By Doris Obinna
With a person dying every 30 seconds from a hepatitis-related illness, it is estimated that 354 million people worldwide live with hepatitis B or C and for most; testing and treatment remain beyond reach.
In Africa, hepatitis is a silent epidemic. More than 90 million people are living with hepatitis accounting for 26 per cent of the global total. Nigeria has a prevalence rate of 8.1 and 1.1 per cent for hepatitis B virus (HBV) and hepatitis C virus (HCV) among adults aged 15-64 years respectively according to the Nigeria HIV-AIDS Indicator and Impact Survey (NAIIS 2018).
The World Health Organisation (WHO) further stated that some estimates reveal that the country has more than 20 million people living with hepatitis B, C, or both; yet more than 80 per cent of the people who have the disease do not know their status.
Hepatitis is an inflammation of the liver that is caused by a variety of infectious viruses and noninfectious agents leading to a range of health problems, some of which can be fatal.
According to experts, there are five main strains of the hepatitis virus, referred to as types A, B, C, D and E.
They disclosed that while they all cause liver disease; they differ in important ways including modes of transmission, severity of the illness, geographical distribution and prevention methods and in particular, types B and C lead to chronic disease in hundreds of millions of people and together are the most common cause of liver cirrhosis, liver cancer and viral hepatitis-related deaths.
Every year, July 28, the world observes World Hepatitis Day to raise awareness of viral hepatitis. This year’s theme: “It’s time for action,” WHO called for accelerated action on better prevention, diagnosis, and treatment to save lives and improve health outcomes.
Director, Disease Control, Ministry of Health, Lagos State, Dr. Rotimi Agbolagorite, explained that hepatitis viral infection causes liver inflammation and damage and remains one of the deadliest infectious diseases, accounting for over 1.3 million deaths yearly. He said the World Hepatitis Day aimed to raise public awareness of hepatitis’s devastating effects and to upscale efforts to end the global scourge.
According to WHO, some types of hepatitis are preventable through vaccination; a WHO study found that an estimated 4.5 million premature deaths could be prevented in low- and middle-income countries by 2030 through vaccination, diagnostic tests, medicines and education campaigns.
WHO’s global hepatitis strategy, endorsed by all WHO Member States, aims to reduce new hepatitis infections by 90 per cent and deaths by 65 per cent between 2016 and 2030.
Causes
Consultant Gastroenterologist, Lagos State University Teaching Hospital (LASUTH), Dr. Rufina Igetei, disclosed that about 90 to 95 per cent of Nigerians acquire the infection in childhood, either through the placenta from an infected mother or childhood spread:
“Viral hepatitis is caused by a virus and can either be acute (lasting less than six months) or chronic (lasting more than six months). Viral hepatitis can be spread from person to person. Some types of viral hepatitis can be spread through sexual contact.
“Hepatitis can be caused by immune cells in the body attacking the liver. Infections from viruses such as: hepatitis A, hepatitis B, or hepatitis C, bacteria, or parasites and liver damage from alcohol or poison.”
He said precaution against the deadly disease is by getting tested and vaccinated, maintaining good personal and environmental hygiene, and avoiding the sharing of sharp objects.
Signs and symptoms
According to WHO many people with hepatitis A, B, C, D or E exhibit only mild symptoms or no symptoms at all and each form of the virus, however, can cause more severe symptoms. “Symptoms of hepatitis A, B and C may include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-coloured urine and jaundice (a yellowing of the skin and whites of the eyes). In some cases, the virus can also cause a chronic liver infection that can later develop into cirrhosis (a scarring of the liver) or liver cancer. These patients are at risk of death.
“Hepatitis D (HDV) is only found in people already infected with HBV; however, the dual infection of HBV and HDV can cause a more serious infection and poorer health outcomes, including accelerated progression to cirrhosis. Development of chronic HDV is rare.
“Hepatitis E (HEV) begins with mild fever, reduced appetite, nausea and vomiting lasting for a few days. Some persons may also have abdominal pain, itching (without skin lesions), skin rash or joint pain. They may also exhibit jaundice, with dark urine and pale stools, and a slightly enlarged, tender liver (hepatomegaly), or occasionally acute liver failure.
Treatment
“Safe and effective vaccines are available to prevent HBV. This vaccine also prevents the development of HDV and given at birth strongly reduces transmission risk from mother to child. Chronic hepatitis B infection can be treated with antiviral agents. Treatment can slow the progression of cirrhosis, reduce incidence of liver cancer and improve long-term survival.
“Only a proportion of people with chronic hepatitis B infection will require treatment. A vaccine also exists to prevent infections of hepatitis E (HEV), although it is not currently widely available. There are no specific treatments for HBV and HEV and hospitalization is not usually required. It is advised to avoid unnecessary medications due to the negative effect on liver function caused by these infections.
“HCV can cause both acute and chronic infection. Some people recover on their own, while others develop a life-threatening infection or further complications, including cirrhosis or cancer. There is no vaccine for hepatitis C. Antiviral medicines can cure more than 95 per cent of persons with hepatitis C infection, thereby 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 due to reduced access to clean and reliable water sources and the increased risk of contaminated food. A safe and effective vaccine is available to prevent hepatitis A. Most HAV infections are mild, with the majority of people recovering fully and developing immunity to further infection. However, these infections can also rarely be severe and life threatening due to the risk of liver failure.”
Efforts to mitigate disease
Permanent Secretary, Ministry of Health, Lagos State, Dr. Olusegun Ogboye, emphasized that the fight against viral hepatitis must be intensified in order to address the 2024 WHO Global hepatitis report, which indicates that deaths resulting from viral Hepatitis have become the second leading cause of death, with about 1.3 million deaths annually, globally, 100 times more than HIV/AIDS.
He outlined the state’s efforts, including subsidised hepatitis C testing, vaccination and extensive community outreach programs aimed at reducing the disease’s impact on the population.
Ogboye said: “In 2016, a baseline assessment conducted with support from the Lagos state government showed a higher prevalence of HBV and HCV (five per cent and one per cent) when compared to the national average.
“These figures suggest that an estimated two million and 200,000 Lagosians are chronically infected with hepatitis B and C, all of whom are at risk of developing cirrhosis and primary liver cancer if left untreated.
“Government has provided access to hepatitis C viral load testing at subsidized prices, and so far, 435 hepatitis C viral load tests have been performed in two diagnostic facilities in collaboration with the Clinton Health Access Initiative (CHAI).”
He added that government screened and vaccinated about 5,000 individuals and primarily health workers.
Creating awareness
Lagos State Viral Hepatitis Control Programme Coordinator, Dr. Mazeedat Erinosho, said there has been a consistent community awareness campaign: “These campaigns aim to inform citizens about the government’s prevention and control strategies and provide basic information on where and when to seek medical intervention against the deadly disease.”