The smoking of the traditional 'shisha' water pipe is increasingly emerging as a significant health risk in Egypt, due to air-borne tuberculosis (TB) transmission from pipe sharing and uncontrolled, manual preparation of the pipe.

Rania Siam, professor of microbiology at the American University in Cairo (AUC), said the most important risk factor for TB infection was close household contact with a TB case, but she said water pipe smoking (WPS) and the sharing of the pipe with someone with pulmonary TB led to a great risk of TB transmission, especially among young adolescents.

"'Shisha' [smoking] is Egyptian culture, where people smoke tobacco and inhale directly from this device. If I smoke 'shisha', some bacteria may reside in it. When you go to a fancy bar, they do change the mouthpiece, but what about the tube of the pipe? And the water? You still have water in the container where the bacteria resides," she said.

The World Health Organization (WHO) regional office in Cairo estimates that 17 percent of TB cases in the eastern Mediterranean are attributable to the smoking of water pipes.

According to the latest WHO statistics for Egypt, 31.6 in every 100,000 people had TB in 2005, and the rate of new TB cases that year was estimated at 25 per 100,000 people.

The WHO regional office said lack of TB control initiatives led to inadequate health care behaviour, affecting patients' diagnoses and treatment, and it therefore called for new public health care strategies.

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