There are Five main strains of the Hepatitis Virus which are A, B, C, D and E. Together, Hepatitis B and C are the most common cause of deaths. This Article will be looking at the Viral Hepatitis B and C. Viral Hepatitis is a major global health problem with more than 400 million patients chronically infected, causing over 1.4 million deaths per Year globally. Its prevalence varies throughout the World, but is highest in the Tropical Regions. It is estimated that 5-15% of Adults in Sub-Saharan Africa are chronically infected with HBV. There is a 15-25% risk of dying prematurely in Adulthood from HBV-related Cirrhosis and Hepatocellular Carcinoma, while a small proportion of those with acute infections may also succumb to fulminant liver failure.
Nigeria contributes significantly to the global burden of chronic viral Hepatitis with the prevalence rate of 8.1% for Hepatitis B and 1.1% for Hepatitis C. This translates to an estimated 16.2 million people with HBV and 2.2% million people living with HCV. Despite the clinical impact associated with this disease, majority of infected people are unaware of their status, largely driven by the asymptomatic nature of the disease. Globally awareness on Hepatitis B and C is very low at about 10% and 19% as estimated by the W.H.O. In Nigeria alone there could be about 15million people who are unaware that they are infected. Hepatitis B and C account for about 90% death of all types of Hepatitis. The danger is that those who are unaware of their *INFECTED* status could go on and develop liver diseases including cancer, also infect family members and sexual partners or die out of ignorance.
In Cross River State the prevalence of Hepatitis B and Hepatitis C are 8.8% and 10% respectively with Urban and Rural disparity. In a recent study conducted by Okoro etal in Cross River State, it was discovered that HBV/HCV positivity was higher among males than females. Age was significantly associated with being HBV negative and HCV negative. Communal use of toothbrush was significantly associated with HBV positivity. The first ever global Hepatitis strategy was adopted by the World Health Assembly in 2016, setting the World’s first Hepatitis elimination targets. The strategy calls for the elimination of viral Hepatitis as a public health threat by 2030 reducing new infections by 90% and mortality by 65%, new drugs and expanded access to vaccines are making it possible. To support that goal, W.H.O is now supporting a global process for validating the elimination of Hepatitis, just as we do for other diseases. Also, there are other strategies like “find the missing million” by the World Hepatitis Alliance and the Yearly World Hepatitis Day (WHD) is commemorated each Year on the 28th of July bringing the World together under a single theme to enhance awareness of viral Hepatitis, an inflammation of the liver that causes a range of health problems, including liver cancer.
On July 28 2020, Individuals, Organizations and Governments around the World celebrated the Tenth Official World Hepatitis Day (WHD), which is one of the World Health Organization’s (WHO) seven officially-mandated global public health days. WHD is a day for the World's’s Hepatitis community to unite and make their voices heard. It’s a day to celebrate the progress we have made and to meet the current challenges. It’s also an opportunity for us to increase awareness and encourage a real political change to jointly facilitate prevention, diagnosis and treatment.
“HEP (Hepatitis) Can't’ Wait” is the theme for 2021 World Hepatitis Day.
With a person dying every 30 seconds from viral Hepatitis related illness even in the COVID-19 crisis, we can’t wait to act on viral Hepatitis. HBV infection is a vaccine-preventable disease. Vaccination with the monovalent HBV vaccine was introduced in Nigeria in 2004 as part of the National Program on Immunization (NPI), to be given at 6, 10, and 14 weeks of age.
*MODE OF TRANSMISSION:*
Hepatitis B and C shares the same mode of transmission with HIV such as unprotected sexual intercourse, sharing of needles and sharps, transfusion with infected blood, semen and other body fluids and Mother to Child Transmission. Hepatitis can also be transmitted during organ transplant and through direct contact with sweat from an infected person.
*SIGNS AND SYMPTOMS OF HEPATITIS B:*
Abdominal pain.
