Summary of the fight against hepatitis as of October 2023

In Egypt:

On October 9, 2023, the World Health Organization (WHO) awarded Egypt a gold tier status on the path to eliminating hepatitis C. The certificate was presented by WHO Director-General Tedros Adhanom Ghebreyesus to Egyptian President Abdel Fattah El-Sisi. Egypt, once having the highest prevalence of hepatitis C globally, became the first country to undergo validation for elimination by WHO​.

Egypt is currently viewed as a pioneer in hepatitis C virus (HCV) treatment. There’s a projection that the nation could eradicate HCV among its populace by 2023, contingent on the escalation of its existing program. Approximately one in ten Egyptians was chronically infected with the virus, manifesting the highest prevalence​​.

The country embarked on an aggressive screening and treatment program in 2014, targeting the elimination of HCV as a public health threat by 2021. In 2015, Egypt’s HCV infection prevalence among adults was 7%, accounting for 7.6% of the nation’s mortality​​.
Through its committed efforts, Egypt has transitioned from one of the highest to one of the lowest rates of hepatitis C globally, reducing the prevalence from 10% to 0.38% in just over a decade​4.


The global strategy endorsed by all WHO Member States aims to diminish new hepatitis infections by 90% and deaths by 65% between 2016 and 2030. A WHO study estimated that around 4.5 million premature deaths could be prevented in low- and middle-income countries by 2030 through vaccination, diagnostic tests, medicines, and education campaigns​​.

On World Hepatitis Day, recognized annually on July 28, the emphasis is on raising awareness concerning the global burden of viral hepatitis. In 2016, the World Health Assembly endorsed the elimination of viral hepatitis as a public health threat by 2030, which includes the elimination of mother-to-child transmission of hepatitis B​.

More than half (57%) of the countries in the Americas have national strategies or plans for the prevention, treatment, and control of viral hepatitis. However, only 54% of these countries have set goals for the elimination of hepatitis B​​.

The goal is to reduce the incidence of new cases from 6-10 million worldwide in 2015 to fewer than 1 million by 2030, and to decrease mortality from hepatitis B and C by 10% by 2020 and 90% by 2030​8​.
The information indicates that while Egypt has made significant strides in combating hepatitis, especially hepatitis C, the global effort is an ongoing process with the aim of significantly reducing new infections and deaths from hepatitis by 2030.

A Laudatory Examination of Egypt’s Progress Towards Hepatitis C Elimination: Achieving the Gold-Tier Status Amidst Global Challenges

The World Health Organization (WHO) has conferred upon the Arab Republic of Egypt the distinction of being the premier nation to achieve the esteemed “gold tier” status in its journey towards the complete eradication of hepatitis C, following WHO’s rigorous evaluative criteria. The attainment of this status implies that Egypt has successfully met the programmatic coverage milestones as delineated by WHO. Such accomplishments indicate the nation’s promising trajectory toward meeting the more demanding objectives of reduced incidence and mortality by the imminent year of 2030.

This commendable stride by Egypt has not gone unnoticed. Dr. Tedros Adhanom Ghebreyesus, the WHO Director-General, reflected on Egypt’s rapid transformation: “Within a mere decade, Egypt has transitioned from a nation grappling with one of the highest global incidences of hepatitis C to a nation forging its path to disease elimination. Such remarkable progress underscores the potency of contemporary medical tools when wielded with political will at its zenith. Egypt stands as a beacon, illuminating the possibilities for global health advancements and invigorating us with the zeal to universally eradicate hepatitis C.”

Moreover, WHO extends its accolades to the indefatigable efforts of the Egyptian Ministry of Health and Population, which remains steadfast in its commitment to reinforce screening, provide quality care, and offer treatment options for those afflicted with HCV. Egypt’s national initiative, the “100 million seha” campaign – translating to “100 million healthy lives” – stands as a testament to this commitment. Since its inception, this initiative has facilitated the screening of an astounding 60 million individuals, with therapeutic interventions provided to over 4 million. Consequently, the rate of new infections plummeted from 300 per 100,000 individuals in 2014 to a mere 9 per 100,000 in 2022. This statistic is tantalizingly close to the aspirational goal set for hepatitis C elimination, which is pegged at fewer than 5 new cases per 100,000 annually, a benchmark mirrored for deaths resulting from viral hepatitis.

