May 19 is world hepatitis day. In a bid to sensitise Nigerians on the disease, the Society for Gastroenterology & Hepatology in Nigeria (SOGHIN) organised a one-day workshop for journalists in Abuja during which some frightening statistics detailing the massive destructions in its wake.

Dr. Edith Okeke who is the Treasurer of the association disclosed that I9 million Nigerians have been infected with the Hepatitis B virus, and five million others have died, thus putting Nigeria among high risk nations. She gave the following facts about the infection.

Hepatitis B is caused by a virus known as the Hepatitis B virus (HBV). It is a DNA virus first reported in Germany in 1883 as transmissible through blood and blood products." Transmission of hepatitis B virus occurs through body fluid exposure such as blood, semen, vaginal secretions, or saliva, acupuncture, drug abuse and any practice involving use of sharp items. While Hepatitis C is spread through direct contact with infected blood," pointing out some of the symptoms to include nausea, fatigue, aching muscles and joints, poor concentration, loss of appetite, among others. Infants may also develop the disease if they are born to a mother who has the virus. It is 50-100 times more infectious than HIV and can remain in the environment for up to seven days. Infected children often spread the virus to other children if there is frequent contact (i.e., household contact) or a child has many scrapes or cuts.

Globally there are about 200 million people infected with about 400 million as chronic carriers. Roughly 50 million new infections occur annually. 15-40% of those infected will develop into cirrhosis, liver failure or cancer. The world is divided into three regions based on the prevalence of HBV infection. Low prevalence regions of less than 2% include the United Sates (except Alaska), Canada Northern Europe, Australia and the Southern parts of South America. Intermediate prevalence of 2-7% is Japan, parts of South America South and Easter Europe and parts of Central Asia. Regions of high prevalence (8-15%) include South East Asia, Philippines, Indonesia, Middle East, parts of South America and Africa. In Nigeria reports have shown a range of 10 to 20 per cent with higher rates in patients with liver cancer.

Symptoms are acute hepatitis (could be with or without jaundice) and chronic hepatitis. It could also not show any of these symptoms. In which case it is only through tests it can be diagnosed.

It could be prevented by behaviour change, passive immunisation which is necessary for newborns of positive mothers, patients who have had liver transplantation, after a needlestick injury and sexual exposure.

Active immunisation is another preventive method which is recommended for all newborns, in high prevalence areas like Nigeria and where they have not yet been vaccinated and are negative for HBV infection. This is the most practicable step in the prevention of HBV infection.

Supportive treatment is available for acute hepatitis. No specific treatment for asymptomatic chronic carrier outside regularised expert monitoring. For patients needing subclinical/symptomatic treatment, there are antivirals - Lamivudine, Inteferon and Pegylated interferon. Complicated cases usually require both antivirals and other modes of treatment which may include liver transplant (not presently done in Nigeria).

Dr. Austin Uhunmwangho, a member of SOGHIN went on to give facts about Hepatitis C infection.

Hepatitis C is caused by Hepatitis C (HCV) an RNA virus. It is an important health problem because it is a major cause of chronic hepatitis, cirrhosis and liver cancer. The ability HCV to induce persistent in at 85% of infected persons make it unique.

Globally about 700 million people are chronically infected with about 3-4 million new infections yearly. The world prevalence is estimated at 3%. How ever, marked geographical variations exist from 0.4% to 1.1% in North America to 9.6% to 13.6% in North Africa. HCV infection is predominant among those between ages 30-49 in the US and Australia. The more elderly in Japan are more prone to it while it cuts across every age group in Egypt. In Nigeria, information on prevalence of the disease are varied and not synchronized. In Jos, 5.7% of the patients infected with HIV have HCV in a hospital base study. In an Abuja hospital, 12.9% of patients with liver cancer have HCV.

Symptoms include acute viral hepatitis (could go unnoticed), chronic viral hepatitis (in more than 85% of those infected) have no symptoms. There may be extra hepatic manifestation like rash, joint pains and diabetes as well as cirrhosis and liver cancer.

There is no effective vaccine available. With adequate sterilisation of medical and surgical equipment, modification in use of sharp object practices, blood and blood products screening, test for HCV especially those who got blood transfusion before 1990, avoidance of sharing personal items and proper sexual conduct, HCV could be prevented.

Treatments for HCV include Interferon a± Ribavirin, Pegylated interferon a 2a ± Ribavirin and Pegylated interferon a 2b ± Ribavirin. When there are complications like cirrhosis additional treatment could include liver transplant.

It is the responsibility of the media to enlighten the public on dangers of the infection as they did with HIV/AIDS. They also need bring the attention of policy makers to the disease so that allocations can be made towards combating it through immunizations for newborns, free testing for in health institutions and make provisions for antivirals in the National Health Insurance Scheme.