Bangladesh devising national strategy to eliminate hepatitis

Bangladesh, having taken control of deadly hepatitis in under-5 children, is now focusing on eliminating the disease from the country by 2030, a SDG target.

“We have to eliminate hepatitis B and C by 2030. And for that a national strategy and a national action plan have already been drafted. Last week a consultation workshop was held,” said Prof Mamun Al Mahtab Shwapnil, one of the researchers who developed breakthrough hepatitis B drug ‘NASVAC’.

He was speaking at the Association for the Study of Liver Diseases Bangladesh organised discussion marking the World Hepatitis Day on Sunday with its President Prof Salimur Rahman in the chair.

Prof Shwapnil is secretary general of the Association. National Professor Dr Shahla Khatun was present as chief guest.

Bangladesh along with Bhutan, Nepal and Thailand has become the first countries in WHO South-East Asia Region to achieve Hepatitis B control which means that the virus is less than 1 percent prevalent in under -5 children, the UN body announced on Saturday.

Prof Shwapnil said a strong commitment of the government to reach every child with life-saving Hepatitis B vaccines through childhood immunisation has made this achievement possible.

“But still we have to sail a long way to achieve the SDG target of eliminating Hepatitis B and C,” he said, suggesting massive awareness.

“We have to make people aware about the disease, and they should know that they have hepatitis. One in 18 people have hepatitis B while 1 in 119 people have hepatitis C. But only 10 percent knows their condition,” he said.

“We have to create massive awareness to find out those missing cases,” he said, as finding ‘missing’ cases is the theme of this year’s Day.

WHAT IS HEPATITIS?

Hepatitis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer.

Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis, according to the WHO.

There are five main hepatitis viruses, referred to as types A, B, C, D and E.

In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.

Hepatitis A and E are typically caused by ingestion of contaminated food or water.

Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.

Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

A SILENT KILLER

Assistant Professor of hepatology Dr Sheikh Mohammad Noor-E-Alam Dew while presenting keynote paper said hepatitis is a “silent” killer.

“In most cases hepatitis B does not show up with any signs and symptoms. In some cases, patients feel uncomfortable in the right side of the abdomen, fatigue and lack of appetite. Of the hepatitis B-affected people, 70 percent patients do not have any history of jaundice,” he said.

“Some patients end up at the hands of a doctor directly with liver cirrhosis or cancer,” he said, adding that stigma remained attached to the disease with many believing that the virus can be contracted from the affected person by toyching, hugging or sharing dining plates with them.

Dr Dew said even mother with hepatitis can breastfeed their children. “Vaccine can prevent hepatitis B, but there is no vaccine for hepatitis C.”

National Professor Shahla Khatun also stressed making people aware of the disease though she acknowledged that “it's really a challenge”.

“We have to find out new ways to reach people,” she said.

Experts at the discussion also suggested introducing hepatitis elimination programme into the primary healthcare so that people in remote areas can have the prevention and treatment service.

One speaker suggested having a Goodwill Ambassador for Hepatitis such as Amitabh Bachchan who is the WHO Goodwill Ambassador for Hepatitis in the South-east Asia region.

The WHO said his advocacy added impetus to efforts against hepatitis.