World Hepatitis Day: In Pakistan 12m people suf er from Hepatitis B or C

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Staff Report
Islamabad

Viral hepatitis is the 8th highest cause of mortality globally and is responsible for an estimated 1.34 million deaths. Globally, approximately 257 million persons are chronically infected with Hepatitis B and 71 million with Hepatitis C.
At this rate, an estimated 20 million deaths were estimated to occur between 2015 and 2030, Dr Nadeem Iqbal, Gastroenterologist at Shifa International Hospital shared this data on World Hepatitis Day.
Shifa International Hospital launched on Saturday ‘Find the Missing Millions’, an awareness campaign to educate, influence national testing policies and encourage people to get screened and become advocates in the quest to find the undiagnosed.
This campaign was aimed at to bring much needed attention to the fact that millions of people are living with viral Hepatitis unaware.
It should also be used to inspire the community to take action to support the uptake in screening and diagnosis, whilst driving an action to join the quest and link people living with the disease to care. He shared that within Pakistan almost 12 million people are suffering from Hepatitis B or C.
Each year brings about 150,000 new cases. The majority of people catch this infection in health care settings without being aware of it. The disease is called a silent killer because many patients remain undiagnosed and untreated for many years before developing the complications and dying.
World Hepatitis Day (WHD) takes places every year on 28 July bringing the world together under a single theme to raise awareness of the global burden of viral Hepatitis and to influence the real change.
Major risk factors for the transmission of Hepatitis B and C infection includes: therapeutic injections, syringe reuse, surgery, improper sterilization of invasive medical devices, blood transfusion, hospitalization and sharing of razors while getting shave from barbers.
Some population groups are highly affected by Hepatitis B and Hepatitis C such as injecting drug users and thalassemia patients. For hepatitis C, high prevalence of infection is reported in children especially those who were admitted in hospitals with acute hepatitis, while for HEV, most of the infections were due to faecal contamination of water.
“Highly effective recombinant vaccines are now available. Vaccine can be given to those who are at increased risk of HBV infection such as health care workers.
It is also given routinely to neonates as universal vaccination in many countries. Hepatitis B Immunoglobulin (HBIG) may be used to protect persons who are exposed to Hepatitis B. It is particular efficacious within 48 hours of the incident. It may also be given to neonates who are at increased risk of contracting Hepatitis B whose mothers are HBsAg and HBeAg positive. Other measures include screening of blood donors, blood and body fluid precautions,” he said.
Hepatitis is a disease of liver characterized by abnormalities in the liver leading to its failure. Liver is one of the main organs of the body responsible for numerous functions.
It acts as a part of digestive system and helps digest food especially fat. It detoxifies waste products produced in the body and processes different drugs and hormones. It is responsible for production of useful materials and is a storage site for certain vitamins (A, D, E, K and B12) and minerals (Iron and copper).
Consultant Physician at a private hospital in the capital Dr Azmat Ali informed that hepatitis is commonly caused by viruses but there are other possible causes of hepatitis as well including autoimmune hepatitis, and hepatitis secondary to drugs, medication, toxins and alcohol.
There are five main hepatitis viruses, referred to as types A, B, C, D and E. Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of contact with infected body fluids and blood, he said.
He further explained that following the infection with the hepatitis C virus (HCV), chronic infection typically occurs, with approximately 50 to 85 per cent of cases developing chronic hepatitis.
However, chronic HCV infection is usually slowly progressive and may not result in clinically apparent liver disease in many patients. Approximately five to 30 per cent of chronically infected individuals develop cirrhosis over a period of 20 to 30 years. Estimates of the risk of developing liver cancer once cirrhosis has developed have varied from 0 to 3 per cent per year in various reports, he said.
Major risk factors for viral transmission
The risk factors for transmission of this virus include Injection Drug Users (IDUs), blood transfusions, reuse of syringes, facial and armpit shaving by barbers and unprotected sex. In Pakistan major modes of transmissions are I/V injection/drip, nail cutter sharing, shaving from barbers, razor sharing, needle stick accident, dental procedures, sexual promiscuity or ear and nose piercing.
Symptoms
He added that most people with hepatitis C have no symptoms. When symptoms occur, they may include feeling tired or weak, lack of hunger, nausea, muscle or joint aches and weight loss. In most cases, hepatitis C lasts for many years. That can lead to liver scarring, called “cirrhosis”, he said.
He also informed that in many cases, patients with cirrhosis have no symptoms and when occur, symptoms may include swelling in the belly and legs, and fluid build-up in the lungs, bruising or bleeding easily, trouble taking in a full breath, feeling full in the belly, yellowing of the skin or whites of the eyes, called jaundice, confusion that can come on suddenly and coma.
Treatment
Treatment of this devastating illness has evolved over time and has reached a point where this threat has almost been made controllable. Introduction of Directly Acting Antivirals (DAAs) have revolutionized the management of Hepatitis C. DAAs are oral drugs to be taken with or after meals having no serious side effects and high rate of cure, Dr said.
Availability of sofosbuvir, daclatasvir and velpatasvir (DAAs) for hepatitis C has improved response rates in hepatitis C treatment. Sofosbuvir is being marketed in Pakistan but daclatasvir and velpatasvir are still not available for use. Their low price, very well tolerability, negligible side effects and duration of treatment as low as 12 weeks in majority of cases, all by oral route will revolutionize treatment for common man, he said.
He revealed that currently no vaccine is available for protection from hepatitis C. In order to protect liver, people should avoid alcohol, maintain healthy weight and should not use over-the-counter medications. Hepatitis C does not spread by sharing spoons, forks, cups, food, sneezing, coughing, hugging, kissing or breast feeding, said Dr Azmat.

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