World Hepatitis Day is observed annually on the 28 July by WHO and its partners to increase the awareness and understanding of viral hepatitis and the diseases that it causes.
According to WHO, Viral Hepatitis affects hundreds of millions of people worldwide, causing acute and chronic liver disease and killing close to 1.4 million people every year. In Africa Viral Hepatitis is an urgent public health issue. There are five known hepatitis viruses: A, B, C, D and E. The most common forms of the disease are hepatitis A, hepatitis B and hepatitis C.
Hepatitis A infection is estimated to be high in all Member States of the African Region. Hepatitis A virus (HAV) can cause severe acute liver disease. While many young children who become infected with the virus remain asymptomatic (having or showing no symptoms of the disease), older children and adults may develop jaundice and severe illness and be at risk of liver failure and death.
Children who suffer from hepatitis A can be absent from school for weeks or even months and adults can be absent from work for similar lengths of periods.
The most common risk factors for hepatitis A infection include unreliable access to safe drinking water and other indicators of low socioeconomic status. However, the growth of the economy in many African countries over the two past decades means that it is possible that HAV infection rates are beginning to decrease in some populations within sub-Saharan Africa.
A safe effective hepatitis A vaccine has been available for nearly two decades.
Hepatitis B and C
Research from the Department of Surgery and Cancer at Imperial, London show that « the region most affected by hepatitis B is Sub-Saharan Africa, where around 80 million people are infected. It is the leading cause of liver cancer and cirrhosis in Sub-Saharan Africa ». Liver cancer, the fifth most common cancer worldwide, is the most common cancer among men and third most common in women in Africa.
WHO data shows that hepatitis B is highly endemic in West Africa with a prevalence of 8%, the highest in the world. It is also estimated that 2% of the population in the Region are chronically infected with hepatitis C. The likelihood that infection becomes chronic depends upon the age at which a person becomes infected. Children less than 6 years of age who become infected with the hepatitis B virus are the most likely to develop chronic infections.
The hepatitis B virus is commonly transferred from mother to baby during birth. However the virus causes no immediate symptoms, and can remain silent in the body for decades until triggering severe complications such as liver damage (cirrhosis) and cancer. Hepatitis B is also spread by exposure to infected blood and various body fluids, as well as through saliva, menstrual, vaginal, and seminal fluids.
Transmission of the virus may also occur through the reuse of needles and syringes either in health-care settings or among persons who inject drugs. In addition, infection can occur during medical, surgical and dental procedures, through tattooing, or through the use of razors and similar objects that are contaminated with infected blood.
« Most patients do not realise they are infected until they develop severe symptoms » according to Dr. Maud Lemoine of Imperial College London. These symptoms include yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.
Describing the effects of hepatitis B on patients that she has seen in The Gambia, Dr. Lemoine states that «In our clinic in The Gambia we would often see patients, in their twenties or thirties, with liver tumours the size of footballs. They had probably been infected with the virus since childhood, but by the time they came to us in the clinic there was little we could do for them. »
These comments are contained in new research findings, from researchers at a number of international institutions including the Medical Research Council Unit, The Gambia and Imperial College London.
Hepatitis B is preventable with a safe and effective vaccine. Although there has been an effective vaccine for hepatitis B available since 1990, around one third of the population of Africa are still not vaccinated. People born before 1990 – the date the vaccine became available – will not be protected.
Only one in 10 infants are vaccinated at birth, as recommended by the WHO as many areas lack the infrastructures and resources to administer the vaccine. The greatest number of viral hepatitis related deaths is found in countries that are least able to deal with these diseases.
The virus can be successfully treated with antiviral medications, however people are not routinely tested for hepatitis B unless they have conditions such as HIV, and so most cases go undetected. Furthermore, these antiviral medications are expensive.
Hepatitis C is not preventable by vaccination, current treatment regimens offer high cure rates that are expected to further improve with upcoming new treatments.
The Women’s Torch is joining WHO to celebrate the day to contribute to its goal of increasing awareness and understanding of viral hepatitis.