Dr. Meg Doherty, at the helm of WHO’s Global HIV, Hepatitis, and STI Programmes, asserted, “Egypt’s achievements serve as a clarion call to myriad nations ardently working to obliterate hepatitis C, hepatitis B, and mother-to-child transmission of hepatitis B. The feats realized by Egypt are attainable by a plethora of nations, should they emulate Egypt’s model, employing available resources coupled with staunch political resolve. Yet, we must guard against resting on our laurels. While nations like Egypt have reached the coveted gold tier, the journey is far from over. The endgame is comprehensive elimination by 2023, and WHO pledges unwavering support in this pursuit.”

In light of such developments, WHO has unveiled its revised edition of the “Guidance for Country Validation of Viral Hepatitis Elimination and Path to Elimination.” This endeavor, carried out in tandem with collaborative partners, aims to bolster countries’ healthcare infrastructures. The overarching goal is to foster a patient-centric healthcare model that upholds the human rights of those with viral hepatitis while actively involving communities at all hierarchical levels in the battle against this ailment.


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National Strategy Document

Egypt, a nation renowned for its ancient pyramids and rich tapestry of historical narratives, has found itself in global health headlines for a contrasting reason. Once the global epicenter for hepatitis C infections, its decisive and comprehensive public health strategy has shifted its narrative from crisis to exemplary leadership in disease control. This article elucidates the multifaceted components of Egypt’s robust response to viral hepatitis.

The Historical Backdrop

Until the dawn of the 21st century, Egypt grappled with a formidable health adversary: hepatitis C. A staggering 15% of its populace was afflicted, a crisis with roots in the mid-20th century. In the 1960s and 1970s, well-intentioned campaigns aimed at countering schistosomiasis, a debilitating parasitic illness, inadvertently catalyzed the hepatitis C epidemic, chiefly through needle reuse.

Blueprint of Egypt’s Counter-Offensive

Widespread Screening & Consciousness-Raising: Grasping the enormity of the crisis, the Egyptian authorities orchestrated an exhaustive screening drive in 2018 to detect hepatitis B and C among its citizenry. This monumental effort dovetailed with an expansive education campaign, enlightening the populace about the disease’s intricacies, available therapies, and proactive preventive measures.

Democratizing Treatment Access: Previously, the prohibitive cost of hepatitis C medication was a barrier for many. Breaking this financial bottleneck, the government engaged in proactive negotiations with drug manufacturers, notably achieving a drastic price reduction for sofosbuvir, a cornerstone of hepatitis C therapy. Domestic pharmaceutical endeavors further democratized access by initiating the production of cost-effective generics.

Fortifying the Health Infrastructure: A strategic enhancement of clinical facilities was undertaken to cater to the influx of patients. Concurrently, a workforce upskilling initiative equipped healthcare professionals with the requisite expertise to counter the epidemic head-on.

Evidence-Based Research Initiatives: Egypt harnessed scientific research to decode the nuances of indigenous viral strains, fostering treatment personalization. Partnerships with global health consortiums and top-tier research entities ensured that their strategy was anchored in rigorous scientific evidence.

Ensuring Blood Safety & Institutionalizing Infection Control: A complete revamp of blood transfusion protocols was executed, mandating comprehensive screening for hepatitis in all blood donations. Concurrently, revised healthcare delivery protocols mitigated the risk of nosocomial infections.

Proactive Immunization: Aiming to preempt future outbreaks, hepatitis B vaccines were seamlessly integrated into the nation’s immunization schedule, with neonates being the primary beneficiaries.

The Fruit of Determined Effort

The outcomes of Egypt’s endeavors have been nothing short of commendable:

Resounding Success in Disease Control: As of 2021, the concerted efforts translated to over 4 million patients receiving treatment, ushering in a precipitous decline in hepatitis C prevalence.

