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The Silent Killer: Hepatitis B & C

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The Silent Killer: Hepatitis B & C

Danjuma Adda

I have a grudge against viral hepatitis. For several years I lived with hepatitis B. Self-stigma, the fear of neglect and discrimination from family, friends and my future wife then made me to keep sealed lips about my status. I spent sleepless dreadful nights thinking of death from liver disease. I lived with the fear and the worry and the dread of discrimination, until the event of 19th August, 2007, when I had the voice and courage to speak up. 

Viral hepatitis B related complications killed my mother on 19th August, 2007- one of the more than 200 000 people in Africa who die from complications of viral hepatitis B and C-related liver disease, including cirrhosis and liver cancer every year. Dying of viral hepatitis in Africa is becoming a bigger threat than dying of AIDS, malaria or tuberculosis. 

While the whole world marks World AIDS Day, a day set aside by the WHO to raise awareness on HIV/AIDS, and to remember the over 28.8 to 41.2 million lives lost to AIDS to date, equal importance and attention should be given to a disease that kills 1.4 million yearly, 100 times more infectious than HIV and has since surpassed HIV/AIDS as a major cause of mortality and killer world wide — Viral Hepatitis infections! 

Viral Hepatitis is a neglected global health crisis. Hepatitis B and C, affects more than 320 million people globally (about the population of the United States) – more than HIV/AIDS, tuberculosis and malaria – and is the seventh biggest annual killer worldwide. Since 1990, the death rate from Viral Hepatitis has risen rapidly, contrasting sharply with the fall in HIV and TB-related deaths over the same period. In 2016, a Global Burden of Disease analysis determined that more people die each year from viral hepatitis than from HIV, malaria or tuberculosis. Almost half of these deaths (48%) are caused by the hepatitis C virus (HCV). More than 70% of all cases of hepatitis B affect young people between the ages of 15 and 39

Burden of Viral Hepatitis in Africa and Nigeria

Sixty million people in the WHO Africa Region were living with chronic hepatitis B infection in 2015. More than 4.8 million of them are children under five years old. A further 10 million are infected with hepatitis C, most likely due to unsafe injection practices within health facilities or by communities.

In Nigeria, over 16 million people are living with Hepatitis B and about 3 million are living with hepatitis C conditions. Sadly, less than 5% of these people have been diagnosed and less than 1% of those diagnosed have access to treatment.

Viral Hepatitis and Quality of Life

Viral Hepatitis has a major impact on overall health and quality of life. People living with hepatitis B and hepatitis C suffer worse health and wellbeing, experience considerable social stigma and have lower self-esteem. People with hepatitis C also have a greater burden of cardiovascular disease, kidney disease and type 2 diabetes. Viral Hepatitis often affects people in the prime of their working life and reduces social and workforce participation, and personal financial security, with major implications for national economies.

When analyzing the impact of HCV infection on work productivity, activity, and fatigue, results of a survey conducted in France indicated that a majority of patients aged between 18 and 65 years, the so-called “active population” had the greatest work impairment and fatigue, especially cognitive fatigue. It is not surprising that work productivity and activity were most affected in patients reporting the highest levels of fatigue. Moreover, the study showed that fatigue was more prevalent in women and in patients consuming illicit drugs, thereby confirming past observations.

What is Hepatitis?

Hepatitis refers to inflammation of the liver. Inflammation is a tissue’s reaction to irritation or injury. It generally results in pain, redness, and swelling.

There are many causes of hepatitis. Viral hepatitis is caused by a virus. Viral hepatitis can either be acute (lasting less than 6 months) or chronic (lasting more than 6 months). Viral hepatitis can be spread from person to person. Some types of viral hepatitis can be spread through sexual contact. 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 for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.

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There are certain risk factors and lifestyle choices that fuel the spread of this virus. The hepatitis B and C virus can survive outside the body for at least 7 days. During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine. Transmission of the virus may occur through the reuse of needles and syringes either in health-care settings or among persons who inject drugs, men who sleep with men, multiple sexual partners, and an infected mother to her baby. 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.

HBV is very similar to HIV in the ways it is transmitted; through direct blood-to-blood contact and through sexual activity. However, blood levels of HBV are much higher than levels for HIV or hepatitis C virus, making this virus much easier to transmit in certain situations.

Both HIV and hepatitis C are RNA viruses. But note, they are different types of RNA viruses—HIV is a retrovirus and HCV is a flavivirus. HIV mainly infects human immune cells (CD4, macrophages, and dendritic cells). The hepatitis C virus mainly infects liver cells. 

However, a safe and effective vaccine that offers a 98-100% protection against hepatitis B is available. Preventing hepatitis B infection averts the development of complications including the development of chronic disease and liver cancer. And for Hepatitis C, there is an effective treatment that cures up to 95% of patients using Direct Acting Antiviral agents after three months’ treatment.

If I have lost people because of the lack of access to quality diagnosis and treatment and low information on viral hepatitis, I strongly feel that nobody else should, and we can make that change! This recognition has driven my interest in promoting advocacy and civic engagement on viral hepatitis elimination in my community and beyond.

Working together, we can achieve hepatitis elimination.

References: 

  • (Hepatitis C virus infection impacts work productivity and fatigue: An epidemiologic real-life study Victor de Ledinghena,, Bertrand Hanslikb, Joseph Moussallic, Si Nafa Si Ahmedd, Denis Ouzane, Dominique Larreyf)
  • WHO Global Health Sector Strategy (GHSS) 2016-2021: WHO
  • WHO Viral Hepatitis Fact Sheets: WHO 2016
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