Scaling up efforts to eliminate viral hepatitis

Today, July 28, 2017 is World Hepatitis Day (WHD) with the theme “Eliminate Hepatitis”. It is a day set aside by the World Health Organisation (WHO) to raise awareness on a silent killer that is associated with the rising cases of chronic liver disease, cancer, and death.

It is estimated that about 20 million Nigerians are living with viral hepatitis compared to 325 million people globally.

“Few people know they have contracted the virus. However, the vast majority are silent sufferers who do not know they have the disease,” said the Minister of Health, Prof. Isaac Adewole.

Adewole said viral hepatitis can be a silent killer with little or no symptoms for a very long time or it can take life very quickly through acute hepatitis.

He explained: “Hepatitis itself means inflammation of the liver. And if you do not know, the liver removes waste products from the blood and gets rid of it. Without the liver, we would all die of internal poisoning from the accumulation of the waste products. Such an acute disease causes yellowness of the eyes, severe body itching and brain injury from the toxins.

“For those that the disease does not kill immediately, it lies quietly in the body in a chronic infection.

“They can infect other people without knowing through blood transfusion, needle stick injury and unprotected sex. Mothers can also transmit the infection to their children during delivery and childbirth. The cycle thus continues with new victims made every day.”

According to the WHO, there are five types of viral hepatitis (A, B, C, D, E) and three are vaccine-preventable (A,B and E). Hepatitis B and C – the two main types out of five different hepatitis infections – are responsible for 96 per cent of overall hepatitis mortality.

The WHO had earlier in the month raised red alert for acute outbreak hepatitis E in Nigeria. The WHO blamed the hepatitis E epidemic on the ongoing humanitarian crisis in north-eastern Nigeria.

According to the WHO, the Nigerian Ministry of Health notified her of an outbreak of hepatitis E located in the north-east region of the country on June 18, 2017.

The first case was detected on May 3, 2017 in Damasak, a locality at the border with the Republic of the Niger. As of July 2, 2017, 146 confirmed and suspected cases were reported including 21 confirmed cases.

The apex UN body said the hepatitis E outbreak could propagate rapidly due to the ongoing humanitarian crisis in the region, which arises from the volatile security situation in north-eastern Nigeria and continues to persist.

According to the WHO, the WHD 2017, is an opportunity to add momentum to all efforts to implement the WHO’s first global health sector strategy on viral hepatitis for 2016-2021 and help Member States achieve the final goal – to eliminate hepatitis.

Minister of Health told journalists, on Tuesday, in Abuja, that the Federal Government is committed to the elimination of viral hepatitis in Nigeria by 2021.

Adewole said that the First Global Health Sector Strategy on viral hepatitis for 2016-2021, was approved during the Sixty- Ninth World Health Assembly in 2016.

The Minister said there was need for all stakeholders to take proactive steps of knowing their status by getting tested and finally seek for treatment to reduce needless deaths from this preventable and treatable infection.

He added that the viral hepatitis was the seventh leading cause of death globally, and the disease was a silent killer and responsible for about 1.44 million deaths annually.

Adewole said that without appropriate diagnosis and treatment, around one- third of those chronically infected with viral hepatitis would die as a result of serious liver disease, including cirrhosis, liver cell cancer and liver failure.

The physician said that with appropriate treatment of hepatitis B and C, it would prevent the development of major life- threatening complication of chronic liver disease of cirrhosis and liver cancer.

Adewole further stated that with the emergence of new antiviral drugs over 95 per cent of the people with hepatitis could be completely cured of the virus within three to six months.

Also, the National Guild of Medical Directors (GMD) has joined the fight to eliminate viral hepatitis from Nigeria.

The GMD is a national organization made up of the medical directors of private hospitals in Nigeria.

Public Relations Officer for the GMD, Abuja‎, Dr. Biodun Ogungbo, in a statement, said the association is waging an advocacy war on hepatitis focused on the prevention through vaccination, early detection to treat the disease and the management of chronic infection with hepatitis to forestall the significant liver damage that can result.

According to him, “the GMD has thrown its weight behind efforts aimed at eradicating viral hepatitis in our dear country.”

The GMD had chosen the theme, “Let us make Nigeria HEPATITIS free” for its Annual General Meeting (AGM) in May 2017.

According to the WHO, activities and awareness around World Hepatitis Day are designed to:
*Build and leverage political engagement following official endorsement of the Global Health Sector Strategy on viral hepatitis at the World Health Assembly 2016.
*Showcase emerging national responses to hepatitis in heavy burden countries.
*Encourage actions and engagement by individuals, partners and the public.
*Highlight the need for a greater global response as outlined in the WHO’s Global hepatitis report of 2017.

