Epidemiology and control of scabies in an Egyptian village.

BACKGROUND: Some studies have addressed the epidemiology of scabies among rural populations in developing countries; however, the epidemiology of scabies among the rural population in Egypt is unknown. We sought to determine the magnitude of scabies infestation in an Egyptian village and to evaluate the control measures after 1 year. METHODS: This study was carried out on 3147 residents of Mit-Moaned village in Dakahlia govemorate, Egypt. It was a cross-sectional follow-up study where the same individuals examined in round I were re-examined in round III. The two rounds were separated by a period of 1 year, during which infested patients were followed up and new cases were discovered (round II). Patients and their household contacts received treatment with topical permethrin. Patients showing resistance to permethrin received a single oral dose of ivermectin. RESULTS: In round III, the overall prevalence rate of scabies was reduced from 5.4% in round I to 1.1%. The incidence of new cases among susceptible persons during round II was 1.1%. Scabies was significantly (P < 0.05) more prevalent among families of large size, high crowding index at night, low socioeconomic standards, and those receiving their water supply from a hand pump. Children younger than 10 years showed the highest prevalence. CONCLUSIONS: Our data provide the first complete picture of the epidemiology of scabies in rural Egypt. The epidemiologic characteristics of the disease should be considered in the design of disease control programs for other villages with scabies epidemics. Our findings revealed that good control was achieved with the following: increased awareness and better case finding, education of the staff at the rural health unit, improved hygiene measures, and massive treatment campaigns using effective drugs such as topical permethrin and oral ivermectin.

Hepatitis G virus in Egyptians infected with other parenterally transmitted hepatitis viruses.

A novel hepatitis-associated virus, hepatitis G virus (HGV) has recently been identified. The virus is known to be parenterally transmitted and has been found frequently in subjects chronically infected with hepatitis C virus (HCV). We investigated the seroprevalence of HGV infection in 91 Egyptians infected with hepatitis C and/or B virus including 52 patients with chronic liver disease and 39 asymptomatic subjects. A newly developed immunoassay was used to detect antibody to HGV envelope protein E2. The overall prevalence of anti-HGV in study subjects was 34.1%. Hepatitis G virus antibody was more frequent in patients with chronic liver disease (36.4%-43.9%) than in asymptomatic persons (23.1%). Analysis of demographic features, risk factors and clinical history of the study population revealed that older age and history of schistosomiasis were the factors significantly associated with anti-HGV positivity. The study demonstrated that HGV is highly prevalent in individuals infected with other parenterally transmitted hepatitis viruses. The impact of such observation rises in view of the endemicity of hepatitis C and B viruses in Egypt.

Association of hepatitis C virus with liver cirrhosis and hepatocellular carcinoma compared with hepatitis B virus in Egyptian patients.

Hepatocellular carcinoma (HCC) is an aggressive malignancy and carries a poor prognosis. Documentation of the wide geographical variation in its incidence has led to clear identification of several risk factors. These include hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in endemic areas. The present study investigated the association of HBV with HCV and cirrhosis, the latter is regarded as a premalignant lesion and underlies most cases with HCC. Serum samples from 94 patients with HCC (n=25) and cirrhosis (n=69) were tested for hepatitis C virus antibody (anti-HCV), hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) and serum alphafetoprotein (AFP). Of the 94 patients, 71 (75.5%) had anti-HCV, 6 (6.4%) were positive to HBsAg, while 64 (68.1%) were positive to anti-HBc. These viral markers were more prevalent among HCC patients, 19 (76.0%) had hepatitis C antibody, 3 (12.0%) were positive to HBsAg and 22 (88.0%) were positive to anti-HBc compared with 52 (75.4%), 3 (4.3%) and 42 (60.9%), respectively in patients with cirrhosis. Regarding serum AFP measurement, 14 (56%) of patients with carcinoma and 35 (50.7%) of patients with cirrhosis demonstrated levels above 7 ng/ml. In patients with cirrhosis, elevated serum AFP and presence of anti-HCV in serum were significantly associated. In conclusion, this study shows that viral hepatitis is strongly associated with the development of cirrhosis and HCC in Egyptian patients. Hepatitis C virus seems to play a predominant role compared with hepatitis B virus.

