Hepatitis: Why it remains a thorn in the flesh

Rwanda will next month join the rest of the world to mark World Hepatitis Day (WHD). A series of activities on prevention, access to testing, treatment and care will feature during the celebration. A graphic illustration oh how hepatitis affects the liver. / Net photo. Last year, the activities to mark World Hepatitis Day included a vaccination campaign of about 2,000 individuals for hepatitis B (HBV) and hepatitis C (HCV), as well as screening of about 500 people in Kigali. This year, the Ministry of Health (MOH),is targeting to screen 250,000 people for HBV and HCV, as well as vaccinating 400,000 against HBV . The objective of this year’s campaign, according Rwanda Biomedical Centre (RBC), is to increase awareness of the Rwandan population on HBV and HCV and the availability of services in the country, mobilisation of national and international stakeholders for HBV and HCV control, as well as increasing access to preventive, diagnostic, treatment and care services of HBV and HCV for those in need in Rwanda. Jean Damascene Makuza, the acting director of Viral Hepatitis and STI Unit at RBC, says screening and vaccination will take place in 30 district hospitals and 15 prisons’ health dispensaries, to ensure that many people, especially high risk groups, are screened. He says people aged over 45, healthcare providers (HCPs), nurses and laboratory technicians, students, prisoners, as well as other risk groups such as sex workers and drug users, are the most targeted group. What is hepatitis? Makuza defines hepatitis as the inflammation of the liver which can be acute if it has lasted less than 6 months or chronic when it lasts more than 6 months. He says it can be caused by excessive alcohol consumption, over use of both traditional or modern drugs and viruses (viral hepatitis). “There are different types of viruses that can cause viral hepatitis (A, B, C, D, and E). Most of the time we put more effort on hepatitis B and C, as they are more prevalent and both are transmitted through blood and sexual intercourse - for hepatitis B. These two types of viral hepatitis have also the particularity of causing cancer of the liver and are hard to treat,” he says. However, Makuza points out that hepatitis B is not curable but can be prevented by vaccination, noting that a drug called tenofovir is prescribed to reduce the chances of getting serious complications from hepatitis B and is prescribed for life. Hepatitis C does not have a vaccine, but can be treated and cured. Challenges in prevention “Common challenges when it comes to preventing and treating hepatitis are lack of awareness among the population for viral hepatitis, expensive hepatitis B and C tests and drugs,” says Makuza. He further explains that, this is because the population does not have an idea on what to do to prevent its transmission. For instance, he says some people don’t know that sharing objects such as razor blades and needles can lead to transmission of hepatitis C. Another challenge, Makuza says, is that people don’t know when to go for screening. And for those who do, they do it when it’s late and sometimes the virus would have resulted into other complications, which makes it harder to prevent or treat. He advises that people should go for early screening and testing for hepatitis even if they are not sick. This, according to him, will prevent further complications which come along with the virus. On the other hand, due to complexity of the virus, some people especially those who do not have any idea about hepatitis always seek solutions from native doctors, which is risky and unhealthy. “This does not help; rather it worsens the situation. And most of the time it results into complications and other diseases,” he notes. Makuza says that a lot needs to be done to educate the public about hepatitis. Who is at risk? According to Dr Libakare Mupundu, director for HIV care and treatment at RBC, people with HIV, those aged over 45, healthcare providers, nurses and laboratory technicians, students, prisoners, sex workers, drug users, people with chronic diseases like diabetes as well as pregnant women, face the highest risk. She explains that because the mode of transmission is sexual intercourse, chances are high that one can contract the HIV infection and hepatitis at the same time. Mupundu notes that for people with HIV, the progression of hepatitis is quicker. Additionally, John Muganda, a gynecologist based in Kigali, says for pregnant women, there are high chances of the child being exposed to the Hepatitis B during the time of delivery, the reason they need to be screened and vaccinated. “It’s estimated that 60 per cent of pregnant women who acquire acute hepatitis B infection at or near delivery will transmit the virus to the foetus. This is why vaccination becomes vital in preventing HB infection for any pregnant woman,” he says. Mukaza says healthcare providers are at risk because they always attend to different people and are exposed to different kinds of diseases. They are also exposed to the virus because they get in contact with blood in the course of their work. Prevention and treatment “Prevention of viral hepatitis B and C is avoiding direct contact with blood by not sharing razors, syringes and other sharp objects,” says Dr Francis Kazungu, a general practitioner. He also notes that avoiding unprotected sex is important as far as preventing hepatitis is concerned. Kazungu says vaccination is necessary for people who are over 15 years. He says those suffering from hepatitis A don’t normally require treatment. “This is because it’s a short-term illness. What is recommended is for the patient to be given bed rest if symptoms cause discomfort,” he says. Kazungu adds that if they experience symptoms such as vomiting or diarrhoea, sticking to hydration and proper nutrition is ideal, but only with a doctor’s guidance. To prevent infection, Muganda says hepatitis A vaccine can be given. “It’s recommended to begin vaccination for children aged between 12 and 18 months. It’s a series of two vaccines. Vaccination for hepatitis A is also available for adults and can be combined with the hepatitis B vaccine,” he says.