IS hepatitis really a disease that Nigerians should worry about?
It is a disease to worry much about because the organisms that cause hepatitis are very much around with us in Nigeria. We have a very high prevalence of hepatitis in Nigeria, especially hepatitis B. We have 11 per cent of our population having hepatitis B, and another 2.2 per cent has been positive for hepatitis C.
Hepatitis simply means inflammation of the liver, and its causes are many, but the most important cause is viruses. These viruses are named in alphabetical order. We have hepatitis A, B, C, D and E essentially. However, hepatitis could either be viral or non-viral in nature. Causes of non-viral hepatitis include drugs, alcohol, herbal medications, and bacteria.
How does alcohol or herbal medicines lead to hepatitis?
Drugs and alcohol are processed in the liver. In the course of handling them, some of their breakdown products over time damage the liver and cause hepatitis.
Like viral hepatitis is caused by viruses, we also have other types like alcohol-induced hepatitis and auto-immune hepatitis, wherein the body starts to react to itself instead of reacting to foreign organisms or substances, and so destroying the liver.
In China, mother-to-child mode of hepatitis transmission of hepatitis is the most common. What is the most common mode for hepatitis transmission in Nigeria?
Viral hepatitis B is the most common type in Nigeria. It spreads from person to person through contact with the body fluid of someone with the virus. This could happen, say when sharing an implement that lets out blood, like razor blade, and sharp objects like needles for injections, or toothbrush.
It can also happen through contact sports like wrestling and football. Of course, there must be an opening on the skin before it can enter into the body system.
The 2019 World Hepatitis Day celebration theme is ‘Investment in Eliminating Hepatitis’. What can help ensure hepatitis is eliminated in Nigeria?
World Health Organisation (WHO) is advising all governments to invest in eliminating hepatitis, and one of the ways to start is by ensuring a community awareness of the disease. Hepatitis B is vaccine-preventable at birth, so every child needs to be vaccinated.
Lifestyle modifications are also helpful in preventing non-viral hepatitis. Maintaining an ideal body weight can help prevent fatty liver, a reason for hepatitis in some individuals. Also, avoidance of excess alcohol will prevent what is called non-alcoholic fatty liver disease, a precursor also for hepatitis and liver cirrhosis.
Similarly, avoiding abuse of medications, including non-prescription drugs like paracetamol that can damage the liver, is important. At certain doses, paracetamol can cause the liver to shut down completely.
Experts say that hepatitis is more deadly than HIV? Why is this so?
The hepatitis virus, especially the B, is about 100 times as infectious as HIV. HIV as a virus is a freak. When you leave it on the surface, within hours, it is dead but hepatitis B can live on a surface for weeks and still be infective. So, it is more readily transmitted than HIV.
Of course, the consequences that follow getting a hepatitis B, like chronic hepatitis, liver cirrhosis and liver cancer, could be deadly. In fact, liver cancer is like a death sentence because usually we do not discover it early. People at the early stages of liver cancer usually have no symptoms.
Is hepatitis, therefore, a silent killer?
Yes; the reason is that most people who have the virus are not aware because there are no symptoms, until it has caused severe damage to the liver.
The liver is the largest solid organ in the body. It can continue to tag on to manage to function until about 90 to 95 per cent of it is damaged, and then fail. That is why even with advanced disease, a person will not know that something is wrong unless they go for a test.
Most people who are discovered to have the disease get to know either when the test is required when they go for marriage counselling, before going for surgery or when they have already developed liver cancer.
And that is why vaccination is the most important way of preventing hepatitis. For hepatitis A and B, there are effective vaccinations. Also, everybody should get tested to know if they are positive for hepatitis B.
At UCH, we have been offering tests for hepatitis for decades. Just present yourself with a request form and blood sample will be taken for the test. They will give you a result in less than 24 hours. The basic test that is done is called hepatitis B surface antigen.
There are also facilities to ascertain hepatitis viral load, liver function as well as to assess its damages on the liver. A liver scan can show chronic hepatitis, scarred liver or even liver cancer.
Common practices that predispose to viral hepatitis B in Nigeria
Scarification is one. The herbalist will take a razor and make marks, and as a result, blood is let out. Many times, they do not sterilise their implements but use the same pieces of equipment for every patient.
Some use the horn to suck blood from what looks like swollen limbs and so on. All these can lead to transmission of viral infections. People that use drugs like cocaine also share needles, thus getting exposed to contracting hepatitis too.
Why is awareness on the disease low?
In any society where a large proportion are illiterate, even when they are told, because of their beliefs, values and social status, they do nothing about it.
Some, due to the religious belief that they are healed, will not go for test. They believe they are healthy and will remain so, even when there is evidence to the contrary.
But our association, the Society for Gastroenterology and Hepatology in Nigeria, every year celebrate the World Hepatitis Day with the whole world and carry out information dissemination on the disease both in English and local languages. Of course, not everyone listens.
Is this hepatitis B curable?
Hepatitis B is not curable, but it is treatable. Unlike malaria that you take malaria medication and the parasite goes away from your body, it is not so with hepatitis B.
Although there are drugs to cure hepatitis C, there is no drug that can cure hepatitis B yet. The virus is complex; it hides in the recess of the liver where currently available drugs cannot reach. For hepatitis C, within six weeks to three months, it can be cured.
But the good news is there is a once-daily tablet that will suppress the virus for as long as the individual takes it so that it will not have any effect. So, its treatment is for life, just like persons with diseases like hypertension or diabetes.
Diseases are supposed to be fenced off when the body’s immunity is high. Why is this not the case with hepatitis? Can it be said that hepatitis is the failure of the immune system?
Level of immunity of individuals varies from one person to another and from one organism to another, but it is not wrong to say that hepatitis is a failure of the immune system. The immune system has failed in preventing the virus from staying in you.
For those who have good immunity against the virus, they will eliminate it and develop antibodies against it. But it does not mean that they are cured of it. There is a part of the virus that stays in the inner core of the liver and does not leave until death.
It will be there, but not causing any problem. Like HIV drugs suppress HIV, so do the drugs prescribed for hepatitis B ensure that the virus, even though in the body, does not cause any problem. However, when you stop the drug any time, it flares up.