Bringing hepatitis care closer to primary health facilities and communities

Paul John According to the World Health Organization (WHO), every 30 seconds, someone loses his life to Hepatitis B or C, and the world is currently facing a new outbreak of unexplained acute hepatitis infections affecting children.  WHO, together with scientists and policy makers in affected countries, is working to understand the cause of this […]

Paul John

According to the World Health Organization (WHO), every 30 seconds, someone loses his life to Hepatitis B or C, and the world is currently facing a new outbreak of unexplained acute hepatitis infections affecting children. 

WHO, together with scientists and policy makers in affected countries, is working to understand the cause of this infection that does not appear to belong to any of the known 5 types of hepatitis viruses: A,B,C,D, and E.

WHO maintains that this new outbreak brings focus on thousands of acute viral hepatitis infections that occur among children, adolescents and adults every year.  Most acute hepatitis infections cause mild disease and even go undetected. But in some cases, they can lead to complications and be fatal. In 2019 alone, an estimated 78,000 deaths occurred worldwide due to complications of acute hepatitis A to E infections.

Hepatitis is a health condition characterized by the presence of inflammatory cells in the tissues of the liver. It can be self-limiting (healing on its own) or can simply progress to fibrosis (scarring), Cirrhosis, liver failure or liver cancer. Hepatitis can be acute when it lasts for less than six months or chronic when it lasts for more than six months.

Viral hepatitis is mainly classified into five groups: Hepatitis A, B, C, D and E. There are other classifications of hepatitis such as autoimmune, alcoholic hepatitis etc., but the main aim of the World Hepatitis Day is to sensitize and encourage people on how to prevent, diagnose and treat these five VIRAL hepatitis infections.

Global efforts prioritise the elimination of the hepatitis infections B, C and D. Unlike acute viral hepatitis, these 3 infections cause chronic hepatitis that lasts for several decades and culminate in over one million deaths per year from cirrhosis and liver cancer. These three types of chronic hepatitis infections are responsible for over 95 per cent of hepatitis deaths.

While we have the guidance and tools to diagnose, treat, and prevent chronic viral hepatitis, these services are often out of reach of communities and are sometimes only available at centralized/specialized hospitals.

The main aim of July 28, World Hepatitis Day is to sensitize and encourage people on how to prevent, diagnose, and treat viral hepatitis infections.

It pains me when patients who received blood transfusion in the past later come down with hepatitis B or C infection and the cause is traceable to no other source except the past blood transfusion.

In view of this, our hospitals should upgrade to the use of Polymerase Chain Reaction (PCR) in screening blood samples (especially those units of blood from donors with questionable lifestyles). This is because the current tests used in detecting the viral infections in many hospitals in developing countries are targeted at detecting the antigen or antibody to the infecting viral particles in the serum, hence it takes some time (the incubation period etc) before the current tests in many developing countries can detect the antigen/antibody in a newly infected individual. PCR can detect the infection at each stage of the disease.

We cannot forget, in a hurry, the 2006 incident at the Lagos University Teaching Hospital (LUTH) where baby Oyinkansola Eniola was transfused with HIV positive blood in a tertiary hospital where the highest form of medical treatment was expected in line with international best practices. It is a crime and unethical to transfuse a unit of blood without first screening it for HIV 1 & 2, Hepatitis B and C and VDRL, among other preliminary tests.

Was the blood screened before the transfusion? Believe you me, the answer will be in the affirmative; then, why didn’t the screening pick up the HIV in the donor’s blood? The window period of HIV infection cannot easily be ruled out at the time of screening that blood hence, screening with PCR remains the only trusted test at all stages of the infection. If that was possible with HIV, it is still possible with some of the viral hepatitis, especially hepatitis B and C.

The WHO in its theme for this year is highlighting the need for bringing hepatitis care closer to the primary health facilities and communities so that people have better access to treatment and care, no matter what type of hepatitis they may have.

Brief history of World Hepatitis Day

Initially, the World Hepatitis Day was celebrated on May 19 every year but in 2010, the World Health Assembly changed the date to July 28 in honour of the birthday of the nobel laureate, Professor Baruch Samuel Blumberg, who discovered Hepatitis B.

Coming to data available in Nigeria, Dr Chukwuma Anyaike, a Community Health physician, few years ago argued that about 20 million Nigerians are infected with Hepatitis B and C. The physician, who was then the Head, Prevention, Department of Public Health at the Federal Ministry of Health, stated this at a one-day stakeholders’ advocacy workshop on Viral Hepatitis awareness organised by the Yakubu Gowon Foundation in Abuja. He further pointed out that “Viral Hepatitis is a very big public health issue in Nigeria.”

It was further revealed that out of approximately 20 million of Nigeria’s 170 million population who are infected by the virus, 25 percent go on to develop chronic liver disease and between 500,000 to 700,000 result in deaths annually.

From the survey (2000-2013), Kano had the highest number of people infected with the B variant of the virus while Kwara State had the highest number of people with Hepatitis C.

Prevention

Hepatitis A can be prevented by adequate supply of safe drinking water; proper disposal of sewage within the communities; personal hygiene such as regular hand washing with safe water and soap; getting immunized with Hepatitis A vaccine.

Hepatitis B can be prevented by quality-assured screening of all donated blood and blood components used for transfusion; safe injection practices; safe sex practices, including minimizing the number of partners and using barrier protective measures (condom).

Hepatitis C and D infections have almost the same preventive measures as Hepatitis B except that Hepatitis C vaccine is currently unavailable globally though research is still ongoing.

Hepatitis E can be prevented by maintaining quality standards for public water suppliers; establishing proper disposal systems to eliminate sanitary wastes; maintaining hygienic practices such as hand washing with safe water, particularly before handling food; avoiding water/or ice of unknown purity; adhering to WHO safe food practices.

In view of the above, our government should map out comprehensive national guideline to tackle this silent killer called viral hepatitis, especially in our rural communities since many women get to know their statuses during antenatal period where the hospitals make it compulsory that all pregnant women must be tested for HIV 1 & 2, Hepatitis B and C, VDRL (for syphilis) among other relevant tests. Hepatitis B can easily be transmitted from mother to the baby during pregnancy or at birth.

Dr John writes from Port Harcourt.