According to W.H.O. website, globally 325 million people are living with viral hepatitis B and C causing annual death of 1.4 million patients. It is the second most killing infectious disease after tuberculosis. What is even more alarming is the fact that around 80 percent of the people living with hepatitis lack prevention, testing and treatment.
Just like Corona and HIV, the awareness campaigns among the illiterate masses, instead of promoting understanding of the disease, on the contrary, resulted more in stigmatizing the infected person. The extent of stigma severity can be judged by the fact that if a doctor, would tell patient, without proper counseling, that s/he might have symptoms of Hepatitis A or E, then this would eventually result in the patient switching doctors or staying back at home without telling anyone. However, Hepatitis A or E, are neither lethal nor do it spread via blood. It is spread by oro-fecal (oral and fecal) route only and can be highly contagious. It may be part of the contaminated food and water that we consume or may spread due to improper hygiene practices, especially after using toilets. The most common way is the fecal contamination of water. It is empirically proven that by the time children reaches the age of 14 years in Pakistan, they have already developed Hepatitis A antibody, which is indicative of the fact that they had an exposure of Hepatitis A and have already developed immunity against the viral infection. Both Hepatitis A and E are endemic to Pakistan. The reasons are very crystal; Pakistan is an economically challenged developing society and secondly the poor water and sewage system of the country.
The point is that there is stark difference between the entire pathogenesis and possible outcomes when we compare Hepatitis A and E to the Hepatitis B and C. The presenting symptoms of Hepatitis may include low grade fever, loss of appetite, fatigue, nausea, vomiting, dark urine, abdominal discomfort especially on the area where liver is located etc. It is the physical examination, patient’s history, family history and the subsequent testing which becomes the distinguishing feature within the umbrella diagnosis of Hepatitis.
Due to its mild nature, there is no specific treatment for Hepatitis A and E. Patients are generally advised to continue with proper hydration and nutrition, rest and symptomatic treatment is given, if required. The virus generally washes out of the system in its due time. It is important to maintain proper hygiene and to ensure avoidance of any fecal contamination of the surrounding water. On the other hand, there is a vaccine for Hepatitis B, but no absolute treatment. Different anti-viral medications are also given to slow down the progression of liver damage due to chronic Hepatitis B virus. Many people with Hepatitis B do fully recover also. Almost, same conditions apply for Hepatitis C, except we do not have any vaccination for Hepatitis C currently. Chronic Hepatitis B and C, if left untreated, can go undetected for decades and may result in cirrhosis of liver and liver cancer also.
Within Pakistan almost 12 million people are suffering from Hepatitis B or C infection while 0.3 million people adds to the total in every 2 years. Sadly, most people acquire this infection unknowingly, within the health care facilities while taking medical treatment for some other ailment. Thus, patients remain unaware and may have the potential to infect others as well, thus promoting the Silent Killer. Patients tend to remain unaware and undiagnosed of the underlying condition for many years and it is only after they develop complications do they realize that they are carrying the unwanted. As trumpeted, through different advertisements and awareness campaigns on radio, social media, newspapers and television Hepatitis B and C are spread by cuts during shave while re-using of blades at the barbers, re-usage of syringes, surgical items, improper sterilization of medical and surgical products before usage, blood transfusions, bodily fluids and unprotected sexual intercourse with a patient. Currently, due to absence of any national programs, provinces are dealing with the prevention and control programs for Hepatitis.
What can be done to curb the spread of Hepatitis in Pakistan? Creating more awareness, proper water and sewage mechanisms, proper testing, curbing the re-use of blades, disposing razors and syringes after using, proper sterilization of operation theatres and invasive, surgical products, waste management, decrease in the culture of treatment with injectable and regulated blood transfusions can help to curtail the speed of prevalence of the Hepatitis. Availability of timely and reliable data on national level is fundamental; not only to identify the patients but also to find those who are part of the missing millions.
‘Find the Missing Millions’ is the W.H.O. theme for 2020 on World Hepatitis Day which will be celebrated on July 28th, 2020. It is believed that currently 290 million people live globally with viral hepatitis, totally unaware of their condition. W.H.O. suggests that without bringing them to the healthcare that they may require, they not only suffers in the long run but also become the vector to infect others. Always remember, as per W.H.O. “Hepatitis is preventable, treatable and in the case of Hepatitis C, curable.”
The author is a Physician, health care leader, and a seasoned writer for local English newspapers and blogs. He tweets as @Ali_Shahid82
