Combatting hepatitis

The world marks July 28 as World Hepatitis Day with an aim to create awareness about the disease, its prevention, diagnosis and treatment. Global estimates suggest that viral hepatitis is the eighth-highest cause of mortality, with an annual estimated death toll of 1.4 million attributed to acute infection, hepatitis-related liver cancer and cirrhosis.

Though the majority of the deaths are caused by virus B and C, according to the World Health Organization, the prevalence and frequency of outbreaks of Hepatitis E is rapidly increasing, especially in developing countries. Data also reflects an alarming situation, as WHO reports that every year there are an estimated 20 million HEV infections worldwide, with approximately 44,000 deaths in 2015 due to complications of Hepatitis E. Unfortunately, Hepatitis E is never given importance or prioritized as a public health issue in these countries.

Pakistan reflects the same picture in the context of Hepatitis E, and is ranked as a Highly Endemic Country. The disease is transmitted through fecal-oral route, and more specifically via drinking contaminated water. Hepatitis E is more common in areas that are deprived of having clean drinking water. Moreover, compromised sanitation hygiene augments the occurrence and act as one the major underlying determinants of the disease. It has been assessed that the primary source of contamination in water is sewerage which is extensively discharged into drinking water system supplies, and becomes a key source of spreading HEV.

In most healthy adults, HEV does not pose life threatening condition and is less harmful in young adults with common symptoms as fever, fatigue, abdominal pain and dark urine. However, there are important high-risk groups in which acute Hepatitis E can lead to fulminant hepatitis causing liver failure and can put patients at risk of death.

The most vulnerable group in this case are pregnant females. Pregnant women with hepatitis E, especially in their second or third trimester, are susceptible to increased risk of acute liver failure, miscarriages and death. Around 20–25 percent of pregnant women carry chances of death if they have HEV in their third trimester. Other high-risk groups include the elderly and those people already infected with HEP B or C or with any underlying liver disease. These groups are also exhibit high mortality rates if they contact Hepatitis E virus.

With increasing population, scarce availability of clean drinking water and frequent episodes of the disease, it is mandatory for the government to address the issue on an emergency basis. The burden of the disease also impacts health economics of the country in a negative way which can easily be avoided if timely preventive measures are taken. The viral hepatitis response requires healthcare system strengthening to disseminate health promotion activities intended to create awareness among general population and specifically identification of vulnerable population through behavior change strategies, early diagnosis and prompt treatment.

Like Hepatitis B, Hepatitis E is also a vaccine preventable disease.

This vaccine is a recombinant vaccine given in three doses, but unfortunately its registration is still pending with the Drug Regulatory Authority of Pakistan (DRAP) since 2017. The vaccine reduces infection probability and successfully saves the individual from the Hepatitis E virus. Its approval and usage can definitely reduce the burden caused by HEV and avoid complications of the disease. The vaccine has proved as the most efficient and promising intervention to address the challenging epidemics of HEV in China.

Linkages with the private sector are also required to address the disease. It has been assessed that public health service delivery system is addressing the requirements of only 30-40 percent of total population while remaining gets services from private sector. Reviewing secondary literature and successful case studies globally clearly depicts that communicable diseases are effectively controlled through suitable public-private partnerships. There is a need for the government to explore new linkages to control frequent episodes of the disease. Providing clean drinking water, provision of vaccines with social change communication and bringing all stakeholders together are the areas where the public and private sectors can work with each other.

The media should also play their role in creating awareness about the disease and its consequences. The government can adopt a media policy to sensitize the public at large about HEV. July 28 as World Hepatitis Day should be utilized to conduct public advocacy seminars at the district and tehsil levels involving community leaders, healthcare providers, civil society, public and private representatives to be educated. Hepatitis E information should be developed and disseminated at all levels.

There is no doubt that through collaborative efforts, especially by facilitation of the government to provide preventive measures in the form of vaccinations, availability of clean drinking water with an effective sewerage system can result in a healthy population without Hepatitis E.

The writer is a public health consultant.

Email: fauziawaqar_28@hotmail.com