Hepatitis B infection…Stepping up awareness and education

A nurse treating a patient with Hipatitis B in a hospital

A nurse treating a patient with Hipatitis B in a hospital

It is tempting to relent in creating awareness about Hepatitis B virus infection particularly if you have been doing it for so long.

Yet, from time to time you stumble upon issues which indicate that there is more work to be done. The country’s expanded programme of immunization (EPI) with coverage for hepatitis B virus infection took off in 2002.

The EPI gives protection against five diseases : diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenza epidemic type b, given at 6, 10, 14 weeks after birth.

It means that a number of persons born in Ghana before 2002 are not covered by the free hepatitis B (Hep B) vaccine.

One could test this in a group of students in SHS and tertiary institutions or youth within the community. Just ask simple questions. Have you heard of the hepatitis B virus?

Do you know the mode of transmission of Hepatitis B virus infection?

Have you been tested against hepatitis B virus infection?

You will be surprised to find out the number of persons who have not tested and vaccinated against hepatitis B virus infection.

An extract from the new Policy on Viral Hepatitis indicates that Ghana belongs to the areas where the prevalence of chronic Hepatitis B Virus infection (HBV) is high , that is greater than 8%.

I have across some literature that puts the prevalence between 10-20%.

There is therefore a high burden of infection with resulting high prevalence of chronic liver disease and liver cancer (hepatocellular carcinoma).

Liver cancer is also the leading cause of cancer death affecting both Ghanaian men and women (UN Globacon Report 2012).

The National Health Insurance Scheme (NHIS) does not cover free testing and vaccination against HBV infection. I do recall some of the key messages in the national campaign against HBV infection by the Pharmaceutical Society of Ghana (PSGH).

About ten percent of persons infected perinatally (mother-to-baby at birth) will clear the disease spontaneously without any specific treatment when exposed to HBV. It means that 90% of such persons risk having chronic HBV infection.

About 70-75% of children will be able to clear the disease spontaneously without specific treatments. It means that about 25% of such persons risk having chronic HBV infection when exposed to the virus. About 90% of adults will be able to clear the disease spontaneously when exposed to the HBV.

It means that about 10% of such persons risk having chronic HBV infection when exposed to the virus.

Chronic HBV infection is a high risk for developing cirrhosis (scarring of the liver), liver failure and hepatocellular carcinoma (HCC) or simply liver cancer. It is true that about one million people die each year from hepatitis B making it the 10th leading cause of death in the world.

HBV accounts for up to 80% of cases of liver cancer and it is considered the second most important human carcinogen after tobacco.

HBV is a preventable, highly infectious viral infection of the liver. HBV is found in the body fluids of infected people (blood, sweat, tears, breast milk and semen).

The virus can be spread from mother to infant during birth, through unprotected sex, or through blood-to-blood contact, which could occur through the sharing of needles, razors or toothbrushes (ELPA). HBV is about 100x more infectious than HIV. The HBV is also a very tough (robust) and able to remain viable outside the body for about a week compared to HIV.

It is important to know your hepatitis B status before vaccination. So first get tested. If you test negative for HBV it is important to begin vaccination. The Normal Vaccination schedule is 0, 1, 6 months. For the normal vaccination you do not need a booster. There is the Rapid vaccination of 0, 1, 2 months. But for this you need a booster on the 12 month.

There is the Accelerated vaccination schedule of 0, 7, 21 days. A person who gets the Accelerated vaccination schedule will also need a booster dose at the 12 month (360 days). It is important to stress that these alternative (rapid or accelerated) are used only in peculiar situations with the decision-maker being your health care provider.

I believe that putting all these information together will show that we need to do more to increase awareness and education about HBV.

Looking at the number of persons who turn up for hepatitis B screening programme, that is about 10yrs after the national campaign, there are still gaps. Some come and test for HBV but are unable to vaccinate right after when the test result is negative with the main reason being the wherewithal.

Some also begin the vaccination but for some reasons are unable to complete the schedule. It is important to stress that full protection against the virus can be achieved by completing the schedule. The vaccine can not give one the hepatitis B virus (HBV) infection. If you tested positive after getting vaccinated against HBV it can only mean you were already positive for the virus before the vaccination.

This year’s World Hepatitis day was marked under the theme “Prevent Hepatitis. Act Now”. It is clear from the characteristics of the HBV that we should not only keep the education and awareness campaign going but find ways to step it up year in and year out.

By Edward O. Amporful

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