Revisiting hepatitis infection - Get tested, vaccinated, treated

The Hepatitis B Virus (HBV) is one of the key etiological agents for liver diseases, including chronic hepatitis, liver cirrhosis and liver cancer.

It is the second most common human carcinogen after tobacco. The virus is highly contagious and is 50 to 100 times more infectious than the human immunodeficiency virus (HIV).

Its extreme resilience allows it to survive for more than a week on dry surfaces, complicating its epidemiology and increasing the risk of horizontal intra-familial transmission.

Severe disease, death

HBV infection can lead to severe disease and death. About two billion people worldwide are estimated to have been exposed to HBV, with almost one-quarter of them having a chronic infection.

More than half a million HBV-related deaths are recorded all over the world every year. Sub-Saharan Africa (SSA) and East Asia are highly endemic areas for HBV infection.

Individuals with chronic HBV infection have an increased risk of liver disease and hepatocellular carcinoma (HCC). About 10-33 per cent of individuals who develop a persistent infection will end up with chronic hepatitis.

Among these, 20-50 per cent are likely to develop liver cirrhosis. HCC is a dangerous cancer with few treatment options and remains a challenge in many resource-constrained settings. SSA has one of the highest HBV-related liver cancer rates in the world. The mean age for developing HCC in Africa is younger than seen in developed regions such as North America and Western Europe.

The ensuing is from the WHO website. In highly endemic areas, Hepatitis B is most commonly spread from mother to child at birth (perinatal transmission) or through horizontal transmission (exposure to infected blood), especially from an infected child to an uninfected child during the first 5 years of life.

The development of chronic infection is common in infants infected from their mothers or before the age of five.

Hepatitis B is also spread by needlestick injury, tattooing, piercing and exposure to infected blood and body fluids such as saliva and menstrual, vaginal and seminal fluids

Transmission of the virus may also occur through the reuse of contaminated needles and syringes or sharp objects either in health care settings, in the community or among persons who inject drugs. Sexual transmission is more prevalent in unvaccinated persons with multiple sexual partners.

Hepatitis B infection acquired in adulthood leads to chronic hepatitis in less than five per cent of cases, whereas infection in infancy and early childhood leads to chronic hepatitis in about 95 per cent of cases. This is the basis for strengthening and prioritising infant and childhood vaccination.

HBV is highly contagious and is 50 to 100 times more infectious than HIV. Its extreme resilience allows it to survive for more than a week on dry surfaces. During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine.

 The incubation period of HBV ranges from 30 to 180 days. The virus may be detected within 30 to 60 days after infection and can persist and develop into chronic Hepatitis B, especially when transmitted in infancy or childhood.

No symptoms

Most people do not experience any symptoms when newly infected. Some people have acute illnesses with symptoms that last several weeks. These include yellowing of the skin and eyes (jaundice), dark urine, feeling very tired, nausea, vomiting and pain in the abdomen.

When severe, acute hepatitis can lead to liver failure, which can lead to death. Although most people will recover from acute illness, some people with chronic Hepatitis B will develop progressive liver disease and complications like cirrhosis and hepatocellular carcinoma (liver cancer). These diseases can be fatal.

In 2015, the World Health Organisation (WHO) set a target to eliminate Hepatitis B by 2030. This means reducing the annual disease incidence and mortality by 90 per cent and 65 per cent respectively, using the 2015 data as a baseline (Ofori-Asenso et al. Hepatitis B in Ghana: a systematic review & meta-analysis of prevalence studies (1995-2015).2016.16(1): p.1-15).

In Ghana, HBV infection is a significant cause of viral hepatitis. HBV is an infection of public health significance. Interventions to curb HBV infections include vaccination of babies, vaccination of uninfected individuals and active case search for management. The Hepatitis B vaccine provides about 98-100 per cent protection against HBV. The standard regime is three doses: zero, one and six months.

The estimated prevalence rate of HBV in West Africa is six-16 per cent in the adult population. Ghana has a national prevalence of about 12.3 per cent. The vaccination rate is low even though the Hepatitis B vaccine is available.

 In early 2000, the Pharmaceutical Society of Ghana (PSGH), in collaboration with Roche, launched a major campaign against HBV in the country. The World Hepatitis Day is observed globally in July. Ghana has a national strategy against viral hepatitis.

Given the major public health concern of HBV, coupled with the availability of a vaccine, there is a need to step up awareness, screening and vaccination to make it part and parcel of our lives. The PSGH campaign theme at the time “Get tested, Get vaccinated, Get treated” is still relevant today. While at it, you must regularly consume polyphenol-rich cocoa to boost your immunity against infections. 

The writer is Chief Pharmacist, Cocoa Clinic