Hepatitis silent disease on the prowl in Nigeria — Expert

Hepatitis is a common but deadly cause of liver disease. Dr Adegboyega Akere, a consultant gastroenterologist at the University College Hospital, Ibadan, in this report by SADE OGUNTOLA, said millions of people live with this infection that now is endemic in Nigeria but is better prevented through many lifestyle modifications. Excerpts:

The 2020 World Hepatitis Day is aimed at fighting viral hepatitis. Why is this important?

Hepatitis is a disease of the liver. There are many causes of this liver disease, including virus, drugs, toxins, alcohol and so on. But one of the most common and dangerous ones is that caused by the virus. Out of all the viruses, there are five major ones– hepatitis A, B, C, E and D– that cause liver disease.

Hepatitis B is very common in this part of the world, causing liver cancer and liver cirrhosis. But the virus can be prevented with a vaccine, which is why people that don’t have it can get vaccinated and be protected.

Unfortunately, many people that have it don’t know because it may not show symptoms at the beginning. However, those that test positive to the hepatitis B need to see the doctor and be treated when necessary to prevent the diseases that can arise as a result of it.


Which is deadlier, COVID-19 or hepatitis B virus?

It is hepatitis. COVID-19 cannot cause cancer. Of course, not everybody that develops symptoms of COVID-19 dies from it. Hepatitis B has been here for a long time but many people still don’t believe that the virus can kill. So the fact that it can cause ill health and liver cancer, including death from cancer, makes it more deadly than the COVID-19.


What are the peculiarities of the different types of hepatitis virus

The major hepatitis virus –A, B, C, D and E –have some peculiarities in terms of how individuals can contract them. Hepatitis A and E are mainly contracted through fecal-oral means. Although hepatitis E can also be transmitted through blood, its transmission is mainly through the intake of contaminated food and water.

Hepatitis B and C are gotten from contaminated blood and blood products, sexual contact, use of contaminated sharp objects as well as from mother to child during childbirth.

Hepatitis D is a partial virus, in the sense that it cannot infect on its own; it needs Hepatitis B to infect a person. So, it is either superimposed or a co-infection. Hepatitis D is gotten the same way as hepatitis B.


Can eating out predispose individuals to contracting hepatitis B?

Yes, eating out can predispose individuals to contracting viral hepatitis B. The virus can be shed in the stool. A food vendor, for instance, can easily contaminate the food in the process of preparing or serving such a portion of food. So, any person that eats out may get the virus, A and E, which is contracted mainly through the intake of contaminated food and water.


Global leaders agree to bring the numbers of viral hepatitis down by 2030. Can Nigeria meet this target?

As a country, we can do it if we have the political will and we get our priorities right. But we are still far from that target. First, some of those that have the virus and need treatment cannot afford the treatment. Some can afford to do the test but cannot afford the drugs. The drug needs to be taken for a long period of time.

So, if the government subsidises its test and drugs, it will ensure that people with the virus who need to be treated can then get treatment, and invariably reduce the burden of the disease eventually.

Vaccination, which is to prevent people from coming down with hepatitis B, is costly. It has to be paid for. Will someone that has not eaten go and get the vaccine? The person will say he is well, that nothing is wrong with him. So, the government needs to either make the vaccine free or subsidize its cost for people to be able to get it.

Howbeit, vaccination against hepatitis B is now part of the national immunization programme. So, every newborn is vaccinated now. That step by the government will eventually stem it down but it will take some years. Even still, people that were born before the commencement of this vaccination programme that don’t have the virus need to be vaccinated.  And the government needs to put resources into ensuring free vaccination for everybody. Due to poverty, people don’t make the vaccination a priority.


Where is Nigeria in terms of testing and treatment for hepatitis? What are the changes that need to be made?

In terms of testing, we have many centres both in the public and private settings now that can test, so testing is okay. The challenge only comes in when the test result comes back negative and you need the vaccine or it comes back positive and requires treatment. It is not free and people have to pay for it. The government needs to subsidise or make its treatment free.

There are many people with undiagnosed hepatitis indulging in alcohol use in the community. Of what significance is this in stopping deaths and ill health from viral hepatitis?

Both hepatitis B and alcohol can damage the liver on their own. They can also cause liver cancer. So, if somebody has hepatitis B and is also drinking, then the person’s risk of developing liver cancer further goes higher. The synergist effect of hepatitis and alcohol use, which are risk factors for liver cancer, can make the person develop liver cancer rapidly.

Medically, individuals with hepatitis B are always advised to stop alcohol intake. At least, a reason for further liver damage by alcohol is avoided. So people should also desist from too much alcohol because it can damage the liver. Those that don’t even know their hepatitis B status and are still drinking alcohol may be risking their lives.


What is the prevalence of hepatitis in Nigeria?

Nigeria is in the category of countries highly endemic for hepatitis globally, having an average national prevalence of 11.2 per cent.  But in some places, hepatitis prevalence is as high as 25 per cent.

In fact, most countries in Africa are classified as high endemic zone for hepatitis B. The implementation of testing, prevention and treatment of hepatitis in many African countries is poor.

Although hepatitis vaccination of newborns is now part of the National Immunisation Programme, not much is being done by African governments on other things that can contribute further to the reduction of hepatitis cases such as testing, vaccination and treatment for adults.

Second, many practices that encourage the transmission of hepatitis B like sharing of sharp objects, scarifications, reuse of needles and syringes, tattoos, local circumcision, use of unsterile equipment for surgeries and so on are still prevalent in Africa.


The social media is rife with diets that promote healthy livers, foods to avoid in preventing liver diseases and so on. Can these diets also protect against hepatitis?

When we talk about food generally and hepatitis, it concerns hepatitis A and E that are transmitted through intake of contaminated food and water. So, it is important to make sure your food is clean and prepared in a hygienic environment to prevent contamination with any microorganism, especially hepatitis A or E.

Now, one’s diet will not prevent one from getting hepatitis B or C because these are gotten through blood and blood products, and preventing them is largely by lifestyle modifications.

But diet generally that will help the liver as an organ to function very well include fruits and vegetables because they contain vitamins and minerals which serve as antioxidants to mop up oxygen radicals that are released in the body that can cause diseases, including cancer.

Foods rich in vitamins and minerals can reduce the risk of liver disease, but they cannot prevent an individual from getting hepatitis. However, such foods can help to improve the functioning of the liver in individuals with hepatitis, thus reducing the burden of the disease that may occur thereafter.


Are all cases of hepatitis curable?

Hepatitis B is not curable, but it is treatable. In a small percentage of people with hepatitis B, when you treat, they can become negative. But the majority will still remain positive but there is a parameter that you look at to say that this person, because he is on treatment is not likely to develop chronic liver disease or liver cancer. For hepatitis C, it is curable; there are drugs that we give that will cure HCV.



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