Viral hepatitis one of leading causes of death

Rawalpindi: Viral hepatitis is one of the leading causes of death globally, accounting for as many as 1.34 million deaths in 2015 and the number is increasing while hepatitis B virus and hepatitis C virus cause 80 per cent of liver cancer cases in the world.

Viral hepatitis is swelling at alarming rate in Pakistan as well, killing an estimated 150000 people annually. As such over 400 people are losing life to hepatitis every day. Pakistan is among 11 countries of the world which carry 50 per cent of the global burden of chronic hepatitis. New hepatitis infections continue to occur, mostly hepatitis C.

The World Health Organisation is urging countries to take rapid action to improve knowledge about the disease, and to increase access to testing and treatment services. Today, only one in 20 people with viral hepatitis know they have it. And just one in 100 with the disease is being treated. This can result in real possibility of developing fatal liver disease at some point in their lives and in some cases unknowingly transmitting the infection to others.

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 Friday (today) around the globe.

This year, 7th official WHO World Hepatitis Day is being marked on July 28 with the theme ‘Eliminate Hepatitis,’ a simple call to action that everyone can get behind. Regardless of your priorities, the theme can be easily adapted for local use; to achieve elimination, greater awareness, increased diagnosis and key interventions including universal vaccination, blood and injection safety, harm reduction and treatment are all needed. Every activity that addresses viral hepatitis is a step towards eliminating it by 2030.

With the availability of effective vaccines and treatment for hepatitis B and a cure for hepatitis C, the elimination of hepatitis is achievable, but greater awareness and understanding of the disease and the risks is a must, as is access to cheaper diagnostics and treatment, said Dr. Ashraf.

He said Hepatitis B and C infections are transmitted through contaminate blood as well as through contaminated needles and syringes in health care setting and among people who inject drugs. The virus can also be transmitted through unsafe sex and from infected mother to her newborn child, unclean barber equipment, toothbrushes, dentistry and surgical tools.

He added that 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. Pre-operative screening of patients for hepatitis B and C is not performed routinely, he said.

According to Dr. Ashraf, rate 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 in Pakistan, he said.

The high risk groups in Pakistan are injecting drug users, health care workers (due to needle stick injury), newborns 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, truck drivers, cleaners, transgender, elderly people and those living with HIV.

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.

Dr. Ashraf said 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 said.

He explained that about 90 per cent of healthy adults who are infected with HBV can recover and be completely rid of the virus within six months, but 10 per cent become chronic carriers of 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.

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) and cure rate is over 95 per cent, he said.

He added 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.

He said awareness is inexplicably low and the majority (over 95%) of those infected is 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, he said.

People should avoid administration of unnecessary injections, drips, surgeries 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. People should not share toothbrushes, razors, needles, or unsterilised medical equipment, he said.

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.