Op-ed on the Occasion of World Hepatitis Day by WHO Representative Dr Arvind Mathur
Hepatitis is a disease of the liver. Five main hepatitis viruses (A, B, C, D and E) are the most common cause of hepatitis. Viral hepatitis is a global public health concern. 1.4 million people die globally because of Viral Hepatitis- a toll equivalent to the HIV and Tuberculosis. Infection with Hepatitis B and C virus can also lead to chronic disease including liver cancer. In WHO South East Asia Region alone, 410 000 people die of Hepatitis B and C infections annually.
Knowing the modes of transmission of the viruses helps in prevention. Hepatitis A and E are water- and foodborne infections and therefore have largely been controlled with improved water, sanitation and hygiene. Hepatitis B, C and D spread by sexual contact, injectable drug use, receipt of contaminated blood or blood products, and invasive medical procedures using contaminated equipment. In addition, hepatitis B transmission may also occur from an infected mother to baby at birth. But note that these infections can be prevented or can be treated.
With better understanding of the routes of infection, injection and blood safety and importantly vaccination for hepatitis A and B; people can prevent themselves from getting infected or passing the infections on to others. The Hepatitis B vaccine is highly effective when provided within 24 hours of birth to a newborn child, with follow up of at least two more doses of vaccine during the first year of life. Hepatitis B vaccination has been an integral part of Maldives primary immunization schedule. Universal vaccination of all newborns and infants has the highest impact on preventing new hepatitis infections. Point of care and rapid diagnostic tests are now available for Hepatitis B and C infections. There is effective treatment for Hepatits B, and newer drugs for hepatitis C can cure the disease in 95% of cases that get access to treatment. Safe injection practices such as eliminating unnecessary and unsafe injections can also prevent transmission. Importantly all blood products needs to be screened for the viruses and only safe ones processed for transfusion services.
Hepatitis B virus infectionis a major public health issue in the Maldives. As noted above, Injectable drug use and unsafe sexual practices put individuals at risk for Hepatitis B and C irrespective of their nationalityHepatitis B is detected commonly inmigrant workers -- 513 cases from 31 different nationalities have been reported in 2017 so far. Numbers are compelling enough to push the urgency for acting now to protect ourselves and prevent Hepatitis from spreading further in the country and the community.
With available tools at hand, efforts towards addressing viral hepatitis in a holistic manner and with a public health approach need to be enhanced. With the goal of ending viral hepatitis as a public health threat by 2030 as outlined in Regional Action Plan, I urge some key actions to be implemented as we observe the World Hepatitis Day: these include sustaining high coverage of Hepatitis B vaccine with the regular 2-3 doses of the same vaccine per national guidelines, ,investing in Reuse Prevention syringes (RUP) and Injection safety,. continuing to screen each donated blood or product for hepatitis B and C., continuing the collaboration to ensure safe drinking water and effective sanitation at every community, and finallyproviding opportunity to people for knowing their individual Hepatitis status so that appropriate treatment would be provided to those infected.
What is heartening to note is that in Maldives many of these recommended actions are already in place though there is a need for enforcement and compliance with focus on quality.
As we commemorate the 7th Hepatitis Day, with the theme “Eliminate Hepatitis”; I see an opportunity to add momentum to all ongoing efforts in the Maldives. It may be useful to emphasize the importance of developing a country specific action plan targeting Elimination of Hepatitis as has been outlined in WHO’s first Global Health Sector Strategy for 2016-2021 and included as a target in Sustainable Development Agenda 2030.
As WHO Representative, I extend my highest commitment and full support a to the Government of the Maldives, policy makers, health workers and people in taking forward our collaborative actions for realizing the vision of eliminating Hepatitis. The Maldives is a forerunner in eliminating diseases such as Malaria, Filariasis and Measles and I am optimistic that with highest political commitment and people’s actions, it would strive towards Hepatitis Elimination too- Let us build the momentum to actualize this vision
Elimination at Hand
