Mohamed A. Daw

Hepatitis C Virus in Arab World: A State of Concern

Hepatitis C virus has been considered to be one of the most important devastating causes of chronic hepatitis, cirrhosis, and hepatic cellular carcinoma. The prevalence of such virus varies greatly over the world. Arab world has a unique geography and consists over nineteen countries who share the same heritage and customs and do speak the same language. In this area, the epidemiology of hepatitis C is not well understandable. Hepatitis C virus was found to be endemic in Arabia. The serostatus of such virus was found to be variable among these countries with uniform patterns of genotypes. Such prevalence varies tremendously according to the risk factors involved. Blood and blood products, haemodialysis, intravenous, and percutaneous drug users, and occupational, habitual, and social behavior were found to be the important factors involved. Hepatitis C will have major social, economic, and even political burdens on such young and dynamic societies. Thus, strategies and clear policy of intervention are urgently needed to combat the consequences of HCV both regionally and at state level of each country.

Prevalence of hepatitis B and hepatitis C infection in Libya: results from a national population based survey

BackgroundLibya is one of the largest countries in Africa and has the longest coast in the Mediterranean basin facing southern Europe. High rates of prevalence of viral hepatitis have been observed in various regions in Africa, but the prevalence in Libya is not well documented. We report on a large-scale nationwide study that evaluated the epidemiology of hepatitis B and hepatitis C in Libya and assessed the risk factors involved.MethodsA cross-sectional study was carried out in 2008 on 65,761 individuals all over Libya. The country was divided into 12 regions according to the population density and sampling within each region was carried out under the supervision of the National Centre for Prevention of Infectious Diseases. Serum samples were collected from both males and females of all ages in both urban and rural areas and tested for HBsAg for hepatitis B and anti-HCV antibody for hepatitis C. Prevalence rates were determined in regions and in different groups and correlated with different demographic and risk factors involved in the spread of these viruses.ResultsThe prevalence of hepatitis B and hepatitis C viruses varied regionally across the country. The overall prevalence of hepatitis B was 2.2% (95% CI 2.1%-2.3%) and was higher among males than females (1.4:1.0). Hepatitis C virus (HCV) prevalence was 1.2% (95% CI 1.1-1.3) and it increased gradually after the age of 30 years (0.7-0.9% for < 30 years; 3.6% for ≥ 60 years). Prevalence of HBsAg was 0.8-0.9% below the age of 10 years, and higher but similar in older age groups (2.3-2.7%). There was an association between literacy and prevalence of hepatitis, particularly for HCV. Hospital admission, surgical operation, blood transfusion, and intravenous drug use were the main risk factors, and they were associated independently with a higher prevalence rate of viral hepatitis.ConclusionsLibya may be considered an area of low-intermediate endemicity for hepatitis B virus infection, with lower rates in young age groups, and an area of low endemicity for hepatitis C. The prevalence of hepatitis B and C across Libya is not homogeneous, with indications of the effect of the higher rates in some neighbouring countries. Libya should adopt full coverage national plans and guidelines to face the future consequences of viral hepatitis, particularly hepatitis C virus.

Seroprevalence of HBV, HCV & HIV Co-Infection and Risk Factors Analysis in Tripoli-Libya

Background In 1998 Libya experienced a major outbreak of multiple blood borne viral hepatitis and HIV infections. Since then, no studies have been done on the epidemic features and risk factors of HBV, HCV, HIV and co-infection among the general population. Methods A prospective study was carried out using a multi-centre clustering method to collect samples from the general population. The participants were interviewed, and relevant information was collected, including socio-demographic, ethnic, and geographic variables. This information was correlated with the risk factors involved in the transmission of HBV, HCV and HIV. Blood samples were collected and the sera were tested for HBsAg, anti-HCV and anti-HIV using enzyme immunoassay. Results A total of 9,170 participants from the nine districts of Tripoli were enrolled. The average prevalence of HBsAg was 3.7%, anti-HCV 0.9%, anti-HIV 0.15% and co-infection 0.02%. The prevalence varied from one district to another. HBV was more prevalent among those aged over 50 years and was associated with family history. Anti-HCV and anti-HIV were more prevalent among those aged 20–40 years. Intravenous drug use and blood transfusion were the main risk factors for HCV and HIV infection. Conclusion HBV, HCV, HIV and co-infection are relatively common in Libya. High prevalence was associated with geographic, ethnic and socioeconomic variability within the community. HCV and HIV infections among the younger age groups are becoming an alarming issue. Regulations and health care education need to be implemented and longer term follow-up should be planned.

