KUALA LUMPUR, Aug 8 — With symptoms not showing until an advanced stage, an expert is warning that up to 95 per cent of those living with hepatitis are unaware that they are infected.
University Malaya Medical Centre consultant hepatologist Prof Dr Rosmawati Mohamed said the vast majority of those infected with hepatitis B or C do not experience any symptoms until the disease has progressed to an advanced stage.
“This makes early detection and timely treatment a great challenge,” said Dr Rosmawati, who is also the president of Hepatitis Free Malaysia non-profit organisation.
Viral hepatitis is one of the biggest global health threats that affects approximately 325 million people worldwide and causes 1.4 million deaths annually.
This is more than HIV/AIDS or malaria.
For the uninitiated, hepatitis refers to the inflammatory condition of the liver.
There are five main hepatitis viruses, referred to as types A, B, C, D and E, but chronic hepatitis B and C are life-threatening infectious diseases that cause serious liver damage, cancer and premature death.
To address the issue, Dr Rosmawati noted that there is an urgent need to increase awareness efforts and emphasise that everyone should undergo hepatitis B testing at least once in a lifetime, particularly those born before 1989.
“The priority action plans by the WHO (World Health Organisation) regional office for the Western Pacific this year include task-shifting and simplified method to testing and treatments via public health approach to make the service available at primary health care or community level,” she added.
On the flip side, Dr Rosmawati said hepatitis C (HCV) is not only treatable but also curable.
“Without doubt, the government’s effort to ensure access to affordable hepatitis C treatment is a great initiative, but cure can only be achieved if people living with hepatitis C are tested, diagnosed and treated,” she said.
In order to encourage more people to go for screening, Dr Rosmawati said provision of free rapid diagnostic tests for hepatitis C at health centres, instead of hospital setting, is a major step forward to address the gap in HCV testing.
However, she highlighted that diagnosed patients must undergo further tests for hepatitis C confirmation and assessment of their liver disease before any treatment can be offered.
“HBV (hepatitis B) testing among pregnant mothers may provide further opportunity to prevent mother-to-child transmission of the virus, which is the commonest transmission way in this region, including Malaysia.
“Pregnant mothers who tested positive for hepatitis B will require further tests to assess the degree of the virus replication.
“Those with high virus count can benefit from treatment to prevent or at least reduce the risk of hepatitis B transmission to their unborn child.”
Efforts made bearing fruit
She said HBV was the commonest cause of cirrhosis (liver scarring) and liver cancer in Malaysia.
But she said its prevalence has shown a downward trend thanks to Health Ministry’s (MOH) HBV vaccination programme for newborns, which was implemented in 1989.
She said the effort led to a significant reduction in the HBV infection in those born after 1989.
But that’s not the case for hepatitis C (HCV) as there is no such vaccine to combat the virus yet.
With that in mind, Dr Rosmawati warned that a significant number of Malaysians will face serious complications due to HCV related to cirrhosis and liver cancer as well as relentless rise in the hepatitis C deaths if key action plans are not put in place to address this public health issue.
Citing the most recent data from MOH disease control division, Dr Rosmawati said the overall prevalence of HCV has already overtaken HBV, with an estimated 380,000 people living with the virus.
Those at risk
Unlike hepatitis B, Dr Rosmawati said mother to child or sexual transmission of HCV is uncommon.
She also noted that those at high-risk of hepatitis B who must go for screening are those born before 1989 and had not received HBV vaccination.
“Hepatitis C is transmitted mainly through direct contact with blood.
“Therefore, people at risk of HCV include those who had received transfusion of unscreened blood and blood products prior to 1994, have body piercings or tattoos using unsterilised equipment, or currently injecting drugs into their body through the sharing of needles.”
Dr Rosmawati was recently in Sydney, Australia for a conference on hepatitis elimination and to highlight the monitoring impact of direct-acting antivirals on presentation of decompensated cirrhosis (DC), liver cancer (HCC) and mortality among people with chronic HCV infection.
During the conference, she highlighted that countries have shown a decline in HCC, DC and deaths after the availability of DAAs, but would require drastic increase in testing and treatment to achieve elimination of infection and diseases as a serious public health concern.