Karachi: A hepatitis epidemic has engulfed Pakistan with nearly 12 million people suffering from hepatitis B and C and there is an urgent need to understand and confront this growing threat. These were the thoughts of experts attending the one day seminar held at the Aga Khan University in observance of the World Hepatitis Day; the theme for the day – ‘Hepatitis affects everyone, everywhere. Know it. Confront it.’
This is the first time that World Hepatitis Day is being sponsored globally by the World Health Organization following the passing of the resolution on Viral Hepatitis at the 63rd World Health Assembly in May 2010 which recognised the importance of taking a multi-pronged global initiative against hepatitis which includes increasing awareness, improving prevention in terms of better injection and blood safety, providing timely diagnosis and making treatment cost-effective and affordable.
Of the five hepatitis viruses, A, B, C, D and E, the types B and C can be considered the most dangerous as they account for 78 per cent of the liver cancer cases, stated Dr Wasim Jafri, Consultant Gastroentologist, AKUH. Both hepatitis B and C can be transmitted through the use of tainted blood or blood products, the use of contaminated syringes during medical procedures or injection drug use. Hepatitis B can also be transmitted from mother to infant at the time of birth or from an adult infected with the virus caring for the baby through ‘unapparent’ means such as a small cut. Another major reason for the spread of hepatitis B and C has been the careless attitude of health care professionals in not ensuring the use of sterilised syringes and untainted blood, while hospitals not disposing off their waste products properly also add to the risk of spreading hepatitis, added Dr Jafri.
Hepatitis A and E are prevalent predominantly in developing countries and are spread through contaminated food or water, said Dr Rustam Khan, Consultant Gastroenterologist, AKUH, further adding that in Pakistan most of the hepatitis A and E cases occur during the summer and monsoon seasons.
Fortunately these infections subside after a few weeks except acute hepatitis E in pregnant women which can sometimes lead to serious, at times fatal consequences. Hepatitis D is the strangest of the five viruses as it requires the person to be infected with the type B virus to cause an infection.
Highlighting the importance of prevention, Dr Khan said that creating awareness among the general public and the health care community about preventive measures such as insisting on the use of properly sterilised syringes and surgical instruments, avoiding sexual contact with those known to carry the virus, and ensuring that blood and blood products being used have been properly screened are essential in controlling the spread of both HBV and HCV. In the case of hepatitis A and E preventive measures included drinking boiled water and washing hands properly after using the toilet.
Prevention through immunisation is the preferable course of action when dealing with hepatitis, stated Dr Saeed Hamid, Consultant Gastroenterologist, AKUH. Both hepatitis A and B vaccines are easily available and are more than satisfactory in protecting against infection, but are generally underutilised lamented Dr Hamid. This in a developing country like Pakistan was due to a lack of awareness and a belief in the curative powers of alternative therapies such as traditional and herbal cures. Discounting these, Dr Hamid stressed that treatment is available for both hepatitis B and C in the form of interferon injections as well as oral medications which can be extremely effective, provided that treatment is begun early. He further stressed that treatment for hepatitis should be administered by experts since the medications could have significant side effects.
Emphasising the role of the laboratory in diagnosing and managing viral hepatitis, Dr Erum Khan, Consultant Microbiologist, AKU, mentioned that a number of tests like liver function tests, good sensitivity serological tests and advanced technology tests like polymerase chain reaction were essential in diagnosing the disease as well as monitoring the response to treatment. Unfortunately, the availability of these tests outside of large urban centres was a concern, as many people didn’t have the resources to travel to the larger cities to get tested.