Hepatitis on the prowl
in Nigeria
How to prevent yourself & family against Hepatitis B
How to prevent yourself & family against Hepatitis B
By Chukwuma Muanya
TWENTY NINE
year-old Obinna Okwute was battling with feverish conditions, headaches and
bodily pains for sometime. “I have taken the best of malaria drugs and I am not
feeling better,” he told a friend. Obinna died two months later of liver damage
caused by hepatitis infection. Obinna was one of the estimated 20 million
Nigerians infected with hepatitis and one of the five million that die annually.
Children born to mothers with hepatitis and sex
partners of people with hepatitis are also at risk of becoming infected.
According to the Society for Gastroenterology and
Hepatology in Nigeria (SOGHIN), Hepatitis B virus (HBV) is 50 to 100 times more
infectious than Human Immuno-deficiency Virus (HIV) and it is estimated that
over two billion people are infected worldwide and approximately one million
deaths occur annually from HBV related illnesses.
Formed in September 2007, SOGHIN is a professional
body made up of Nigerian physicians, surgeons, pathologists and allied health
professionals dedicated to the advancement of knowledge on the recognition,
prevention, investigation and treatment of liver diseases.
Publicity Secretary of SOGHIN, Dr. Uchenna Ijemo,
said: “There are 300 to 400 million carriers of HBV in the world. Several
studies have demonstrated that HBV is endemic in Nigeria and have also shown
the sero-prevalence among various groups. About 170 million people are infected
with hepatitis C virus. “Studies carried out in Nigeria have put the burden of
Hepatitis B in most Nigerian cities to an average of 13 per cent translating to
an estimated 20 million people infected. This means that at least one of every
10 Nigerian is a chronic carrier of hepatitis B and not only at risk of liver
diseases and death but also at risk of transmitting it to others.
It is estimated that about five million die annually
due to the consequences of this disease “Viral hepatitis is described as a
‘silent killer’ because most persons do not realize that they are infected and
usually are without any clinical symptoms.
Over decades, the disease slowly progress to damage
the liver. Symptoms of disease appear in advanced stages of disease when the
effect of medical care will be limited.” In addition to hepatitis B and C,
hepatitis A and E viruses also cause viral hepatitis.
These two viruses are primarily transmitted through
contact with contaminated food and water and are responsible for less than one
per cent of all hepatitis-related deaths.
Medical experts including those from the World Health
Organisation (WHO), SOGHIN, World Hepatitis Alliance, Nigerian Institute for
Medical Research (NIMR), and the Federal Ministry of Health say these needless,
preventable deaths are often unreported or misclassified as deaths after a
“brief illness” since Hepatitis B and C symptoms only become obvious few days
or weeks to the death of the patient.
They say there is need to educate the population about
Hepatitis B and C especially on the need to prevent infection since unlike HIV,
tuberculosis (TB) and malaria, which are backed by donor funds, control is not
yet subsidised and patients have to bear the cost of their testing, vaccine and
of course treatment for those who must be on treatment.
The experts say the infection can also be innocuous in
many patients and may even be eradicated in some cases by the body’s immune
system without treatment. “But you need to be armed with the right information
about this disease,” they say.
So, how do you know when the virus has become acute or
chronic and to the point of becoming a terminal disease? How do you know your
body is fighting the disease and there is no cause for alarm? How do you know
when you are at risk of being infected or passing on the Hepatitis virus? What
treatment options are available to a patient infected with Hepatitis B or C and
what are the chances of treatment success? At what point can you say, “This
patient cannot be helped?” Education and public enlightenment makes all the
difference.
Growing burden Researchers have long known that
patients with hepatitis C are at increased risk of liver cancer. But a new
study recently presented at the European Association for the Study of the
Liver’s 50th International Liver Congress in Vienna, Austria, finds hepatitis C
virus (HCV) may also raise the risk of developing other cancers.
The researchers calculated that patients with HCV were
2.5 times more likely than non-HCV patients to be diagnosed with cancer,
including liver cancer, and at two times higher risk of cancer when liver
cancer was excluded.
According to the Centers for Disease Control and
Prevention (CDC), most people become infected with HCV by sharing needles or
other drug-injecting equipment.
Though less common, HCV can also be spread through
having sexual contact with an infected person, sharing personal care items –
such as toothbrushes and razors – that may have come into contact with the
blood of an infected individual, or being born to a mother with hepatitis C. It
is well established that infection with HCV can increase a person’s risk of
liver cancer.
The CDC state that one to five in every 100 people
with HCV die from liver cirrhosis (scarring of the liver tissue) or liver
cancer. Meanwhile, the WHO has highlighted the urgent need for countries to
enhance action to prevent viral hepatitis infection and to ensure that people
who have been infected are diagnosed and offered treatment.
The WHO, in a press statement said it is focusing
particularly on hepatitis B and C, which together cause approximately 80 per
cent of all liver cancer deaths and kill close to 1.4 million people every
year.
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Vaccination….Vaccinate children as well as adults: A safe and effective vaccine can be given and this protects from hepatitis B for life.
