Hepatitis a burden
CELEBRATED on May 29 every year, World Digestive Health Day is dedicated to spreading knowledge about the latest research, diagnoses, treatments and issues related to digestive health.
The World Gastroenterology Organisation initiated this day of awareness in 2004 to mark its 45th anniversary of incorporation, with all its member societies coming together to organise various awareness events.
The theme for this year is “Viral Hepatitis B and C: Lift the Global Burden”, which was chosen because there is an estimated 325 million people worldwide who live with chronic hepatitis B and C, according to data published by the World Health Organization (WHO) in 2015.
Hepatitis refers to inflammation of the liver, which can be caused by several factors including alcoholism, fat accumulation in the liver and autoimmune diseases. However, the most common type of hepatitis worldwide is viral.
There are five types of viral hepatitis – hepatitis A, B, C, D and E. Only hepatitis A, B and D are preventable by vaccination.
Among the five, hepatitis A, B and C are the most common. Hepatitis B and C are more dangerous as both can develop into chronic conditions.
When someone is first infected, she is considered an acute hepatitis patient. If she does not recover from the infection within six months, the infection is considered chronic. A blood test can reveal whether someone is infected with acute or chronic viral hepatitis.
The chances of an acute hepatitis C infection turning chronic is 90% while the risk of an acute hepatitis B infection turning chronic decreases with age.
According to WHO, 5% to 10% of adults develop chronic infections when infected with hepatitis B, while 50% of children infected between one and five years old develop chronic infections. This risk increases dramatically when infants below one year old are infected, with up to 90% of cases turning chronic.
Chronic hepatitis B and C can often lead to complications such as liver cancer and cirrhosis. WHO estimates that around 1.34 million people worldwide died of these types of hepatitis in 2015.
The WHO-mandated Western Pacific region, which includes Malaysia, accounts for 50% of all chronic hepatitis B cases. Malaysia also belongs to the global high-prevalence belt for hepatitis B (8%) and C (2.5%), which includes Thailand, Indonesia, the Philippines, China, South Korea and Taiwan.
For chronic hepatitis C, WHO estimates that Malaysia has 454,000 infected individuals out of 140 million worldwide, according to Prof
Lee Yeong Yeh, professor of medicine and consultant of gastroenterology, hepatology and internal medicine at
Universiti Sains
Malaysia.
Hepatitis B is preventable with proper vaccination, but a vaccine for hepatitis C has not yet been found.
Prof Lee shares, “Most people with acute hepatitis B will recover, but not hepatitis C patients since it can result in a chronic infection even with proper, timely treatment.
“However, hepatitis B causes more deaths than hepatitis C in Malaysia. This will be even more apparent in the next few years as effective therapy is not yet available for hepatitis B.”
Prof Lee believes that, currently, the only way to prevent viral hepatitis B and C is to be vigilant.
“Both hepatitis B and C are blood-borne infections. Therefore, preventing the transmission of infected blood is important.
“Having unsafe sex with one or multiple partners and using unsterilised equipment for body piercings or tattoos are some common ways that hepatitis B and C can spread.
“For healthcare workers, not wearing protective clothing or properly disposing of contaminated objects can put them at risk.”
WHO is advocating for elimination of hepatitis B and C by 2030, and Malaysia is wholeheartedly supporting the call.
“There has been tremendous development in the treatment of hepatitis C with 90% of cases effectively cured with direct-acting antivirals,” says Prof Lee.
“These drugs are expensive, but they became more affordable and accessible this year when the Government issued a licence that allowed for import or production of generic versions of these drugs.”
The Government has made hepatitis B immunisation compulsory for newborns to eradicate the condition, but Prof Lee
Adults who are already infected need to continue being treated, especially if they are pregnant and have a high viral load. It is common for the virus to pass from mother to foetus. Prof Lee Yeong Yeh
believes it will take time to achieve this goal.
“Some misconceptions have caused people to avoid vaccinating their children, so we need more education and awareness.
“Adults who are already infected need to continue being treated, especially if they are pregnant and have a high viral load. It is common for the virus to pass from mother to foetus,” says Prof Lee.
Only time will tell if these government initiatives will be enough to eradicate hepatitis B and C in Malaysia by 2030. Until then, Malaysians need to do their part by educating themselves and getting vaccinated against preventable types of viral hepatitis.