July 28 is a day that would stand out in the calendar of health practitioners and followers worldwide. Why? The day marks the World Hepatitis Day. And Nigeria was not left out of the celebration, as the Society of Gastroenterology and Hepatology in Nigeria (SOGHIN) celebrated the day in style, with an awareness walk in Lagos and free Hepatitis B virus screening of the population.
In playing its own little part in spreading the gospel, African Health magazine brings you this short piece on hepatitis.
In an interview with Dr. Funmi Lesi, a Consultant Gastroenterologist at the Lagos University Teaching Hospital, Lecturer and Associate Professor at the College of Medicine, University of Lagos and secretary of Lagos chapter of SOGHIN, hepatitis can be defined as any inflammation or injury of the liver and could be caused by so many factors, such as viral infections (Hepatitis viruses), drugs, alcohol, etc.
But according to her, Hepatitis B virus (HBV), a silent killer, is the most common cause of hepatitis in our environment. Unfortunately, the knowledge base of the general population on hepatitis in general and HBV in particular is very faint, which is why SOGHIN has decided to focus on HBV in this year’s world hepatitis day celebration, with the sole aim of increasing the awareness level among the population, via the theme, “B aware, B tested, B treated.”
It is worthy to note that over 19 million Nigerians are chronic carriers of the HBV, with half of this figure falling within the middle age bracket. Twenty percent will eventually develop advanced liver disease while the remaining eighty percent will end up becoming persistent, chronic inactive carriers.
So how is this deadly virus transmitted? Dr. Lesi emphatically states, “Hepatitis B virus is a hundred times more infective than the HIV virus.” The HBV can survive for seven days outside the human body while HIV will become inactive within a few minutes. She says, “The most common mode of transmission is through childhood contact, usually less than five years of age. These children get infected when they share sharps such as clippers, injections, and through unsafe cultural or scarification marks. The children later go on to become chronic carriers if the infection is not properly dealt with.”
Other modes of transmission are through contaminated blood products and sexual transmission (another reason to abstain from unsafe sexual practices).
When asked the typical sequela of a person infected with HBV, Dr. Lesi smiles and says, “The first stage of infection is known as the acute phase, which usually lasts between one to three months. Patients typically come down with malaise, tiredness and abdominal pain, with many people at first thinking it’s malaria until the characteristic yellowness of the eyes occurs, also known as jaundice. The infection can then be completely dealt with by the body’s immune system after which it resolves or can be partially dealt with, which then results in the patients becoming chronic carriers of the virus.”
Chronic carriers frequently end up with advanced cases of liver disease, with the notable cases being liver cancer (80% of liver cancers are due to HBV) and liver cirrhosis (chronic replacement of healthy liver tissue with scar tissue).
Dr. Lesi also points out that there are certain risk factors that predispose a chronic carrier to developing advanced liver disease. They include: male gender, alcohol, obesity, aflatoxins (toxins found in molded groundnut, which is why hepatitis patients are advised to stay off groundnuts) and a family history of liver cancer.
Detection of HBV is quite simple, as it is an infection that can be easily screened within the population to prevent liver disease, which is what groups like SOGHIN are advocating for – screening for all Nigerians at any level, whether pre-school entry or post-school leaving.
Diagnostic tests include: a blood test to detect Hepatitis B surface antigen (HbsAg – an antigen that tells you the patient is infected), liver function tests, heamatology tests, ultrasound scan and liver biopsy.
Is HBV easy to prevent as it is to detect? Dr. Lesi’s answer is yes. She affirms, “HBV infection is a vaccine-preventable disease. HBV vaccine has been available for over forty years in developed countries and is no longer a problem. The vaccine has recently been incorporated into the NPI as a routine examination for newborns which would further help prevent the disease.” Adults are advised to get tested before taking the vaccine.
Treatment of the disease does not seem to be easy as it is usually a life-long disease. Therefore, patients are managed on the long term. There are two modalities of treatment – an oral therapy, which can last for two to four years or an injection therapy which can last up to forty eight months.
Dr. Lesi commended the government for their efforts so far in increasing the awareness of HBV but still suggested they do more, especially in the area of including HBV as a separate entity in the infectious disease unit in the ministry of health. She said the future of Nigeria was bright and was optimistic that HBV would soon become a thing of the past but like the popular saying goes, “It begins with you.”
Therefore, B aware, B tested and B treated.