Abstract
Egypt is the country with the world's largest hepatitis epidemic C. This epidemic is attributable to the transmission of the hepatitis virus C during campaigns to treat bilharzia with intravenous injections of antimony salts in the 1960s and 1970s. With the arrival of the first diagnostic tests in the 1990s, the Egyptian government became aware of the scale of the disaster, as cirrhosis and liver cancer emerged as late complications of the infection. In 2008, in a survey of a representative national sample, the prevalence of chronic infections was estimated at 10 % among adults, i.e. 6 million infections in the country. However, given the very long incubation period of the disease (20 to 30 years), the worst is yet to come : modelling work shows that the peak of cirrhosis mortality should occur in 2020, and hepatocarcinoma in 2035.
Several case-control studies in Cairo hospitals and cohort studies in rural areas have identified the factors associated with transmission of the virus in the 2000s : these are primarily medical injections and intravenous infusions, surgical procedures and dental care such as scaling. Transmission within the same household remains limited, estimated at 5 % of new cases. While prevention programs (limiting injections, using single-use equipment and sterilizing repeated-use devices) were being put in place, the Egyptian government decided to launch a national treatment program for chronically infected patients. While the combination of pegylated interferon and ribavirin cured 60 % of patients, at the cost of a long, arduous and expensive treatment (several thousand euros), the first direct-acting antivirals were introduced in mid-2010 . These treatments, taken orally for 12 weeks, have few side effects, and cure rates in excess of 95 %. The Egyptian government opts for local production of generics of these treatments, and manages to supply them at costs 1 000 times lower than those charged in industrialized countries ($74 versus $75,000 for the sofobusvir-daclatasvir combination). Since October 2018, Egypt has been running a nationwide screening campaign covering 65 million individuals. The road to elimination is still long, but the progress made in Egypt has been remarkable after the seriousness of the situation was recognized.
