HEPATITIS IS A SILENT DISEASE As millions still live with the disease

Sarjo Camara Singateh

At a press briefing to commemorate World Hepatitis Day on 28 July 2016 at the Central Medical Store conference hall in Kotu, Madam Ramatoulie Sarr, the deputy permanent secretary at the ministry of health and social welfare, deputising the minister, said hepatitis is a silent killer as an estimated 1.45 million people died of the disease in 2013 – up from less than a million in 1990.

“Of those deaths, approximately 47% are attributable to hepatitis B virus, 48% to hepatitis C virus and the remainder to hepatitis A virus and hepatitis E virus. Viral hepatitis is also a growing cause of mortality among people living with HIV. About 2.9 million people living with HIV are co-infected with hepatitis C virus and 2.6 million with hepatitis B virus,” she further disclosed.

She said the theme for this year is “Know hepatitis  – Act  now”, adding that the  aim  is to increase global  awareness and to strengthen prevention, diagnosis and treatment services.

Underscoring the importance of the theme, the deputy permanent secretary of the ministry of health said it is indeed befitting as most people globally who need treatment have not been treated, largely due to a lack of awareness and access to hepatitis treatment services.

“Today, only 1 in 20 people with viral hepatitis know they have hepatitis and just 1 in 100 with the disease is being treated,” she disclosed.

Madam Sarr noted that the viral hepatitis pandemic is an international public health challenge, comparable to other major communicable diseases, including HIV, tuberculosis and malaria.

“It takes a heavy toll on lives, communities and health systems. Around the world, 400 million people are infected with hepatitis B and C, more than 10 times the number of people living with HIV,” she added.

She said it was in May 2016 at the World Health Assembly when 194 governments adopted the first-ever Global Health Sector Strategy on viral hepatitis and agreed to the first-ever global targets. She noted that the strategy includes a target to treat 8 million people for hepatitis B or C by 2020. The longer term aim is to reduce new viral hepatitis infections by 90% and to reduce the number of deaths due to viral hepatitis by 65% by 2030 from 2016 figures.

“It must be re-called that The Gambia in collaboration with the Medical Research Council The Gambia Unit (MRC) and the WHO’s International  Agency for Research on Cancer (WHO- I ARC) became the first country in sub-Saharan  Africa to achieve mass infant vaccination against hepatitis  B infection, since February 1990,” said the deputy permanent secretary of the health ministry.

Also addressing the press, Professor Umberto d’ Allessandro, the Unit Director of Medical Research Council (MRC) in The Gambia, said hepatitis was very common in Gambian children before 1980s but added that since they started introducing the immunisation at the clinic levels to date, people who were not fortunate to receive the vaccination are those amongst the population at risk.

The MRC Director therefore encourages people to go for screening to know their status. He said MRC is still managing Hepatitis patients and the drugs they use for treatment are effective.

Mr. Sheriff Badjie, the National Aids Control Programme (NACP) Deputy  Program Manager, said the WHO urges countries to take rapid action to improve  knowledge about the disease and to increase access to testing and treatment services to reduce needless deaths from this preventable and treatable infection.

“With better information and knowledge about hepatitis, people can prevent themselves and their families from getting infected and passing the infection on to others. One cost effective means of disseminating information to the general public is through the media. Therefore, I have  no doubt  that  at  the  end  of this  forum, information on  hepatitis will reach  every individual across  the length and breadth  of this country and beyond,” he said.

Hepatitis B and C infections are transmitted through contaminated blood as well as through contaminated needles and syringes in healthcare setting and among people who inject drugs. The viruses can also be transmitted through unsafe sex and from an infected mother to her new-born child. Increasing access to hepatitis testing is key to scaling up hepatitis treatment and care.  An estimated 95% of people with hepatitis are unaware of their infection, in part due to a lack of awareness and lack of access to testing services in countries.

“HIV and Hepatitis-Virus (HCV) have common routes of transmission, and it is estimated that, globally, 2.3 million persons are co infected with these two viruses. With the widespread use of antiretroviral therapy (ART), which reduces the risk of HIV-associated opportunistic infections, HCV-related liver disease has started to overtake AIDS defining illnesses as a leading cause of death in some high-income countries,” said the NACP Deputy Program Manager.

Mr. Badjie noted that the WHO 2013 consolidated guidelines on comprehensive HIV treatment have provision for the management of Viral Hepatitis. These guidelines, he added, were adopted by The Gambia in 2015. “As we speak, more than 350 health care workers were trained on the use of the guidelines. Even the recommended drug (Tenofovir) for treatment of viral hepatitis is available in the country. At WHO level, hepatitis and HIV programs are both housed in the same department. It is in line with this understanding that viral hepatitis activities are to be coordinated by the National  AIDS Control  Program  under MOH&SW. The Ministry  of Health  have  started engaging  its  key  partners on  the  need  to  develop and implement coordinated multi-sectoral national  strategies for the prevention, diagnosis and treatment of viral  hepatitis,” he concluded.

Representing the WHO representative to the  Gambia, Dr. Patric Abok, read the message of the WHO Regional Director for Africa, Dr Matsbidiso Moeti,  which stated that the theme this year calls on countries and people to become informed  about the risks of hepatitis infection, get tested and advocate for increased access to treatment and care.

The WHO Regional Director noted that viral hepatitis, an infection of the liver caused by five distinct hepatitis viruses (A, B, C, D, and E), is a highly widespread public health   problem in the African Region, similar to other major communicable diseases, including HIV, tuberculosis and malaria. “All five hepatitis viruses can cause severe disease, but the highest numbers of deaths result from liver cancer and cirrhosis – a condition in which there is irreversible scarring of the liver,”  noted the statement. It added that this occurs after several years of chronic hepatitis B or C infection.

The statement further notes that in the African Region, hepatitis B affects an estimated 100 million people.  “It is also estimated that 19 million adults in the Region are chronically infected with hepatitis C. However, most people with chronic viral hepatitis are not aware of their infection and do not receive appropriate treatment,” according to the statement.

The WHO Regional Director said World leaders have committed to taking specific actions to combat hepatitis under the 2030 Agenda for Sustainable Development.  “At the World Health Assembly in May 2016, countries across the globe agreed to implement the first Global Health Sector Strategy on viral hepatitis for 2016-2021,” he said.

Dr. Moeti urges all Member States in the African Region to use the World Hepatitis Day campaign as a vital opportunity to step up national efforts on hepatitis and to spur action to implement the strategy on viral hepatitis. “I appeal to the general public to seek information about viral hepatitis and services for prevention and treatment from the nearest health facility. I call on international partners, civil society, other United Nations agencies, and the private sector to advocate for adequate domestic investments and to mobilize external funding for the viral hepatitis response in the African Region,” said the WHO Regional Director for Africa.

He concluded that WHO will support Member States to implement the hepatitis  strategy to tackle this growing public health problem in the Region.

For his part, Mr. Dawda Sowe, the Programme Manager, EPI, said pregnant women should be encouraged to give birth at the health facilities so that their babies can get the hepatitis dose after birth. He said treatment and screening should be available to all and sundry.

The programme was chaired by the deputy director health education and promotion.