Awareness among public and prompt response must for prevention and control
An estimated 20 million people in Pakistan are infected with hepatitis C or hepatitis B virus and the number of patients is continuously on the rise at an alarming rate while the infections kill nearly 400 people daily on average.
Various studies reveal that the number of patients infected with hepatitis C virus in Pakistan is around 15 million while nearly five million people are suffering from hepatitis B. Hepatitis as a whole claims around 150,000 lives in Pakistan every year, the number based on data of reported cases.
It is believed that every year, well over 150,000 new patients of hepatitis are added to the existing load of patients in the country. Viral hepatitis affects 400 million people globally. Every year, six to 10 million people are newly infected with the hepatitis virus around the globe.
Hepatitis B and C are both ‘silent viruses’ and because many people (about 80 per cent) 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.
Head of Community Medicine at CMH Lahore Medical College Professor Dr. Muhammad Ashraf Chaudhry expressed this while talking to ‘The News’ in connection with the sixth official WHO World Hepatitis Day being marked on July 28 around the globe.
He said the theme of World Hepatitis Day this year is ‘Know hepatitis. Act now.’ And through it, the WHO calls on policy makers, local authorities, civil society, public, media and other stakeholders to raise awareness and encourage people to know hepatitis and act now. The vision of eliminating hepatitis as a public health threat can be achieved, if people and countries affected by this disease are better equipped and enabled to “know hepatitis” and “act now”, he said.
Talking of the increasing number of hepatitis patients in Pakistan, Dr. Ashraf said the main reasons for rising incidence of Viral Hepatitis C in Pakistan are 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/unsterilised surgical and dental instruments in operation theatres/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 that pre-operative screening of patients for hepatitis B and C is not performed in routine and rate of incidence of hepatitis C due to dialysis is much higher in Pakistan. The causes could be negligence in disinfecting dialysis equipment and reusing vials between different patients. The improper disposal of hospital waste is one of the most common contributing factors associated with hepatitis C. Besides this, drug abusers and sex workers are also common factors in acquiring hepatitis C, he said.
To a query, he said the high risk groups are injecting drug users, health care workers (due to needle stick injury), newborn to hepatitis C infected mothers, 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.
Talking of the remedies, he said early diagnosis of disease in hepatitis patients may help controlling the situation however, for it there must be sufficient awareness among public on signs and symptoms of viral hepatitis.
Dr. Ashraf 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/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 said that about 90 per cent of healthy adults who are infected with hepatitis B virus (HBV) recover and be completely rid of the virus within six months, but 10% 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 explained that there is currently no vaccine for hepatitis C, however, 90 per cent cases of hepatitis C can be completely cured of the virus within 3-6 months. Recently, new antiviral drugs have been developed. “These medicines, called direct antiviral agents (DAA) are more effective, safer and better tolerated than the older therapies and treatment is shorter (usually 12 weeks).”
He said that appropriate treatment of hepatitis B and C can prevent the development of major life threatening complications of chronic liver disease; cirrhosis, liver cancer and liver failure.
In case of liver failure, ultimate treatment is liver transplantation. In Pakistan an estimated 2.5 million patients need urgent liver transplantation but most of them cannot afford high cost procedure. Lack of trained surgeons, long queues and strict regulation regarding blood relation with donors are hindering surgeries in Pakistan, said Dr. Ashraf.
To a query, he said the awareness is inexplicably low and the majority, over 95 per cent of those infected is unaware of the aspects of the disease. “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.”
Talking of preventive measures, he said people should avoid administration of unnecessary injections and choose oral medications where possible and should also avoid drips and surgeries unnecessarily and should follow careful dental treatment, hand hygiene, safe cleaning of equipment, safe handling and disposal of sharps and waste, use condoms correctly, use only screened blood for transfusion, avoid roadside dentists for dental treatment and get vaccinated their children against hepatitis B.
He said people should not share toothbrushes, razors, needles, or unsterilised medical equipment. When a mother with hepatitis B gives birth to her baby, vaccination (active and passive) in the hours after birth protects nine out of ten babies from becoming infected, said Dr. Ashraf.
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