It is described as a ‘silent epidemic’ because most persons do not realize that they are infected and, over decades, slowly progress to liver disease and death. Viral hepatitis has cut down many Nigerians in their prime and recent studies have shown that it kills as many people as Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS).
In fact it affects over 20 million Nigerians and causes thousands of deaths each year because less than 500,000 of them have access to treatment. However, many countries, including Nigeria, are only now realizing the magnitude of the disease burden and devising ways to address it.
SEVERAL studies have shown that hepatitis virus A, B, C, D and E are responsible for acute and chronic infections and inflammation of the liver that can lead to liver cirrhosis and liver cancer. It has been shown that while hepatitis virus A and E are transmitted faeco-orally and largely responsible for acute hepatitis, hepatitis virus B and C which are blood-borne are majorly responsible for chronic hepatitis.
According to stakeholders, these viruses therefore constitute a major global health risk with around 240 million people said to be chronically infected with hepatitis B and about 150 million people chronically infected with hepatitis C.
The stakeholders include the World Health Organisation (WHO); the Society for Gastroenterology and Hepatology in Nigeria (SOGHIN); the World Hepatitis Alliance (WHA); and the Nigerian Medical Association (NMA).
Available statistics show that millions of people world-wide are living with viral hepatitis with millions at high risk of being infected. Most people with chronic infection with hepatitis B or C virus are unaware that they carry the virus, and are therefore at risk of developing severe chronic liver disease before they are clinically diagnosed. They also unknowingly transmit the virus to other people because of their lack of awareness.
According to the Global Burden of Disease study released last year in the Lancet, viral hepatitis was responsible for almost 1.45 million deaths in 2010, the same as HIV/AIDS and significantly more than tuberculosis or Malaria.
The WHO in the first-ever country hepatitis survey, covering 126 countries, released last week reported that 63 per cent of countries including Nigeria are ill-equipped to tackle the disease.
The WHO “Global policy report on the prevention and control of viral hepatitis in WHO Member States” showed that only 37 per cent of the countries have national strategies for viral hepatitis, and more work is needed in treating hepatitis.
It also highlighted that while most of the countries (82 per cent) have established hepatitis surveillance programmes, only half of them include the monitoring of chronic hepatitis B and C, which are responsible for most severe illnesses and deaths.
The report identified successes as well as gaps at country level in the implementation of four priority areas. The priority areas are raising awareness, evidence-based data for action, prevention of transmission, and screening, care and treatment.
However, stakeholders, on the World Hepatitis Day (WHD), urged governments to act against the five hepatitis viruses that can cause severe liver infections and lead to 1.4 million deaths every year. They called on the government to declare the disease a public health emergency in Nigeria.
The stakeholders said some of these hepatitis viruses, most notably types B and C, can also lead to chronic and debilitating illnesses such as liver cancer and cirrhosis, and in addition to, loss of income and high medical expenses for hundreds of millions of people worldwide.
July 28 was chosen to mark WHD in honour of the birthday of Nobel Laureate Baruch Samuel Blumberg, the discoverer of the Hepatitis B virus.
Thus, every year on July 28, WHO and its partners mark WHD to increase the awareness and understanding of viral hepatitis and the diseases that it causes.
This year’s theme, “This is Hepatitis, Know it, confront IT” emphasizes the fact that hepatitis remains largely unknown as a health threat in most parts of the world.
The NMA President said about one million people die each year from causes related to viral hepatitis, most commonly from liver cirrhosis and liver cancer.
Enabulele said though viral hepatitis, particularly hepatitis B and C remain largely under-reported and under-diagnosed in Africa, Sub- Sahara African region has about the highest prevalence of hepatitis A globally, with around 90 per cent children in the region being exposed to hepatitis A before the age of 10.
“Hepatitis B prevalence is estimated at eight per cent in West Africa, while prevalence of Hepatitis C is about 10 per cent in parts of Africa. Indeed, about 20 to 25 per cent of Africa’s population are chronic hepatitis carriers with liver cancer prevalent among affected individuals, with men in the 30 to 45 age group severely affected with almost 100 per cent mortality, as well as great economic and social impact, he said.
SOGHIN President, Prof. Olusegun S. Ojo, in a statement ahead of WHD said the Society is disturbed that so many Nigerians vulnerable to hepatitis infection lack quality information to protect themselves while millions of Nigerians living with hepatitis B virus still lack access to treatment.
Ojo called on government to prioritise hepatitis B response in the country by first having an established goal of eliminating Hepatitis B and declaring the epidemic as a national public health emergency. “That is exactly what it is! Or how else can we describe a virus that has affected over 20million Nigerians and causing thousands of deaths each year?”
The SOGHIN President said out of the over 20 million Nigerians living with the virus, less than 500 thousand of them have access to treatment including quality treatment literacy hence the Society’s demand for publicly funded Hepatitis B treatment programmes across the country.
The Society demanded that treatment subsidy programmes be initiated by the Federal and state governments as a way of reducing Hepatitis-B related mortality and the rate of infection. “The time to act is now as delay means more needless loss of lives,” Ojo said.
Formed in September 2007, SOGHIN is a professional body made up of Nigerian physicians, surgeons, pathologists and allied health professionals dedicated to the advancement of knowledge on the recognition, prevention, investigation and treatment of liver and digestive diseases.
NMA urged governments at all levels to ensure greater investment of funds and resources for regular conduct of national surveys/researches to determine the burden of hepatitis in Nigeria.
NMA in a statement released as part of activities to mark the 2013 World Hepatitis Day, also called for the subsidization of the high cost of treatment of people with liver cancer and liver failure in Nigeria, especially through the National Health Insurance Scheme.
