Hepatitis: The ignored silent killer on the rise

Irene Mutangana, aged 34, felt generally weak and observed that she was passing yellow urine. Without going for a medical check up, she concluded that it was malaria and rushed to buy malaria tablets from the nearest drug shop. “Usually when I take tablets, I feel much better within a short time but it wasn’t the case this time. The situation instead got worse. I started vomiting and caught a fever which resulted into abdominal pain. It was at this point that I went to the hospital and they found that I had Hepatitis B,” Mutangana says. What is Hepatitis? According to the World Health Organisation, 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 causes of Hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause it. 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 Hepatitis B is transmitted from mother-to-child at birth, from family member to child, 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. Treatment “The doctor took very good care of me which helped me recover very fast. He, however, warned that if I had been a child, the treatment would not have been as effective,” Mutangana said. A major new analysis from the Global Burden of Disease Study published in The Lancet, shows that accelerated progress against the global burden of HIV, malaria, and Tuberculosis (TB) has been made since 2000 when governments worldwide adopted Millennium Development Goals (MDG). Despite similarly high mortality rates, viral Hepatitis was inexplicably left out of MDGs and consequently became the leading cause of death from infectious diseases. The new findings by The Lancet highlight that the number of deaths from HIV/Aids has reduced from 1.7 million in 2005, to around 1.3 million people in 2013. Comparatively, deaths from viral hepatitis increased by 50% between 1990 and 2010 and now kills 1.5 million people every year. Charles Gore, President of the World Hepatitis Alliance, said: “The global community has worked extremely hard to tackle HIV/Aids. The result is a plummeting death toll. Viral hepatitis in contrast has been almost completely ignored and has spiralled into a global epidemic. We must learn lessons from the response to HIV/Aids. We need the same commitment to tackle viral Hepatitis, now.” Where does Rwanda stand? Dr. Osee Sebatunzi, the director of Kibagabaga, says in Rwanda, the most common types of Hepatitis are B and C. “We have had a number of cases of people suffering from this disease and sometimes patients confuse it for malaria which isn’t a good thing. It has similar symptoms only that Hepatitis causes inflammation of the liver, which means that the liver becomes swollen and damaged and begins losing its ability to function,” he notes. He says today all new born babies, HIV patients and health workers are vaccinated against Hepatitis B, adding that even normal adults can take the dose. A dose is Rwf 9,000 but one has to take three to be safe. “It’s a very serious disease and people have to take heed. It’s easily transmitted orally, through unprotected sex and sometimes contact with sick persons,” he warns. Allan Kwitonda, a pharmacist, says it’s very important to educate people about the dangers of this disease as the first measure of prevention. He advises that children be vaccinated at birth and also be given the remaining two doses within the first 6 months while children below 19 who didn’t get the vaccine are given what is called a ‘catch-up’ dose. “Adults who are sickly or work with sick people should be vaccinated and always endeavour to have protected sex,” he advises. How to prevent Hepatitis Hepatitis B and C viruses are spread through contact with blood or bodily fluids of a person with the virus. The viruses are NOT spread through casual contact, such as holding hands, sharing utensils, breastfeeding, kissing, hugging, coughing, or sneezing. To avoid coming in contact with blood or bodily fluids of others: Avoid sharing personal items, such as razors or toothbrushes. l Do not share drug needles or other drug equipment (such as straws for snorting drugs). Clean blood spills with a solution containing 1 part household bleach to 9 parts water. Be careful when getting tattoos and body piercings. All people who have sex outside their monogamous relationship should practice safer sex behaviours to avoid Hepatitis B and C. Different hepatitis viruses? Scientists have identified 5 unique hepatitis viruses, identified by the letters A, B, C, D, and E. While all cause liver disease, they vary in ways. Hepatitis A virus (HAV) is present in the faeces of infected persons and is most often transmitted through consumption of contaminated water or food. Certain sex practices can also spread HAV. Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections. However, HAV infections can also be severe and life threatening. Most people in areas of the world with poor sanitation have been infected with this virus. Safe and effective vaccines are available to prevent HAV. Hepatitis B virus (HBV) is transmitted through exposure to infective blood, semen, and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant in early childhood. Transmission may also occur through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. HBV also poses a risk to healthcare workers who sustain accidental needle stick injuries while caring for infected-HBV patients. Safe and effective vaccines are available to prevent HBV. Hepatitis C virus (HCV) is mostly transmitted through exposure to infective blood. This may happen through transfusions of HCV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. Sexual transmission is also possible, but is much less common. There is no vaccine for HCV. Hepatitis D virus (HDV) infections occur only in those who are infected with HBV. The dual infection of HDV and HBV can result in a more serious disease and worse outcome. Hepatitis B vaccines provide protection from HDV infection. Hepatitis E virus (HEV) is mostly transmitted through consumption of contaminated water or food. HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized as an important cause of disease in developed countries. Safe and effective vaccines to prevent HEV infection have been developed but are not widely available. How is Hepatitis Diagnosed? Physical Exam During a physical examination, your doctor may press down gently on your abdomen to see if there is pain or tenderness. He or she can also feel if the liver is enlarged. If your skin or eyes are yellow, your doctor will note this during the exam. Liver Biopsy A liver biopsy is a minimally invasive test that involves the doctor taking a sample of tissue from your liver. This is closed procedure. In other words, it can be done through the skin with a needle and does not require surgery. This test allows the doctor to determine if an infection or inflammation is present or if or liver damage has occurred. Liver Function Tests Liver function tests use blood samples to determine how efficiently the liver works. These tests check how the liver clears blood waste, protein, and enzymes. High liver enzyme levels may indicate that the liver is stressed or damaged. Ultrasound An abdominal ultrasound uses ultrasound waves to create an image of the organs within the abdomen. This test will reveal fluid in the abdomen, an enlarged liver, or liver damage. Blood Tests Bloodtests used to detect the presence of hepatitis virus antibodies and antigen in the blood will indicate or confirm which virus is the cause of the Hepatitis. Viral Antibody Testing Further viral antibody testing may be needed to determine if a specific type of the Hepatitis virus is present.

Insight

Hepatitis: The ignored silent killer on the rise