Prevention is the Best Protection against Hepatitis B & C

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Hepatitis B & C are the commonest cause of primary liver cancer – Dr. Muhammed Aasim Yusuf (Acting CEO of the SKMCH&RC)

To mark the World Hepatitis Day ahead of July 28th, Dr Muhammed Aasim Yusuf, Consultant Gastroenterologist and Acting CEO of the Shaukat Khanum Memorial Cancer Hospital and Research Centres, spoke to the media and answered common questions on the subject. He said that the theme this year is “Hepatitis Can’t Wait” because somewhere in the world, someone dies every 30 seconds from a hepatitis-related illness. “We must act on viral hepatitis even during the ongoing coronavirus pandemic. Pakistan has one of the highest incidences of hepatitis B & C in the region and by one estimate, 12 million people in our country are suffering from hepatitis B or C. Unfortunately, a large number of people suffering from chronic hepatitis remain unaware of their diagnosis. Chronic hepatitis is often called a silent-killer because symptoms may develop decades after exposure, when significant damage to the liver has already occurred”, he said.

Dr. Aasim Yusuf explained that the word hepatitis refers to inflammation of the liver which can cause impairment of the functions of the liver to variable degrees. While there are various causes of hepatitis, including drugs, alcohol and obesity, the commonest cause, worldwide, is infection with one or more of the hepatitis viruses – hepatitis A, B, C, D and E. Commenting on the modes of transmission he said, “While each of these can cause hepatitis and serious liver disease, it is important to understand that they have different modes of transmission, cause different patterns of disease and require different means of prevention. While hepatitis A and E can be transmitted through contaminated food or water which is also called the faecal-oral route, Hepatitis B, C and D are transmitted by infected blood and body fluids.”

He highlighted the types of hepatitis that cause serious illness. “Hepatitis B, C & D require special attention because they often lead to prolonged illness and severe progressive liver damage, known as chronic hepatitis. This can progress to an irreversible stage of advanced liver disease, known as liver cirrhosis, which can lead, in some, to liver cancer and/or liver failure and death. Unfortunately, over one million people are still dying annually from viral hepatitis each year, despite the availability of a vaccine for hepatitis B and a cure for hepatitis C. The reasons for this are several, chief amongst them, in Pakistan, being a lack of awareness, lack of screening programmes, paucity of treatment facilities, inability to afford treatment and an ongoing cycle of infection caused in large part by unsafe injection practices, transfusion of un-screened blood and unsafe surgical and dental practices.”

Sharing about a study published in 2007 by the Shaukat Khanum Memorial Cancer Hospital and Research Centre, he said, “Infection with Hepatitis B and C is the commonest cause of primary liver cancer. Treatment of liver cancer is both clinically challenging and resource intensive, underscoring again the importance of prevention of liver cancer by addressing the root cause in Pakistan – infection by hepatitis B and C – and early diagnosis and treatment of those infected.”

Speaking about prevention of hepatitis B and C, he said, “Avoid high-risk behaviour such as unsafe injection practices involving re-use of needles for injection, using un-screened blood for transfusions, avoiding the use of unsterilized equipment for dental or surgical procedures, and engaging in unsafe sex. A vaccine is available for hepatitis B, which makes it an important tool in controlling new cases of hepatitis B. Screening of pregnant women for hepatitis B and ensuring that birth dose of vaccination is available for those who test positive can avoid mother to child transmission of the virus. Vaccination of children against hepatitis B, as part of national immunisation programmes, can effectively prevent future infection. The Government of Pakistan has introduced steps such as vaccination for hepatitis B as part of the Expanded Programme on Immunisation (EPI) in 2009, but there are still millions who were born before this time and continue to live unaware of their infection.  Since no equivalent vaccine against hepatitis C exists currently, the best strategy is to reduce the risk of infection by avoiding the high-risk behaviours described above, and by ensuring  access to treatment in a timely manner for those infected, since hepatitis C is now essentially a completely curable infection.”

Dr. Aasim Yusuf, in a message for the public, encouraged voluntary annual screening to promote early detection, allowing for immediate treatment and thus disrupting the cycle of infection and transmission.

Answering a question about reaching the masses, he said that media could play a critical role in disseminating authentic information amongst the public. He acknowledged that lack of awareness contributed towards stigma around the subject of hepatitis but extensive and regular awareness efforts can play an important role to fight hepatitis at the grassroots level.