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Hepatitis B: A growing public health concern
Blood tests can detect signs of the hepatitis B virus in your body and tell your doctor whether it is acute or chronic. PHOTO | www.niddk.nih.gov
What you need to know:
- Yesterday, as the world commemorated World Hepatitis Day, statistics showed the number of new infections is on the rise, with the majority of these in Africa. Globally, every day, 3,500 people die due to hepatitis B and C infections. In 2022, an estimated 1,250 Ugandans died of the disease, and around six percent of the country’s population remains chronically infected as Beatrice Nakibuuka reports.
Emmanuel Lutamaguzi, the founder of the Hepatitis Aid Organisation was diagnosed with hepatitis B in 2016. Although he did not have any symptoms of the disease, he was diagnosed after tests were carried out as a requirement for anyone who wishes to travel out of the country.
“The hepatitis B test is one of the requirements when travelling. Probably, I would never have known I had the disease if it was not for that mandatory test. After the diagnosis, I was referred to a government hospital. The doctors assessed me and came to the conclusion that I did not need to be put on treatment,” he says.
While Lutamaguzi was able to lead a normal life after his diagnosis, the same cannot be said for Tonny Odongo Ocen. The hepatitis B activist was diagnosed nine years ago during a routine blood checkup. Today, he takes medication every day.
“The diagnosis was shocking because I did not know much about the disease. I was tested in a private hospital but the medical personnel who gave me the results did not give me proper guidance on what to do next,” he says.
Ochen took to the Internet, reading any available information about the disease. What scared him was that he had to go for further tests to find out if he had acute or chronic hepatitis B.
“I took the confirmatory tests at Lira Regional Referral Hospital and the results indicated I had chronic Hepatitis B. I had to start taking medication as soon as possible. In the beginning, life was not easy. Sometimes, I would forget to take the medicine. It was hard for me to break the news to my family. I tried to find a way to tell my wife calmly and convince her to get tested as well,” he recalls.
Chronic hepatitis B lasts six months or longer and can lead to an increased risk of developing illnesses such as liver cirrhosis, liver failure or liver cancer.
An acute hepatitis B infection lasts less than six months since the immune system can clear it from the body. However, infected persons can pass the virus on to others during this time.
The causes
According to estimates contained in the World Health Organisation (WHO) 2024 Global Hepatitis Report, by 2022, 254 million people were living with hepatitis B while 50 million were living with hepatitis C. The African region bears 63 percent of new hepatitis B infections.
Half of the burden of chronic hepatitis B and C infections is among people aged 30-54 years with 12 percent among children under 18. Men accounted for 58 percent of all cases.
The report further indicates that only 13 percent of people living with chronic hepatitis B infection had been diagnosed and approximately three percent (seven million) had received antiviral therapy at the end of 2022.
For hepatitis C, 36 percent had been diagnosed and 20 percent (12.5 million) had received curative treatment. The statistics fall well below the global targets to treat 80 percent of people living with chronic hepatitis B and hepatitis C by 2030.
Globally, viral hepatitis is the second leading infectious cause of death, with 1.3 million deaths per year. Of these, 83 percent were caused by hepatitis B and 17 percent by hepatitis C.
Dr Rachel Beyagira, the technical officer in charge of hepatitis at the Ministry of Health, says in Uganda, the highest prevalence of the hepatitis B virus occurs in northern Uganda.
“About six percent of the population in Uganda is chronically ill with hepatitis B and most of these cases are in Karamoja, West Nile, the mid-northern region, and the cattle corridors. The cases are lower in the southwestern areas of Kigezi and Ankole. High prevalence of hepatitis B infection is usually driven by low vaccination coverage,” she says.
She attributes this to vaccination hesitancy and war disruptions in the 1990s to the early 2000s in the northern region.
“Hepatitis is the inflammation or injury of the liver and there are several causes such as excessive alcohol intake and recreational drugs such as cannabis and marijuana. Some herbal medicines and over-the-counter drugs can be toxic if taken in excess. Most people, though, get hepatitis through bacterial, viral or fungal infections through contaminated food and drinks,” Dr Beyagira says.
Hepatitis B is transmitted when blood, semen, or other body fluids from an infected person enter the body of an uninfected person. This can happen through sexual contact, sharing needles, syringes, or other drug-injection equipment; or from mother to baby at birth.
Dr George Akabwai, a consultant physician at Baylor College of Medicine Children’s Foundation Uganda, says the human body can fight off most infections from hepatitis A and E.
“Infections from hepatitis B and C usually persist because the immune system cannot fight them. Although there is a known cure for hepatitis C, hepatitis B has no cure. However, hepatitis B is not spread through hugging, kissing, handshakes, sharing utensils, or contact with sweat as most people allude to,” he says.
Symptoms of hepatitis include abdominal pain, loss of appetite, fever, dark urine, weakness and fatigue, joint pain, nausea and vomiting, and yellowing of the skin and the whites of the eyes. The symptoms of acute hepatitis B range from mild to severe.
They usually appear about one to four months after exposure to the disease, although about 90 percent of the people who test positive for hepatitis B virus do not show signs. They only show signs in the late stages when complications set in.
