About 500 million people worldwide are currently infected with chronic hepatitis B or C. This number is 10 times the number infected with HIV/AIDS. Chronic hepatitis B and C are silent infections. Most of the 500 million infected people are unaware of it. However, it causes persistent damage to the liver and in about 20 years causes incurable serious diseases like cirrhosis and liver cancer. Amitabh Bachhan, the famous Indian film star, is an example of this scenario of the long silent nature of chronic hepatitis. Twenty-eight years back he got hepatitis infection from blood transfusion he received for injury he sustained during filming of “Coolie”. As a result of which he developed cirrhosis of liver which was recognized only recently.
A patient with cirrhosis develops many life-threatening complications and it ultimately ends in rapidly fatal conditions like liver failure and cancer. Every year about one million people in the world die from hepatitis B or C. Chronic hepatitis is more common in developing countries. According to Cary Adams, the Chief Executive of International Union against Cancer, while cancer is not infectious, about 22% of cancer deaths in developing world and 6% in industrialized countries are caused by chronic infections.
There are about 315,000 people infected with chronic hepatitis B in Nepal. Hepatitis B together with hepatic vena cava disease is the common cause of cirrhosis and liver cancer in Nepal. Both these diseases are preventable. Unlike in China where hepatitis B is transmitted from mother to child at birth, and in the West through sex among adults, hepatitis B in Nepal spreads mainly among children between the ages of 6 to15 years. About 5 % persons who acquire infection at an adolescent age develop chronic hepatitis. Hepatitis B can be prevented by vaccination. The appropriate strategy of prevention of hepatitis B in Nepal is to give hepB vaccine to new-born babies. The Government has already introduced it through child immunization programs. People of Tibetan origin, Gurungs from Manang and Sherpas have very high prevalence of the disease. Control of hepatitis B in Nepal will depend on effective vaccination cover of these high risk groups.
At present, there is no vaccination against hepatitis C. Its control depends on public awareness about the disease. More than 80 % of the hepatitis C infections in Nepal are among intravenous drug users (IDU). A few is caused by tattooing. The number of people exposed to hepatitis C virus in Nepal is estimated to be about 240,000, of these nearly 75 thousands have chronic hepatitis C. Chronic hepatitis C has increased threefold in the country in the last 2 decades, mainly the IDU. It is estimated that from the present pool of chronic hepatitis C, 38 thousand new patients of cirrhosis and 4 thousand new patients of liver cancer will be added in Nepal in the next two decades.
Drug abuse and hepatitis C start together among children in our schools. There is a treatment for
hepatitis C now. Depending on the type of hepatitis C virus, the treatment is
given for 6 months to a few years. Treatment of hepatitis C however is very costly.
The blood test done before starting treatment to find out the type and amount
of the virus alone costs about Rs 20,000. And the 6 months treatment costs about Rs. 500,000.
The silent epidemic of hepatitis C in Nepal is like a volcano. The problem continues to smolder inside without the knowledge of the infected persons or the community. And in 20 years time when it will explode it will add to our many health problems, a costly and tragic dimension of having to care for a large number of patients with cirrhosis and liver cancer. Managing cirrhosis and liver cancer is more costly than treating hepatitis C. Liver cancer or liver failure is treated by liver transplantation which can cost around Rs. 4 million. “Narkonan Nepal” has adopted an effective way to wean people from the drug habit. But, preventing hepatitis C may be more difficult. There is a greater need to banish altogether this menace from our schools. The first step in this direction is the spread of awareness about drug abuse and hepatitis C among school children as it is the problem of our youth. The best way to beat it is being aware of it and by sharing concern and love for fellow human beings.
At present, diagnostic tests for hepatitis B and C are not available in Nepal. But, the equipment and technical know-how are available within the country. Ministry of Health must play a facilitator’s role to develop these facilities in the country. Drugs for hepatitis are costly. Patient pressure group, LFN, Ministry of Health, World Hepatitis Alliance and WHO should co-work with multinational drug companies to make these drugs available in poor countries like Nepal at an affordable price. The World Hepatitis Day 2010 reminds us to come together and make an effort to take the first step to change the adverse conditions for a hepatitis free world. This is one year, one opportunity to change.
By: Dr. Santosh Man Shrestha- President, Liver Foundation Nepal