2015 WORLD HEPATITIS DAY: PREVENTING VIRAL HEPATITIS

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IMG_20141212_154139The main aim of July 28, World Hepatitis Day, is to sensitize and encourage people on how to prevent, diagnose, and treat viral hepatitis infections. The  Theme for is Prevention  of  Viral hepatitis . It pains me when patients who were transfused with some  units of blood ( that were certified Hepatitis B and C negative) 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 particle 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 Lagos University Teaching Hospital (LUTH) where baby Oyinkansola Eniola was transfused with a HIV positive blood in a tertiary hospital where the highest form of medical treatment was  expected in line with international best practices  . As a medical student and later a house officer( a junior doctor ) then  we were taught that it was (and is still) 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. The question in that case in LUTH is ,what the blood screened before the ill-fated 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 infections,especially hepatitis B and C .

BRIEF HISTORY

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

INTRODUCTION:

About 23 million Nigerians are infected with Hepatitis B, making Nigeria one of the countries with the highest Hepatitis infection in the world since about 500 million people in the world are living with either Hepatitis B or C . However, WHO puts the figure at 400 million people worldwide . It is pathetic that many people worry more about contracting AIDS than Hepatitis, even when in reality in each year about 1.4 million people worldwide die due to these viral hepatitis  infections and more become infected. At times ,infected people  die faster with viral hepatitis than they would with AIDS. Remember that globally, HIV-AIDS currently  kills close to 1.6 million people yearly. And more unfortunate is the fact that just only Hepatitis B virus is about 50 to 100 times more infectious than HIV. Despite this mind-boggling data,the disease has attracted very little attention from both the government and the people of Nigeria.

Meanwhile, Dr Chukwuma Anyaike,a Community Health physician ,argued that about 20 million Nigerians are infected with the Hepatitis B and C virus infections .The said physician who is 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. By the work Federal Ministry of Health has done, we have 20 million Nigerians living with Hepatitis B and C and they are at the risk of developing cirrhosis of the liver and cancer of the liver. Most importantly, these ones are living in the communities and they are not aware of it and in the same process, they are transferring the infection to other people in the community.”

In the occasion,it was further revealed  that  approximately 20 million of Nigeria’s 170 million population that are infected by the virus, 25 percent of them go on to develop chronic liver disease and between 500,000 to 700,000 result in deaths annually.
From the survey, Kano has the highest number of people infected with the B variant of the virus while Kwara state has the highest number of people with Hepatitis C.

DEFINITION AND CLASSIFICATION:

Hepatitis is a medical 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.

Hepatitis A:
Caused by Hepatitis A virus and it occurs when an uninfected person ingests food or water contaminated with the faeces of an infected person. It can also be contracted through close physical contact with an infectious person,although casual contact among people does not spread the virus. There are about 1.4 million cases each year worldwide. Unlike Hepatitis B & C, it does not run a chronic course but can lead to debilitating symptoms and fulminant hepatitis(acute liver failure), which has a very high mortality rate.

Hepatitis B:
It is a potentially life threatening disease of the liver caused by Hepatitis B virus and it is contracted by contact  with the blood or body fluids of an infected person. It is commonly spread from mother to child at birth,or from person to person in early childhood. In the rural settings, it can be contracted by sexual transmission (when no barrier protective measure is used) and the use of contaminated sharp objects like needles, razor blades etc., and inadequately sterilized hospital equipment. It runs both acute and chronic courses and about 240 million individuals globally have chronic Hepatitis B infection whereas in each year, about 780,000 people die globally  from acute and chronic Hepatitis B infections. It is an important occupational hazards for health care professionals, members of the Federal Road Safety Corps,commercial sex workers,long distance drivers etc.

Hepatitis C:
Caused by Hepatitis C virus and it is contracted the same way Hepatitis B infection is contracted through unsafe injection practices;inadequate sterilization of medical equipment in healthcare settings;and unscreened blood and blood products. Like Hepatitis B,it runs both acute and chronic courses but it has more propensity of running chronic course than Hepatitis B.A significant number of the chronic carriers of the disease will come down with Cirrhosis or Liver cancer. It is estimated globally that about 130-150 million people are chronic carriers of the infection while about 350,000-500,000 people die annually from Hepatitis C related infections.