Treatment options
Dr Andrew Kazibwe, the head of medical services at The Aids Support Organisation (TASO), says hepatitis B virus mutates, making it a hard target for medication.
“The virus can hide in the inner cells of the liver. It is hard to identify a drug that can enter the cells of the liver and destroy the virus without destroying the liver itself. This is why there is no cure for hepatitis B,” he says.
However, there are approved treatments with antiviral drugs such as entecavir, lamivudine, adefovir, telbivudine and the common tenofovir used in Uganda. While telbivudine and adefovir are mainly used to treat chronic hepatitis B, the rest are also used as combination drugs for the treatment of HIV.
Dr Kazibwe says these medicines work by slowing down the speed of replication of the virus in the body, which would otherwise cause destruction of the liver cells and progress into scarring and cancer. Before a patient is started on the treatment, they have to first be assessed to find out if they need to take the drugs.
“We check for cirrhosis and measure the viral load as well as the level of vulnerability, especially for pregnant mothers. The measure of the viral load is very important and the threshold is determined according to the individual. If one has a co-infection of hepatitis B and HIV, they need to start treatment immediately,” Dr Kazibwe says.
He adds that children who acquire the disease from their mothers are at risk of suffering chronic hepatitis B, which leads to scarring (cirrhosis) and liver damage.
Although treatment for hepatitis B is free and available at all public health centres in the country, Ocen says there are no designated clinics for hepatitis B.
“We get treatment at the anti-retroviral treatment (ART) clinics. There is congestion and delays on the days those living with HIV/Aids because people see us lining up together,” he says.
Dr Kazibwe says due to lack of sensitisation, many people do not go for hepatitis screening, making it challenging to identify those who need to be put on treatment immediately. Ochen concurs, saying because of the myths and misconceptions many patients are isolated and left to die without their families seeking medical attention for them.
“People think the disease is contagious and that a diagnosis is a death sentence. This is not true. I have been on medication for the last nine years and I can work and take care of my family,” he says.
Government strategies
The government introduced the hepatitis B vaccination through the pentavalent vaccine as part of the National Expanded Programme on Immunisation in 2002. The three-dose series, administered in phases, has had coverage of more than 90 percent since 2013 and is available at all public health centres and regional referral hospitals.
The Ministry of Health (MoH) provides prevention, screening and treatment services in the maternal–child health clinic for syphilis, HIV and hepatitis B.
“All pregnant mothers are tested for hepatitis B, HIV and syphilis. Blood that is donated is also screened for these transmittable diseases. The government of Uganda has advocated for the immunisation of all infants at six, 10 and 14 weeks. We also introduced the hepatitis B birth-dose which is given within 24 hours after the baby is born,” Dr Beyagira says.
In 2015, with an investment of around US$3 million (Shs11b), the country embarked on a massive, free hepatitis B screening programme , with widespread community awareness-raising efforts.
“An adult qualifies to get the hepatitis B vaccine if they test negative upon screening. The vaccination is done in three phases. We are researching to find out if we need booster doses but for now, we believe that the vaccines we have are capable of giving the protection required by the body,” Dr Akabwai notes.
The doctors advise that prevention is better than cure and one can reduce their risk by knowing the hepatitis B status of their sexual partner, using condoms during sexual encounters with people they do not know, and taking precautions with body piercing and tattooing.
Numbers
- According to estimates contained in the World Health Organisation 2024 Global Hepatitis Report:
- By 2022, 254 million people were living with hepatitis B
- 50 million were living with hepatitis C.
- The African region bears 63 percent of new hepatitis B infections.
- Half of the burden of chronic hepatitis B and C infections is among people aged 30-54 years with 12 percent among children under 18.
- Men accounted for 58 percent of all cases.
- Globally, viral hepatitis is the second leading infectious cause of death, with 1.3 million deaths per year.
- Of these, 83 percent were caused by hepatitis B and 17 percent by hepatitis C.
What they say
“I took the confirmatory tests at Lira Regional Referral Hospital and the results indicated I had chronic Hepatitis B. I had to start taking medication as soon as possible. In the beginning, life was not easy. Sometimes, I would forget to take the medicine. It was hard for me to break the news to my family. I tried to find a way to tell my wife calmly and convince her to get tested as well,” says Tonny Odongo Ochen, Hepatitis B activist.
“Hepatitis is the inflammation or injury of the liver and there are several causes such as excessive alcohol intake and recreational drugs such as cannabis and marijuana. Some herbal medicines and over-the-counter drugs can be toxic if taken in excess. Most people, though, get hepatitis through bacterial, viral or fungal infections through contaminated food and drinks,” says Dr Rachel Beyagira, the technical officer in charge of hepatitis at the Ministry of Health.
“We check for cirrhosis and measure the viral load as well as the level of vulnerability, especially for pregnant mothers. The measure of the viral load is very important and the threshold is determined according to the individual. If one has a co-infection of hepatitis B and HIV, they need to start treatment immediately,” says Dr Andrew Kazibwe, the head of medical services at The Aids Support Organisation
