World Hepatitis Day falls on the 28th of July every year. Exactly one week ago, the world raised awareness on viral hepatitis; an infection with a hepatitis virus characterized by an inflammatory response(irritation simply put) in the liver, and subsequent damage to this vital organ.
One of the liver’s roles is to remove waste and unneeded substances from the blood, through faeces and urine. Hepatitis, in general, can be caused by other infections, toxins and also autoimmune diseases. [However, World Hepatitis Day focused on viral hepatitis, a disease that is more worrisome to public health]
The theme of this year’s campaign was ‘invest in eliminating hepatitis’, a campaign the World Health Organisation (WHO) has said is intended to urge countries to speed up their response to the disease. About 2.4 billion people are infected with one or more of the hepatitis viruses (Hepatitis A, B, C, D & E), with 325 million living with the two most fatal – Hepatitis B and C.
The campaign also wanted to encourage each person to access Hepatitis prevention, testing and treatment services thereby reducing not only the national burden of this serious disease but also the global burden.
To put this into perspective, there are more than 7 times the number of people living with hepatitis B alone than those living with HIV worldwide. Not to mention, this data represents only one amongst the five total groups of hepatitis that people can have.
To create more awareness, here are 6 facts on the state of hepatitis in Nigeria.
1. Causes of hepatitis
The three most common viruses that cause hepatitis are hepatitis A, B and C. In addition to these are hepatitis D and E. Hepatitis B & C cause more fatal infections, easily leading to death. More emphasis is usually placed on diagnosing and treating B and C.
2. Number of Nigerians with hepatitis
In the absence of sentinel data collection systems, what we do know from WHO is that Nigeria is among the countries with the highest burden of hepatitis B and C, in particular. The African region is well-known for having a high rate of hepatitis B. In Nigeria, about 1 person out of every 10 has hepatitis B and about 1 in every 40 has hepatitis C.
What’s more, the Society for Gastroenterology and Hepatology in Nigeria (SOGHIN) noted that approximately 1 in 10 Nigerians suffer from a type of hepatitis! Infections with hepatitis surpass HIV, and both share similar modes of transmission.
3. Mode of transmission
- Infection with hepatitis A is from contaminated food or water, or contact with an infected person. It is thus common in environments with poor hygiene and sanitary conditions.
- Hepatitis B (HBV) is transmitted through contact with the blood or other body fluids of an infected person. Having unprotected sex, kissing, breastfeeding with cracked nipples, during birth, or sharing sharp objects can get one infected. In addition to these modes of transmission, scientists note that the minimum infectious dose is so low (more than HIV) that even sharing a toothbrush or eating utensils can transmit the infection.
- Hepatitis C is transmitted through blood to blood contact. Practices involving body piercing, poor sterilization of medical equipment, use of unscreened blood, sharing sharp objects, or sexual activity where blood is involved can transmit the virus. transmission in sex acts not involving contact with blood is not certain, although this increases in the presence of other sexually transmitted infections.
- Infection with Hepatitis D occurs only in the presence of one being already infected with HBV. It does not occur on its own. Transmission is through contact with infected blood. Syringes, toothbrushes, razors, needles, etc can carry the infection
- Hepatitis E is also transmitted through contaminated food and water. And like Hepatitis A is common in environments with unsafe water and poor sanitation.
4. Health outcomes
According to WHO, hepatitis B and hepatitis C are responsible for at least 95% of death and sickness from the disease. The mortality is often linked to hepatitis associated complications. These complications include cirrhosis (late-stage liver damage) or liver cancer which leads to eventual death.
The WHO showed that each day, 3600 people die from liver disease, liver failure and liver cancer associated with hepatitis. According to the American Cancer Association, the link between liver cancer and hepatitis, especially when it is viral chronic hepatitis is well-defined. They also note that it is the single most common risk factor for liver cancer, worldwide. Liver cancer is the third most common type of cancer and the fifth most common in Nigerian men and women respectively, according to data from the International Agency for Research on Cancer (IARC).
5. Hepatitis can be prevented
As hepatitis, is a viral infection, some types can be prevented with a vaccine.
- Both hepatitis A and hepatitis B can be prevented with the aid of a vaccine. Evidence suggests that the hepatitis B vaccine is 90% effective in protecting individuals. Hepatitis B vaccine is delivered in three doses and A in two doses. Both can be administered at infancy and to adults. The hepatitis B vaccine was introduced into the National Program on Immunisation in 2004. The uptake of hepatitis B is relatively low, as identified by a study in Enugu state which found a rate of only 14.2% in their over 3000 participants.
- There is no vaccination for Hepatitis C and E, and hepatitis D can be prevented by vaccination against Hepatitis B.
6. Is Hepatitis Treatable?
- Infection with hepatitis A and E are usually self limiting; the body mounts a defence system that usually clears up the infection. Both do not have any treatment, and in cases of a complicated infection, it can be fatal.
- Hepatitis B can be treated with antiviral drugs that slow the growth of the virus and prevent its complications such as liver cirrhosis and cancer. Such treatment can even result in clearance of the virus, but this is not in all cases.
- Hepatitis C has the only sure cure. Cure rates with the new antiviral drugs are almost 100%. However, these drugs are expensive in Nigeria.
- Treatment for Hepatitis D consists of using a drug known as interferon, but this is not very effective.
The best way to treat hepatitis remains vaccination, safe living practices, and living in a sanitary environment! Treatment is expensive in low and middle income countries such as Nigeria.