World Hepatitis Day: Prevent hepatitis. Act now! ......#HepatitisB

Viral hepatitis is the inflammation of the liver caused by a virus. Five different types of hepatitis virus exist, namely: A, B, C, D and E. All types cause short term, or acute infection. Only hepatitis B, C and D viruses cause long-term infection, called chronic hepatitis which could lead to life-threatening complications such as cirrhosis (liver scarring), liver failure, and liver cancer. Viral hepatitis is the leading cause of liver cancer and most common reason for liver transplantation. Liver cancer is one of the ten most common cancers worldwide. In Nigeria, it has been reported that over 11,000 persons die yearly of liver cancer. Hepatitis B and C viruses have the highest prevalence of infection, while over 240 million people worldwide are chronically infected with hepatitis B virus (HBV); about 150 million are infected with hepatitis C virus. More than 780,000 people die every year due to the consequences of hepatitis B. It is an important occupational hazard for health workers. The World Health Organisation has recognised the HBV as a silent killer. The infection is preventable with the currently available safe and effective vaccine.

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Hepatitis B virus is transmitted through contact with the blood or other body fluids of an infected person. The routes of transmission include the following: Transfusion of unscreened blood and blood products, unsterilised medical or dental equipment, mother to child transmission during childbirth, and sharing equipment for injecting drugs. Other methods include sharing razors, toothbrushes or other household articles; tattooing and body piercing using unsterilised equipment; unprotected sex with an infected person.

In acute stage, most people do not experience any symptom but for those who manifest, the symptoms include: Yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. In chronic cases, liver infection can later develop into cirrhosis of the liver or liver cancer. Over 90 per cent of healthy adults infected, recover and completely rid of the virus within six months. Children who are infected when less than six years of age are at risk of acquiring chronic infection while less than five per cent of adults acquiring the infection will develop the chronic stage of the disease. Most people in sub-Saharan Africa become infected during childhood and five to 10 per cent of the adult population is chronically infected.

There is no specific treatment for acute infection except proper nutrition and fluid replacement. For chronic infection, oral antiviral agents are used. Treatment does not cure but slows the progression of cirrhosis, reduces incidence of cancer and improves long term survival. Treatment, however, is not readily accessible in many resource-constrained settings. However, measures to prevent of hepatitis B infection include the following:

• Health education for the public and health workers
• Immunisation of non-immune persons
• Screening and vaccination of health workers
• Screening of pregnant women and immunisation of babies born to infected women
• Blood and organ screening before transfusion or transplantation
• Proper disposal of sharps and no recycling of disposable instruments used for medical procedures
• Sterilisation of instruments used by traditional medical practitioners
• Access to post-exposure prophylaxis
• Practise Abstinence, Be faithful and Condom use

Similarly, hepatitis C virus is a blood borne virus and the most common modes of infection are through unsafe injection practices; inadequate sterilisation of medical equipment in some health care settings; transfusion of unscreened blood and blood products. About 130-150 million people globally have chronic hepatitis C infection. A significant number of those who are chronically infected will develop liver cirrhosis or liver cancer. Between 350,000 and 500,000 people die each year from hepatitis C-related liver diseases. Antiviral medicines can cure hepatitis C infection but access to diagnosis and treatment is low. Treatment is successful in 50 to 90 per cent of persons but some infected persons spontaneously clear the virus within six months from their system. Others develop chronic HCV infection and the risk of cirrhosis of the liver is 15 and 30 per cent within 20 years. Currently, there is no vaccine for hepatitis C; however, research in this area is ongoing.

It is very important to know your hepatitis B and C status in order to reduce the risk of infecting others if you are infected, consider your treatment options and self-management strategies as early as possible. Knowing your status will also help to prevent complications such as liver cirrhosis and cancer and improve the quality of life. In Nigeria, it has been found that people report for health care only when the viral disease has advanced and the risk of developing cirrhosis and liver cancer is very high. For that reason, the Nigerian Institute of Medical Research, Lagos will mark the 2015 World Hepatitis Day by having a road walk to sensitise the public, organise a symposium in the Institute for more awareness creation and also provide free screening and vaccination on July 28 in her premises in Yaba. So, we urge you to prevent hepatitis and act now.

- DR Rosemary Audu/ Punch

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