Reply: To PMID 22366833.

Thank you for your interest in our article. In fact, according to the World Federation of Hemophilia Report last survey in 2010,1 there are 5307 hemophiliacs in Egypt. It is true that 100 hemophilia patients is not enough to be generalizable to the Egyptian hemophilia population in general and the pediatric group in particular, but our study is a cross-sectional one with children collected from two of the biggest hematology referral centers for hemophiliacs in Egypt. This is referred to in the title by saying in a “cohort” of Egyptian children meaning “group.”

Although the prevalence of HCV among patients with inherited coagulation disorders is 48.3% in Eastern Mediterranean region, it can exceed that percentage in Egypt. This can be attributed to the lack of accurate medical data as a lot of patients with inherited coagulation disorders, especially mild forms, receive replacement therapy irregularly and in different places and so are usually not screened for HCV. A screening program for HCV has started in Egypt in 1994 and is currently mandatory for all blood donors to be routinely screened. The study by Khalifa et al, among subjects with hematologic disorders before implementing the screening program, showed a HCV prevalence of 15%—higher than in our study group, pointing to the relative efficacy of the screening program. 2 This is further supported by another recent report that included only thalassemic patients showing a decrease in the prevalence of HCV antibody in our hospital hematology department pediatric patients from 71% in 1995 to 51.7% in 2011.3

In view of the significantly lower mean age of children with negative HCV antibody as opposed to those with positive HCV antibody, age can be considered another indicator of the relative efficacy of the screening program. However, it was better to compare the HCV infection rate of hemophilia patients before and after transfusion transmitted infections screening program for determination of the program efficacy. This was not possible in view of inavailability of accurate medical records are available to make this comparison as patients who were children at the time the screening program started are either lost to follow up or are followed in adult medicine, usually in hospitals close to their residential areas.