The Association in the statement signed by the President, Dr. Osahon Enabulele, thanked the Federal Government for including Hepatitis in the list of routine National Programme on Immunisation (NPI)- driven vaccinations and strongly urged government to expedite all actions in the process of domestic vaccine production or more effective collaboration with partners in ensuring greater availability of vaccines at much reduced cost.
The NMA also called for: development of a sound and updated national policy and strategy for combating viral hepatitis in Nigeria; increase in Hepatitis B vaccination coverage; carrying out of massive awareness campaigns; provision of adequate housing, food supply/nutrition and clean potable water to Nigerians; and enforcement of Environmental Sanitation and Public health laws.
Enabulele said the goal is moving from awareness to commitment and action to address the ‘silent epidemic’ of viral hepatitis, hence the World Hepatitis Day provides an opportunity to focus on specific actions, such as: strengthening prevention, screening and control of viral hepatitis and its related diseases; increasing Hepatitis B vaccine coverage and integration of the vaccine into national immunization programmes; and coordinating a global response to viral hepatitis
WHO Assistant Director-General for Health Security and the Environment, Dr Keiji Fukuda, said: “The fact that many hepatitis B and C infections are silent, causing no symptoms until there is severe damage to the liver, points to the urgent need for universal access to immunization, screening, diagnosis and antiviral therapy.
“Many of the measures needed to prevent the spread of viral hepatitis disease can be put in place right now, and doing so will offset the heavy economic costs of treating and hospitalizing patients in future.”
President of the WHA, Charles Gore, said: “Viral hepatitis is the 8th leading cause of death worldwide, killing as many people as HIV/AIDS every single year. 500 million people worldwide are chronically infected. In the face of these numbers how is it possible that viral hepatitis receives so little priority across the world?”
Director, Pandemic and Epidemic Diseases at WHO, Dr Sylvie Briand, said: “Many of the measures needed to prevent the spread of viral hepatitis disease can be put in place right now, and doing so will offset the heavy economic costs of treating and hospitalizing patients in future.
“The findings underline the important work that is being done by governments to halt hepatitis through the implementation of WHO recommended policies and actions.”
To effectively limit the spread of viral hepatitis in Nigeria, the NMA said there is need for a comprehensive strategy.
The statement reads: “In this regard, the following proposals are worth considering: Huge investment in public awareness campaigns to close the information gap with respect to the current low level of awareness of Hepatitis and its devastating consequences amongst Nigerians.
“All stakeholders, including the relevant ministries and agencies of government must show increased commitment in this direction.
“In this regard, the NMA shall continue to create awareness and sensitize Nigerians on the reality of this silent killer, Hepatitis. More public health enlightenment campaigns shall be organized by NMA.
“The NMA shall also contribute to research efforts on Hepatitis, especially the conduct of surveys to establish the burden of Hepatitis in Nigeria.
“The NMA shall continue to constructively engage policy makers on the need for formulation of a robust Hepatitis policy and strategy for Nigeria.
“We also encourage Individuals to take steps towards ensuring that they are not infected with Hepatitis B, C and D through abstinence, being mutually faithful to a sexual partner, not sharing skin piercing instruments, ensuring that blood products are properly screened before a patient is transfused.
“Individuals are encouraged to ensure that they drink clean potable water and eat well cooked food to prevent infection with Hepatitis A and E.”
As part of activities to mark this year’s WHD, the WHA has launched a mass awareness campaign under the theme “This is hepatitis. Know it. Confront it,” to encourage people to find out more and to confront the silence around the disease.
The Alliance is also coordinating a global Guinness World Record attempt for the number of people performing the ‘see no evil, hear no evil, speak no evil’ actions at the same time, actions chosen because in the same way the Three Wise Monkeys ignore the world around them, so the world has been ignoring viral hepatitis. With 58 teams from 25 countries around the world taking part, this is a considerable challenge but with a clear message: viral hepatitis is a silent epidemic. Know it. Confront it.
WHO is currently developing new hepatitis C screening, care and treatment guidelines, which will provide recommendations on seven key areas such as testing approaches; behavioural interventions (alcohol reduction); non-invasive assessment of liver fibrosis; and the selection of hepatitis C drug combinations.
The complexity of hepatitis disease lies in the existence of different types of viruses. Hepatitis A and E are foodborne and waterborne infections which cause millions of cases of acute illness every year, sometimes with several months needed for a person to fully recover.
Hepatitis B, C, and D are spread by infected body fluids including blood, by sexual contact, mother-to-child transmission during birth, or by contaminated medical equipment. Hepatitis B and C have a greater health burden in terms of death because they can cause life-long infection (called chronic infection), which can lead to liver cirrhosis and cancer. In fact, chronic hepatitis is the leading cause of liver cirrhosis and cancer.
WHO-approved vaccines are available to prevent hepatitis A and B, while screening of blood donors, assuring clean needle and syringes, and condom use can prevent bloodborne and sexual transmission.
Hepatitis B can be prevented by reaching every child with immunization programmes that include hepatitis B vaccine. There is no vaccine for hepatitis C. In addition, infections can be prevented by protecting against mother-to-child transmission of the virus and ensuring the safety of blood, transfusion services, organ donation and injection practice (treatment can include antiviral medications if needed).
Hepatitis A and E can be prevented by avoiding contaminated food and water; in addition, there is an effective WHO approved vaccine for hepatitis A.
Hepatitis medicines are now included in the WHO Essential Medicines List, which Member States are encouraged to adopt. Essential medicines are selected based on disease prevalence, safety, efficacy, and comparative cost-effectiveness. The WHO Model List can be used by countries as a guide for the development of their own national list.
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