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To curb the
rising cases of the viral infection, the WHO recommends among other things that
people should:
·
Know their risks;
·
demand safe injections;
·
get vaccinated;
·
get tested and seek
treatment.
WHO is alerting people to the risks of contracting
hepatitis from unsafe blood, unsafe injections, and sharing drug-injection
equipment.
Some 11 million people who inject drugs have hepatitis
B or C infection. Children born to mothers with hepatitis B or C and sex
partners of people with hepatitis are also at risk of becoming infected.
The organisation emphasises the need for all health
services to reduce risks by using only sterile equipment for injections and
other medical procedures, to test all donated blood and blood components for
hepatitis B and C (as well as HIV and syphilis) and to promote the use of the
hepatitis B vaccine. Safer sex practices, including minimising the number of
partners and using barrier protective measures (condoms), also protect against
transmission.
Demand safe injections According to the WHO,
approximately, two million people, a year, contract hepatitis from unsafe
injections. These infections can be averted through the use of sterile syringes
that are specifically designed to prevent reuse. The WHO noted that eliminating
unnecessary injections is also an effective strategy to protect against
hepatitis transmission. There are 16 billion injections administered every
year.
Around five per cent of these injections are for
immunisation, a further five per cent for procedures like blood transfusions
and injectable contraceptives, and the remaining 90 per cent to administer
medicines. For many diseases, injections are not the first recommended course
of treatment and oral medications could be used.
Recommendations SOGHIN urges all Nigerians to pay
attention to the following key preventive messages:
· Knowing the risks: Unsafe blood, unsafe
injections, sharing of sharps including drug injection equipment can all result
in hepatitis
· Demand safe injections: About two
million people contact hepatitis from unsafe injections.
Using sterile single use disposable syringes can
prevent these infections. Approximately 8 billion injections are given
unnecessarily globally and unnecessary injections increase the risks.
· Vaccinate children as well as adults:
A safe and effective vaccine can be given and this protects from hepatitis B
for life.
· Get tested, seek treatment. Effective
treatment options exist for hepatitis B and cure for hepatitis C It is
important to: Talk to your doctor about testing you for hepatitis virus
infection, irrespective of your health status and about receiving a vaccine to
prevent hepatitis B if you test negative for the virus. All pregnant women
should be screened for hepatitis with a view to protecting the yet-unborn baby
To prevent being infected by hepatitis viruses, paying attention to the
following will be helpful
· Avoid sharing personal
items such as razors or toothbrushes.
· Do not share needles or
other drug equipment (such as straws for snorting drugs).
· Clean blood spills with
dilute household bleach.
· Avoid getting tattoos,
body piercings and circumcision with poorly sterilized instruments.
· Avoid unsafe and
unnecessary injections.
· Avoid transfusion of
unscreened blood and other blood products.
· Avoid casual and
unprotected sexual intercourse SOGHIN wants Nigerians to be aware that viral
hepatitis is eminently preventable and by embracing the preventive strategies
outlined above. “We can control this disease in our country and reduce its
burden on our society.
This way also we can prevent the personal misery and
suffering that chronic hepatitis, cirrhosis and liver cancer bestow on affected
individuals,” Ijemo said. WHO recommends vaccinating all children against
hepatitis B infection, from which approximately 780, 000 people die each year.
A safe and effective vaccine can protect from
hepatitis B infection for life. Ideally, the vaccine should be given as soon as
possible after birth, preferably within 24 hours. The birth dose should be
followed by two or three doses to complete the vaccine series. WHO also
recommends vaccinating adults who are at increased risk of acquiring hepatitis
B.
These include people who frequently require blood or
blood products (for example dialysis patients), health-care workers, people who
inject drugs, household and sexual contacts of people with chronic hepatitis B,
and people with multiple sexual partners.
According to the WHO, since 1982, over one billion
doses of hepatitis B vaccine have been used worldwide and millions of future
deaths from liver cancer and cirrhosis have been prevented. In a number of
countries where around one in 10 children used to become chronically infected
with the hepatitis B virus, vaccination has reduced the rate of chronic
infection to less than 1 in 100 among immunised children.
To date, there is no available vaccine against
hepatitis C. Medicines are now available that can cure most people with
hepatitis C and control hepatitis B infection. People who receive these
medicines are much less likely to die from liver cancer and cirrhosis and much
less likely to transmit the virus to others.
WHO, therefore, urged people who think they might have
been exposed to hepatitis to get tested so they can find out whether they need
treatment to improve their own health and reduce the risk of transmission. In 2015,
WHO issued new guidelines for treatment of hepatitis B infection.
These recommend using simple non-invasive tests to
assess the stage of liver disease to help identify who needs treatment. WHO
also calls for prioritising treatment for those with cirrhosis – the most
advanced stage of liver disease and for the use of two safe and highly
effective medicines, tenofovir or entecavir.
Continued monitoring using simple tests is important
to assess whether treatment is working, and if it can be stopped. In 2014, WHO
issued guidance for testing and treatment of hepatitis C infection.
WHO recommends providing testing for people considered
at high risk of infection and ensuring treatment for those who have the virus
with several effective medicines, including new regimens that use only oral
medicines.
