This Is Hepatitis: Know It, Confront It

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Since its launch by the World Hepatitis Alliance in 2010, this theme has witnessed great success because it focuses on the real-life impact of viral hepatitis. In fact, nowadays, viral hepatitis is a major global public health problem threatening millions of lives worldwide.

Viral hepatitis is the inflammation of the liver caused by a virus; there are five different hepatitis viruses: hepatitis A, B, C, D, and E. All of them cause short term, or acute infection; however, hepatitis B, C, and D viruses can also cause long-term infection, known as chronic hepatitis, which can lead to life-threatening complications such as cirrhosis, liver failure, and liver cancer.

Hepatitis A is usually transmitted through eating food or drinking water contaminated with the virus. It is the least dangerous form of hepatitis because it almost always gets better on its own. Hepatitis B, on the other hand, can spread through blood transfusions and needle sharing. It can also pass from mother to child at birth or soon afterward—vertical transmission—and can pass between adults and children to infect whole families—horizontal transmission. Hepatitis D and Hepatitis E are less common.

Hepatitis C, our main focus in this article, is usually spread through contact with blood or contaminated needles. Although Hepatitis C may cause only mild symptoms or none at all, about 20% to 30% of those infected develop cirrhosis within 20–30 years. As opposed to Hepatitis B, Hepatitis C has no vaccine.

Hepatitis C Virus (HCV) was first discovered in the 1980s, when it became apparent that there was a new virus, not Hepatitis A or B, leading to liver damage. Before being properly identified in 1989, by Michael Houghton, it was originally known as non-A non-B hepatitis.

According to the World Health Organization (WHO), every year, there are 3‑4 million new infections. About 150 million people are chronically infected and at risk of developing liver cirrhosis and/or liver cancer; more than 350,000 people die from hepatitis C-related liver diseases every year. Hepatitis C can be treated using antiviral medicines, but this treatment is usually not well tolerated by the patients and has numerous side effects. HCV has thus become the primary reason for liver transplantations among adults in Western countries.

The HCV is most commonly transmitted through exposure to infectious blood; through receipt of contaminated blood transfusions, blood products or organ transplants. It is also transmitted via injections given with contaminated syringes, as well as injection drug use, and being born to a hepatitis C-infected mother.

However, it is not spread through breast milk, food, or water, or by casual contact with an infected person. In many countries, transmission rates decreased substantially with the introduction of routine blood screening in 1991, which is not the case in most of underdeveloped countries.

HCV is often not detected until its chronic stages, when it has already caused severe liver disease. With a typical cycle of disease from infection to symptomatic liver disease taking as long as 20 years, the true impact of this disease on our growing infected population has become more apparent after decades.

Hepatitis C usually goes undiagnosed for many years, because its symptoms can often be put down to other illnesses. For example, depression, fatigue, skin problems, insomnia, pain and digestive disorders could all have other causes. For these reasons, it is often referred to as the “silent epidemic”.

Hepatitis C in Egypt

Egypt has the highest HCV prevalence worldwide, with an estimated overall prevalence of 21.9% among adults.

The history of HCV in Egypt is very unique. In fact, the virus was introduced in Egypt through the mass campaigns of Parenteral Anti-schistosomiasis Treatment (PAT) in the 1960–1970s. This treatment consisted of weekly injections in endemic areas and the insufficient sterilisation of the injecting equipment used during this mass treatment campaign is considered to be the cause of the HCV transmission at that time. In an attempt to eradicate schistosomiasis (bilharziasis) from Egypt, another more serious disease has emerged.

Despite the broad spread introduction of oral anti-bilharzial drugs later on, the transmission of HCV in Egypt has continued through a variety of mechanisms, including blood transfusion, unsafe injections, dental treatment, and various surgical procedures.

The outbreak of Hepatitis C in Egypt was announced by the outside. In 1991, in Riyadh, Saudi Arabia, during a campaign of blood donation, about 20% of Egyptian blood donors were detected positive for HCV; at that time, this incident triggered a crisis and it was the real start of the epidemic in Egypt.

Nowadays, the population of Egypt has a heavy burden of liver disease and is currently experiencing a wave of HCV-related morbidity with a growing number of patients with end-stage cirrhosis and hepatocellular carcinoma.

Extending the treatment of hepatitis at a large scale in Egypt is not feasible and is facing a number of major challenges; treatment costs are still too high for the vast majority of Egyptians and health care infrastructure is inefficient, especially in rural areas to allow for a proper delivery of treatment to the patients.

For patients in end-stage liver disease, treatment options are very limited; liver transplantation is the only effective treatment. As Egypt is one of the few countries around the world where organ transplants from deceased donors is not yet allowed, surgeons currently engage in living donor liver transplantation under extremely strict conditions.

The preparations for the program of living donor liver transplantation, “Living donor liver transplantation,” began at the National Liver Institute, Menoufiya University, since 1992. At first, surgeries were performed with an Egyptian–Japanese joint team; from July 2007 until now, the cases are entirely operated by the team of the Institute.

The donor should be a close relative of the patient, and has to have the same blood group as the patient, a liver which is large and healthy enough to donate a piece, and should be free from any diseases with good results in all liver function tests. If the donor is not a relative, doctors need to apply the same criteria if they are considering a foreign donor and also make sure he/she understands the risks he/she is putting him/herself through.

A Hepatitis C patient seeking a transplant is usually faced with two problems. First, is to be able to find an eligible donor; second, is to be financially able to afford the liver transplant surgery. The cost of typical liver transplant surgeries in Egypt ranges from EGP 200,000 to EGP 400,000 including the hospital expenses.

However, many patients do not find a suitable living donor. The opportunity to travel abroad for liver transplantation from deceased donors attracts more patients who are able to finance its costs. It is said that a liver transplant in China is more affordable compared to the cost of medical care in the United States and Europe. Similarly, it is possible to obtain a liver from a deceased donor body in China in a relatively short time.

Role of World Health Organization (WHO)

In response to the outbreak of the hepatitis epidemic, WHO established the Global Programme of Hepatitis in order to reduce the transmission of agents that cause viral hepatitis; reduce morbidity and mortality due to viral hepatitis through improving the management of the patients, and reduce the socio-economic impact of viral hepatitis at individual, community and population levels.

WHO, in coordination with the World Hepatitis Alliance, also organizes World Hepatitis Day on 28 July of each year. This annual event aims at providing international focus for patient groups and people living with viral hepatitis. It is an opportunity to raise global awareness and influence real change in disease prevention and access to testing and treatment.

As a relatively new disease there are still many aspects of Hepatitis C which are yet to be fully understood. Countries should review their strategies to fight Hepatitis C and to improve access to early detection and treatment of chronic patients to prevent liver complications. They must also ensure access, equity and sustainability of care by allowing all eligible people to access treatment services.

Global efforts are needed to fight Hepatitis C, help low-income countries to increase access to treatment and encourage scientific research to find new drugs and an effective vaccine against the silent epidemic that is threatening the world.

References

www.webmd.com

www.who.int

www.epidemic.org

www.hepctrust.org.uk

www.dailynewsegypt.com

www.worldhepatitisalliance.org


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