title: The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt.
abstract: BACKGROUND
  The population of Egypt has a heavy burden of liver disease, mostly due to chronic infection with hepatitis C virus (HCV). Overall prevalence of antibody to HCV in the general population is around 15-20%. The risk factor for HCV transmission that specifically sets Egypt apart from other countries is a personal history of parenteral antischistosomal therapy (PAT). A review of the Egyptian PAT mass-treatment campaigns, discontinued only in the 1980s, show a very high potential for transmission of blood-borne pathogens. We examine the relative importance of PAT in the spread of HCV in Egypt.
  
  
  METHODS
  The degree of exposure to PAT by cohort was estimated from 1961-86 Ministry of Health data. A cohort-specific exposure index for PAT was calculated and compared with cohort-specific HCV prevalence rates in four regions.
  
  
  RESULTS
  HCV prevalence was calculated for 8499 Egyptians aged 10-50 years. A significant association between seroprevalence of antibodies to HCV and the exposure index (1.31 [95% CI 1.08-1.59]; p=0.007) was identified across four different regions. In all regions cohort-specific HCV prevalence was lowest in children and young adults than in older cohorts. These lower prevalence rates coincided with the gradual and final replacement of PAT with oral antischistosomal drugs at different points in time in the four regions.
  
  
  CONCLUSIONS
  The data suggest that PAT had a major role in the spread of HCV throughout Egypt. This intensive transmission established a large reservoir of chronic HCV infection, responsible for the high prevalence of HCV infection and current high rates of transmission. Egypt's mass campaigns of PAT may represent the world's largest iatrogenic transmission of blood-borne pathogens.
authors.affiliation: University of Maryland, School of Medicine, Department of Epidemiology and Preventive Medicine, Baltimore, USA. tstrickland@som.umaryland.edu
authors.forename: C
authors.initials: C
authors.lastname: Frank
authors.forename: M K
authors.initials: MK
authors.lastname: Mohamed
authors.forename: G T
authors.initials: GT
authors.lastname: Strickland
authors.forename: D
authors.initials: D
authors.lastname: Lavanchy
authors.forename: R R
authors.initials: RR
authors.lastname: Arthur
authors.forename: L S
authors.initials: LS
authors.lastname: Magder
authors.forename: T
authors.initials: T
authors.lastname: El Khoby
authors.forename: Y
authors.initials: Y
authors.lastname: Abdel-Wahab
authors.forename: E S
authors.initials: ES
authors.lastname: Aly Ohn
authors.forename: W
authors.initials: W
authors.lastname: Anwar
authors.forename: I
authors.initials: I
authors.lastname: Sallam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017848:Blood-Borne Pathogens; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006526:Hepatitis C / Q000635:transmission*; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012552:Schistosomiasis / Q000188:drug therapy*; D012556:Schistosomicides / Q000008:administration & dosage*
chemical_list: D012556:Schistosomicides