WHO will update recommendations on drug treatments
periodically as new antiviral medicines become available and as new evidence
emerges.
Weight loss for a healthy liver Weight loss through
both lifestyle modification and bariatric surgery can significantly reduce
features of nonalcoholic steatohepatitis (NASH), a disease characterized by fat
in the liver, according to two new studies published in Gastroenterology, the
official journal of the American Gastroenterological Association.
Lifestyle modifications: Eduardo Vilar-Gomez and
colleagues from Cuba report in Gastroenterology that a weight reduction of 10
percent or more, induced by a comprehensive lifestyle program, is necessary to
bring about NASH resolution and reverse scarring of the liver in overweight and
obese patients.
To a lesser degree, modest weight loss (seven to 10
percent) reduced disease severity in certain subsets of patients, including
male patients and those without diabetes. Conversely, 93 percent of the
patients with little or no weight reduction (less than five percent)
experienced worsening of liver scarring.
This is the first large prospective study conducted in
real-world clinical practice that explores the potential benefit of a 12-month
lifestyle intervention on NASH-related features, as well as the cut off points
for positive outcomes. While promising, less than 50 percent of patients
achieved the necessary weight loss goal of seven to 10 percent, providing a
stark reminder of the sustainability of weight loss interventions.
Going forward Stem cell therapy for liver failure
could replace liver transplants. For the first time, scientists have restored
organ function in a severely damaged liver in a live animal by transplanting
lab-grown stem cells. The achievement brings closer the day when cell-based
therapies that regenerate the organ replace the need for liver transplants.
The study brings closer the day when cell therapies
that regenerate liver tissue replace the need for liver transplants. In the
journal Nature Cell Biology, the researchers describe what happened when they
transplanted liver stem cells into mice with severely damaged livers.
Over the ensuing months, the cells spurred major areas
of the liver to regrow, improving the structure and function of the animals’
organs.
The liver is generally very good at healing itself.
This is because it contains cells called hepatocytes that are capable of
self-renewal following injury. However, these cells are less capable of
self-renewal following severe injury, such as that caused by conditions like
cirrhosis and acute liver failure.
Also, hepatocytes are not easy to grow under lab
conditions, which limits their potential for transplant. That is why the team
decided to find out whether liver stem cells – called hepatic progenitor cells
(HPCs) – can regenerate liver tissue.
HPCs are much easier to grow in the lab, and they have
the flexibility to transform into hepatocytes and other types of liver cells.
Investing in hepatitis C drugs could save the economy billions, researchers
suggest Researchers who examined the effect of treating hepatitis C patients
with the newer generation of oral drugs suggest while these medications may
cost tens of thousands of dollars for a 12-week course, they could avert
billions in lost productivity.
The drugs interfere with enzymes that help hepatitis C
multiply. They conclude that the higher cure rate and reduced side effects of
treating hepatitis C patients with an all-oral combination of ledipasvir and
sofosbuvir (LDV/SOF) led to substantially less absenteeism and better work
productivity that could save economies of the US and five European countries
more than $3.2 billion a year.
The study featured at Digestive Disease Week 2015, an
international gathering being held May 17-19 in Washington DC of clinicians and
researchers from gastroenterology, hepatology, endoscopy and gastrointestinal
surgery. Drugs produce high hepatitis C eradication rates, even in
liver-diseased patients A course of new antiviral drugs in a clinical trial has
resulted in almost all the patients with chronic hepatitis C infection becoming
virus-free, even those whose disease meant they had scarring of the liver and
so were at transplant or cancer risk.
Hepatitis C virus was eliminated for most patients
whose chronic infection had led to liver scarring. The direct-acting medicines,
designed against the genotype 1 virus, the most common hepatitis C (HCV)
infection in the US, also worked in people with chronic infection but no liver
cirrhosis.
The results of the two trials of the drugs used in
combination – daclatasvir, asunaprevir and beclabuvir – are published online by
JAMA.
The trials, one including people with liver disease,
the other without, both saw eradication rates of around 90 per cent and more
against a measure of aviremia called sustained virologic response (SVR).
Malaria’s key to the liver uncovered Scientists uncover a port of liver entry
for malaria parasites in a report published in The Journal of Experimental
Medicine.
If these results hold up in humans, drugs that target
this entry protein might help prevent the spread of disease. The first stop for
malaria parasites in humans is the liver, where a few organisms multiply into
tens of thousands, which are then released into the bloodstream.
Passage through the liver is essential for the
parasite to establish a productive infection and cause disease, and the bug’s
entry route has been traced to specialized liver cells called Kupffer cells.
But exactly how the parasite traverses these cells is not clear.
A team of scientists at Johns Hopkins Bloomberg School
of Public Health now find that a Kupffer cell protein called CD68 is needed for
parasite passage and efficient liver infection, as mice lacking CD68 had 70 per
cent fewer parasites in their livers compared to intact animals.
If this reduction is sufficient to substantially limit
blood infections (and thus disease), CD68 may represent a potential new drug
target in the fight against malaria.
