Why you should get vaccinated against hepatitis B

Aminu Haruna’s offer to donate blood to his relative who was ill and needed blood transfusion led to his diagnosis with hepatitis B. He was stopped from donating the blood, and advised to commence treatment. “I was told there is no cure for hepatitis B, but that there are drugs to treat me to put […]

Aminu Haruna’s offer to donate blood to his relative who was ill and needed blood transfusion led to his diagnosis with hepatitis B. He was stopped from donating the blood, and advised to commence treatment.

“I was told there is no cure for hepatitis B, but that there are drugs to treat me to put it at a very minimal level,” he said.

The forty-year-old said he was however sad when he learnt that vaccination could have protected him from having the disease.

Christy, 31, was shocked when she was diagnosed with hepatitis B during a medical screening exercise for a job. She couldn’t recollect having any symptoms, and felt very healthy. She had to commence treatment for the disease which experts say damages the liver and can lead to death.

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 Many Nigerians are increasingly coming down with hepatitis particularly B and C. The Minister of Health, Dr Osagie Ehanire, says nearly 20 million people are estimated to be infected with hepatitis B or C in Nigeria.

Inspite of the fact that vaccination protects against hepatitis B, many Nigerians are not harnessing it.

Hepatitis is a disease that causes an inflammation or damage of the tissues of the liver.  The five types of viral hepatitis are A, B, C, D, and E.

According to Dr Matthew Olumuyiwa Bojuwoye, a consultant gastroenterologist at the University of Ilorin Teaching Hospital, “When the term “hepatitis” is used unqualified, it is taken to mean viral hepatitis. Viral hepatitis thus refers to acute or chronic diffuse inflammation of the liver caused by a virus, usually one of the hepatotropic viruses (viruses that have affinity for the liver).”

He said viral hepatitis affects hundreds of millions of people worldwide, causing acute and chronic liver disease and killing close to 1.5 million people every year, mostly from hepatitis B and C.

“It is referred to as being “acute” if the inflammation of the liver lasts less than six months but as “chronic” if the inflammation persists for more than six months.

“Hepatitis B, C and D are capable of causing both acute and chronic disease (acute and chronic viral hepatitis) whereas A and E cause acute disease only,” he said.

He said causes of hepatitis include:

Ø Infectious agents: viruses, bacteria, fungi, parasites

Ø Toxins:  Alcohol, aflatoxin (produced by a fungus Aspergillus flavus which grows on stored grains)

Ø Chemicals: Carbon tetrachloride, yellow phosphorus

Ø Drugs: Paracetamol (acetaminophen), anti-tuberculous drugs, some antibiotics, antipsychotics, etc.

Ø Autoimmune hepatitis (a disease in which the body fails to recognise its own cells and attacks them)

Ø Non-alcohol steatohepatitis (NASH): inflammatory response to the abnormal presence of fat cells in the liver

Ø Infiltrative diseases: sarcoidosis, amyloidosis

How hepatitis B is transmitted

The expert said hepatitis is transmitted in the following ways:

Ø Contact with contaminated blood and/or body fluids through sharing of contaminated needles, syringes, blades, clippers, knives, manicure and pedicure sets and other sharp objects; some of our cultural practices such as scarifications, tribal marks, tattooing, female circumcision/genital mutilation, ear piercing, nail paring put individuals at risk of contracting the virus.

Ø Transfusion of infected blood or blood products, thus screening of blood donors for the virus before transfusion is important.

Ø Contact with infected blood. Thus healthcare workers, emergency care workers and law enforcement/military personnel are particularly at high risk of acquiring the virus.

Ø Child to child transmission through close contact during play

Ø Mother to child transmission (referred to as vertical transmission) during child birth

Ø Sexual transmission

Ø Organ transplantation

Dr Bojuwoye explained that there are some differences in the prevailing routes of transmission of hepatitis B infection throughout the world.

“In underdeveloped nations or areas of high endemicity such as Southeast Asia, China, and Africa, the most common route of transmission is by perinatal or mother to child transmission (vertical) and transmission from one child to another (horizontal).

“In more developed nations (areas with low endemicity) including North America, Western Europe and Australia, most HBV infections are acquired in early adult life through intravenous drug use, occupational exposure, or unprotected sexual activities (horizontal). However, for 20% to 30% of infected persons, no clear risk factors can be identified,” he said.

Symptoms of hepatitis B infection

Dr Bojuwoye said the majority of patients with chronic infection are asymptomatic (no symptoms).