Hepatitis C Virus in North Africa: An Emerging Threat

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.

Geographic integration of hepatitis C virus: A global threat

AIM To assess hepatitis C virus (HCV) geographic integration, evaluate the spatial and temporal evolution of HCV worldwide and propose how to diminish its burden. METHODS A literature search of published articles was performed using PubMed, MEDLINE and other related databases up to December 2015. A critical data assessment and analysis regarding the epidemiological integration of HCV was carried out using the meta-analysis method. RESULTS The data indicated that HCV has been integrated immensely over time and through various geographical regions worldwide. The history of HCV goes back to 1535 but between 1935 and 1965 it exhibited a rapid, exponential spread. This integration is clearly seen in the geo-epidemiology and phylogeography of HCV. HCV integration can be mirrored either as intra-continental or trans-continental. Migration, drug trafficking and HCV co-infection, together with other potential risk factors, have acted as a vehicle for this integration. Evidence shows that the geographic integration of HCV has been important in the global and regional distribution of HCV. CONCLUSION HCV geographic integration is clearly evident and this should be reflected in the prevention and treatment of this ongoing pandemic.

Viral Haemorrhagic Fever in North Africa; an Evolving Emergency

Viral hemorrhagic fever has been associated with high mortality rate which brought serious concern for public health worldwide and prompted a sense of urgency to halt this infection. The clinical symptoms are very general and could be easily missed, consisting of onset of fever, myalgia, and general malaise accompanied by chills. In unstable countries of North Africa with fragile health services complicated with armed conflicts and population displacement, such infections could be easily confused with other local parasitic and viral diseases. Libya has the longest coast in North Africa facing the South European region. Emerging of Viral hemorrhagic fever in this region will pose an evolving risk to the European countries and thus worldwide. An outbreak of unidentified VHFs was reported in June/July 2014 among twenty three African patients from immigrants encamps in North West of Libya, twelve of them reported dead. The clinical and laboratory evidences strongly suggest VHF as the likely cause. Since then no more similar cases were reported till February 2015. With the arrival of viral hemorrhagic fevers in North-West of Libya, the South European countries is now at severe risk, then it is only a matter of time before it becomes apparent in developed countries. This review aims to highlight a recent spread of VHFs in North Africa in the light of political instability associated with massive immigration from the endemic areas of West African countries.

Influence of Healthcare-Associated Factors on the Efficacy of Hepatitis C Therapy

Hepatitis C infection is a complex entity associated with sizable morbidity and mortality, with great social and economic consequences that put a heavy potential burden on healthcare systems allover the world. Despite the great improvement of hepatitis C virus (HCV) therapy and its high clinical efficacy, major influencing factors are still hindering and diminishing the effectiveness of hepatitis C treatment. This minimizes the quality of life of the infected patients and reduces the outcome of such therapy, particularly in certain groups of patients such as intravenous drug users and patients coinfected with human immune deficiency virus (HIV). A variety of factors were evolved either at patient individual level, healthcare providers, community surrounding levels, or healthcare setting systems. Analyzing and understanding these factors could help to improve HCV interventions and, thus, reduce the burden of such infection. The objectives of this paper were to highlight such factors and outline the holistic approaches that could be used to overcome such factors.

The role of hepatitis C virus genotyping in evaluating the efficacy of INF-based therapy used in treating hepatitis C infected patients in Libya

