Hepatitis: Silent but preventable killer many don’t know about

FUNMILAYO AREMU examines the Hepatitis Virus as a disease, including how it is contracted, its symptoms, cost of treatment, prevention and the difficulties that patients face.

Charles Oluwadamilola woke on a Monday morning in October 2019, just five months before his 20th birthday with a slight pain in the upper-right part of his stomach. He took some stomach pain relief medications, thinking it was just the usual stomach ache from indigestion.

Later that evening, when the discomfort didn’t get better, he took the spiritual approach and prayed, asking God for healing and sealing the prayers by drinking some ‘prayer water’ (omiadura) that his mother had brought from church.

Unfortunately, the discomfort persisted for two weeks but he kept it to himself because he didn’t think it was severe. However, one Friday, he couldn’t hold it in any longer and had to open up to his mother, who suggested that they visit the hospital the following day. When his condition worsened that evening, he warned his mother, “If you don’t want to lose me, we need to go right to the hospital.”

Speaking with Sunday Tribune he said: “When my mother and I arrived at the hospital that evening, the receptionist registered my name and I was scheduled for a doctor’s visit the same day. When we saw the doctor, I told him everything and he recommended some urgent blood tests and a stomach scan.

“After an hour, my results were ready, and we returned to the doctor’s office with them. I was terrified when the doctor examined the results because he had an unpleasant expression on his face. My mother was visibly shaking as the doctor explained the results.

“He was perplexed as to how I developed liver inflammation (specifically, Hepatitis B Virus) at such a young age after advising me on nutrition and lifestyle. He believed that it could be due to excessive alcohol or narcotics use,” adding that he never drank alcohol or used drugs, but got his liver damaged “by consuming too much junk food and a certain drug I had taken earlier in the year.”

According to the World Health Organisation (WHO), hepatitis is an inflammation of the liver caused by a variety of infectious viruses and noninfectious agents leading to a range of health problems, some of which can be fatal. In Nigeria, there are 20 million people suffering from chronic hepatitis infections, as confirmed by the Minister of Health, DrOsagie Ehanire.

“There are five main strains of the hepatitis virus, referred to as types A, B, C, D and E. While all cause liver disease, they differ in important ways including modes of transmission, severity of illness, geographical distribution and prevention methods.

“In particular, types B and C lead to chronic diseases in hundreds of millions of people and together are the most common cause of liver cirrhosis, liver cancer and viral hepatitis-related deaths. An estimated 354 million people worldwide live with hepatitis B or C,” the global organisation explained.

 

How it is contracted

Many people wonder at possible causes of such a lethal disease. They often ask how it is contracted and whether patients could survive. Dr Chidiebere Okorie, Consultant Gastroenterologist\Hepatologist at the Federal Medical Centre in Abuja, spoke with Sunday Tribune about these issues.

According to him, “Hepatitis is the inflammation of the liver which can be due to drugs, toxins, alcohol and viruses. Commonly, there are Viral Hepatitis A, B, C, D and E. Viral Hepatitis B and C are contracted through blood and products while A and E are contracted through the faecal-oral route (i.e dirty hands, food or water contaminated by human sewage and anal intercourse).”

It should be noted, however, that the WHO confirmed that outbreaks of these diseases occur globally, particularly in areas with poor sanitation. The Centre for Disease Control and Prevention (CDC) explains that “hepatitis, particularly Hepatitis B Virus is transmitted through activities that involve percutaneous (puncture through the skin) or mucosal contact with infectious blood or body fluid like semen or saliva.

“HBV can also be got through sexual intercourse with an infected person; injection drug use that involves sharing needles, syringes; birth to a person who has HBV, contact with blood from or open sores on a person who has HBV infection; exposure to sharp instruments and sharing certain items with infected persons that can break the skin or mucous membranes like razors, toothbrushes and glucose monitoring equipment, potentially resulting in exposure to blood.”

On the symptoms of the viral infection, Dr Okorie mentioned that some patients have no symptoms while others do. He said, “The most common symptom of Hepatitis is no symptom. Most patients will be discovered when they are being investigated for something else or during medical awareness exercises.

Those that will come with symptoms will present with Malaria-like symptoms, yellowish discolouration of the eyes, dark-coloured urine, right-sided abdominal pain, loss of appetite etc. Sometimes patients present with symptoms of complication.”

