HEPATITIS B VIRUS PREVENTION- CONTINUING THE GLOBAL CAMPAIGN

Because of COVID-19, July 25 which is the World Hepatitis Day nearly passed by quietly. That is the other aspect of COVID-19 – till we get full grips of the pandemic every other health issue risk not getting the desired attention.  

On May 18, The Global Hepatology Society, which is composed of the major professional clinical liver societies around the globe, encouraged people with liver disease to be vaccinated for COVID-19. The Global Hepatology Society includes the American Association for the Study of Liver Disease (AASLD), European Association for the Study of the Liver (EASL), ALEH (Latin American Association for the Study of the Liver) and The Asian Pacific Association for the Study of the Liver (APASL).The Society recommends that patients with advanced chronic liver disease, liver cancer, and those with post-liver transplant should be prioritized for vaccination for SARS-CoV-2.

As usual the World Health Organization (WHO) website has lots of information on hepatitis B virus (HBV). Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease. The virus is most commonly transmitted from mother to child during birth and delivery, as well as through contact with blood or other body fluids during sex with an infected partner, unsafe injections or exposures to sharp instruments. 

The WHO estimates that 296 million people were living with chronic hepatitis B infection in 2019, with 1.5 million new infections each year. In 2019, hepatitis B resulted in an estimated 820 000 deaths, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer).

The WHO stresses that HBV can be prevented by vaccines that are safe, available and effective. A safe and effective vaccine that offers 98% to 100% protection against HBV is available. Preventing HBV infection averts the development of complications including chronic disease and liver cancer. The burden of hepatitis B infection is highest in the WHO Western Pacific Region with 116 million people with chronic hepatitis B infection (CHB) and the WHO African Region with 81 million people having CHB.

In highly endemic areas, hepatitis B is most commonly spread from mother to child at birth (perinatal transmission) or through horizontal transmission (exposure to infected blood), especially from an infected child to an uninfected child during the first 5 years of life. The development of chronic infection is common in infants infected from their mothers or before the age of 5 years.

HBV is also spread by needlestick injury, tattooing, piercing and exposure to infected blood and body fluids, such as saliva and menstrual, vaginal and seminal fluids. Transmission of the virus may also occur through the reuse of contaminated needles and syringes or sharp objects either in health care settings, in the community or among persons who inject drugs. Sexual transmission is more prevalent in unvaccinated persons with multiple sexual partners.

HBV acquired in adulthood leads to chronic hepatitis in less than 5% of cases. HBV in infancy and early childhood leads to CHB in about 95% of cases. This is the basis for strengthening and prioritizing infant and childhood vaccination.

The hepatitis B virus can survive outside the body for at least 7 days. During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine. The incubation period of the hepatitis B virus ranges from 30 to 180 days. The virus may be detected within 30 to 60 days after infection and can persist and develop into chronic hepatitis B, especially when transmitted in infancy or childhood.

It is not possible on clinical grounds to differentiate hepatitis B from hepatitis caused by other viral agents, hence laboratory confirmation of the diagnosis is essential. Several blood tests are available to diagnose and monitor people with hepatitis B. They can be used to distinguish acute and chronic infections. WHO recommends that all blood donations be tested for hepatitis B to ensure blood safety and avoid accidental transmission.

There is no specific treatment for acute hepatitis B. Therefore, care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids lost from vomiting and diarrhoea. Most important is the avoidance of unnecessary medications, especially. Acetaminophen.

Chronic hepatitis B infection can be treated with medicines, including oral antiviral agents. Treatment can slow the progression of cirrhosis, reduce incidence of liver cancer and improve long term survival. The WHO recommends the use of oral treatments (tenofovir or entecavir) as the most potent drugs to suppress hepatitis B virus. Most people who start hepatitis B treatment must continue it for life.

WHO recommends that all infants receive the hepatitis B vaccine as soon as possible after birth, preferably within 24 hours, followed by 2 or 3 doses of hepatitis B vaccine at least 4 weeks apart to complete the vaccination series. Protection lasts at least 20 years. In addition to infant vaccination, WHO recommends the use of antiviral prophylaxis for the prevention of hepatitis B transmission from mother-to-child. Implementation of blood safety strategies and safer sex practices, including minimizing the number of partners and using barrier protective measures (condoms), also protect against transmission.

In May 2016, the World Health Assembly adopted the firstGlobal health sector strategy on viral hepatitis, 2016-2020. The 74th World Health Assembly in 2021 adopted a previous decision of the Executive Board to request that Global Health Sector Strategies on HIV, viral hepatitis and sexually transmitted infections are developed for the period 2022-2030. Among other measures are to raise awareness, promote partnerships and mobilize resources, formulate evidence-based policy and data for action, prevent transmission, and scale up screening, care and treatment services.

WHO organizes annual World Hepatitis Day campaigns (as 1 of its 9 flagship annual health campaigns) to increase awareness and understanding of viral hepatitis.

Natural polyphenols are secondary metabolites of plants and are considered as potential agents for prevention and treatment of several diseases, such as cancer, cardiovascular diseases, diabetes mellitus, aging, and neurodegenerative diseases. Polyphenols have been found to possess a variety of pharmacological effects on oxidative stress, lipid metabolism, insulin resistance, and inflammation, which are the most important pathological processes in the etiology of liver diseases. . Though there is opportunity to prevent and treat viral hepatitis, all the currently approved antiviral drugs have their limitations.  Therefore, natural products, are considered promising as antiviral agents.

Chemoprevention is defined as the use of specific natural (dietary) or synthetic agents to prevent, delay, or slow the carcinogenic process. This is the case for polyphenols, natural dietary compounds present in fruits and vegetables. In addition, the low toxicity and the very few adverse side effects linked to polyphenols consumption give them potential advantages. Cocoa has the highest flavanol content of all foods on a weight basis and is a significant contributor to the total dietary intake of flavonoids. Many  polyphenolic extracts have been associated with the anti-viral activities against poxviruses, influenza, HIV-1 and herpes. There is need for more work on the antiviral effects of cocoa flavanols against hepatitis B.

DR. EDWARD O. AMPORFUL

CHIEF PHARMACIST

COCOA CLINIC.

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