Dr Abdul Razak Shaikh
WORLD Hepatitis Day, 28 July, is an opportunity to step up national and international efforts on hepatitis, encourage actions and engagement by individuals, partners and the public. Highlight the need for a greater global response as outlined in the WHO’s Global hepatitis report of 2017. The date of 28 July was chosen because it is the birthday of Nobel-prize winning scientist Dr Baruch Blumberg, who discovered the hepatitis B virus (HBV) and developed a diagnostic test and vaccine for the virus. Low coverage of testing and treatment is the most important gap to be addressed in order to achieve the global elimination goals by 2030. Worldwide in 2015, hepatitis A occurred in about 114 million people, chronic hepatitis B affected about 343 million people and chronic hepatitis C about 142 million people. In the United States, Nonalcoholic steatohepatitis (NASH) affects about 11 million people and alcoholic hepatitis affects about 5 million people. Hepatitis results in more than a million deaths a year, most of which occur indirectly from liver scarring or liver cancer. In the United States, hepatitis A is estimated to occur in about 2,500 people a year and results in about 75 deaths.
Hepatitis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis. There are 5 main hepatitis viruses referred to as types A, B, C, D, and E. These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer. 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 parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, and also by sexual contact. Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.
Viral hepatitis is a major cause of morbidity and mortality worldwide and a rising cause for concern in Asian countries. Whether it is blood-borne or water/foodborne hepato-tropic virus, the increasing burden is alarming for Asian countries. In this review, we have evaluated the existing data to estimate the burden of viral hepatitis in populations of all age groups nationwide, along with an assessment of the risk factors and preventive and management strategies currently employed in Pakistan. The aim of our work is to consolidate and supplement the present knowledge regarding viral hepatitis in light of past and present trends and to provide future direction to the existing health policies. Hepatitis B and C are big health issues worldwide as more than 400 million people are suffering from chronic hepatitis B and C which result in more than 1.4 million deaths each year. According to a study done by Pakistan Medical Research Council in 2007-08, 7.6% Pakistani population suffered from hepatitis B and C, with around 4.8% with hepatitis C only. Government of Pakistan has taken different initiatives like vaccination, patient safety, blood screening, education and awareness about the disease but still there is a high prevalence of hepatitis in Pakistan. According to some studies injecting drug users have the highest prevalence of hepatitis B and C in the country. The follow-up studies and documentation of hepatitis patients were not very good which need to be improved. There is no recent large scale study on risk factors and prevalence of hepatitis B and C in Pakistan so it should be done on an urgent basis. If the government set up regional laboratories for prevalence study and also a central institute for hepatitis research and treatment, the disease could be prevented in a better and proper way. The treatment of hepatitis is very costly and a developing country like Pakistan cannot afford such high costs.
Therefore more the focus should be on preventive measures. Key challenges for an effective national response include, limited timely and reliable data available on coverage and quality of essential hepatitis services; unnecessary injection practices, the capacity of staff on safe injection practices and effective sharp and waste management; unregulated blood transfusions in general as well as inadequate screening; and limited access to the new direct-acting antiviral treatment in the public sector. The national response to Hepatitis prevention and treatment in the country is being implemented through provincial hepatitis prevention and control programs, through their own PC1’s. In the absence of a national program, the Pakistan Health Research Council, under the Ministry of National Health Services, Regulation and Coordination is coordinating the hepatitis response at federal and the provincial levels, through a ‘Technical Advisory Group’. Additionally, the private sector is also playing a significant role in hepatitis treatment. A Field Epidemiology and Laboratory Testing Programme has established a surveillance system of acute viral hepatitis, in 5 public sector tertiary-care hospitals located in Lahore, Peshawar, Karachi, Quetta and Islamabad, and generates quarterly reports. World Hepatitis Day, WHO is calling on countries to step up efforts to eliminate hepatitis by 2030. With one of the world’s highest rates of hepatitis C, Pakistan is tackling this serious health issue from many angles to improve prevention diagnosis, and treatment.
— The writer is retired officer of Sindh Govt.
Dr Abdul Razak Shaikh