Wednesday, October 23, 2019

Hepatitis : A Cause For Concern For Millions Of People Globally


Sarjo Camara-Singateh

Viral hepatitis is an inflammation of the liver, due to a viral infection. It has five different types ranging from A-E.

The Permanent Secretary, Ministry of Health and Social Welfare, said viral hepatitis is widely spread, affecting 400 million people worldwide, over ten times the number of people infected with HIV, with about 1.4 million people dying each year.

Hepatitis B (Hep-B), is a virus which is very common in the Gambia and about 10% of adults above 30 years are infected with the virus. This virus can be passed through blood and infected body fluids, from mother to child at birth, or in early life from child to child with close contact. Since 1990, most children in the Gambia, have been vaccinated against HBV. However, adults over 30 years of age were born before the vaccine was introduced and may carry the virus, health officials say.

People with Hep-B who are carriers of the virus, usually have no symptoms. When a person is infected with the virus or accepts the virus, there is no sign of liver damage.

The Director of Health Services Dr. Mamadi Cham, said in May 2016, the World Health Organisation adopted the first-ever Global Health Sector Strategy on viral hepatitis, which among others, is to treat 80% of eligible person with chronic hepatitis B or C infections, by 2030, in order to reduce new viral hepatitis infection and death by 90% and 65% respectively.

The WHO country representative Dr. Desta A. Tiruneh, said liver cancer is the commonest cancer among Gambian men and third commonest in women; that it is responsible for many premature deaths in young Gambians; that preventative measures include vaccination, practice good sanitary habits and avoiding contact and contamination for hepatitis A.

Dr. Tiruneh said besides vaccines, the best way to prevent hepatitis B is to avoid contact with people and body fluids; that safe sex needs to be practiced and avoid sharing of needles and other razor sharp instruments.

Dr. Tiruneh said globally, most people who need treatment have not been treated, largely due to lack of awareness and access to hepatitis treatment services; that over 90% of people with hepatitis C, can be completely cured of the virus within 3-6 months.

The Permanent Secretary at the Ministry of Health and Social Welfare Muhamadou Lamin Jaiteh, said viral hepatitis is widely spread, affecting 400 million people worldwide; that it is estimated only 5% of people with chronic hepatitis, know of their infection, and less that 1% have access to treatment.

He urged that Hepatitis is fully preventable and treatable.

‘‘Hepatitis B virus and Hepatitis C virus are leading causes of liver cancer in the world, yet more that 80% of those affected with viral hepatitis, are unaware of their status,’’ Jaiteh said; that viral hepatitis does not restrict itself to one specific region or people, but found worldwide, making it a global epidemic; that in the Gambia, previous research has shown that nearly one in every ten individuals, is infected with HBV.

          Global and National statistics the virus

The Director of Health services Dr. Mamadi Cham, said HBV infection is more prominent in the WHO Africa and the Western Pacific Regions; that sadly most people in these regions who need treatment, have not been treated, largely due to lack of awareness and access to hepatitis diagnosis and or treatment services.

Dr. Cham said available literature has informed them, that few people with viral hepatitis have been diagnosed i.e. 9% and 20% of HBV and HCV infected persons respectively.

He said in 2015, 8% of those diagnosed with HBV infection or 1.7 million people, 7.4% with HCV infection were on treatment.

“These statistics revealed stack service delivery gaps relating to viral hepatitis management and should be addressed,” he said.                                           

Dr. Desta A. Tiruneh said every year, about 1.4 million people die from liver disease, caused by untreated infection; that in addition, 60% of liver cancer cases are due to late testing and treatment of viral hepatitis B and C; that thus viral hepatitis is a major global health problem and needs urgent response.

The African Region has nearly 22% of the global viral hepatitis burden. Hepatitis B and C is often referred to as the silent epidemic, as symptoms and signs may remain undected for years.

Among the infected, 9 out of 10 people have never been tested because of lack of awareness and poor access to testing and treatment.

Global figures or statistics indicate that despite the significant burden it places on communities across the globe, hepatitis has been largely ignored as a health and development priority.

Contributions by the Government and Stakeholders:

It should be recalled that the Gambia Government in collaboration with the Medical Research Council, MRC, and WHO’s International Agency for Research on Cancer, WHO-IARC, became the first country in sub-Saharan Africa, to achieve mass infant vaccination against hepatitis B infection, since February 1990.

Dr. Cham said they have instituted free immunization services including HBV, in public health facilities across the country ; that the Edward Francis Small Teaching Hospital, EFSTH, has introduced birth dose coverage immunization of newborns in 2017, and will be rolled out to other hospitals countrywide; that data from the EPI Unit reveal a birth dose coverage of 98% in the Gambia.

Dr. Cham said transfused blood is screened for hepatitis before transfusion; that an active surveillance system is in place where all vaccine preventable diseases, are integral components.

Dr. Tiruneh said the first global hepatitis report produced by WHO in 2017, shows that there are approximately 325 million people living with chronic hepatitis B virus infection or hepatitis C virus infection at the end of 2015.

Dr. Cham said hepatitis is recognised as a global public health challenge, and caused 1.34 million deaths in 2015; that in 2015, an estimated 257 million people globally, lived with chronic HBV infection and 71 million with chronic HCV infection; that it is time to mobilise a global response to hepatitis on the scale similar to that generated to fight other communicable disease like HIV and AIDS, Tuberculosis and Malaria

Dr. Cham said it was estimated that the global coverage with three doses of hepatitis B vaccine in infants, was 84% which substantially reduced HBV transmission in the first five years of life, as reflected in the HBV prevalence among children; that coverage with initial birth dose, vaccination still painfully remains at 39%, up to 5% of health-care-related remains unsafe, resulting to an estimated 1.75 million new HCV infection recorded in 2015.

Facts about Hepatitis:

Dr. Tiruneh said viral hepatitis is an inflammation of the liver due to viral infection ; that Five viruses are responsible for most cases of viral hepatitis; that most are not even aware of Hepatitis A, B, C, D and E viruses ; that in a small proportion of individuals however, the virus remains active and causes the liver to become inflamed and eventually damaged, leading to cirrhosis, irreversible scaring of the liver, or even liver cancer.

Promote safe sex to prevent hepatitis B:

Liver cancer is the commonest cancer among Gambian men and the third commonest among women, and is responsible for many premature deaths in young Gambians.

Available treatment include a one daily tablet called Tenofovir and that the drug has few side effects; that the drug can affect the kidneys but that this is something that can be picked up during blood tests.

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