National News

Sindh faces an alarming hepatitis threat with 300,000 critical patients

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By Professor DR SADIK MEMON

HYDERABAD – Hepatitis is one of the 10 reportable diseases in Pakistan. Worldwide, one among 12 people worldwide lives with the hepatitis. Along with other leading diseases in prevalence, it should be a warning that hepatitis is growing fast in Pakistan, and that immediate action needs to be taken to combat the disease.

The burden of disease related to hepatitis infection is very high, in most countries especially in PAKISTAN; there are approximately 1 million chronic carriers of hepatitis B and 1.7 million chronic carriers of hepatitis C in Sindh. According to survey by Pakistan Medical Research Council, prevalence of hepatitis B is 2.5% and of HCV it is about 5.0%. The HBV figures were high in Khairpur (6.3%), Ghotki (5.9%), Larkana (4.3%), Noshero Feroze (4%). Very high figures about HCV were seen in Ghotki (12.7%), Sanghar (7.8%), Dadu (7.2%), Hyderabad (5.7%), Thatta (5.4%), Shikarpur and Jacobabad 5.3%. Around 300,000 patients have developed end-stage liver disease and need urgent liver transplantation.

The key message of this day is that hepatitis is a preventable disease. Everyone can get this disease, yet it rarely affects those who consciously guard against it. It is important for people to be aware of this serious disease, how it is transmitted and how they can protect themselves.
So the World Hepatitis Day provides an opportunity to focus on specific actions, such as:
I. strengthening prevention, screening and control of viral hepatitis and its related diseases;
ii. Increasing hepatitis B vaccine coverage and integration of the vaccine into national immunization programmes;
iii. Coordinating a global response to hepatitis.

The problem has not been addressed in a comprehensive way for many reasons. These include the fact that most people do not develop any symptoms when they become infected and that they remain free of symptoms often for decades until they develop chronic liver disease.

These factors together have resulted in “the silent epidemic” we are experiencing today. Viral hepatitis also places a heavy burden on the health-care system because of the high costs of treatment of liver cancer and liver failure from cirrhosis. In PAKISTAN, liver failure from viral hepatitis is the leading reason for liver transplants. Such end-stage treatments are expensive, easily costing up to millions of rupees per person and Pakistan’s total budget is insufficient to take care of these end stage liver disease patients and there are no existing transplant facilities in Pakistan.

It is very unfortunate despite several efforts are taken by public and private sector; there is no well develop liver transplant facility centre in PAKISTAN. Government needs to takes serious action of this situation and establish good quality liver transplant center in the PAKISTAN.

Hepatitis B is entirely preventable and could be eradicated in a single generation. If only we had the will. Vaccines are clearly making a difference today. The hepatitis B vaccine is now offered to children in 178 countries worldwide, providing a level of protection that prevents more than 700,000 deaths from cirrhosis and liver cancer in each new generation.

Besides effective vaccines, tests for viral hepatitis have made the blood supply safer by dramatically lowering the risk for transfusion-associated hepatitis B and C infections. And for persons living with hepatitis B and C, improved access to screening and referral for treatment can reduce disease and death. Today, new therapies for hepatitis C can eliminate the virus in 2 out of 4 persons treated; essentially curing their infection, but still there is very high ratio of patient non-responder and relapsers as well. The message for SINDH Government to deal this alarming situation is to try to gives best treatment option to every patient, which is one weekly PEG-BASED INTERFERONE and Ribavirin.

While we celebrate these gains, we have much more to do. In the PAKISTAN especially for a population living in rural areas and are very prone to this lethal disease, many if not most people living with hepatitis are not aware of their infection, and thus cannot benefit from the effective treatments that are available. Lack of progress in countries with fewer resources has been directly related to the inability to implement what works-providing clean water and guaranteeing a safe food supply, routinely offering the birth dose of hepatitis B vaccine and ensuring that every child receives 3 doses, educating health care providers and at-risk people about the importance of being tested, improving infection control procedures in health care facilities, and raising awareness of risk among injection drug users. We must redouble our commitment to ensure these effective tools are fully utilized to benefit all people at risk for viral hepatitis.

Treatment is prevention. If we do nothing now, we will see a dramatic increase in hepatitis B and C related liver cirrhosis in the next 10 to 20 years. By catching it in time, we can cure the majority of people infected. And by targeting the most at risk group, we could see a huge reduction in transmission over a period of time. It is not unrealistic to suggest the disease could be virtually eliminated in future.

August 12, 2013

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