Sunday, July 28, 2013

World Hepatitis Day: Confronting the scourge of Hepatitis in Nepal

Every year, July 28 is celebrated by World Health Organization as World Hepatitis Day. The day is the birthday of Nobel Laureate Professor Baruch Samuel Blumberg who discovered the hepatitis B virus, then known as Australia antigen. The World Hepatitis Alliance first launched World Hepatitis Day in 2008, and this year will be the sixth year it is marked. It has become an annual event focused on patient groups and people living with hepatitis, particularly hepatitis B and C, which can cause chronic liver disease, liver cirrhosis, and liver cancer. The World Hepatitis Alliance is a not-for-profit international non-governmental organization whose membership is composed of organizations working in the field of viral hepatitis. It is a purely patient-led and patient-driven organization, full membership of which is available to patients only. It is working with more than 150 international organizations worldwide towards its aim of a world without viral hepatitis B and C.

Hepatitis is one of only four diseases marked by WHO on a specific date. WHO and partners mark World Hepatitis Day to increase the awareness and understanding of viral hepatitis and the diseases caused by hepatitis virus infection. This year, the theme of World Hepatitis Day is “This is hepatitis. Know it. Confront it.”

Know it
Hepatitis viruses have a special affinity for the liver. Viral hepatitis means the inflammation (damage) of liver cells by those viruses. Hepatitis A, B, C, D and E can cause acute and chronic infection. Hepatitis A and E are transmitted by feco-oral route, which means by taking food and drinks contaminated with fecal matter. Both of them cause acute viral hepatitis. Although this disease is often self-limiting, it can sometimes cause acute liver failure and even death. Pregnant women are at risk along with newborns, elderly people, and people with chronic liver diseases. It is estimated that about 1,400,000 new hepatitis A virus infections occur globally each year, and underdeveloped countries bear most of the burden. Every year, there are 20,000,000 hepatitis E infections, over 3,000,000 acute cases of hepatitis E, and 70,000 hepatitis E related deaths.

Hepatitis B and C cause chronic inflammation of the liver that can lead to cirrhosis and liver cancer. These viruses constitute a major global health risk. WHO estimates that there are about 2,000,000,000 people who have been infected with hepatitis B worldwide. More than 300,000,000 are chronically infected and require treatment. Between 500,000 and 700,000 people die every year due to hepatitis B related cirrhosis and liver cancer. At the same time, it is estimated that about 150,000,000 people are chronically infected with hepatitis C virus. More than 350,000 people are estimated to die from HCV-related liver diseases each year worldwide.

Confront it
Viral hepatitis B and C place a heavy burden on the healthcare system because of high costs of treatment of liver cancer and liver failure from cirrhosis. The actual burden of diseases related to hepatitis B and C infection is not exactly known in our country. In fact, the problem has not been addressed in a comprehensive way so far by the stakeholders. Researchers and clinicians are also to blame for this, as there have been no researches in this area so far. As most people do not develop any symptoms for decades, until they come down with liver disease, hepatitis has created a “silent epidemic.”

Moreover, most people with chronic infection of hepatitis B or C are unaware that they carry the virus and unknowingly transmit it to other people. Hepatitis B vaccination is the best way to deal with this disease. It has been included in Nepal’s Expanded Program on Immunization Schedule, which is commendable. However, it is still not available in every district. Early detection is the best way to treat this disease, as it is curable. Early detection also prevents the development of complications. Those who are at risk should be tested. Treatment of hepatitis C is very costly. It is the lone virus without a vaccination. Intravenous drug abuse, which accounts for more than 90 percent of the transmission, should be discouraged. Universal precaution should be practiced in health care institutes, since prevention is better than cure.

Hepatitis A and E can be prevented by maintaining good personal hygiene. Avoiding unsafe and uncooked food and taking processed water can control this disease. Vaccine against hepatitis A is available, while vaccine against hepatitis E is awaiting mass production.


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