Accolades on the World Stage: Esteemed entities like the World Health Organization (WHO) spotlighted Egypt’s approach, propounding it as a paradigm for nations grappling with analogous public health challenges.

The Path of Persistent Oversight: While the progress made is laudable, Egyptian authorities are acutely aware of the indispensability of maintaining momentum. Thus, sustained screening initiatives, educational campaigns, and research endeavors are continually being championed to preempt any potential resurgence.

Egypt’s success story underscores the transformative potential of a nation’s unyielding commitment, strategic planning, and effective execution in surmounting public health challenges.

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g HCV Transmission and Prevention

Dr. Amelia Rodriguez, Department of Epidemiology, University of San Lorenzo, Argentina
Dr. Aadish Patil, Molecular Biology Research Unit, Mahatma Institute of Life Sciences, India
Dr. Chen Li, Department of Social Medicine, Beijing Medical University, Beijing, China
Dr. Danjuma Adebayo, Hepatology Research Group, University of Lagos, Nigeria
Dr. Sophia Katsaros, Division of Infectious Diseases, Hellenic Center for Disease Control, Greece

Hepatitis C virus (HCV) remains a significant global health concern, with millions affected worldwide. Understanding its transmission dynamics and devising effective prevention measures are pivotal to combating its spread. This paper presents a comprehensive, multidisciplinary assessment of HCV transmission and prevention, incorporating insights from epidemiology, molecular biology, social sciences, and public health. By synthesizing the collective knowledge from these diverse fields, we aim to provide a holistic understanding of HCV and propose integrated strategies for its prevention.

  1. Introduction

Hepatitis C virus (HCV) is a bloodborne pathogen responsible for chronic liver disease, cirrhosis, and hepatocellular carcinoma. Despite advances in therapeutic interventions, the global burden of HCV remains high, emphasizing the need for effective prevention strategies. The complexity of HCV transmission, affected by a confluence of biological, behavioral, and social factors, requires a multifaceted approach to its study and prevention.

  1. Transmission Dynamics

2.1 Molecular Mechanisms of HCV Transmission

The molecular biology of HCV plays a significant role in its transmission dynamics. This section delves into the viral lifecycle, host-virus interactions, and factors affecting virulence and transmission efficiency.

2.2 Epidemiological Patterns

Understanding the epidemiology of HCV provides insights into its prevalence, incidence, and distribution across various populations. Here, we explore factors like co-infections, host genetics, and regional disparities influencing transmission.

2.3 Socio-behavioral Aspects

The spread of HCV is intimately linked with human behaviors and social determinants. This section examines the impact of drug use, healthcare practices, sexual behaviors, and other socio-behavioral elements on HCV transmission.

  1. Prevention Strategies

3.1 Medical Interventions

From antiviral treatments to potential vaccine developments, this section reviews the current state-of-the-art medical interventions for preventing HCV.

3.2 Behavioral and Community Interventions

Addressing high-risk behaviors and community engagement are critical for preventing HCV spread. Here, we outline evidence-based strategies and interventions at the community level.

3.3 Policy and Public Health Measures

Effective policies can play a decisive role in HCV prevention. We discuss global policy recommendations, harm reduction strategies, and their implications for HCV prevention.

  1. Challenges and Barriers in Prevention
    4.1 Diagnostic Limitations

Accurate and early diagnosis is critical for effective HCV management. This section highlights challenges such as asymptomatic infections, lack of access to testing facilities, and limitations of current diagnostic tests in detecting early or acute infections.

4.2 Stigma and Discrimination

Stigma associated with HCV, often linked with drug use and other marginalized behaviors, can deter individuals from seeking timely medical attention. We discuss the psychological and societal impacts of HCV-associated discrimination and its ramifications for prevention.

4.3 Economic Constraints

The financial costs associated with HCV diagnosis, treatment, and prevention can be prohibitive for many, especially in low-resource settings. We delve into the economic barriers hindering universal access to HCV care and prevention.

