This is a reply from Egyptian Minstry of HealthThe Egyptian MOH reply to the article titled "Egypt: Hepatitis C infection reaches alarming figures": Los Angeles Times, 8th Nov., 2010The Egyptian government considers viral hepatitis and HCV in particular, one the most significant public health priority. therefore, the Egyptian Ministry of Health (MOH) has in the last five years established the National Committee for Viral Hepatitis and has undertaken the following steps towards HCV prevention and control:1) Viral Hepatitis Control Strategy (2008-2012): it was outlined to ensure strengthening and expansion of the national multisectoral response to viral hepatitis. it is available online at: hepegypt.org/htdocs/NSP_10_April_2008_final.pdf

2) National Survey: a national HCV survey was conducted in all Governorates of Egypt to determine the actual prevalence of HCV. the survey was conducted within the context of the Demographic and Health Survey (DHS, 2008) in collaboration with international organizations such as UNICEF, USAID and Macro International. the prevalence in individuals above 15 years was 9.8%

3) HCV Treatment plan: the national HCV treatment program was started in 2006 and has, up to date, treated 125,000 patients in 21 centers that were established within the MOH Hospitals nationwide. the cost of peglycated Interferon per person is about 18,000 EGY Pounds (about 3000 $) and is totally supported by the MOH in what is considered to be one of the largest hepatitis treatment program worldwide.

4) HCV Prevention: the Egyptian MOH has been pursuing a comprehensive Infection Control Program which includes infection control in hospitals and other medical and paramedical settings, in addition to the establishment of a national blood bank, a full coverage rate of childhood vaccination against HBV and a strategy to control infection in high-risk groups as health care workers, sanitation workers and injecting drug users (IDUs). A public awareness campaigns is being conducted using media, and other channels of communication.concerning the article published in the Los Angeles Times on November 8th, 2010; it has the following inaccurate information:- The study mentioned in the article was published in the National Academy of Science, estimated the HCV incidence by using a mathematical models and various assumptions. Caution is required in interpreting the results of such studies. therefore, the figure 500,000 new HCV cases does not reflect the actual number of cases, which needs properly designed incidence studies. moreover, detection of new HCV infection is challenging because the majority of infected cases are asymptomatic.

- Previous studies have estimated the HCV incidence but the validity of their results was limited because of the very small sample size (the majority of these studies were conducted in selected small geographic areas with high HCV prevalence; not representative of the general population or reflecting the national figures). in other words, they lacked the generalizability of their results.

- The most accurate and accepted figure regarding the HCV prevalence in population above 15 years is 9.8% (Egyptian DHS, 2008). the MOH conducted a study to estimate the HCV prevalence in children below 15 years that represent 36% of the total population. the prevalence of HCV in this age group was 0.52%. in other words, the weighted average of overall prevalence is about 6.6%.

- The cost of HCV treatment per person in Egypt is currently about 3000 $ not 12.000 $. the total annual expenditure for HCV treatment in Egypt is about 900 million EGY pounds (about 158 millions $). the vast majority of anti-HCV medicines are imported from international companies and the remaining small portions are manufactured nationally and verified by the local authority. Randomized controlled clinical trials are now underway to study its efficacy, and preliminary results are encouraging. in conclusion, the MOH totally disagrees with the claims that were published in your Journal as it is far from fact or any scientific basis. the figures mentioned in the article were a mix of inaccurate scientific data and wrong subjective interpretation. moreover, the article neglected the achievements that have been done by the Egyptian government towards prevention and control of HCV as the MOH is allocating its maximum available resources in its battle against HCV infection.

Dr.Abdul Rahman Shahen Media Consultant of Egyptian Minstry of Health