Dark-colored urine.
Fever.
Joint pain.
Loss of appetite.
Nausea and vomiting.
Weakness and fatigue.
Yellow discoloration of the skin and eyes (jaundice)
*SIGNS AND SYMPTOMS OF HEPATITIS C:*
In addition to the above, Hepatitis C patient will also present with the following signs and symptoms:
Bleeding easily.
Bruising easily.
Itchy skin.
Fluid buildup in the abdomen (ascites)
*PATIENT EDUCATION:*
Blood-borne disease that can be transmitted during sexual intercourse or at the time of Childbirth.
Prophylaxis is strongly advised.
Family members born by the same parents should also be checked for HBV
infection.
The best preventative measurement is vaccination.
*WHO SHOULD BE SCREENED*
All Cross Riverians are at risk- and deserve to be counseled and screened for HBV
at any opportunity eg:
Clinic/Hospital visits
Pregnancy
Pre –school children
Blood/organ donation
Contact with identified person
*SPECIAL SUBJECTS REQUIRING SCREENING*
Recurrent blood transfusion patients
Post transfusion jaundice or Liver Function Test abnormality
Hepatocellular Carcinoma
1st degree relatives of Hepatitis +ve patients
Patients with HIV
Pre-commencement of chemotherapy or immunosuppressive therapy
Prisoners
Men who have Sex with Men (MSM) Female Sex Workers ( FSW) and
People Who Inject Drugs (PWID )
History of STDs
*PREVENTION OF Hepatitis B and C INFECTION*
Health /Education for Health Care Workers and the general public
Universal Immunization (infants, children, adolescents) and implementation
of National Programme for Immunization (NPI) scheme for HBV
vaccination.
Immunoprophylaxis against HBV is of two types: Passive Immunization
using HBIG- confers only immediate and short-lived protection and Active Immunization using inactive HBsAg- gives long-term immunity,
Contact tracing and Immunization of non-immune persons
Screening and vaccination of all special risk groups especially surgeons,
dentists, Lab staff, Accident/Emergency staff, Key Populations and law enforcement agents
Screening of pregnant women at ANC and Immunization of the non-immune.
Immunization of all babies born to HBV +ve pregnant women immediately
after birth.
Screening of all blood/organ and blood products before transfusion/transplantation.
Proper disposal of all sharp instruments (needles, lancets, blades).
Harm reduction programs
*MY TAKE HOME MESSAGES TO CROSS RIVERIANS*
HBV infection is a Worldwide problem. More in Nigeria
100 times more infectious than HIV. Spreads is similar.
All Nigerians are at risk. Screen at any available opportunity.
TREATMENT to be initiated by SPECIALISTS ONLY!!!
Prevention through Vaccination is the best.
*SUMMARY*
Viral Hepatitis is common
HBV & HCV are associated with Chronic liver Cirrhosis.
Immunoprophylaxis is proving to be difficult – no effective neutralising immune response has been achieved.
Diagnostic tool still a challenge
Treatment is expensive
Prevention through vaccinaution is the key for HBV (NONE FOR HCV)
*IN CONCLUSION:*
Without finding the undiagnosed and linking them to care,
millions will continue to suffer, and lives will be lost. On World Hepatitis Day, 28 July, we call on people from across the State to take action and raise awareness.
In the current COVID-19 crisis, we can’t wait to act on Viral Hepatitis.
People living with viral Hepatitis who are unaware can’t wait for testing.
People living with hepatitis can’t wait for life saving treatments.
Expectant mothers can’t wait for Hepatitis screening and treatment.
Newborn babies can’t wait for birth dose vaccination.
People affected by Hepatitis can’t wait to end stigma and discrimination.
Community organizations can’t wait for greater investment.
Decision makers can’t wait and must act now to make hepatitis elimination
a reality through political will and funding.
*Dr Betta Edu*
*Honorable Commissioner For Health, CRS*
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