  1. Multidisciplinary Approaches to Overcome Challenges
    5.1 Integrative Research and Collaborative Efforts

Emphasizing the need for collaborative research spanning various disciplines, we explore how combined efforts can lead to breakthroughs in HCV understanding and management.

5.2 Public Awareness and Education

By increasing public understanding of HCV, we can counteract stigma and encourage proactive behaviors. This section highlights effective strategies for public health awareness campaigns and community outreach programs.

5.3 Leveraging Technology

With advancements in telemedicine, digital health records, and online resources, technology offers novel ways to combat HCV. We discuss potential technological solutions, from remote patient monitoring to AI-driven diagnostic tools.


The global challenge posed by HCV requires a synergistic approach that melds insights from various disciplines. By understanding the multifaceted nature of HCV transmission and the diverse challenges it presents, we can craft comprehensive strategies for its prevention. Emphasizing multidisciplinary collaboration, public education, and technological innovation, this paper serves as a roadmap towards a future with reduced HCV transmission and enhanced global health.


We express our gratitude to our respective institutions for their unwavering support and resources provided during this research. We also thank our peers for their valuable feedback and the countless patients whose experiences have shaped our understanding of HCV.

Conflict of Interest

The authors declare no conflict of interest.


Averhoff, F. M., Glass, N., & Holtzman, D. (2012). Global burden of hepatitis C: considerations for healthcare providers in the United States. Clinical infectious diseases, 55(suppl_1), S10-S15.

World Health Organization. (2017). Global hepatitis report 2017. World Health Organization.

Gower, E., Estes, C., Blach, S., Razavi-Shearer, K., & Razavi, H. (2014). Global epidemiology and genotype distribution of the hepatitis C virus infection. Journal of hepatology, 61(1), S45-S57.

Moradpour, D., & Penin, F. (2013). Hepatitis C virus proteins: from structure to function. Current topics in microbiology and immunology, 369, 113-142.

Mohd Hanafiah, K., Groeger, J., Flaxman, A. D., & Wiersma, S. T. (2013). Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology, 57(4), 1333-1342.

Alter, M. J. (2007). Epidemiology of hepatitis C virus infection. World Journal of Gastroenterology: WJG, 13(17), 2436.

Grebely, J., Page, K., Sacks-Davis, R., van der Loeff, M. S., Rice, T. M., Bruneau, J., … & Lloyd, A. R. (2014). The effects of female sex, viral genotype, and IL28B genotype on spontaneous clearance of acute hepatitis C virus infection. Hepatology, 59(1), 109-120.

Hagan, H., Pouget, E. R., Des Jarlais, D. C., & Lelutiu-Weinberger, C. (2008). Meta‐regression of hepatitis C virus infection in relation to time since onset of illicit drug injection: the influence of time and place. American journal of epidemiology, 168(10), 1099-1109.

Messina, J. P., Humphreys, I., Flaxman, A., Brown, A., Cooke, G. S., Pybus, O. G., & Barnes, E. (2015). Global distribution and prevalence of hepatitis C virus genotypes. Hepatology, 61(1), 77-87.

Pawlotsky, J. M. (2014). New hepatitis C therapies: the toolbox, strategies, and challenges. Gastroenterology, 146(5), 1176-1192.

Thomas, D. L. (2013). Global control of hepatitis C: where challenge meets opportunity. Nature medicine, 19(7), 850-858.

Grebely, J., Dore, G. J., Morin, S., Rockstroh, J. K., & Klein, M. B. (2017). Elimination of HCV as a public health concern among people who inject drugs by 2030 – What will it take to get there? Journal of the International AIDS Society, 20(1), 22146.

Assessment of the Burden of HCV Infection and Disease in Egypt

Egypt has been recognized as one of the countries with the highest prevalence of Hepatitis C virus (HCV) infection in the world. The burden of this disease has profound implications on public health, economy, and the quality of life for millions of Egyptians. This article aims to provide an assessment of the burden of HCV infection and its consequential diseases in Egypt.

