Silent epidemic on the rise

From Doris Obinna

With Every 30 seconds, someone dies from a hepatitis-related illness. An estimated 354 million people worldwide are living with hepatitis B or C, and testing and treatment remain out of reach for most.

In Africa, hepatitis is a silent epidemic. More than 90 million people are living with hepatitis, which is 26 percent of the global total. According to the Nigeria HIV-AIDS Indicator and Impact Survey (NAIIS 2018), the prevalence rate of hepatitis B virus (HBV) is 8.1 percent and hepatitis C virus (HCV) is 1.1 percent among adults aged 15 to 64 years.

The World Health Organization (WHO) further stated that according to some estimates, more than 20 million people in the country are living with hepatitis B, C or both, but more than 80 percent of those affected do not know whether they have the disease.

Hepatitis is an inflammation of the liver caused by a variety of infectious viruses and non-infectious pathogens and leads to a number of health problems, some of which can be fatal.

According to experts, there are five main strains of the hepatitis virus, called types A, B, C, D and E.

They announced that while they all cause liver disease, they differ in important ways, such as transmission routes, disease severity, geographic distribution and prevention methods. Types B and C in particular cause chronic disease in hundreds of millions of people and together are the leading cause of cirrhosis, liver cancer and deaths associated with viral hepatitis.

Every year on July 28, the world observes World Hepatitis Day to raise awareness of viral hepatitis. Under this year's theme, “It's time to act,” WHO called for accelerated action for better prevention, diagnosis and treatment to save lives and improve health outcomes.

The Director of Disease Control, Lagos State Ministry of Health, Dr. Rotimi Agbolagorite, explained that viral infection of hepatitis causes liver inflammation and damage and remains one of the deadliest infectious diseases, causing over 1.3 million deaths annually. He said World Hepatitis Day aims to raise public awareness of the devastating effects of hepatitis and intensify efforts to end this global scourge.

According to the WHO, some types of hepatitis are preventable through vaccination. A WHO study estimates that vaccination, diagnostic tests, medicines and education campaigns could prevent an estimated 4.5 million premature deaths in low- and middle-income countries by 2030.

The WHO Global Hepatitis Strategy, supported by all WHO Member States, aims to reduce the number of new hepatitis infections by 90 percent and the number of deaths by 65 percent between 2016 and 2030.

Causes

Gastroenterologist at the Lagos State University Teaching Hospital (LASUTH), Dr. Rufina Igetei, explained that about 90 to 95 percent of all Nigerians become infected with the infection during childhood, either through the placenta of an infected mother or through transmission during childhood:

“Viral hepatitis is caused by a virus and can be either acute (lasting less than six months) or chronic (lasting longer than six months). Viral hepatitis can be transmitted from person to person. Some types of viral hepatitis can be transmitted through sexual contact.

“Hepatitis can be caused by immune cells in the body attacking the liver, infections caused by viruses such as hepatitis A, hepatitis B or hepatitis C, bacteria or parasites, and liver damage caused by alcohol or poison.”

He said people can protect themselves from the deadly disease by getting tested and vaccinated, maintaining good personal and home hygiene and avoiding sharing sharp objects.

Signs and symptoms

According to the WHO, many people with hepatitis A, B, C, D or E have only mild symptoms or no symptoms at all, but each form of the virus can cause more serious symptoms. “Symptoms of hepatitis A, B and C may include fever, malaise, loss of appetite, diarrhea, nausea, abdominal pain, dark-colored urine and jaundice (yellowing of the skin and whites of the eyes). In some cases, the virus can also cause chronic liver infection, which can later develop into cirrhosis (scarring of the liver) or liver cancer. These patients are at risk of death.

“Hepatitis D (HDV) occurs only in people who are already infected with HBV; however, dual infection with HBV and HDV can lead to more severe infection and worse health outcomes, including accelerated development of liver cirrhosis. The development of chronic HDV disease is rare.

“Hepatitis E (HEV) begins with mild fever, loss of appetite, nausea, and vomiting that last for a few days. Some people may also have abdominal pain, itching (without skin lesions), rash, or joint pain. They may also have jaundice with dark urine and pale stools, and a slightly enlarged, tender liver (hepatomegaly), or occasionally acute liver failure.

Treatment

“There are safe and effective vaccines to prevent HBV. This vaccine also prevents the development of HDV and significantly reduces the risk of transmission from mother to child at birth. Chronic hepatitis B infection can be treated with antiviral agents. Treatment can slow the progression of liver cirrhosis, reduce the incidence of liver cancer, and improve long-term survival rates.

“Only a proportion of people with chronic hepatitis B infection require treatment. There is also a vaccine to prevent hepatitis E (HEV) infection, but it is not currently widely available. There are no specific treatments for HBV and HEV and hospitalisation is usually not required. It is recommended to avoid unnecessary medications as these infections have negative effects on liver function.

“HCV can cause both acute and chronic infections. Some people recover on their own, while others develop life-threatening infection or further complications, including liver cirrhosis or cancer. There is no vaccine for hepatitis C. Antiviral drugs can cure more than 95 percent of people with hepatitis C infection, reducing the risk of death from cirrhosis and liver cancer, but access to diagnosis and treatment remains low.

“HAV is most common in low- and middle-income countries where access to clean and reliable water sources is limited and the risk from contaminated food is increased. There is a safe and effective vaccine to prevent hepatitis A. Most HAV infections are mild, and the majority of people recover completely and develop immunity to further infections. However, in rare cases, these infections can be severe and life-threatening, as there is a risk of liver failure.”

Efforts to contain the disease

The Permanent Secretary, Ministry of Health, Lagos State, Dr. Olusegun Ogboye, stressed that the fight against viral hepatitis must be intensified to meet the requirements of the WHO World Hepatitis Report 2024, which indicates that deaths from viral hepatitis are now the second leading cause of death, with approximately 1.3 million people dying from the disease annually worldwide, 100 times more than HIV/AIDS.

He outlined the state's efforts, which include subsidized hepatitis C testing and vaccinations, as well as extensive community education programs aimed at reducing the impact of the disease on the population.

Ogboye said: “A baseline survey conducted in 2016 with the support of the Lagos State Government found a higher prevalence of HBV and HCV (five percent and one percent respectively) than the national average.

“These figures suggest that an estimated two million and 200,000 people in Lagos are chronically infected with hepatitis B and C, and all of them are at risk of liver cirrhosis and primary liver cancer if the disease is not treated.”

“The government has provided access to hepatitis C viral load tests at subsidized prices, and so far, 435 hepatitis C viral load tests have been conducted at two diagnostic facilities in collaboration with the Clinton Health Access Initiative (CHAI).”

He added that the government had screened and vaccinated about 5,000 people, mostly medical personnel.

Raising awareness

The coordinator of the Viral Hepatitis Control Programme in Lagos State, Dr. Mazeedat Erinosho, said there had been a consistent awareness campaign among the population: “The aim of these campaigns is to inform citizens about the government’s prevention and control strategies and to give them basic information on where and when they can seek medical treatment against this deadly disease.”