Hepatitis-C poses real threat to lives of millions

Rawalpindi
An estimated 12 million people in Pakistan are infected with Hepatitis-C virus, of which four million can have serious liver disease and the disease is constantly on the rise.
Pakistan was recognised as one of the countries in the world with highest prevalence of Hepatitis-C virus and in the Middle East and Asia Pacific region, Pakistan stands second after Egypt. The prevalence of HCV in Pakistan is at least eight per cent, with higher figures for certain population pockets.
Studies in Pakistan on small targeted groups including blood donors, health professionals, drug abusers and chronic liver disease patients indicate that the prevalence of Hepatitis-C is as high as 40 per cent. Several studies indicate that the rate of positivity for HCV is much higher in rural areas than the peri-urban areas of Pakistan. According to estimates, well over 150,000 deaths per year can be attributed to Hepatitis-B and C mainly due to cirrhosis and liver cancer.
Head of Community Medicine at CMH Lahore Medical College Professor Dr. Muhammad Ashraf Chaudhry expressed this while talking to ‘The News’ in connection with World Hepatitis Day being observed on July 28 (today) around the globe.
This year the fifth official WHO World Hepatitis Day is being observed and the theme for the day for 2015 is ‘Prevent hepatitis. Act now.’
Professor Ashraf said the main reasons for rising incidence of Viral Hepatitis-C in Pakistan include non-availability of vaccine against Hepatitis-C, use of unscreened blood transfusions, re-use of needles and syringes by health care providers, sharing of needles by IV drug users, use of improper or unsterilized surgical and dental instruments in operation theatres and dental clinics, road side dentists and barbers, administration of unnecessary injections, bad medical practice and quackery.
“The other contributing factors are lack of audits and monitoring system in hospitals and poor management hierarchy,” he said. He added pre-operative screening of patients for Hepatitis-C is not performed routinely. Rate of hepatitis C due to dialysis is much higher in Pakistan. The causes could be the negligence in disinfecting dialysis equipment or reusing vials between different patients, he said while responding to a query.
He added the improper disposal of hospital waste is one the most common contributing factors associated with spread of Hepatitis-C. Besides this, drug abusers and sex workers are also common factors in acquiring hepatitis C in Pakistan, he said.
According to Professor Ashraf, high risk groups are injecting drug users, health care workers (due to needle stick injury), newborn to Hepatitis-C infected mothers, household contacts of infected persons, persons who frequently use blood or blood products and persons with multiple sexual partners and with high-risk sexual behaviour, elderly people and those living with HIV.
To a query, he said the main signs and symptoms of viral hepatitis are fatigue, nausea, vomiting, loss of appetite, jaundice (yellowing of the skin and eyes), abdominal pain and dark urine and bright stools, depression and joint pains in case of Hepatitis-C.
“The most frequent symptom of hepatitis is that people feel very tired, however, blood test is required for confirmation of diagnosis of viral hepatitis,” he said. He added that ELISA is screening test and PCR is confirmatory test for Hepatitis-C.
He is of the view that Hepatitis-B and C are both ‘silent viruses’ and because many people (about 80%) feel no symptoms, you could be infected for years without symptoms. If left untreated, both the Hepatitis-B and C viruses can lead to liver scarring (cirrhosis), ascites (accumulation of fluid in the abdominal cavity), bleeding, coma, liver cancer, liver failure and death. Therefore, it is important to get tested as soon as possible, he suggested.
He explained that about 90 per cent of healthy adults who are infected with HBV will recover and be completely rid of the virus within six months, but 10 per cent become chronic carriers of the disease; whereas in case of Hepatitis-C, four out of five people (55 to 85%) develop a chronic infection, which may cause cirrhosis and liver cancer after 15-30 years.
He said there is currently no vaccine for Hepatitis-C, however, 50 to 90 per cent cases of Hepatitis-C can be treated, but access to diagnosis and treatment is low. Combination antiviral therapy with interferon and ribavirin has been the main stay of hepatitis C treatment, he said.
Recently, new, very effective oral anti-viral drug, ‘Sovaldi’ has been introduced, but it is very expensive. Cost of 28 tablets is around Rs55,000 and a patient had to bear total expense of nearly Rs 200,000 for Sovaldi drug for a complete course, said Professor Ashraf.
He added even if treatment is not an option for you, you can do something about your disease. A healthy lifestyle is important.
He said awareness about various aspects of hepatitis is inexplicably low and the majority of those infected are unaware. Creation of awareness among people through mass media about measures to prevent hepatitis is a need of the hour to check the growing incidence of fatal disease.