When asked how long it could take for an infected person to exhibit symptoms after getting infected, he stated that it depends on the immune status of the patient concerned. He said: “For children and the elderly whose immune systems are not strong enough to fight the virus, they can carry the infection for years without symptoms. In adults with strong immune systems, patients can develop symptoms within a few days of being infected.”

He added that while the virus is not gender-specific and does not affect fertility, there could be a mother-to-child transmission.

Hepatitis:

Creating awareness

Mr Danjuma Adda, President of World Hepatitis Alliance (WHA), who is also living with Hepatitis B, stressed the need for more information and awareness on treatment of hepatitis, especially hepatitis B.

“Information is very crucial. Hepatitis B is totally misunderstood by the majority of people. It is more complicated than hepatitis C. For hepatitis c, if you have a confirmed diagnosis, you just treat. But HBV is more complicated because of the lifelong treatment and because of the nature of the disease.

“The majority of the people with hepatitis B today, are undiagnosed and are not even on treatment. The virus attacks the liver, so, what you do, is assess your health condition on a regular basis, and the state of your liver so that you can track the activity of the virus on your liver.

“The majority of people with hepatitis B are not necessarily eligible for treatment. Treatment eligibility depends on the state of the liver and the activity of the virus. For some people, they might have hepatitis b but the virus is inactive in them it is not replicating; it is not reproducing and if it is not, your liver doesn’t get damaged.

“I happen to find myself in this sphere of people. I routinely check my liver and I live a healthy lifestyle; I don’t aggregate the condition of my liver with risky lifestyles like taking alcohol or other herbal medications and toxic substances. All these have to be adhered to avoid complicating the conditions of the liver,” he advised.

 

Treatment, Affordability and Prevention.

Every sickness or infection, it is considered, should have a treatment or cure. In the case of Hepatitis, Dr Okorie told  Sunday Tribune that the treatments are oral medications. According to him, “currently, the drugs for treatment are majorly oral medications. The injectables are not commonly used now.”

He also stated that the mode of prevention is vaccination. “For children, it is part of the childhood immunization programme and for adults, they are encouraged to get tested and then vaccinated if negative.

The CDC corroborated Dr Okorie’s claim and explained further that “Safe and effective vaccines to protect against hepatitis A and hepatitis B are available. Many unvaccinated children continue to become infected. The biggest gap in vaccination coverage is caused by the failure to administer the first dose of vaccine within 24 hours of birth. This dose protects infants, particularly infants born to HBV-infected mothers, from the virus.”

The CDC also informed that all types of viral hepatitis can be controlled or prevented, adding that “Hepatitis C can be cured; a once-daily medication taken by mouth for 8-12 weeks can cure most people who are infected with hepatitis C. Medications to manage hepatitis B are available to help prevent liver damage and slow the progression of the disease.

“Hepatitis A and hepatitis E can also be prevented, and cases reduced with improvements in sanitation because these infections are transmitted from infected faeces either person-to-person or through contaminated food and drinking water.

“On who should be vaccinated, the Advisory Committee on Immunization Practices (ACIP) under the CDC, recommends that all infants, unvaccinated children under 19 years, adults from 19 to 59 years, adults aged 60 years and older with a risk factor for hepatitis B, people at risk for sexual exposure, etc.”

Treating Hepatitis could be very expensive. According to Charles Oluwadamilola, since he got the diagnosis, he has been spending about N100,000 on tests and drugs every month. Explaining that he has tried to reach out to non-governmental organisations both in Nigeria and abroad for help to no avail. Although he is still managing his health, the treatment is not affordable.

 

Intervention of NGOs

Sunday Tribune spoke with the Advocacy for the Prevention of Hepatitis in Nigeria (APHIN), a Non-Governmental  Organisation and member of the World Hepatitis Alliance (WHA), on how they can help infected persons with the challenge of affordable healthcare.

A Gastroenterologist, and Board member of APHIN, Dr Solomon Obekpa told Sunday Tribune that the non-governmental organisation provides free consultation for people living with hepatitis.

He said, “APHIN provides free specialist consultation for persons living with hepatitis because many patients find it difficult to get the right information about the treatment and prognosis of the disease. So, in APHIN, we have specialists that offer free counselling and consultation to our clients and members.

“Also, APHIN assists in sourcing drugs at a subsidised price for those with viral hepatitis requiring treatment. We also carry out campaigns and health education to enlighten the public against the stigmatization of persons living with viral hepatitis.