According to the WHO, Nigeria and ten other countries carry almost 50 per cent of the global burden of chronic hepatitis. The other countries include: Brazil, China, Egypt, India, Indonesia, Mongolia, Myanmar, Pakistan, Uganda, and Viet Nam.

17 countries that also have high prevalence and together with the above, account for 70 per cent of the global burden: Cambodia, Cameroon, Colombia, Ethiopia, Georgia, Kyrgyzstan, Morocco, Nepal, Peru, Philippines, Sierra Leone, South Africa, Tanzania, Thailand, Ukraine, Uzbekistan, Zimbabwe.

In support of the “Eliminate hepatitis” campaign, WHO will today release new information on national responses in 28 countries with the heaviest burden.

According to the WHO, the key messages for World Hepatitis Day 2017 are:

Viral hepatitis is a major global health problem and needs an urgent response.
There were approximately 325 million people living with chronic hepatitis at the end of 2015.

Globally, an estimated 257 million people were living with hepatitis B (HBV) infection, and 71 million people were living with hepatitis C (HCV) infection in 2015.

Very few of those infected accessed testing and treatment, especially in low- and middle-income countries.

By the end of 2015, only nine per cent of HBV-infected people and 20 per cent of HCV-infected people had been tested and diagnosed. Of those diagnosed with HBV infection, eight per cent (or 1.7 million people) were on treatment, while seven per cent of those diagnosed with HCV infection (or 1.1 million people) had started treatment in 2015.

The global targets for 2030 are: 90 per cent of people with HBV and HCV infections tested and 80 per cent of eligible patients are reached with treatment.

Viral hepatitis caused 1.34 million deaths in 2015 – comparable with tuberculosis (TB) deaths and exceeding deaths from Human Immuno-deficiency Virus (HIV). Hepatitis deaths are increasing.

New hepatitis infections continue to occur, mostly hepatitis C.

The number of children under five living with chronic HBV infection was reduced to 1.3 per in 2015 (from 4.7 per cent before vaccines were introduced).

Hepatitis B vaccine is preventing approximately 4.5 million infections per year in children.

However, 1.75 million adults were newly infected with HCV in 2015, largely due to injecting drug use and due to unsafe injections in health care settings in certain countries.

Achieving the 2030 elimination goal is not overly ambitious; reports from 28 high-burden countries give cause for optimism.

On World Hepatitis Day 2017, WHO is publishing information from 28 countries, which show that, despite many challenges, the global effort to eliminate hepatitis is gaining ground. However, major obstacles still remain.

The WHO Global hepatitis report, 2017 indicates that the large majority of these people lack access to life-saving testing and treatment. As a result, millions of people are at risk of a slow progression to chronic liver disease, cancer, and death.

Hepatitis B levels vary widely across WHO regions with the WHO African Region and WHO Western Pacific Region sharing the greatest burden.

Today, unsafe injections in health care settings and injecting drug use are considered to be the most common routes of HCV transmissions.

There is currently no vaccine against HCV, and access to treatment for HBV and HCV is still low. WHO’s Global Health Sector Strategy on viral hepatitis aims to test 90 per cent and treat 80 per cent of people with HBV and HCV by 2030.

HBV infection requires lifelong treatment, and WHO currently recommends the medicine tenofovir, already widely used in HIV treatment. Hepatitis C can be cured within a relatively short time using the highly effective direct-acting antivirals (DAAs).

“We are still at an early stage of the viral hepatitis response, but the way forward looks promising,” said Dr. Gottfried Hirnschall, Director of WHO’s Department of HIV and the Global Hepatitis Programme. “More countries are making hepatitis services available for people in need – a diagnostic test costs less than US$ 1 and the cure for hepatitis C can be below US$ 200. But the data clearly highlight the urgency with which we must address the remaining gaps in testing and treatment.”

WHO’s Global hepatitis report, 2017 demonstrates that despite challenges, some countries are taking successful steps to scale-up hepatitis services.

China achieved high coverage (96 per cent) for the timely birth dose of HBV vaccines, and reached the hepatitis B control goal of less than one per cent prevalence in children under the age of five in 2015. Mongolia improved uptake of hepatitis treatment by including HBV and HCV medicines in its National Health Insurance scheme, which covers 98 per cent of its population. In Egypt, generic competition has reduced the price of a three-month cure for hepatitis C, from US$ 900 in 2015, to less than US$ 200 in 2016. Today in Pakistan, the same course costs as little as US$ 100.

Improving access to hepatitis C cure received a boost at the end of March 2017, when WHO prequalified the generic active pharmaceutical ingredient of sofosbuvir. This step will enable more countries to produce affordable hepatitis medicines.