Although an overwhelming 400 million people around the world are infected with hepatitis B and C, only 1 in 20 people with viral hepatitis know they have it and just 1 in 100 with the disease receive treatment. According to the World Health Organisation, there is limited knowledge about hepatitis without which access to medication remains restricted.
Dr Sabin Nsanzimana, the head of HIV, sexually transmitted infections and other blood-borne diseases at Rwanda Biomedical Centre, says this is a big challenge in the fight against hepatitis.
“Some think hepatitis is the worst disease without any treatment. This is very wrong. Hepatitis B can be vaccinated against at all levels, but that can only happen if people go for screening,” says Dr Nsanzimana.
With this high level of unawareness, Nsanzimana adds that people tend to live with the disease for some time, only to discover it in its advanced stage.
“It is a common scenario in the villages, the same reason we need to extend services to these areas and not only in Kigali. Hepatitis is a problem in all areas. After people knowing how the disease is spread, they can learn how to safeguard themselves against it,” he adds.
What is hepatitis?
Hepatitis is an inflammation of the liver. This illness can be self-limiting, but worse, it can progress to fibrosis (scarring), cirrhosis or liver cancer. The commonest causes of hepatitis are viruses, but other infections, toxic substances such alcohol drugs and autoimmune diseases can also cause the disease.
There are five types of hepatitis viruses, referred to as types A, B, C, D and E, which are responsible for the burden of illness and death. In fact, the World Health Organisation estimates that 45 million people died of the disease in 2013 – up from less than a million in 1990.
Particularly, types B and C lead to chronic disease in hundreds of millions of people and both are the most common cause of liver cirrhosis and cancer.
Hepatitis A and E are typically caused by ingestion of contaminated food and fluids while Hepatitis B, C and D usually occur as a result of 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 child or sexual contact is very likely.
When someone contracts hepatitis, an acute infection may occur with limited or no symptoms, and may come with symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.
But Jean Bosco Rutikanga, the president of Rwanda Organisation for Fighting against Hepatitis, an association made of survivors and patients living with hepatitis, explains that individuals do not have to wait for these sorts of symptoms but rather go for screening as early as possible.
He, however, expresses concern over the fact that fear to screen for viral hepatitis is common.
“This is another challenge yet one can leave with this disease for over 10 years without a single clue. The first thing the association has to deal with is to fight fear among individuals. There many people, including government workers, who are part of this cause and ensure people go for screening,” says Rutikanga.
He adds that individuals need to desist from certain lifestyle habits such as alcoholism and smoking since they are predisposing factors to hepatitis.
“When they tell you to stop tobacco smoking and taking liquor, it is important you do so because these substances have an effect on the liver,” he adds.
In Rwanda, out of every 100 people, 3 have hepatitis B. Hepatitis C occurrence falls in a similar range. At the national level, hepatitis prevalence stands at 4 per cent, according to Nsanzimana.
A global fight
At the recently concluded World health Assembly, 194 governments adopted the first-ever Global Health Sector Strategy on viral hepatitis and agreed to the first-ever global targets. The strategy includes a target to treat 8 million people for hepatitis B or C by 2020. The longer-term aim is to reduce new viral hepatitis infections by 90 per cent and to reduce the number of deaths due to viral hepatitis by 65 per cent by 2030 from 2016 figures.
The bigger challenge, however, is that there is no vaccine for treating for hepatitis C and the only available vaccine caters for hepatitis B. Fortunately introduction of oral medicines, called direct-acting antivirals, has made it possible to potentially cure more than 90 percent of patients within 2–3 months. But in many countries, current policies, regulations and medicine prices put the cure out of most people’s reach.
“We need to act now to stop people from dying needlessly from hepatitis. This requires a rapid acceleration of access to services and medicines for all people in need,”said Dr Gottfried Hirnschall, WHO’s director of the HIV/AIDS Department and Global Hepatitis Programme, a head of this year’s World Hepatitis Day which was marked on July 28.
Figures from the WHO reveal that hepatitis affects more than 10 times the number of people living with HIV. With this years theme being ‘Elimination’ since member countries are required to focus on the elimination strategies for viral hepatitis.
However, the cost of treating hepatitis remains a big challenge around the world. In developed countries like the United States, treating one person may cost as much as Rwf60m, while in Rwanda it could be as high as Rwf900,000.
Types of hepatitis and how they are spread
Currently, five different viruses are known to cause viral hepatitis:
Hepatitis A: Sometimes called “infectious hepatitis,” hepatitis A is spread by eating food or drinking water contaminated with human waste. Hepatitis A is rarely life-threatening.
Hepatitis B: Also called “serum hepatitis,” hepatitis B spreads from mother to child at birth or soon after, and also through sexual contact, contaminated blood transfusions and needles. Hepatitis B may scar the liver (cirrhosis) and lead to liver cancer.
Hepatitis C: Formerly known as “non-A, non-B hepatitis,” hepatitis C is the most common form of viral hepatitis. While it can be transmitted through contaminated blood transfusions and/or needles, for a substantial number of patients, the cause is unknown. It may scar the liver. Hepatitis C infection is common in about 25 percent of people who are HIV-positive. Hepatitis C also infects up to 90 percent of HIV-infected injection drug users. And it is more severe in patients with HIV.
Hepatitis D: This form most often infects intravenous (IV) drug users who are also carriers of the hepatitis B virus. It is spread only in the presence of the hepatitis B virus and is transmitted in the same ways. Hepatitis D is a serious health problem because it occurs in those with hepatitis B, increasing the severity of symptoms associated with hepatitis B.
Hepatitis E: Similar to hepatitis A, hepatitis E is prevalent in countries with poor sanitation. It is rare in North America and rarely life threatening.
Quick facts about hepatitis
* Hepatitis means inflammation of the liver. With hepatitis, the liver stops working well.
* Viruses cause most hepatitis. Viral hepatitis is the most common cause of liver disease in the world.
* At least five different viruses cause hepatitis in people. Hepatitis A and E are spread through contaminated food, water, and human waste. Hepatitis B, C, and D are spread through an infected person’s blood or body fluids.
* Vaccines protect against hepatitis A and B. No vaccines are available for hepatitis C, D, and E.
* Hepatitis B, C, and D can cause long-lasting problems, including liver scarring (cirrhosis) and cancer.
EXPERTS SHARE TIPS
Yvan Ntwari, a medical student
The best way to stay safe is to make sure one is vaccinated against all the hepatitis virus types. This is because patients infected with the virus rarely show symptoms. Also, seeking medical attention early is vital as it prevents further complications.
Gonzalve Niyigaba, a practitioner at University Teaching Hospital
People with low immunity are at higher risk of getting hepatitis, especially those with HIV/AIDS. In such cases, a shot of hepatitis B immune globulin should be administered to boost the body immunity and help in fighting the infection.
Yvette Tuyisenge, a medical student University of Rwanda
People working in the health facilities should be at the forefront to be tested and vaccinated against hepatitis to prevent the spread. This is because they are more prone to getting the virus due to exposure to different patients. Early vaccination is recommended for all people.
Prince Rwagasore, a nurse
Avoiding sexual relationships with multiple partners is essential since some hepatitis viruses can be spread through unprotected sex. Avoiding sharing shavers and other sharp objects to prevent contracting hepatitis in case the other person is infected.
Iba Mayele, a gynecologist
New-born babies should be vaccinated within the first 24 hours to avoid contracting the virus, especially if their mothers are infected. People with signs such as fatigue, fever, loss of appetite, nausea, vomiting and abdominal pain, should seek medical attention promptly.
Compiled by Lydia Atieno