As defined by the World Health Organisation (WHO) (2017), Hepatitis C is a blood-borne virus that has the potential to cause liver disease. An individual contracts hepatitis C through the exposure of infectious blood from someone who is already infected with the hepatitis C virus (HCV). This can occur through the use of unsafe injection practices, drug-use via injections and inadequate health care (WHO 2017). Sexual transmission of HCV from unprotected sex or from an infected mother to her baby can also occur (SA Health 2018). Those who are infected are usually asymptomatic (not exhibiting any symptoms), which unfortunately means that their HCV status is gone unnoticed for years and even decades (WHO 2017, p.4). Symptoms such as dark urine and faces, jaundice, fatigue, and vomiting are mostly developed and recognised towards the late chronic stage of hepatitis C when liver damage occurs. Thus, if left untreated, hepatitis C can cause liver cancer (WHO 2017). Hepatitis C is a major worldwide health issue, with approximately 399 000 people dying each year (WHO 2017, p.13). According to Kamal (2018), Egypt is said to have the highest prevalence of hepatitis C in the world with approximately 5 to 7 million people actively infected. Contrastingly, in Australia, only around 227 306 people are living with chronic hepatitis C infection (The Kirby Institute 2016, p.8). There is a big contrast in the prevalence of hepatitis C between Australia and Egypt. This difference in prevalence, which is dependent on the modes of hepatitis C transmission between the two countries, will therefore be discussed in this paper.
Australia and Egypt have vast differences in wealth and economy, population as well as healthcare practices. (Central Intelligence Agency 2018). These differences can account for the contrast in the prevalence and transmission of hepatitis C between the two countries.
According to the Central Intelligence Agency (2018), Egypt is a developing country with an ‘uncertain political, security and policy environment [that] restricts economic growth, [ultimately] failing to alleviate persistent unemployment” The unemployment rate in 2017 for Egypt was 12.2%, means that many men, women and children were being subjected to sex trafficking and forced labour as a way of subsisting oneself. The use of illicit drugs is also common in Egypt (CIA 2018), particularly heroin which is usually injected into the user (The Kirby Institute 2016). This information coincides with what was aforementioned; hepatitis C can be transmitted sexually as well as through injections of drugs.
Kamal (2018), observes that the higher prevalence of hepatitis C in Egypt is reflective in the higher rates of sexual transmission that have been reported. It is estimated that sexual transmission of hepatitis C ranged from 3% to 34% (Kamal 2018, p. 48). This transmission occurred because 15% of the individuals had acute hepatitis C, and thus spread HCV to their sexual partners (Kamal 2018, p. 49). Since Egypt is considered a developing country (CIA 2018), the cause of this high morbidity from HCV via sexual transmission may be ascribed to poor health education, particularly about safe, protected sex (Kamal 2018, p. 15). Fewer people having unprotected sex will therefore increase the likelihood of HCV transmission.
It is well known, however, that the mass population treatment for the parasitic infection schistosomiasis involving administration of antischistosomal injections is the main cause of transmission for hepatitis C in Egypt (Elgharably et al. 2017). This disease was the most prevalent health issue in Egypt prior to hepatitis C (Kamal 2018, p. 42). The cause for transmission of HCV during the Schistosomiasis epidemic was due to a number of factors. Firstly, patients were consecutively treated with antischistosomal injections, which increased the likelihood of pathogen transmission (Elgharably et al. 2017). Secondly, the injections were administered via indispensable syringes and needles that were poorly sterilised and reused each time. This mistake eventually became widespread throughout Egypt and more people became HCV infected (Kamal 2018, p. 34). Unfortunately, due to the fact that hepatitis C affected individuals are asymptomatic for most of their lives, it was only in the last decade or so that HCV infection became clinically evident (Elgharably et al. 2017).