He said, “They are  unaware that they are harbouring the infection because they do not have symptoms. Symptoms, however, do occur when the disease reaches an advanced stage hence the disease is referred to as a silent killer.

“Individuals with acute infection may experience symptoms such as fever, headache, abdominal pain, vomiting and jaundice (yellowish discoloration of the eyes and palms). Infected patients may also develop fulminant hepatitis resulting in hepatic failure. Acute hepatitis may also progress to chronic hepatitis and its attendant complications. Majority of individuals infected by hepatitis C develop chronic infection,” he added.

How the disease condition is diagnosed

He said the following are useful in the diagnosis of hepatitis B and C:

Ø Clinical features: The symptoms and signs of the disease as described above.

Ø Liver biochemistry (liver enzymes, serum bilirubin, total protein and serum albumin)

Ø Serological assay of the markers of the virus.

Ø Ultrasound scan of the liver.

Ø Liver biopsy: a procedure in which a tiny piece of liver tissue is obtained with the use of a special needle for histological examination (processing and evaluation under a microscope by a histopathologist).

Ø Other tests: Complete blood count, serum electrolytes, urea and creatinine, clotting profile etc.

Complications of viral hepatitis B and C:

They are:

Ø Liver cirrhosis and attendant consequences.

Ø Liver cancer-primary liver cell carcinoma (PLCC).

Ø Liver failure.

Ø Portal hypertension (elevated pressure within the vessels in the liver).

Ø Life-threatening gastrointestinal bleeding which often presents with vomiting of blood (haematemesis) or passage of tarry black stools (melaena).

Ø Ascites (excessive fluid accumulation within the abdominal cavity).

Ø Spontaneous bacterial peritonitis.

Ø Swelling of the lower limbs (bilateral pitting pedal oedema).

Preventing hepatitis B

Dr Bojuwoye who is also a senior lecturer at the University of Ilorin Teaching Hospital says, “According to the World Gastroenterology Organisation (WGO) guidelines, despite having the hepatitis B vaccine available since 1982, about 350-400 million persons are chronically infected with the hepatitis B virus (HBV) and are at risk of developing HBV-related liver disease. In Nigeria, it is estimated that no fewer than 20 million Nigerians are chronically infected with the hepatitis B virus.”

He said there is an effective vaccine for the prevention of hepatitis B infection. 

“HBV vaccination has been incorporated into the routine immunisation programme for children in Nigeria since the late 1990s and it is free.

“The hepatitis B vaccine is an injection (or shot) that is generally given in the arm as a three-dose series on a 0, 1, and 6-month schedule.

“For adults who are unvaccinated, the first step to take is to get screened for HBV. Those who test negative should get fully vaccinated whereas persons who test positive should see the specialist for further evaluation and possible commencement of treatment. “

He advised Nigerians to visit the website of the National Primary Health Care Development Agency (NPHCDA) for information on vaccination sites where the hepatitis B vaccine can be obtained.

He said other preventive measures include:

Ø Avoidance of sharing blades, knives, barbing clippers, manicure and pedicure kits etc.

Ø Avoidance of unhealthy cultural practices such as scarifications, genital mutilation, traditional uvulectomy (cutting of ‘belu-belu’)

Ø Maintenance of good personal hygiene.

Ø Observance of universal safety precautions by healthcare providers.

Ø Transfusion of safe blood and blood products.

Ø Screening of blood and organ transplant donors.

Ø Routine screening of all pregnant women for hepatitis and prevention of mother to child transmission.

Ø Routine screening for hepatitis B and C should be encouraged and early presentation to the doctor if infected.

Ø Health education of the populace on the transmission, harmful effects and prevention of the disease.

The consultant gastroenterologist says the management of hepatitis involves largely supportive treatment, bed rest, dietary adjustment /Administration of Intravenous (IV) fluids, nursing care plan/observation of universal precaution and specific treatment such as antiviral agents for treatment of chronic hepatitis.

Also, Dr Crystal Chikodili Umejiaku, a Consultant Gastroenterologist and Hepatologist at the University of Abuja Teaching Hospital (UATH), Gwagwalada, advised Nigerians to get tested for hepatitis, adding, “You can never know if you have it, if you are not yet tested.”

She said those that have tested and are negative for hepatitis B should get vaccinated.

“And the vaccine is not just one. Taking only one shot does not help; you get protected when you have taken the three shots for hepatitis B,” she advised.