Feature

Hepatitis: A silent killer

Leading cause of liver cancer –Medical experts

Hepatitis, according to the World Health Organisation (WHO), is an inflammation of the liver that is caused by a variety of infectious viruses and non-infectious agents leading to a range of health problems, some of which can be fatal. It is estimated that one person dies every 30 seconds from a hepatitis related illness. This, perhaps, may be why this year’s World Hepatitis Day theme was carefully chosen: “Hepatitis: Don’t wait, get tested”. This conveys the urgency of efforts needed to eliminate hepatitis as a public health threat. Isioma Madike looks at the silent epidemic through the lens of medical experts

In 2020, Azubuike went to hospital with an injury. While there he had several tests and discovered he had Hepatitis B, contracted from his mother during pregnancy. His siblings also all tested positive. They had all had the virus since birth. With no symptoms, Azubuike was not in a hurry to seek advice. However, one of their hospital nurses met with the whole family to discuss the next steps but Azubuike didn’t attend this meeting: he didn’t think he needed to. But the nurse – the hepatitis hunter, Azubuike calls her – ferreted him out and organised blood tests.

They found Azubuike was the worst-affected of all his family, even though he didn’t drink or smoke and was a healthy vegetarian. The nurse suggested Azubuike start taking medication. Since then his hepatitis status has changed drastically and he’s grateful for the support.

“The nurse’s contact saved me,” he said. Others in his family, sadly, weren’t so lucky; some have lost their battle with the virus Azubuike calls a silent killer. “It’s very serious and should be dealt with properly. Go straight to the hospital and receive regular check-ups,” he advises anyone else in a similar situation. Azubike’s liver condition was picked up during the forced check-up.

It was, understandably, a shock to him. “I didn’t know much about it at the time,” he said. He’s since learned to manage it by having regular blood tests and eating properly. “I don’t really drink, don’t smoke. I only eat meat every few days.”

He also makes a lot of vegetable juices to boost his immune system. “I’ve always liked vegetables.” Azubuike stays fit, exercising at home on a routine, and his physical work helps. It’s a far cry from his pre-hepatitis days. “I was pretty bad back then, eating pies before work,” he said. Stigma is everywhere, he said, adding, “People don’t think about the facts of how the virus is transmitted– they are afraid to even touch someone who has it. Many people don’t even want to get tested, because treatment, they believe, is either not available or costs too much money. They say, “what’s the point?’ This needs to change.” However, Azubuike’s case is one out of the many, who suffer from hepatitis without knowing they have the virus.

This may have been the reason the World Health Organisation (WHO) is taking the message to every nook and cranny of the world, sensitising everyone. World Hepatitis Day (WHD), which WHO initiated, takes place every year on July 28. It is aimed at bringing the world together under a single theme to raise awareness of the global burden of viral hepatitis and to influence real change.

This year’s theme: “Don’t wait, get tested”, is urging people living with viral hepatitis unaware not to wait for testing, and for lifesaving treatments. Medical experts have also said that knowing that hepatitis is the leading cause of liver cancer, getting tested remains the best way to protect oneself. “1 can’t wait” campaign also highlights the need to accelerate the fight against viral hepatitis and the importance of testing and treatment for the real people who need it. The campaign seeks to amplify the voices of people affected by viral hepatitis calling for immediate action and the end of stigma and discrimination.

According to WHO, people living with viral hepatitis unaware can’t wait for testing, can’t wait for life saving treatments, can’t wait to end stigma and discrimination; expectant mothers can’t also wait for hepatitis screening and treatment, likewise newborn babies, who can’t wait for birth dose vaccination. WHO has equally urged community organisations not to wait for greater investment, and decision makers to act now to make hepatitis elimination a reality through political will and funding. There are five main strains of the hepatitis virus – A, B, C, D and E. Together, Hepatitis B and C are the most common, which result in global 1.1 million deaths and three million new infections per year as at 2021, says WHO. Hepatitis in a plain language means inflammation of the liver.

The liver, according to medical experts, is a vital organ that processes nutrients, filters the blood and fights infections. When the liver is inflamed or damaged, its functions, they say, can be affected. Though commonly caused by a viral infection, there are other possible causes of hepatitis such as heavy alcohol use, toxins, some medications, and certain medical conditions. It could be easily contracted from a victim through contact of body fluids. This could be either through sexual contact, blood contact or even saliva. It could also be contracted if by chance a person consumes the waste passed out from a carrier. Slight contact with these fluids can transmit the disease, the medics say.

Former President, Guild of Medical Directors (GMD) and Chief Medical Director, Rachel Eye Centre, Abuja, Professor Olufemi Babalola, has called hepatitis, a silent epidemic in Nigeria. He went on to give a detailed analysis of the virus, saying that about 10-15 per cent of the population are seropositive, in which case, may end up with liver cancer, (hepatoma) having been carriers for several years. Everyone, he said, must have a serological test to rule it out as soon as possible.

