World Hepatitis Day (WHD) is a day set aside by the World Health Organisation (WHO) to raise awareness about hepatitis- one of the most deadly and neglected diseases and health crises that claims a life every 30 seconds. Globally, 354 million people live with hepatitis, with more than 1.1 million lives lost each year to hepatitis B and hepatitis C.
‘We’re not waiting’ is the new campaign theme to launch WHD 2023 and to highlight the need to accelerate elimination efforts of viral hepatitis and the urgent need of testing and treatment for the real people who need it.
2.7 million people live with HIV and hepatitis B. 2.3 million people live with HIV and hepatitis C. 7% of people living with TB also live with hepatitis C.
Sub-Saharan Africa (SSA) and East Asia are among the high-endemic areas where about 5% and 10% of the adult populace, respectively, is chronically infected. In Europe and America, about 1% of the population is chronically infected. The risk of being infected with HBV in one’s lifetime in most countries in Africa and Asia, including parts of the Middle East, is estimated to be more than 60%.
Individuals with chronic HBV infection have an increased risk of liver disease and hepatocellular carcinoma (HCC). It is estimated that 10 to 33 per cent of all individuals who develop a persistent infection will end up with chronic hepatitis, and among them, 20 to 50% will likely to develop liver cirrhosis. HCC is a dangerous cancer with few treatment options and often a challenge in many third world settings. SSA is shown to have one of the highest HBV-related liver cancer rates worldwide.
The hepatitis document of Ghana (2014) notes hepatitis as inflammation of the liver that can be caused by infectious or non-infectious agents/substances such as viruses, bacteria, toxins, drugs, and alcohol use. Viral hepatitis is inflammation of the liver caused by viruses. Viral Hepatitis is commonly caused by one of several viruses. The causes of viral hepatitis include the five unrelated hepatotropic viruses, namely Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E. In addition to the nominal hepatitis viruses, other viruses that can also cause liver inflammation include Herpes simplex, Cytomegalovirus, Epstein-Barr virus, and yellow fever.
Hepatitis A and E viruses are transmitted by faecal-oral route, through person-to-person contact, ingestion of contaminated food or water. Hepatitis B, C and D viruses are transmitted through Infectious blood, semen, vaginal fluid and other body fluids. The most important route of transmission is by sexual contact with an infected person. Transmission may also occur from exposure to infected blood from instruments, such as those used to give injection or perform medical procedures, tattoos, shaving, manicures, circumcision, sharpening of pencils or knives. Hepatitis B and C are major causes of cirrhosis and liver cancer, the second leading cause of cancer death in the world.
Ghana is endemic for hepatitis B virus infection (more than 8%). Prevalence of hepatitis C virus is also high (5-10%). There is thus 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.
The launch of the National policy on viral hepatitis in 2014 is been followed with the National Hepatitis Elimination Profile (NHEP) of 2016. The prevalence of chronic HCV was estimated to be at 3.0% nationally in 2016 while the national prevalence of chronic HBV was estimated to be between 8.36% (2020) and 12.30% (2016). Deaths related to HBV and HCV continue to rise. From 2015 to 2019, there was a 7% increase in HBV-related deaths and an 8% increase in HCV-related deaths in spite of the WHO 2020 goal of reducing HBV and HCV related deaths by 10% from 2015 to 2020. Ghana has achieved the 2020 Sustainable Development Goal target of an HBV prevalence among children under five years of age under 1%.
One of the tenets of NHEP is to increase awareness, improve data on HBsAg sero-prevalence among pregnant women and the risk of HBV transmission from mother to child. There is the Hepatitis Evaluations to Amplify Testing and Treatment (HEAT) project to conduct an HBV and HCV epidemiological situational and lab capacity assessment.
Updated clinical guidelines for HBV and HCV were released in 2016 that include direct acting antivirals for hepatitis C. Non-governmental organizations have stepped up routine free screening and outreach campaigns across the country.
The World Health Organization adopted the Global Health Sector Strategy on Viral Hepatitis in 2016 with the goal of eradicating viral hepatitis as a public health threat by 2030 by reaching targets that principally aim to reduce new hepatitis infections by 90%, treat 80% of viral hepatitis patients, and reduce death by 65%. HBV-infected patients are at increased risk of death from liver cirrhosis, hepatocellular carcinoma (HCC), and liver failure.It is important to increase awareness especially for HBV and HCV prevention, encourage testing (and vaccination for persons who test negative for HBV), improve access to treatment of HBV and HCV.
Some difficulties in the management of HBV in sub- Saharan African countries including Ghana is HBV DNA (HBV viral load) testing inorder to determine treatment options. Many patients are unable to afford because of cost and access. The cost of antiviral therapy is another barrier to care of persons with chronic hepatitis B (CHB). Antiviral treatment reduces the risk of hepatocellular carcinoma and improves liver-related and all-cause mortality.
For Ghana to achieve Global Health Sector Strategy to eliminate viral hepatitis B by 2030 with the goal of reducing HBV infection by 90%, especially through mother-to-child-transmission (MTCT), it is important that all pregnant women who test positive to HBV get access to affordable diagnostics, so that effective preventive measures can be put in place to reduce the risk of MTCT.
More than 90% of infants that are infected will develop a chronic hepatitis B infection. Up to 50% of young children between 1 and 5 years who are infected will develop a chronic hepatitis B infection. 5-10% of healthy adults 19 years and older who are infected will develop a chronic hepatitis B infection (that is, 90% will recover from an exposure). Vaccination against HBV is important in our fight against viral hepatitis.
Fruits, vegetables, spices, and herbs are a potential source of phenolic acids and polyphenols. These compounds are known as natural by-products or secondary metabolites of plants, which are present in the daily diet and provide important benefits to the human body such as antioxidant, anti-inflammatory, anticancer, anti-allergic, antihypertensive and antiviral properties.Viral infection disrupts the defensive antioxidant mechanism of the human body, bringing inflammation and oxidative damage. Polyphenols are renowned antioxidants, delay and/or prevent oxidative stress-induced cellular damage and disease (Montenegro-Landívar. Polyphenols and their potential role to fight viral diseases: An overview. Science of the Total Environment 801 (2021) 149719). Dietary polyphenols are powerful immune system health drivers. Polyphenols display immunomodulatory capabilities, one of the major mechanisms involved in inflammation control and immune responses. I will urge all to increase the intake of polyphenol-rich foods and boost the natural responses against viral infections. Cocoa is an excellent source of polyphenols.
BY DR. EDWARD O. AMPORFUL, CHIEF PHARMACIST
COCOA CLINIC