Albeit knowing the high prevalence of hepatitis C, Egypt still faces significant issues with the disease. The absence of insufficient medical strategies in a resource-limited country such as Egypt means that whilst there are standard world-known antiviral treatments available, HCV infected individuals may not have access to the treatments (Kamal 2018, p. 15). For such a small land mass, approximately ninety-seven million people (July 2017 est.) populate Egypt (CIA 2018). Coupling this with the country’s low economic growth, limited resources, high unemployment rate and lack of disease control practices it seems difficult for the country to lower the prevalence of hepatitis C (Elgharably et al. 2017). As a consequence, HCV transmission will continue to ignite if Egypt continues to be in the same state as it is at the current time.
On the other hand, Australia is a well-developed country, described as an advanced market economy having a low unemployment rate (5.6% in 2017) and a low public debt, resulting in the country having a stable and strong financial system (CIA 2018). Already comparing this to Egypt, Australia’s causes for hepatitis C can be assumed to not be related to sex trafficking, an effect of unemployment and low economy. SA Health (2018) verifies this, stating that transmission of hepatitis C via sexual contact is rarely seen in clinical cases. Instead, the Department of Health (2016) found that 90 percent of newly acquired HCV infections and about 80 percent of prevalent cases in Australia are caused by unsafe injecting drug use practices such as sharing injecting equipment.
HCV infections in Australian are also associated with tattooing or body piercing, immigration from a high prevalence country but mostly, being in a closed setting such as a prison (Department for Health and Ageing 2016). Any individuals who are or have ever been incarcerated are associated with having a higher risk of being infected with HCV (SA Health 2018). Larney et.al (2013) reveals that the transmission of HCV in prisons is associated with the high prevalence of risky behaviours, especially among detainees who inject drugs. Despite the strict security in Australian prisons, a substantial amount of injecting drug users (IDU) continue to inject drugs in prison where it is estimated that the prevalence ranged from 3% to 53% (Kinner et al. 2012). Due to the unavailability of sterile injecting equipment in prison, detainees will often share needles, and therefore increasing the risk of being infected with HCV and the likelihood of going on to develop hepatitis C (Larney et.al 2013). Furthermore, in-prison tattooing can often occur, also adding to the risk (Kinner et al. 2012; Larney et.al 2013). A study conducted by Moradi et al. (2018) found that the prevalence of hepatitis C from 2005-2015 in Australian prisons was 26.4%, the highest prevalence of hepatitis C in prisons across the world. This coincides with the fact that the most prevalence offences for prisoners in Australia are associated with possessing and using illicit drugs (Australian Bureau of Statistics 2017). These statistics highlight the major public health concern that Australia faces.
Despite this, since Australia is a country where access to healthcare resources is readily available, hepatitis C testing can always be conducted so that people can determine their hepatitis C status and from there, work with appropriate services to seek treatment (Department of Health 2016). In comparison to Egypt, Australia’s population is far much less, approximately 23 million people (CIA 2018). This makes it easier for infected hepatitis C individuals to be monitored and managed than it would be in Egypt. Due to the fact that Egypt is limited in healthcare resources (Elgharably et al. 2017), it can be presumed that Australia has a better chance to lower the prevalence of hepatitis C through early clinical testing and appropriate treatment plans.
There are similarities and differences between the mode of hepatitis C transmission in Egypt and Australia, which can explain the contrast in prevalence for both countries. Common to both is the transmission through unsafe injection practices such as sharing needles. In Egypt, the main mode of hepatitis C transmission is from the antischistosomal injections that were administered to combat the major Schistosomiasis epidemic. In Australia, it is the transmission of hepatitis C via injection of illicit drugs, especially within prisons. One of the major differences is that sexual transmission of hepatitis C in Egypt is considered highly prevalent, whereas in Australia it is rare. The difference between the common modes of hepatitis C transmissions in Egypt and Australia is largely attributable to available healthcare resources and finances. Egypt is a developing country with limited resources and a poor healthcare system whereas Australia is a well-developed country with strong finances, making resources readily available as well as having a healthcare system that is easily accessible. This results in Egypt having a higher prevalence of hepatitis C compared to Australia.
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