WORLD HEPATITIS DAY 2024:

Shining a Light on Liver Health. It’s Time for Action!

Hepatitis, a general term used to describe the inflammation of the liver, affects millions globally. It can be classified into viral and non-viral types. The non-viral types such as autoimmune hepatitis, alcoholic hepatitis, and drug-induced hepatitis, can be caused by non-viral factors like chemicals, drugs, excessive alcohol use, toxins, certain genetic disorders and autoimmune disorders. As for the viral type, there are five main types of hepatitis viruses (A, B, C, D, and E), each with unique features and methods of transmission. Hepatitis A is mainly spread through contaminated food and water. It's easy to catch, especially for children, but usually doesn't cause serious liver damage and clears up within six months. Hepatitis B spreads through contact with infected blood, needles, bodily fluids, and from mother to baby. It can become a long-term illness, potentially causing liver damage, cancer, or cirrhosis over time. Hepatitis C is transmitted through infected blood or from mother to baby during childbirth, and can also lead to long-term liver issues like cancer or cirrhosis. Hepatitis D only affects people who already have hepatitis B. Hepatitis E is mostly found in Africa, Asia, and South America. Some medications, like acetaminophen (Tylenol) and vitamin A, can cause drug-induced hepatitis if taken in large amounts. Among the five types, hepatitis B and C are particularly concerning as they are the most prevalent infections and collectively causing 1.3 million deaths and 2.2 million new cases annually. Certain forms of hepatitis can be prevented through vaccination. According to research by the World Health Organization (WHO), approximately 4.5 million premature deaths in low- and middle-income nations could potentially be averted by 2030 through the implementation of vaccination programs, diagnostic screenings, medication availability, and educational outreach efforts.

Worldwide, viral hepatitis ranks seventh among leading causes of death, with approximately 48% of these deaths attributed to HBV and HCV infections. Both viruses share common transmission routes, including unsafe injection practices, sexual contact, and mother-to-child transmission. Alarmingly, the World Health Organization (WHO) reports that over 350 million people are currently living with chronic hepatitis B or C, but many lack access to testing and treatment.

Internationally, The Western Pacific Region (WPR) alone accounts for 39% of global hepatitis-related mortality. The countries listed under the WPR include Malaysia and the other South East Asian neighbouring countries. In this region, complications from chronic HBV and HCV infections, namely cirrhosis and liver cancer, contribute to 94% of hepatitis-related deaths.

In Malaysia, viral hepatitis remains as one of the public health concerns and its incidence has been on the rise. In 2017, an estimated 1.1% of the population was infected with hepatitis B virus, while in 2009, the prevalence was 2.5% for hepatitis C virus. Additionally, a higher disease burden leads to increased instances of complications such as liver cirrhosis and hepatocellular carcinoma resulting from viral hepatitis infections. Since 2010, notification of viral hepatitis cases has been mandatory under the Control and Prevention of Communicable Disease Act 1988. Liver diseases, including cirrhosis and liver cancer, were reported as the sixth leading cause of death in Malaysia from 2013 to 2015. This highlights the urgent need for initiatives aimed at reducing hepatitis infections and enhancing diagnosis and treatment.

Every year on July 28th, the world pauses to recognize World Hepatitis Day. World Hepatitis Day is observed to increase awareness about viral hepatitis, a liver inflammation that can lead to severe liver disease and hepatocellular cancer. This year’s theme is “It’s time for action”. Even though viral hepatitis is generally preventable, treatable, and potentially curable, with a person dying every 30 seconds from a hepatitis-related illness, it is crucial to implement appropriate intervention measures to save lives and enhance health outcomes.

The Government of Malaysia is concerned by the rising incidence of viral hepatitis in the country. To align with the global hepatitis strategy is to achieve a 90% reduction in new hepatitis infections and a 65% decrease in hepatitis-related deaths from 2016 to 2030, Malaysia has has pledged to fight viral hepatitis by the year 2030. To fulfil this commitment, Malaysia has developed its first national strategic plan. The National Strategic Plan for Hepatitis B and C (NSPHBC) was endorsed on 22^nd of July 2019 and this document outlines a detailed and organized approach for planning, executing, monitoring, and assessing viral hepatitis programs and activities in the country. The main objectives of NSPHBC are (1) to establish and strengthen national policies for the prevention, control, diagnosis, treatment and care of viral hepatitis B and C. (2) to prevent the transmission of viral hepatitis B and C. (3) to reduce the morbidity and mortality of viral hepatitis through early detection and effective case management. (4) to improve the survival and quality of life among individuals with chronic liver disease, and (5) to promote partnerships with relevant stakeholders for the prevention, control, diagnosis, treatment and care of viral hepatitis B and C.

The NSPHBC also states that the targets to be achieved by 2030 include (1) to diagnose 90% of the population living with viral hepatitis. (2) to reduce the number of new cases of viral hepatitis by 90%. (3) to reduce mortality due to viral hepatitis by 65%. (4) to treat 90% of the population in need of treatment.

The incidence of viral hepatitis in the nation is expected to rise further in the absence of a coordinated response to the pandemic. According to modelled projections in the NSPHBC, if preventive, control, treatment, and care methods are not improved, the number of cases of chronic hepatitis C is expected to climb further, reaching 523,500 in 2039. It is also predicted that the illness burden will rise to 94,900 DALYs annually, of which 47% will result from early mortality. Simultaneously, 2,002 hepatitis C patients are expected to acquire decompensated cirrhosis and 540 to develop hepatocellular carcinoma (HCC) by 2039. These complications will increase the expense of care and treatment.

Participating in World Hepatitis Day events is crucial for raising awareness about viral hepatitis, its prevention, and treatment. Getting screened can detect infections early, leading to timely intervention and improved health outcomes. Supporting hepatitis-related causes through donations or advocacy helps fund research, education, and access to healthcare for those affected globally. Together, we can work towards eliminating hepatitis as a public health threat. Your involvement can make a significant difference in the lives of many.

 Dr. Fezah Othman

Senior Lecturer

Department of Biomedical Sciences

Faculty of Medicine and Health Sciences, Universiti Putra Malaysia

Date of Input: 05/08/2024 | Updated: 04/09/2024 | nadia_rahman