Saturday 4 January 2014

Hepatitis B: The Silent Epidemic By Bukola Akanni


 

By some accounts, Hepatitis B is a new silent epidemic ravaging the health of Nigerians but medical experts insist that the disease has, nonetheless, attracted very little attention from the government and people of Nigeria.
Recent statistics indicate that not less than 23 million Nigerians are estimated to be infected with the Hepatitis B virus (HBV), making Nigeria one of the countries with the highest incidence of HBV infection in the world.
The online Medical News Today says the word hepatitis comes from the ancient Greek word hepar (root word hepat) meaning ``liver’’, and in Latin – an ancient Italic language – it means inflammation.
In essence, hepatitis means injury to the liver with inflammation of the liver cells.
Viral hepatitis may, however, occur in acute or chronic forms.  The most common causes of viral hepatitis are the five unrelated hepatotropic viruses: Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E.
Nevertheless, Hepatitis B and C are the most chronic and the leading cause of death among the five viruses.
According to the World Health Organisation (WHO), HBV is 50 to 100 times more infectious than Human Immunodeficiency Virus (HIV) and about 600,000 people worldwide die every year due to the consequences of hepatitis B.
The WHO says that Hepatitis B is a potentially life-threatening liver infection caused by HBV.
Hepatitis B is a major global health problem and concerned experts bemoan the fact that although HBV infection causes chronic liver disease, it has received little or no attention in Nigeria, thereby making it a major public health hazard in the country.

The experts note that Hepatitis B is a silent disease, which can infect people for many years without clear manifestation or symptom.
But there is a bigger problem: Hepatitis B can be epidemic in nature, as those infected are often unaware of their health condition and can unknowingly pass the virus to others through their blood and bodily fluids.
Dr Funmi Lesi, a Consultant Gastroenterologist at the Lagos University Teaching Hospital (LUTH), said that Hepatitis B and C were the most common of the hepatitis infection that caused long-term disease, chronic liver disease and severe scaring of the liver.
``The viruses which caused hepatitis were known as viral hepatitis and the most common forms in Nigeria are the B and C variants. Hepatitis B is, however, more prevalent than Hepatitis C.
``HBV as a silent killer in our environment; unfortunately, the people’s knowledge of the virus is very faint.
``The average prevalence of Hepatitis B virus infection in Nigeria is 13.7 per cent, with higher prevalence in rural areas than urban areas.
``HBV is more common and spreads more easily than HIV, which has an average prevalence rate of 4.5 per cent.” she said.
Lesi said that in sub-Saharan Africa region, the mode of HBV transmission was mostly through child-to-child transmission, unsafe injection and mother-to-child transmission.
She noted that children could be infected with the virus through sharing of objects like toothbrush, razor and towels as well as through contact with blood and body fluids via bites, cuts, or sores.
``A baby whose mother is infected can also be infected at birth. Adults can get infected through unprotected sex, blood transfusion and the use of used or improperly sterilised syringes.
``The acquirement of the virus during childhood might take between 15 to 20 years to manifest as a disease; so, we customarily see the disease in adults.
``Getting infected through the sharing of household objects, improperly screened blood and unsterilised or used syringes as well as sacrificial cuttings are factors which could be attributed to poverty and culture.
``The use of unsafe injections due to the negligence of some medical practitioners and quacks has resulted in about 32 per cent of new cases of Hepatitis B infection, compared to five per cent of new HIV infections.
``This means that many practitioners are re-using syringes and those needles are not properly sterilised,” she said.
Lesi said that 60 to 65 per cent of liver cancer cases could be linked to untreated HBV infection.
``Unfortunately, most people with chronic HBV infection are not aware that they carry the virus and they are at risk of developing severe chronic liver disease before they are clinically diagnosed.
``These people also unknowingly transmit the virus to other people because of their lack of awareness.
``Sixty to 65 per cent of liver cancer cases, out of every 100 cases, are related to untreated HBV infection,” she said.
Lesi said that Hepatitis B, if detected before progressing to acute liver infections, was treatable with the possibility of prolonging the life of the victim.
``Out of a hundred cases of chronic Hepatitis B, only 20 per cent might progress to liver disease after treatment, compared to nearly 100 per cent of HIV patients.
``Some people with chronic Hepatitis B can be treated with drugs that can slow down the progression of the infection and improve long-term survival,’’ she said.
In a nutshell, Lesi advocated the creation of a government policy on Hepatitis B, akin to the policy on HIV, to aid efforts to reduce the disease burden.
Dr Jude Erege, a private medical practitioner, said that Hepatitis B was gradually turning into an epidemic because most newborns were not vaccinated against the virus.
He stressed that the prevalence of Hepatitis B was also due to dearth of public awareness of the infection, particularly in the rural areas, and lack of treatment in the early stages of the disease.
``Hepatitis B vaccines have been available in the country for over 25 years but why have not all the people been immunised? Why do we still talk about Hepatitis B when it is preventable?
``The lack of national commitment on creating public awareness and the non-integration of the Hepatitis B vaccine into national immunisation programmes have been responsible for the prevalence,” he said.
Erege said that early vaccination of babies, possibly at birth or during infancy, was crucial to efforts to prevent HBV.
He underscored the need to formulate a national policy on screening, vaccination and management of Hepatitis B, saying that this would increase public awareness, while strengthening efforts to reduce the prevalence of the disease.
``HBV infection is a vaccine-preventable disease. The vaccine should be incorporated into our national immunisation programmes to provide easy accessibility for the people and it should be made available to all.
``Children who become infected with the virus become lifelong carriers; if undetected and untreated.
``Untreated HBV might progress into liver disease and it affects adults mostly in their productive years -- between 30 and 50 years of age,” he said.
Besides, Erege stressed that the disease’s prevalence could be reduced via public enlightenment programmes, enforcement of rules on adequate screening of all blood donors and vaccination of the entire population against HBV.
He, however, said that adults ought to be screened to ensure they had not been infected before they got vaccinated because an infected person would require treatment and not vaccination.
All the same, Erege conceded that most of the infected persons would not experience any symptoms, while others might have symptoms like dark urine, extreme fatigue, abdominal pains and vomiting.
The WHO, in its report on its first-ever country hepatitis survey in 2013, said that 37 per cent of the sampled countries had national strategies for viral hepatitis, adding, however, that more work needed to be done in treating hepatitis.
Covering 126 countries, the Global Policy Report on the Prevention and Control of Viral Hepatitis identified successes as well as gaps at the country level in the implementation of four priority areas.
These priority areas are public awareness campaigns, evidence-based data for action, prevention of the virus’ transmission, as well as screening, care and treatment.
The findings show that while 82 per cent of the countries had established hepatitis surveillance programmes, only half of the programmes include the monitoring of chronic Hepatitis B and C, which are responsible for the most severe illnesses and deaths.
-NAN

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