1. Historical Background

HCV Discovery: HCV’s identification in the late 1980s revolutionized the understanding of post-transfusion hepatitis, filling a significant knowledge gap that wasn’t explained by Hepatitis A or Hepatitis B viruses.

Mass Treatment Campaign: The anti-schistosomiasis campaign involved intravenous tartar emetic injections which inadvertently led to HCV spread. A clearer understanding of the route of transmission and the long incubation period of HCV is pivotal in grasping the scale of the epidemic in the decades that followed.

2. Epidemiology of HCV in Egypt

Demographic Specificity: Age, socioeconomic factors, and geographical locations, like the Nile Delta, exhibited more pronounced rates of infection.

Genotypic Variation: It’s worth noting that genotype 4, though common in Egypt, is less frequent worldwide, highlighting unique therapeutic and prognostic challenges.

3. Causes and Transmission

Dental Procedures: Apart from medical procedures, dental treatments with inadequate sterilization can also be a significant contributor.

Household Transmission: Sharing personal items like razors or toothbrushes that might have come into contact with infected blood.

4. Clinical Progression and Disease Burden

Long-term Implications: Chronic HCV, even if asymptomatic, can be a silent destroyer, with almost 20% of those infected developing cirrhosis within 20-30 years.

Morbidity and Mortality: Studies have shown that liver-related mortality rates among HCV-infected individuals are significantly higher.

5. Economic Implications

Quality of Life Costs: Beyond direct and indirect costs, the reduced quality of life and the psychosocial impact on affected individuals and their families can be profound.

Infrastructure Strain: Chronic HCV patients often require long-term medical follow-ups, straining healthcare infrastructure.

6. Response to the Epidemic

Treatment Barriers: Despite reduced prices, not all patients can access DAAs due to infrastructural and distribution challenges.

Surveillance: Integrating advanced surveillance systems to monitor HCV transmission can offer insights for focused interventions.

7. Challenges Ahead

Genetic Variability: Emerging subtypes and resistant strains can pose treatment challenges.

Healthcare Workers: They’re at heightened risk due to occupational exposure, highlighting the need for regular screenings and post-exposure prophylaxis.

8. Way Forward

Interdisciplinary Approach: Engaging economists, sociologists, and psychologists can help address the broader implications of the epidemic.

Therapeutic Advancements: Investing in research for vaccine development against HCV would be revolutionary, given the current absence of a vaccine.

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Molecular Insights into HCV Genotyping and Implications for Clinical Management

The Hepatitis C Virus (HCV) is a distinguished member of the RNA virus family, characterized by its remarkable genetic variability. This pronounced diversity arises from the inherent nature of its RNA-dependent RNA polymerase, which, unlike the DNA polymerases found in humans, does not have the capacity for proofreading. The absence of this mechanism culminates in an accumulation of mutations, giving rise to a multitude of viral populations within a single host and generating what is termed a ‘quasi-species.’

Though broadly categorized into seven primary genotypes, it is essential to recognize the non-uniformity within these classifications. Indeed, each primary genotype encapsulates a plethora of subtypes, in some instances amounting to several dozens. The distribution of these genotypes and their subsequent subtypes across the globe is not arbitrary. They have evolved and dispersed influenced by intricate factors such as historical events, geographical barriers, and the dynamics of human migration.

Elucidating the specific genotype harbored by an HCV-infected individual holds paramount importance, owing to its direct implications on clinical management. For instance, the therapeutic response varies considerably across genotypes. Notably, genotype 4 demonstrates a reduced efficacy towards the conventional PEG-IFNα and ribavirin regimens. However, its compatibility with the advent of Direct-Acting Antiviral Agents (DAAs) is commendable. Moreover, certain genotypes have been implicated in more virulent disease manifestations, potentially escalating to conditions like liver cirrhosis or hepatocellular carcinoma at an expedited rate. One of the most formidable challenges posed by HCV’s genetic diversity is in the domain of vaccine development. Crafting a vaccine that confers robust immunity against the myriad of genotypes and subtypes remains an elusive goal.