Study of the high prevalence of HCV in Egypt.

The correlation of schistosomiasis and other variables as a risk factor behind the remarkable high rates of HCV seropositivity in Egypt was studied by examining the sera of 188 subjects (94 apparently healthy villagers and 94 non professional blood donors) for schistosoma antibodies by Falcon assay screening test enzyme linked immunosorbent assay (FAST-ELISA) and for HCV antibodies by the application of screening (ELISA) and confirmatory (RIBA) techniques. The results showed that the overall prevalence of HCV antibodies was 29.8% by ELISA reduced to 21.8% i.e. 73.2% confirmation by RIBA test. HCV-RNA (HCV viraemia) was detected in 76% of 25 ELISA anti-HCV positive sera by P.C.R. technique. After adjustment for age, there was no statistical significant correlation between the remarkable high rates of HCV seropositivity in Egypt and risk factors studied other than blood transfusion, and schistosomiasis.

Hepatitis C and B viruses, and their association with hepatocellular carcinoma in Egypt.

Hepatitis C and B viruses are associated with hepatocellular carcinoma in Europe, Asia and Southern Africa. A study of hepatitis C and hepatitis B virus infection was carried out on 70 patients with HCC, from the National Cancer Institute, Cairo University. Sera from patients were tested for anti-HCV and HBsAg markers. Twenty patients (30%) were anti HCV positive alone, 15 (21.4%) were HBsAg positive alone, 28 (40%) were positive for both anti-HCV and HBsAg and the remaining 6 patients (8.6%) were negative for the two markers. The total positivity for anti-HCV and for HBsAg in these patients was 70% and 61.4% respectively. The comparable figures in a recent study on 90 blood donors from Egypt, were 24.4% for anti-HCV and 4.4% for HBSAg. These data suggest a possible link between HCV and HBV infection and the development of hepatocellular carcinoma in Egypt, as has been found elsewhere in the world.

Hepatitis C virus infection in blood donors in Egypt.

A study was carried out on 90 serum samples from non-professional blood donors to find out the relative prevalence of HBV and HCV among those blood donors. Results demonstrated overall positivity rate of 14.4% for anti-HCV by RIBA test. The percentage of reactive sera was 6% for the age group of 20 to below 30 years, and 37.5% in those aged above 30 years, and this difference was statistically significant. Considering the combined reactivity of the tested 90 sera for anti-HBs and anti-HCV, the results showed that 41.1% of the sera were positive for anti-HBs; 10% reacted positively with both anti-HBs and anti-HCV, and 4.4% of the sera were positive for anti-HCV only. The high prevalence of anti-HCV in this study (14.4%) exceeds that reported in other countries, and is comparable with that of Saeed and associates (1991). These results may indicate endemicity of HCV in Egypt and/or a possible role of the endemic schistosomiasis. On the basis of data, suggesting that anti-HCV reflects persistent infection rather than immunity, screening for anti-HCV should be included in all blood transfusion services to exclude HCV which is responsible for 90% of PTH (Van der Poel et al., 1990; Weiner et al., 1990; and Esteban et al., 1991). The remarkably high seroprevalence of anti-HCV among Egyptian volunteer blood donors, which has not so far been reported from other countries, should be thoroughly studied. This should cover many aspects including large epidemiological studies, factors pertinent to Egypt as schistosomiasis, and other possible factors that might enhance HCV transmission in Egyptian population. High risk groups as the polytransfused and renal dialysis patients should be studied. Needless to say that, an accurate measure of HCV prevalence depends on specificity and sensitivity of the employed laboratory diagnostic tests; development of new tests for the detection of antibodies to HCV, together with development of tests for other markers such as HCV antigen and the polymerase chain reaction to detect HCV DNA in blood, will be of great help.