There is a need to understand the infection and how it spreads to be able to prevent it and to treat it timely
Despite the availability of antiviral drugs for the treatment of viral hepatitis, no complete cure is available for hepatitis B infection. The virus can only be suppressed with antiviral medicines and the patients have to take them for the rest of their lives. Only 30 to 40 percent people infected with hepatitis B respond to the treatment, which takes four to five years. In other patients, the virus remains present in the bodies and continue to harm their liver, senior gastroenterologists and hepatologists say. They advise people to get themselves vaccinated against hepatitis B. The vaccine has been part of the country’s immunisation programme for the last two decades.
“Around 4 percent of Pakistan’s population is infected with hepatitis B despite introduction of hepatitis B vaccine in the immunisation programme in 2001. There is a ‘hepatitis B belt’ in the border areas of Sindh, Balochistan and the Punjab where hundreds of thousands of hepatitis B carriers are spreading the infection unknowingly. It is immensely important that every child is given a hepatitis B vaccine within 24 hours of birth”, says Dr Lubna Kamani, a renowned gastroenterologist and the president of Pak GI and Liver Disease Society (PGLDS).
On the other hand, she maintains, although no vaccine is available for the prevention of hepatitis C, treatment is available for it. If an infected person continuously takes antiviral medicines, there is a 90 to 95 percent chance that the person will be cured of the infection.
“Unfortunately, hepatitis C is on the rise in Pakistan, especially in Sindh”, Dr Kamani says, citing a joint sero-prevalence survey conducted by the World Health Organisation (WHO) and the Sindh Health Department. The survey found that the incidence of hepatitis C had increased to 6.1 percent in Sindh from 5 percent in 2008 while a downward trend was observed in the prevalence of hepatitis B with a noticeable decline from 2.5 percent to 1.05 percent.
Dr Kamani says that the latest scientific survey also highlights disease spread within family members because of exposure to infected body fluids. Other risk factors all appear to be coming from healthcare settings like receiving therapeutic injections (12 percent), receiving blood transfusion (14.8 percent), getting hospitalised (13.8 percent) or undergoing dental treatment (12.9 percent).
In addition, community spread through traditional practices such as ear and nose piercing, tattooing and shaving heads were also contributing factors in 14.5 percent cases, she adds.
Citing the achievements of Egypt in treating 90 percent of the hepatitis C patients during the past five years, she says Pakistan needs to learn from Egyptian health authorities and send young Pakistani healthcare professionals to Cairo for training in advanced gastroenterology and other procedures of digestive system as well as for the management and treatment of liver cancer.
“Egypt has successfully treated 90 percent of its hepatitis patients. It is now working on the prevention of new infections as well as occurrence of re-infections. Their government conducted free-of-charge mass screening and provided free medicines. They can help Pakistan control the menace of viral hepatitis by training healthcare professionals and through capacity building.”
Senior gastroenterologist and Professor of Gastroenterology at Darul Sehat Hospital in Karachi Dr Shahid Ahmed says instead of spending on treatment, Pakistani authorities should strive to ensure the prevention of this disease. Dr Ahmed suggests launching mass screening campaigns across the country to identify infected people and prescribe them antiviral medicines.
“Prevention is better than cure in the case of hepatitis B and C as is in most cases. The infected people are unaware of their disease and by the time they learn about the infection, their liver is damaged to an extent where liver transplant is the only possible treatment,” he says. “Even after a transplant, people need to take expensive medicines and be extra careful. This compromises their quality of life”, he adds.
Citing figures provided by the World Health Organisation (WHO), Dr Shahid Ahmed says that every year about 150,000 new cases of hepatitis B and C are diagnosed. “A majority of the people catch this infection in healthcare settings without being aware of it. The disease is called a silent killer because many patients remain undiagnosed and untreated for many years before developing complications and dying”, he says.
Dr Shahid says that as most people in rural areas of Pakistan lack education and awareness, they contract these infections through the use of therapeutic injections, syringe reuse, surgery, improper sterilisation of invasive medical devices, blood transfusion, hospitalisation and sharing of razors at barber shops. Some population groups – such as injecting drug users and thalassemia patients – are highly affected by hepatitis B and hepatitis C.
For hepatitis C, a high prevalence of infection is reported in children, especially those who have been admitted in hospitals with acute hepatitis, while for HEV, most of the infections have been reported due to faecal contamination of water.
In these circumstances, a national programme to screen the entire country’s population on the pattern of Covid-19 vaccination programme is required to identify the carriers of viral hepatitis and to ensure their treatment through the provision of free-of-charge medications as has been done in Egypt and some other countries.
“The entire world is heading towards ensuring an elimination of hepatitis B and C. However, its prevalence is increasing in Pakistan, especially in Sindh. If Pakistan fails to eliminate viral hepatitis, it may face travel restrictions in the years to come”, warns Dr Lubna Kamani.
The writer is an investigative reporter, currently covering health, science, environment and water issues for The News International