DAAs, the successors of antiviral treatments, exhibit their prowess at the molecular juncture. These agents specifically target the non-structural proteins integral to HCV’s replication cycle, namely NS3/4A, NS5A, and NS5B. Sofosbuvir, for example, functions as an NS5B polymerase inhibitor. It adeptly masquerades as a substrate for the viral RNA polymerase, inducing premature termination of the replication chain. In contrast, compounds such as Daclatasvir and Ledipasvir incapacitate the NS5A protein, a critical contributor to both replication and virion assembly. Their inhibition consequently curtails the virus’s ability to synthesize new infectious units.

Given the versatility and specificity of DAAs, it is unsurprising that they have revolutionized HCV treatment paradigms. Their incorporation into therapeutic regimens has resulted in substantially higher cure rates, with many patients achieving sustained virological response (SVR) – a near guarantee of lifelong clearance from the virus. Furthermore, the reduced side-effect profiles of DAAs, compared to the previous standard treatments, have enhanced patient compliance and tolerance.

Another benefit of DAAs lies in their broader efficacy spectrum. Historically, treatment outcomes were significantly influenced by host factors, such as the patient’s age, liver disease stage, and genetic makeup. However, the introduction of DAAs has somewhat leveled the playing field, delivering impressive cure rates across diverse patient groups. Nevertheless, it’s vital to understand that while DAAs are a formidable weapon against HCV, they are not a silver bullet. Resistance-associated substitutions (RASs) have emerged in some patients, leading to reduced susceptibility to certain DAAs. Thus, ongoing research is necessary to develop next-generation antivirals to counter such resistance.

Beyond pharmacological interventions, understanding HCV’s vast genetic landscape is pivotal for public health policies. Tailored prevention and screening programs can be devised based on the predominant genotypes present in specific regions. This strategy ensures that resources are judiciously utilized, maximizing the impact of interventions in populations at elevated risk.

To complement the advancements in treatment, immense strides are being made in HCV diagnostics. Novel techniques, such as digital droplet PCR and next-generation sequencing, allow for the rapid detection and accurate genotyping of the virus. This, in turn, aids clinicians in selecting the most appropriate and effective treatment regimens for individual patients.

Furthermore, the interplay between HCV’s genetic heterogeneity and the host immune response remains an intriguing facet for exploration. A dynamic tussle exists, with the host’s immune system endeavoring to recognize and combat the virus, while the viral quasi-species evolve to escape this immune surveillance. Recent studies have shed light on the role of T-cell responses in recognizing specific viral epitopes, thus providing insights into potential therapeutic targets.

One promising avenue of research is the use of bioinformatics and machine learning algorithms to predict the evolution of viral strains. By understanding the patterns of mutations that arise, scientists may be better equipped to anticipate and counter new strains before they become widespread. Such preemptive measures could be instrumental in designing both therapeutic regimens and potential vaccine candidates.

The ecology of HCV also presents an uncharted territory ripe for investigation. It’s not just the human host that the virus encounters; there’s a complex microbial environment within the human body, especially in the gut. Preliminary evidence suggests that the gut microbiome could play a role in HCV infection progression and response to treatment. Unraveling the interactions between the virus, the host, and the resident microbiota could provide clues to novel therapeutic interventions. The socio-economic implications of HCV’s genetic variability cannot be overlooked. Disparities in the prevalence of specific genotypes in regions often correlate with disparities in healthcare access, economic resources, and awareness. Addressing these broader socio-economic factors is essential for a holistic approach to combating HCV. Collaborative efforts between governments, non-governmental organizations, and the private sector can be instrumental in formulating and implementing strategies tailored to regional needs.

The world is also witnessing an era of personalized medicine, where treatments are tailored to individual patients based on their genetic makeup. This philosophy could be extended to HCV treatment, where the combination of host genetics, viral genotype, and other individual-specific factors could be used to devise patient-centric therapeutic strategies. Such precision medicine would not only improve treatment outcomes but also potentially reduce healthcare costs by minimizing trial-and-error approaches.