Hepatitis D:
Caused by Hepatitis D virus, which is called an incomplete virus or subviral satellite because it can propagate only in the presence of Hepatitis B virus,hence the transmission of Hepatitis D can only occur either via simultaneous infection with hepatitis B virus(co-infection) or superimposed on chronic Hepatitis B carrier state (superinfection). Regrettably, in combination with Hepatitis B virus, Hepatitis D infection has the highest mortality rate of all the Hepatitis infections.

Hepatitis E:
Caused by Hepatitis E virus and mainly transmitted through contaminated drinking water. Less commonly,it can also be transmitted by transfusion of infected blood products and vertical transmission from a pregnant woman to her fetus. It is self-limiting,resolving within  four to six weeks,though it may at times run a fulminant course(acute liver failure) leading to death. Globally, there are approximately 20 million incidents of Hepatitis E infections every year; three million acute cases; 56,600 hepatitis E-related deaths. Hepatitis E can also induce a mortality of about 20% among pregnant women in their third trimester.

CLINICAL FEATURES:
The viral hepatitis infections have almost common features which can be asymptomatic (no symptoms) but often lead to jaundice, loss of appetite, and malaise. As noted earlier on, some of them can run either acute or chronic courses.

The acute features:

In children, the features are usually asymptomatic while in older individuals, there may be nonspecific flu-like symptoms,common to almost all acute viral infections which include: malaise; muscle and joint aches; fever; nausea or vomiting; diarrhoea; headache. The more specific acute features include: loss of appetite; aversion to smoking (among smokers); dark urine; yellowing of the eyes and the skin; enlargement of the liver; enlarged lymph nodes in about 5%; enlargement of the spleen.

Meanwhile, a small proportion of the people with acute infections can develop liver failure with associated hepatic encephalopathy (confusion and coma due to inability of the liver to perform its functions); peripheral edema and bleeding.

The chronic features: Although they may present with malaise; tiredness; weakness; jaundice, individuals with chronic infections usually run asymptomatic courses until complicated with cirrhosis, liver cancer, and liver failure.

PREVENTION:
This is the theme for this year’s World Hepatitis day. It is generally believed that ,’prevention is better than cure.’ The transmission of the virus can be prevented through better awareness and services that improve vaccinations ,blood and injection safety,and reduce harm. This annual campaign aims not only to raise awareness among the general public and infected patients,but also to urgently promote improved access to hepatitis services ,particularly prevention interventions by policymakers.

Hepatitis A can be prevented by adequate supplies 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). Moreover, Hepatitis B vaccine is the mainstay of prevention, no wonder it is part of  our National Programme On Immunization. However, adults who were not immunized at childhood and who are among the high risk groups should meet their doctors to ascertain if they are eligible for the vaccination.

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. Hepatitis E vaccine is still not available in the global market, though it has been produced and licensed in China.

DIAGNOSES AND TREATMENTS:
Consult the nearest medical  doctor who is professionally trained to make the diagnosis from clinical history,physical examination and interpretation of laboratory investigation results . The doctor knows when to refer you to a specialist (Gastroenterologist) who is also professionally trained to use simple non-invasive tests to assess the stage of the disease,prioritise treatment for those at  advanced stages of the disease,make use of safe and highly effective medications in the treatment and to further monitor the progress of the treatment or disease using simple tests. The managing medical doctor can as well advise you on the need to get vaccinated especially if you tested negative to the virus(s) in order to prevent  occupational hazards for those whose occupations involve handling of human blood and other bodily fluids.

In view of the above, our government should map out comprehensive national plans 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 many government 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.

REFERENCES:
(1) Kumar and Clark’s Clinical Medicine,8th edition
(2) Davidson’s Principles And Practice Of  Medicine,21st edition
(3) Oxford Handbook Of Clinical Medicine,9th edition
(4) www.who.int/en/
(5) http://en.m.wikipedia.org/wiki/Hepatitis
(6) http://www.who.int/hiv/mediacentre/news/whd2015_preventhepatitis/en/
(7) http://www.dailytrust.com.ng/daily/index.php/news-menu/news/59986-20m-nigerians-infected-with-hepatitis-virus-fg
(8)http://www.who.int/hiv/topics/hepatitis/hepatitisinfo/en/
(9) http://www.google.com/m?q=baby+hiv+positive+parents+negative+lagos+luth+cmd&client=ms-opera-mini-android&channel=new

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Dr Paul John Port Harcourt Rivers state 08083658038