World Hepatitis Day – 28th July 2022

By Dr. Izuagba Kelechi Udoka

INTRODUCTION:

“I can’t wait” is the new campaign to launch World Hepatitis Day 2022.
This is to foster the need to accelerate the fight against viral hepatitis and the importance of testing and treatment.
The campaign will also amplify the voices of people living with viral hepatitis and calling for immediate actions to end stigma and discrimination.

• People living with viral hepatitis unaware “can’t wait” for testing.
• People living with hepatitis “can’t wait” for life saving treatment.
• Expectant mothers “can’t wait” for hepatitis screening and treatment.
• Newborn babies “can’t wait” for birth dose vaccination.
• People afflicted by hepatitis “can’t wait” to end the stigma and discrimination.
• Community organizations “can’t wait” for greater investments.
• Law makers “can’t wait” and must act now to make hepatitis elimination a reality through political will and funding. DO YOU KNOW YOUR HEPATITIS STATUS?

A hepatitis-free future is achievable with collaborative effort.
Though there are different causes of hepatitis, which are viral hepatitis, alcoholic (drug-induced hepatitis), non-alcoholic steatohepatitis and autoimmune causes. Viral hepatitis has shown to be the most prevalent.
There are 5 known viral hepatitis – A, B, C, D, E. Our focus for this campaign/awareness will be on VIRAL HEPATITIS especially B and C.
It is not surprising that approximately 330 million people are living with viral hepatitis worldwide with either chronic hepatitis B or C and they are not aware and about 650,000 deaths occur each year from complications of chronic hepatitis B infection.
Viral hepatitis is a major public health concern with hepatitis B and C being the commonest serious liver infections which attacks the liver cells and consequently, causing acute inflammation of the liver and hepatocellular necrosis.
This is because they are more virulent and can easily overwhelm the liver leading to liver cirrhosis (scarring), liver cancer or liver failure, hepatic encephalopathy and even death.
In fact, viral hepatitis B and C are more infectious than HIV and can also be a co-infection with HIV.
In 1976, Dr Blumberg won the Nobel prize for his discovery of the hepatitis B virus and development of the first hepatitis B vaccine.
Hepatitis B infection is caused by the hepatitis B virus (HBV) which is an enveloped DNA virus that attacks the liver.
The Acute hepatitis B infection is usually self-limiting. Most healthy adults who are infected are able to fight off the infection and clear the virus from their blood which may take up to 6 months and are highly infectious at this time unlike the young children and infants who are at the greatest risk of developing (chronic) infection when exposed to hepatitis B virus and can pass the virus to others as well as increased risk of developing liver disease/cancer later in life.
The annual campaign focuses on the huge impact of viral hepatitis globally aiming at educating, screening and raising awareness in our various communities.
The WHO recommends that all infants must receive hepatitis B vaccine given at birth, 6, 10 and 14 weeks of age. This confers active immunity in them.
As adolescents/adults, 3 jabs/shots over the course of 6 months can confer a lifelong protection of about 10-20 years (given at 0,1 and 6 months).
Early screening and vaccination are important in reducing the burden of this disease globally.

SIGNS / SYMPTOMS OF VIRAL HEPATITIS:

1. ASYMPTOMATIC (NO SYMPTOMS).
2. Acute hepatitis (hepatitis before 6 months/short-term)) can present with or without the following:

• Yellowness of the eyes/skin(jaundice)
• Fever (low grade)
• Dark colored urine
• Pale/light colored stool
• Nausea/vomiting.
• Loss of appetite
• Pruritus(itching)
• Malaise (tiredness)

1. Chronic hepatitis (hepatitis after 6 months/long-term) can be symptomatic in adults and suggestive of advanced disease.

• Fatigue
• Loss of appetite
• Abdominal pain/discomfort
  In progressive liver disease:
• hepatic encephalopathy
• Somnolence
• Mental confusion
• Gastrointestinal bleeding.
• Disturbance in sleep pattern
• Abdominal distension.
• Coagulopathies (blood clotting problems).

MODE OF TRANSMISSION / RISK FACTORS.

• Transmitted via exposure to infected blood or bodily fluids from the mucous membrane. e.g saliva, seminal fluid etc.

1. Through mother -to child transmission (vertical transmission).
2. Through sharing of contaminated sharp objects e.g needles, clippers, pin, razor blade etc.
3. Through use of unsterilized instruments for percutaneous procedures e.g tattooing, circumcisions, ear/nose piercing, manicure/pedicure, scarification marks.
4. Intravenous (IV) drug abuse.
5. Promiscuous lifestyle e.g commercial sex workers, multiple sexual partners, homosexuality etc.
6. Multiple blood transfusion especially with unscreened blood in sicklers and hemophiliacs.
7. Immunocompromised states e.g HIV, Diabetes etc.
8. High-risk jobs e.g health care workers who have needle stick/prick injuries.
9. High-risk individuals e.g children of infected mothers, close contacts of infected persons.

PREVENTION:
IS VIRAL HEPATITIS PREVENTABLE?
YES!!!

1. Education and health awareness/campaign.
2. Early immunization for Hepatitis B virus immediately after birth, 6, 10 and 14 weeks in infants.
3. Practicing safe sex with use of condom.
4. Appropriate screening and safe blood transfusion.
5. Universal precaution.
6. Avoid sharing of sharp objects.
7. Screening all pregnant women and high-risk individuals.
8. Safe organ donation.
9. Ensure healthy lifestyle.

NOTE: YOU MUST BE SCREENED AND IF NEGATIVE, YOU ARE ELIGIBLE TO BE VACCINATED WITH THE 3 SHOTS OF THE HEPATITIS B VACCINE.

The screening is by testing for the virus which is a simple blood test where the “hepatitis B panel” are being requested by your health care provider.
This will give a better understanding on whether you are infected, protected or at-risk of hepatitis B infection.
They include:

1. HBsAg = Hepatitis B surface antigen.
2. HBsAb = Hepatitis B surface antibody.
3. HBcAb = Hepatitis B core antibody.

• If you test POSITIVE for hepatitis B virus (newly diagnosed).
  a) Do not panic, you should know you can live a long and healthy life.
  b) Understand the diagnosis to know whether it is an acute or chronic infection as this will help your Doctor in his/her management plan.
  c) If diagnosed chronic, get a Doctor who is an expert in treating liver diseases (gastroenterologist) to evaluate and manage you further.
  d) Prevent spread to others and loved ones as spread can occur through infected blood and bodily fluids.
  e) Educate yourself more, adhere to your drugs and comply with your follow up visits.
  f) Seek support by joining support groups who are dedicated in supporting people living with hepatitis B.
  g) Lifestyle, dietary modifications must be adhered to.
  h) Use of immunoglobulin can lessen the severity if given quickly after the infection.
  VIRAL HEPATITIS IS REAL!
  SAFE AND EFFECTIVE VACCINATION ARE KEY!!
  GET SCREENED/TESTED TODAY!!!

DR. IZUAGBA KELECHI UDOKA is a medical Practitioner in Abuja and MWAN FCT-YDF COORDINATOR.