He said: “Hepatitis is an inflammation of the liver, which is a large organ on the right side of the body. The liver has many functions, including turning food into energy, and filtering toxins such as alcohol out of the blood. It can occur because of viral infection and exposure to alcohol. The three most common viral forms are: Hepatitis A, B and C. The other forms of hepatitis are D, E, F and G, which are very rare.

“Vaccines can help protect from Hepatitis A and B. But, there is no vaccine against Hepatitis C. Hepatitis can be acute or chronic. Acute hepatitis is short term and begins after the first infection. It can lead to chronic hepatitis, which is long term. “However, Hepatitis A only causes acute infection. Chronic hepatitis can cause lasting damage to the liver. Very serious cases can lead to liver failure or cancer. Both viruses affect the liver and can cause serious illness, even fatality. “Hepatitis A is transmitted mostly through contaminated food or water. The symptoms include the following: Malaise and fever, diarrhoea, nausea, extreme tiredness, itchy skin, stomach pain, jaundice (Yellow eyes), and pale faeces. “Someone with Hepatitis A is most infectious two weeks before jaundice appears.

The virus lives in faeces and is transmitted through the faeco-oral route, especially contaminated food. The virus needs to get into the mouth to infect someone. “It can be prevented by vaccination, frequent washing of hands, eating from hygienic outlets only (Avoid unclean Mama Put), and avoid untreated or contaminated water. A blood test will confirm whether you have picked up the virus. And the usual treatment for Hepatitis A is simply to rest. “Avoid paracetamol, avoid recreational drugs to allow your liver to get better, and avoid alcohol until your liver recovers. However, once you have had Hepatitis A, you’re immune and cannot get it again, but you can still get other types of hepatitis.” Unlike Hepatitis A, that of B, Babalola said, is transmitted through needle injection, blood transfusion or sex (semen and vaginal fluids). He said that many people who get Hepatitis B notice no symptoms, or have ones so mild that they’re easily missed.

But the professor said that after some weeks or months the infection can cause loss of appetite, nausea or vomiting, extreme tiredness, fever, stomach pain, jaundice, and pale faeces. He also said that symptoms can last for several weeks and it can take months to get back to normal. Most people, he further said, make a full recovery but up to one in 20 become ‘carriers’ with chronic (long-term) infection. They usually feel fine but stay infectious to others, with a small risk of going on to develop liver disease.

“Around 1 in 100 people get a more serious illness which can be fatal if it’s not treated. Prevention includes avoiding sharing razors, toothbrushes, nail scissors, hair clippers and tweezers because traces of blood on them can pass on Hepatitis B. This includes dried blood as the virus can survive for at least a week outside of the body. “In our context, giving tribal marks or Female Genital Mutilation, with unsterilised products can lead to transmission. There is a vaccine which can protect one against both Hepatitis A and B. You may need a booster injection of the vaccination after five years. A blood test will confirm whether you have the virus.

“In most cases no treatment is needed for acute Hepatitis B. It may take a while for you to recover and you may want to take some time off work. You should also avoid recreational drugs to allow your liver to get better, avoid alcohol until your liver recovers, avoid smoking because of the health problems it causes, and eat a healthy balanced diet. “If you have chronic Hepatitis B, you may need treatment to slow down the replication of the virus. However, treatment cannot usually cure chronic Hepatitis B. A small number of carriers go on to get liver disease (and a small number of those get liver cancer), and may need a liver transplant. If your body clears Hepatitis B, you’re immune and cannot get it again – but you can still get other types of hepatitis,” he said.

The professor, however, said that Hepatitis C is the most common type of viral hepatitis. According to him, it’s caused by a blood-borne virus that attacks the liver and is easily spread by sharing drug injecting equipment. It can also be spread through sex, he said. He added: “Without treatment, the virus can cause liver disease that can be fatal. Most people will be offered 12 weeks of tablets with few side effects and these give a high cure rate of 90-95%. There is no vaccine against Hepatitis C.

“The first six months of infection with Hepatitis C is called the acute phase. Around 20-25% of people will clear the virus naturally during this time. (This percentage is lower for people who also have HIV.) People who don’t clear the infection will enter the chronic (or longterm) phase and can pass Hepatitis C on to others.

