Viral Hepatitis: Reducing the burden of Hepatitis B and Hepatitis C in Ghana
In this piece I will be using materials from the Global Hepatitis Report 2024 and the National Guidelines for Prevention, Care and Treatment for Viral Hepatitis.
Viral hepatitis is inflammation of the liver caused by viruses. The causes of viral hepatitis include the five unrelated hepatotropic viruses, namely Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E. Hepatitis A and E viruses typically cause acute and self-limiting infections. Hepatitis B and C (HBV and HCV) infections may progress into chronic infections. HBV and HCV are currently the most important viral hepatitis in Ghana because they cause chronic infections. Infection is associated with increased risk of chronic liver disease, cirrhosis, and hepatocellular carcinoma (HCC). The latter is one of the commonest cancers in the country and has a high mortality. Suppression of HBV and HCV leads to reduction or delay in the development of cirrhosis and hepatocellular carcinoma (HCC).
Viral hepatitis has become a major public health concern globally. Over three billion people world-wide are exposed to the infection yearly. An estimated one in 12 persons are currently infected and have to face a life with liver disease like chronic Hepatitis, Cirrhosis of the Liver and Liver Cancer. Globally, 90 per cent of people living with viral hepatitis do not know they have it, and 3,000 people die of the disease every day. The World Health Organisation (WHO)’s global hepatitis strategy, endorsed by all WHO Member States, aims to reduce new hepatitis infections by 90 per cent and deaths by 65 per cent between 2016 and 2030. In 2019, an estimated 1.2 million new hepatitis infections and 125 000 hepatitis- B and C related deaths occurred in the African Region. There were an estimated 254 million prevalent hepatitis B infections and 50 million prevalent hepatitis C infections worldwide in 2022. Half the burden of chronic hepatitis B and C is among people 30–54 years old and 12 per cent among children under 18 years of age. Men account for 58 per cent of all cases.
In Ghana, viral hepatitis is a major health concern for health authorities. Hepatitis B is hyper-endemic, with an estimated prevalence in the population of 9.1 per cent. Hepatitis C also poses a high burden, with an estimated prevalence of 3.3per cent. Currently, there is no vaccine against hepatitis C. However, early diagnosis and treatment can cure over 95 per cent of people, which also helps prevent further transmission of the virus. In Ghana, despite high rates of infection, testing and treatment for hepatitis B and C have historically been very low due to the high costs of services and limited access to treatment.
The risk factors for hepatitis B and C include high-risk sexual behaviour; persons with multiple sexual partners; commercial sex workers; men having sex with men-homosexuals; unsafe sex; non-immune partners and household contacts of HBV infected persons; intravenous and percutaneous drug use e.g. Injection Drug Users; individuals in prisons and persons born in countries with high rates of endemic disease; persons who frequently require blood or blood products e.g regular renal dialysis patient; recipients of solid organ transplantation;those at occupational risk of HBV infection, including health care workers; and international travellers to countries with high rates of HBV; practices such as scarification, bloodletting, circumcision with unsterile instruments, tattooing and body piercing.
The presentation of Viral Hepatitis can be in two forms namely Acute and Chronic. Viral Hepatitis is defined as acute when it lasts less than six months and chronic when it persists longer. The clinical presentation of acute hepatitis is similar for all five viruses. It ranges from the absence of symptoms to mild or moderate features such as jaundice, poor appetite and malaise. In a minority of cases it may result in fulminant hepatitis with a potentially fatal outcome. Non-specific features are flu-like symptoms, common to almost all acute viral infections and may include malaise, muscle and joint aches, fever, nausea or vomiting, diarrhea, and headache. More specific features include profound loss of appetite, jaundice (yellowing of the skin and eyes), dark urine and abdominal discomfort. Less common features are tender hepatomegaly, lymphadenopathy and splenomegaly.
Taking action to prevent and treat viral hepatitis
The increasing burden of hepatitis infections requires urgent action at all levels to protect people and communities. The Ministry of Health and the Ghana Health Service, through the National Viral Hepatitis Control Programme (NVHCP), and with support and technical guidance from WHO, has national guidelines for the prevention, care and treatment of viral hepatitis.
In March 2023, the government of Ghana, with support from the government of Egypt, WHO, and other partners, launched the ‘STOP Hep C Ghana Project’. This initiative reaches out across the nation, from cities to villages, providing free treatment for hepatitis C across all levels of care to all Ghanaians with active infection.
Prevention is key in reducing the burden of hepatitis B and C. Hepatitis B can further be prevented by testing and vaccination if proven to be negative. Hepatitis B can also be managed to reduce the complications of the disease. There is no vaccine for hepatitis C but testing and early identification is important in early treatment to prevent the complications of hepatitis C infection.
For hepatitis B, vaccination is recommended for the non-infected (No detectable HBsAg), and non-immune patients (No detectable Anti-HBs) i.e. all infants. Hepatitis B Vaccination schedule: three doses of hepatitis B vaccine given 0,1 and 6 months interval Persons eligible for Hepatitis B vaccination: infants born to HBsAg positive women. Hepatitis B immunoglobulin should also be added (PMTCT HepB). All new-born infants should be given birth dose of hepatitis B vaccine. Continue with three doses as part of routine childhood immunisation at child welfare clinics starting from six weeks as part of DPT-HepB-Hib vaccine. At risk populations such as health workers (including trainee students and newly recruited staff), partners and household members of Hepatitis B positive persons should be screened and those negative for hepatitis B vaccinated. 2) Practice safe sex Use condoms appropriately. Avoid multiple partners 3) Blood safety-all blood should be screened for Hepatitis B and C before transfusion.
Additional preventive measures is to process all instruments/sharps (by decontamination with 0.5 per cent chlorine, cleaning and high level decontamination or sterilization) before use at all health and non-health facilities. Practice safe injections, use only sterile needles and syringes. Avoid sharing sharps (blades, needles and syringes) and tooth brushes etc. with others.
Nutrition plays a key role in fighting infections and protecting the liver. Diet rich in fruits and vegetables protect the liver. Agents that damage the liver such as alcohol and smoking are particularly harmful in patients who already have viral hepatitis and must therefore be avoided in such persons.
All stages of the virus lifecycle depend on the host; therefore, immune cells, as the first line of defence, play a vital role in protecting our body against pathogens and viruses. Foods rich in polyphenols are notable anti-oxidant, anti-inflammatory, immune system-enhancing properties. Cocoa is a very rich source of polyphenols. The regular consumption of polyphenol-rich cocoa should be part of the dietary approaches to curb viral hepatitis burden in the country.
DR. EDWARD O. AMPORFUL
CHIEF PHARMACIST
COCOA CLINIC
BY DR. EDWARD O. AMPORFUL
