(By Faleti Daniel D.)
Viral hepatitis affects 400 million people globally and, given the size of the epidemic, anyone and everyone can be at risk. The theme for 2016, being a pivotal year for viral hepatitis global campaign on World Hepatitis Day is ELIMINATION.
At the World Health Assembly in May, WHO Member States were set to adopt the first ever elimination strategy for viral hepatitis, with ambitious targets and a goal to eliminate hepatitis as a public health threat by 2030. This will be the first time national governments signed up and committed to the goal of eliminating viral hepatitis (World Hepatitis Alliance, 2016).
Today, only 1 in 20 people with viral hepatitis knows that he/she has it. And just 1 in 100 with the disease is being treated. Around the world, 400 million people are infected with hepatitis B and C, 10 times more than the number of people living with HIV. An estimated 1.45 million people died of the disease in 2013 – up from less than a million in 1990 (World Health Organisation, 2016).
Studies carried out in Nigeria have put the burden of Hepatitis B in most Nigerian cities to an average of 13 per cent translating to an estimated 20 million people infected. This means that at least one of every 10 Nigerians is a chronic carrier of Hepatitis B and not only at risk of liver diseases and death but also at risk of transmitting it to others.
It was estimated that about five million die annually due to the consequences of this disease. “Viral hepatitis is described as a‘silent killer’ because most persons do not realize they are infected and usually are without any clinical symptoms (Muanya, 2015).
In a news release, ahead of the campaign day, Dr Margaret Chan, WHO director general said, “The world has ignored hepatitis at its peril. It is time to mobilize a global response to hepatitis on the scale similar to that generated to fight other communicable diseases like HIV/AIDS and tuberculosis”.
What is hepatitis?
Hepatitis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.
There are 5 main hepatitis viruses, referred to as types A, B, C, D and E. These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.
Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for hese viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B, transmission from mother to baby at birth, from family member to child, and also by sexual contact (WHO, 2016).
People who are mostly at risk for developing viral hepatitis are: workers in the health care profession, Asians and Pacific Islanders, sewage and water treatment workers, people with multiple sexual partnership, intravenous drug users, HIV patients, people with hemophilia who receive blood clotting factors. Viral hepatitis is generally thought to be as much as ten times more common among lower socioeconomic and poorly educated individuals. About one third of all cases of hepatitis come from an unknown or unidentifiable source. This means that a person does not have to be in a high risk group in order to be infected with a hepatitis virus. In countries with poor sanitation, food and water contamination with HAV increases risk. Some day care centers may become contaminated with HAV, so children at such centres are at a higher risk for HAV infections (Davis and Marks, 2016).
Diagnosing viral hepatitis
Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain (WHO, 2016).
The symptoms of chronic viral hepatitis often are mild and nonspecific, and the diagnosis of chronic hepatitis often is delayed. Rarely, acute viral hepatitis causes fulminant hepatic failure (Davis and Marks, 2016).
Acute hepatitis must first be differentiated from other disorders that cause similar symptoms. In the prodromal phase, hepatitis mimics various nonspecific viral illnesses and is difficult to diagnose. Anicteric patients suspected of having hepatitis based on risk factors are tested initially with nonspecific liver function tests, including aminotransferases, bilirubin, and alkaline phosphatase. Usually, acute hepatitis is suspected only during the icteric phase. Thus, acute hepatitis should be differentiated from other disorders causing jaundice.
Liver biopsy is usually not needed unless the diagnosis is uncertain. If acute hepatitis is suspected, efforts are next directed toward identifying its cause. A history of exposure may provide the only clue of drug-induced or toxic hepatitis. The history should also elicit risk factors for viral hepatitis. Other ways to diagnose viral hepatitis include serology test and biopsy (Rutherford, 2015).
As stated in Wiktor and Hutin (2016), a recurring question about viral hepatitis is why it receives so little funding and attention from global health policy makers and donors. For example, the Sustainable Development Goals have a goal to “end the epidemics of” HIV, tuberculosis, and malaria by 2030 while only “combating” hepatitis, despite the fact that hepatitis accounts for more deaths than each of those infections individually.
One reason for this is the difficulty in accurately quantifying and explaining the morbidity and mortality related to viral hepatitis. This difficulty stems from the fact that hepatitis deaths are caused by five distinct viruses (hepatitis A–E) with different routes of transmission, that death occurs decades after infection, and that when people die with hepatitis-related liver cancer and cirrhosis, these deaths are not always linked to the underlying infection.
To achieve elimination, greater awareness, increased diagnosis and key interventions including universal vaccination, blood and injection safety, harm reduction and treatment are all needed (WHA, 2016).
According to Emirates News Agency (2016), the World Health Organisation (WHO) is calling on decision-makers and people affected by the disease to work together to put hepatitis treatment within the reach of all people living with chronic hepatitis C. The newly available treatment known as direct-acting antivirals is safe, easy to administer and can cure over 95 per cent of people with hepatitis C within 12-24 weeks. However, its price is high both for individuals to afford and for governments to make available.
People living with hepatitis C and those affected by it, including health care providers, must take an active role with their governments in stepping up the demand for treatment, through getting organised and taking the lead in making direct-acting antivirals more affordable.
Institute of Nursing Research, Fellowship of Christian Nurses, South West Zone, Nigeria says, ‘Let’s join hands to eliminate viral hepatitis. Preventive measures should be considered by all through adequate awareness and sensitization’.
Institute of Nursing Research, Fellowship of Christian Nurses, South West Zone, Nigeria
Davis, C. P. & Marks, J. W. (2016).Hepatitis (Viral Hepatitis, A, B, C, D, E, G). Retrieved from
Emirates News Agency (2016). WHO calls to put hepatitis C medicines within reach of patients. Retrieved from http://mobile.bignewsnetwork.com/news/246116333/who-calls-to-put-hepatitis-c-medicines-within-reach-of-patients
Muanya, C. (2015). Hepatitis on the prowl in Nigeria. The Guardian. Retrieved from http://m.guardian.ng/features/weekend/hepatitis-on-the-prowl-in-nigeria/
Rutherford, A. E. (2015). Overview of acute viral hepatitis. Retrieved from http://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/hepatitis/overview-of-acute-viral-hepatitis
Wiktor, S. & Hutin, Y. (2016). The global burden of viral hepatitis: Better estimates to guide hepatitis elimination efforts. World Health Organisation. Retrieved from http://www.who.int/mediacentre/commentaries/better-estimates-hepatitis/en/
World Health Organisation (2016). What is hepatitis? Retrieved from http://www.who.int/features/qa/76/en/
World Health Organisation (2016). WHO encourages countries to act now to reduce deaths from viral hepatitis. Retrieved from http://www.who.int/mediacentre/news/releases/2016/world-hepatitis-day/en/
World Hepatitis Alliance (2016). About world hepatitis day 2016. Retrieved from http://worldhepatitisday.org/en/about-us