Theme: Hepatitis can’t wait.
Every 28th day of July, World Hepatitis Day is celebrated. The essence is to raise awareness of viral hepatitis. Viral hepatitis simply means inflammation of the liver caused by hepatotropic viruses. This disease can progress to liver cirrhosis, liver failure and hepatocellular cancer.
This year’s theme which is hepatitis can’t wait is apt with one person dying every 30 seconds from a hepatitis related illness. Even in the current covid-19 crisis, we can’t wait to act on viral hepatitis.
This is a clarion call to all for a concerted effort to achieve the WHO goal of eliminating viral hepatitis as a public health threat by 2030. Government, international organizations, training institutions, private sector, communities and people living with hepatitis, we must all work together to achieve this goal.
All viruses that cause systemic disease may cause hepatitis e.g. yellow fever virus, Epstein bar virus, Cytomegalovirus and Adenovirus. Viral hepatitis, however, primarily refers to hepatitis caused by hepatotropic viruses i.e. viruses which have affinity for the liver. The five clinically important ones are labeled A, B, C, D, and E.
Hepatitis A virus and hepatitis E virus cause acute infections and resolve within 6 months as they are self-limiting. Transmission is mainly from contaminated water and food.
Hepatitis B virus (HBV) and hepatitis C virus (HCV) have been found to be the most important causes of chronic liver diseases. Chronic refers to the ability of the virus to persist beyond 6 months in the body and this poses a lifelong threat of liver cirrhosis, leading to liver failure, hepatocellular cancer (HCC) and death. Hepatitis D virus is an incomplete virus and thrives only with hepatitis B as super infection or co-infection.
Worldwide, about 2 billion people have serological evidence of past or present infection with HBV. About 240 million have chronic infection and these result in 1.1 million deaths annually.
The incidence rate of HBV infection in Nigeria is 8.1%, going by the 2006 national census, with an estimated population of about 206, 000, 000, this translates to 17 million Nigerians currently infected and about 5.6 million of these will die of the consequences of this infection.
For HCV, while the prevalence rate worldwide is 170 million chronically infected people, in Nigeria, the prevalence rate of HCV is 1.1% translating to about 2.2 million chronically infected people.
The liver disease caused by the two viruses is silent and unrecognized in the early stages and the impact is underestimated.
HBV is preventable through vaccination and treatable if diagnosed early.
For a country of high endemicity like Nigeria, studies have shown that universal vaccination at birth is cost effective. For those not vaccinated at birth (children, adolescents and adults) screening tests would be essential to establish HBV status. Those who are negative should be vaccinated and those positive should be evaluated for treatment.
HCV infection has no vaccine but has a cure.
There are two broad means of transmission described as vertical and horizontal. Vertical transmission occurs from mother to child while horizontal transmission occurs from child to child, through unprotected sexual contact, use of contaminated needles and sharp objects and through blood transfusion and contact of blood and blood products with breached skin..
Other means of transmission include body piercing, tattooing, scarifications, circumcision, sharing personal items e.g. hair clippers, razor blades etc.
In Nigeria, most infections occur in childhood, from mother to child and up to 90 % will result in chronic infections.
Most patients have no symptoms in the early stages of the disease and they remain asymptomatic for several years, unfortunately, by the time symptoms of jaundice, abdominal swelling, leg swelling, weight loss etc appear, the disease is already very advanced.
Prevention is achieved by the following means;
- Health education for the public and healthcare providers.
- Universal immunization and implementation of NPI scheme for HBV vaccination. Giving of hepatitis B immunoglobulin to babies born to HBV-positive pregnant women.
- Screening / testing of people e.g. pregnant women, law enforcement agents, blood donors, health workers etc.
- Screening of blood, organs and blood products before use.
- Proper disposal of sharps eg needles and lancets.
- Non-recycling of needles and other instruments used in medical procedures.
- Sterilization of instruments used by traditional medical practitioners eg. for circumcision, tattooing or ear piercing.
- Practice of ABC (abstinence, be faithful and condom) as in HIV prevention.
- Monitoring and treating people with the disease.
Correspondence: Dr. RA Ugiagbe, email; firstname.lastname@example.org
Additional resources :
- Chronic hepatitis B and C Treatment Guidelines for Nigeria (Society for Gastroenterology and Hepatology in Nigeria (SOGHIN)