“Most people who get Hepatitis C don’t notice any symptoms when they are first infected. It can take years before you feel ill, with symptoms often not easily identified as being due to Hepatitis C. “The symptoms, however, can include: Fever and malaise, nausea, extreme tiredness, itchy skin, stomach pain, jaundice, pale faeces, mental confusion (often called ‘brain fog’) and depression – these are specific to the C strain of hepatitis. “Hepatitis C virus is found in blood and is passed on when infected blood gets into another person’s bloodstream. It’s seen as unlikely (but not impossible) that it can be passed on in semen. Most people get the virus from sharing drug-injecting equipment such as needles, syringes, water cups, tourniquets, spoons, filters and swabs. “Sharing things like straws and banknotes that are used for snorting drugs might pass the virus on, as can sharing pipes. “Piercing and tattooing using unsterilised equipment can spread the virus.

A pregnant woman with the virus can give it to her baby during pregnancy or childbirth. Transfusion of unscreened blood and dental treatment using unsterilised equipment can also spread it. “It can take three to six months before the blood test for Hepatitis C will be able to detect signs of infection in your blood; for people with HIV, who may be Immunocompromised, the antibody may not be detectable and it may be necessary to request an RNA test which detects the virus. “There is no vaccination against Hepatitis C, but you can be vaccinated against Hepatitis A and B. If you already have Hep C, it’s recommended to have the vaccination against Hep A and B to protect your liver from further damage. “Drug treatment is available and has recently improved, with a better success rate and fewer side effects. In fact, 90-95% of people can be cured by the new medications, known as direct acting antivirals (DAAs). These are taken in tablet form once or twice a day, typically for 12 weeks.

“If you have Hepatitis C you should also: Avoid alcohol, avoid smoking as it can make the liver damage worse, avoid recreational drugs to allow your liver to get better, eat a healthy, balanced diet. If you’re cured of Hepatitis C, you’re not immune – you can get Hep C again. You can also still get other types of hepatitis, and having Hepatitis C and another type is more serious.

“Hepatitis C can be fatal when left untreated. Untreated Hepatitis C can lead to scarring of the liver known as cirrhosis. A small number of people with cirrhosis will go on to get liver failure, the only treatment for which is a liver transplant. And a small proportion of people with cirrhosis develop liver cancer.” Another professor of Veterinary Medicine and Clinical Virology at Michael Okpara University of Agriculture in Umudike, Abia State, Maduike Ezeibe, also described hepatitis as an inflammation of the liver. Ezeibe, however, said whether it can be cured or not depends on the cause. “There is toxic hepatitis caused by toxins and viral hepatitis which I guess is what you mean. Hepatitis A appears to be the most acute. Patients die or recover while Hepatitis B and C lead to carrier state. Their patients live with them for a long time like HIV/AIDS. “Because the liver is an immune organ, patients of hepatitis also suffer immune deficiency like those of HIV/AIDS. That is the reason Hepatitis B and C are also said to be ‘incurable’ because there is not enough immunity to complement effects of medicines.

“Those two types, like HIV/AIDS, can also be sexually transmitted. They can pass from mother to child and since they may not kill so fast, they appear to run in families. Apart from mother to child and sexual transactions, viral hepatitis is zoonotic (from animals to man). Flies transmit the viruses from infected individuals and animals to people.

“So, we, Veterinarians and others, who work with animals or live close to forests, are at risk. “But thank God that both Hepatitis B and C viruses like other viruses are electrically charged. Hepatitis B virus has negative electrical charges while C is positively charged. The Nigerian MSAMS is made of Nanoparticles that have both positive and negative charged ends. So, it uses the opposite charges to mop any of the viruses that are involved. “Since immune deficiency from hepatitis is a lot milder than that of HIV/AIDS, patients of hepatitis recover faster than those of HIV/AIDS when treated with MSAMS,” Ezeibe said. For Dr. Rotimi Adesanya, a Public Health expert, Family Physician and primary care Paediatrician, hepatitis, as an inflammation/infection of the liver, can result in liver cell damage and destruction. He said though the viruses differ, they have one thing in common: They cause infection and inflammation that are harmful to liver cells. Hepatitis B and Hepatitis C viruses are of public health importance due to the epidemic globally and the contagiousness of the virus.

Babies born to a mother with Hepatitis B have a greater than 90 per cent chance of developing chronic Hepatitis B if they are not properly treated at birth, he said. However, the WHO, Adesanya said, recommends that all women with Hepatitis B should be encouraged to breastfeed their newborns. The benefits of breastfeeding, according to WHO, outweigh any potential risk of infection.

Minister of Health, Osagie Ehanire, while speaking at the WHO virtual high-level commemoration of World Hepatitis Day, confirmed that viral Hepatitis B and C are endemic in the country. According to Ehanire, about 20 million Nigerians are chronically infected with Hepatitis B and C as at 2021. He had said: “In 2018, Nigeria conducted a National AIDS Indicator and Impact Survey, which showed a prevalence of 8.1 per cent for Hepatitis B Virus (HBV) and 1.1 per cent for Hepatitis C (HCV). We can estimate that about 20 million people are chronically infected.”

 

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