Every July 28th the whole world commemorates the “Hepatitis Day” and the birth of Baruch Samuel Blumberg. Baruch is the scientist who discovered the Hepatitis B virus. It is an excellent opportunity to evaluate the strategies applied until now to achieve the World Health Organization’s (WHO) goal of Hepatitis eradication by 2030.
Hepatitis is a general that means inflammation of liver. Despite many agents being able to induce this affection, Hepatitis viruses are the most common ones. There are five types of Hepatitis viruses, named with the letters A, B, C, D and E (HAV, HBV, HCV, HDV and HEV).
Worldwide, about 400 million people suffer from viral hepatitis. WHO estimates that around 15 million of people are infected in Pakistan. This makes us one of the countries with the highest rate of infection in the South Asian region. This has been confirmed by data collected by the Pakistan Medical Research Council.
Because of their transmission pathway, Hepatitis A (HA) and E (HE) are classified as orofecal pathogens. In Pakistan around 80-90% of children are exposed to HAV due to low sanitary conditions, mainly, in rural areas. Moreover, Hepatitis A was considered as an acute infection with a subclinical presentation. However now it is identified as a harmful condition with a high probability of death due to liver failure. There are sporadic cases or outbreaks of HEV infection in situations of overcrowding, where contaminated water is consumed.
Hepatitis A & E
Some reports suggest that the prevalence of infection is around 20-22% in adults and 2.9% in children. In contrast with HA, HE has a clinical presentation of mild to moderate severity in the general population. However it represents a major cause of death in pregnant women population, being responsible of a mortally rate between 20 – 30%.
The situation with HA and HE is not that catastrophic as with Hepatitis B (HB) and C (HC), the most harmful of the hepatitis viruses. HBV and HCV are acquired when a breach in the skin, mucosa or veins is exposed to blood or a body secretion from an infected person. HDV only co-infects HBV-infected individuals, causing a more severe disease and a worse outcome.
Today, 7.4% of the Pakistani population suffers from chronic infection with either HBV or HCV. An official survey done in 2008 revealed that in Pakistan, eight million of people were infected with HCV. The same survey suggested that four million had HBV. This rate of HCV infections gives to Pakistan the second place among the countries with the highest prevalence worldwide. There is not enough data available about the current prevalence of HDV co- infection.
The principal consequence of HBV and HCV infection is a severe liver disease, which ends in hepatocellular carcinoma, cirrhosis and end-stage liver disease. Neverthelesss, it depends, at least in the case of HBV infection, of the age of acquisition. Newborns have over 90% of risk of becoming long term carriers whereas adults have only 2- 5% of risk.
Finally, the prevalence of HBV and HCV varies among the different provinces in Pakistan. Baluchistan has the highest prevalence of HBV (4.3%) followed by Sindh (2.5%). On the other hand, Punjab has the highest prevalence of HCV (6.7%) followed by Sindh (5.0%).
What is mentioned above explains the concerns of Pakistani government in the continuous increase in viral hepatitis infections and a perfect reason for rethink this July 28th ing about the strategies that has been implemented until now by the WHO to battle against this disease and achieve the goals proposed by WHO.