Background: Hepatitis C virus (HCV) therapy has been evolved over years and many parameters were used to evaluate such therapy particularly genotyping. In North Africa and Eastern Mediterranean the genotypes vary from most of world and rarely studies were conducted to assess the influence of such genotypes on the HCV therapy. Aims: This study was designed to determine; the role of HCV genotyping in assessing the efficacy of interferon therapy and to analyze the rates of sustained virological response (SVR) in INF and PegIFN-based regimens according on HCV genotype infecting Libyan patients with chronic hepatitis C infection. Methods: A total of 479 patients with chronic HCV registered at Tripoli Medical Centre were treated with ‘INF alfa or PEGINF- Pegylated INF alfa 2a in combination with ribavirin’ for a five year period. These patients were registered and followed up from January 2007 to October 2012. The information were reviewed and data were collected from each patient regarding age, gender, ALT level, and viral load, viral genotype using qualitative PCR. The statistical analysis were carried using SPSS version 11.5. Results: Of the patients studied 86 patients were treated with INF based regimen, only 54% of them had end treatment response (ETR) and 28% had SVR. Off 143 patients treated with peg-INF alfa 2a based therapy; 69% had ETR and 36% had SVR. The SVR of Peg-INF based regimen was higher than INF based regimen in all genotypes except for genotype 4. The relationship between SVR and gender was significant in patients who were given INF based therapy comparable to PEG INF based regimen, though the relationship between SVR and age, basal viral load and basal ALT were also reported in both regimens. Conclusions: HCV genotyping has been found to play an important valuable role in determining the efficacy of Hepatitis C therapy. SVR vary according to the HCV genotype involved. HCV genotype 1 and 4 were found to be the prevalent resistant genotypes infecting Libyan patients. Such findings are particularly important in guiding the clinical therapy of patients infected with hepatitis C virus.

Modelling the prevalence of hepatitis C virus amongst blood donors in Libya: An investigation of providing a preventive strategy

AIM To determine hepatitis C virus (HCV) seroprevalence among the Libyan population using blood donors and applying the autoregressive integrated moving average (ARIMA) model to predict future trends and formulate plans to minimize the burden of HCV infection. METHODS HCV positive cases were collected from 1008214 healthy blood donors over a 6-year period from 2008 to 2013. Data were used to construct the ARIMA model to forecast HCV seroprevalence among blood donors. The validity of the model was assessed using the mean absolute percentage error between the observed and fitted seroprevalence. The fitted ARIMA model was used to forecast the incidence of HCV beyond the observed period for the year 2014 and further to 2055. RESULTS The overall prevalence of HCV among blood donors was 1.8%, varying over the study period from 1.7% to 2.5%, though no significant variation was found within each calendar year. The ARIMA model showed a non-significant auto-correlation of the residuals, and the prevalence was steady within the last 3 years as expressed by the goodness-of-fit test. The forecast incidence showed an increase in HCV seropositivity in 2014, ranging from 500 to 700 per 10000 population, with an overall prevalence of 2.3%-2.7%. This may be extended to 2055 with minimal periodical variation within each 6-year period. CONCLUSION The applied model was found to be valuable in evaluating the seroprevalence of HCV among blood donors, and highlighted the growing burden of such infection on the Libyan health care system. The model may help in formulating national policies to prevent increases in HCV infection and plan future strategies that target the consequences of the infection.

Mapping the travel route of African refugees who traverse Libya to determine public health implications for Libya and the North-African region

On December 13, 2015, Libya’s National Centre of Disease Control (NCDC), Ministry of Health issued an official statement confirming a single undefined case of malaria in a pregnant Libyan national residing in the southern region (NCDC 2015) [1]. This case (diagnosis based upon laboratory testing) followed the September publication of a Letter by Martelli et al. [2] on malaria in African emigrants who had traversed Libya during their immigration to Europe. The authors reported identification of two Plasmodium falciparum-positive carriers who were Malian immigrants who presented at Italian travel clinics following development of classic and general symptoms of malaria (i.e. pyrexia, cephalgia, arthralgia); antimalarial treatment led to full recovery for both patients. The years-long immigration routes of both patients began in the eastern region of Africa (i.e. Mali) and traversed various sub-Saharan and North African countries to reach the EU through Italy; both of the patients reported having resided in Libya for several years during their immigration. Martelli et al. [2] concluded that both of these immigrants acquired P. falciparum during the immigration travel period, likely during their extensive residence in Libya, classified as a non-malarious region. These two cases may represent the reappearance of malaria in Libya, as supported by the very recent reported case involving a Libyan national. Thus, it is important to explore the possible epidemiological route of this infectious disease to within Libya’s borders. Recent years have seen a drastic increase in African migrants traversing Libya. I