Hepatitis B: Why you should get tested

HEALTH | HEPATITIS B

Hepatitis is a group of viral infectious diseases. The five known hepatitis viruses are types A, B, C, D and E.

Hepatitis B and C cause acute and chronic liver disease and lead to death, according to World Health Organisation.

Speaking at a recent Hepatitis Symposium in Kampala, Prof. Ponsiano Ocama, the president of the Uganda Gastroenterology Society, noted that hepatitis is a significant global epidemic that infects one in 12 people.

According to WHO, Hepatitis B is a potentially life-threatening viral infection that attacks the liver and can cause both acute and chronic disease.

When a person is first infected with the hepatitis B virus, it is called an "acute infection" (or a new infection). While some adults are able to get rid of the virus, others are unable to get rid of it and after six months, they are diagnosed, through a blood test, as having a "chronic infection".

Most of the burden of Hepatitis B virus-related disease results from infections acquired in infancy (before five years) because infection acquired at an early age is more likely to become chronic than infection acquired later in life.

The health ministry encourages members of the general public to test and get to know their status. In addition, those who are negative should seek vaccination to protect themselves against acquiring the disease. Vaccination is done in three doses, ie, at the beginning, after one month; and after six months from the first dose.

Those who are positive are encouraged to seek medical care for further evaluation. According to information from the health ministry, some of those who test positive might need to be put on treatment, while others will just be observed and advised to do regular tests.

According to Emmanuel Seremba from the Uganda Gastroenterology Society, Hepatitis B cannot be cured, although it can be controlled. He adds that treatment aims at preventing progression of the disease, particularly to cirrhosis (liver damage due to scarring), liver failure and liver cancer.

Speaking at the recent Hepatitis Symposium to Mark World Hepatitis Day, Seremba noted that before treatment, a patient is supposed to be assessed through tests such as liver and kidney functioning. He noted that treatment might be lifelong for some patients, while for others, it can be discontinued in certain situations.

Before treatment, doctors recommend that a patient should be counseled about its implications (especially cost), likely benefits and side-effects; the need to go for regular monitoring and importance of adhering to treatment. Adherence is necessary for the drugs to be effective and to reduce the risk of a patient developing drug resistance.

The virus can be passed from mother to child. That is why babies are vaccinated withing the first weeks of birth

Vaccination
The Government has been providing free vaccination for people who test negative in areas with high prevalence. However, Ocama advises that vaccination is more needed for newborns and people in areas with low prevalence. He explained that chronic infection is usually developed if people are infected in infancy or before the age of five years, noting that almost 80% of adults who acquire Hepatitis B clear it/ expel it from their bodies. Therefore, he explained that adults in high prevalence areas could have been exposed to the virus and their bodies expelled it, making them develop immunity. However, those in low prevalence areas might never have been exposed to the virus. This means, they could develop acute infection if they got exposed. Therefore, they need to be vaccinated in order to get protection.

Even the new WHO guidelines state that children should be given the hepatitis B vaccine at birth because many children are exposed to the virus in the first weeks of life if their mother has it or a family member. Therefore, the Government is urged to introduce the Hepatitis vaccine for babies at birth.

Prevalence
According to the Ministry of Health, Uganda is one of the countries most affected by Hepatitis B. Statistics from the ministry show that:
- About 3.5 million (10% of population) are living with chronic hepatitis B infection
- Highest infection rates are in Karamoja (23.9%), Northern Uganda (20.7%), West Nile (18.5%), and Western Region (10.0%).
- Central Region (6%) and South-Western (3.8%) have lower rates.
- Liver cancer (one of the complications of Hepatitis B) accounts for 2% of admissions at the Uganda Cancer Institute.

Mode of transmission
- Contact with infected blood and other body fluids
- Mother-to-child transmission, especially of newborns
- Unsafe blood transfusion
- Use of unsafe sharp materials such as needles, razor blades
- Sexual intercourse
- Child to child (horizontal transmission) especially in high prevalence areas

There different types of Hepatitis, why is focus only on Hepatitis B?
According to Dr. Freddie Bwanga, a senior lecturer in medical microbiology at makerere University, there are five types of hepatitis viruses, that is hepatitis A, B, C, D, E.

Focus is mainly on Hepatitis B, because people with Hepatitis A usually get better without treatment, while hepatitis C is curable. 95% of people with hepatitis C can be completely cured within two to three months of being on treatment. In Uganda B and C cause the most damage. If left untreated, chronic infection with hepatitis B and C may progress to liver cirrhosis or cancer.

Hepatitis B
Hepatitis B can either be acute or chronic. Acute infection is a short-term illness that occurs within the first six months after someone is exposed to the Hepatitis B virus.

Acute infection is usually self-limiting, although it can lead to chronic infection. Chronic infection is long-term illness that occurs when the hepatitis B virus remains in a person's body.

Chronic hepatitis B is whereby a person test positive for atleast six months.

Symptoms
Most people do not experience any symptoms during the acute infection phase. However, some people have acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. A small subset of persons with acute hepatitis can develop acute liver failure, which can lead to death.

In some people, the hepatitis B virus can also cause a chronic liver infection that can later develop into cirrhosis (a scarring of the liver) or liver cancer.

Many people with chronic Hepatitis B do not know they are infected since they do not feel or look sick. However, they can still spread the virus to others and are at risk of serious health problems themselves.

Who should go for Hepatitis B screening?
Adolescents and adults, including pregnant women born before 2002, especially in areas with high prevalence

Who does not need to go for screening and vaccination?
Children below 15 years, except those who missed the routine UNEPI infant vaccinations because since 2002, all infants received the Hepatitis B vaccine. In Uganda, childhood vaccination for hepatitis was rolled out in 2002 and the vaccine is incorporated into a combination vaccine of which children receive three doses. The combination vaccine is given to children at six, 10 and 14 weeks after birth.