] [Indexed: 02/08/2023] Open
Abstract
Hepatitis C virus is a major public health threat associated with serious clinical consequences worldwide. North Africa is a unique region composed of seven countries that vary considerably in the predisposing factors to microbial diseases both historically and at the present time. The dynamics of HCV in the region are not well documented. The data are both limited and controversial in most of the countries in the region. In North Africa, the epidemiology of HCV is disparate and understanding it has been hampered by regional "epidemiological homogeneity" concepts. As the dynamics of HCV vary from country to country, context-specific research is needed. In this review, we assess studies performed in each country in the general populations as well as among blood donors and groups exposed to the HCV infection. The reported prevalence of HCV ranges from 0.6% to 8.4% in the Maghreb countries and is predominated by genotype 1. In the Nile valley region, it ranges from 2.2% to 18.9% and is dominated by genotype 4. In North African countries, HCV seems to be a serious problem that is driven by different vectors even in different geographical locations within the same country. Efforts should be combined at both the national and regional levels to implement efficient preventive and treatment strategies.
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