“We are situated in the southern part of Nigeria. So, there is the challenge of trying to reach other parts of Nigeria. APHIN has offered free consultation and screening for hepatitis B to thousands of Nigerians and conducted sensitization in Secondary schools from the inception of the NGO in 2008 to date. We have also been able to reach out to local communities with free screening for hepatitis B and C.

“We have an annual road walk where we enlighten people on the infection. We have carried out outreaches in several universities and tertiary institutions in several states across the country.”

Obekpa also noted that about 8 to 12 per cent of Nigerians live with hepatitis and about 90 per cent of those with viral hepatitis are not aware of their status. He added that “it is a major concern because it leads to late presentations in the hospitals from complications of the disease when nothing can be done to help them medically.

“Everybody should know his or her hepatitis status, also it is important to note that hepatitis is not a death sentence as many thinks. There is a cure for hepatitis C and an effective vaccine and treatment for hepatitis B. So, those positive for hepatitis should seek medical care and avoid patronizing herbal medications,” he advised.

Speaking on improving the situation and avoid late presentation thus making the disease difficult to manage, Dr Okorie also advised that Nigerians should get tested, avoid sharing sharp objects and avoid unscreened blood transfusion and casual sexual intercourse.

Mr Adda further advised Nigerians to be mindful of their health and maintain a healthy lifestyle.

According to him: “My advice is to have a good health scheme behaviour. If the government is not providing this scheme, it is your health after all. Hepatitis kills 1.1 million people every year, these are human beings, and these are people’s families. If the government is doing nothing in terms of providing free testing, there are NGOs and organisations like ours that give free testing, and they are available in hospitals, just go to any recognised government hospital, and run the hepatitis screening for about a thousand, five hundred.

“The challenge could be that it is expensive, but life is also expensive. People should be cautious with alcohol intake especially people who don’t know their hepatitis or HV status. That is why it is important to know your status so that you will know the lifestyle you will adopt, to live a healthier life. If you know you are living with hepatitis, seek medical help on time,” he recommended.

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The PDP spokesman recalled how the opposition party had on various occasions alerted that the APC government had ceded sovereignty over a large portion of our country to terrorists, “many of whom were imported into our country by the APC.”

He further stated: “From the video, in a brazen manner, terrorists as non-state actors boldly showed their faces, boasting, admitting and confirming their participation in the Kuje Prison break, some of whom were former prison inmates who were either jailed or awaiting trial for their previous terrorism act against our country.

“Nigerians can equally recall the confession by the Governor of Kaduna State, Mallam Nasir el-Rufai that the APC government knows the plans and whereabouts of the terrorists but failed to act.

According to Ologunagba, about 18,000 Nigerians have been killed by terrorists between 2020 and 2022 “as the criminals continue to be emboldened by the failures and obvious complicity of the APC and to which the PDP had always drawn attention.”

“This is not politics; this is about humanity and leadership, which leadership sadly and unfortunately is missing in our country at this time,” he said.

The PDP added that it is appalled by “the lame response by the apparently helpless, clueless and deflated Buhari Presidency, wherein it told an agonizing nation that President Buhari “has done all and even more than what was expected of him as Commander in Chief by way of morale, material and equipment support to the military…”

“This is a direct admission of incapacity and failure by the Buhari Presidency and the APC. At such a time, in other climes, the President directly leads the charge and takes drastic measures to rescue and protect his citizens.

“In time of adversity, the President transmutes into Consoler-in-Chief to give hope and succour to the citizens. Painfully, Nigeria does not have a President who cares and can stand as Consoler-in-Chief to the citizens.

“It has now become very imperative for Nigerians to take note and realize that the only solution to this unfortunate situation is to hold the APC government accountable. We must come together as a people, irrespective of our political, ethnic and religious affiliations to resist the fascist-leaning tendencies of the APC administration.

Ologunagba called for an urgent meeting of the National Council of State to advise on the way to go over the nation’s worsening insecurity.

“Our nation must not fall. The resilient Nigerian spirit and ‘can-do- attitude’ must be rekindled by all to prevail on the President to immediately and without further delay, accede to the demand by the PDP and other well-meaning Nigerians to convene a special session of the National Council of State to find a lasting solution since the President has, in his own admission, come to his wit’s end,” the PDP spokesman declared.

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