Health Tips

There are 290 million people worldwide who are living with viral hepatitis unaware. Without finding the undiagnosed and linking them to care, millions will continue to suffer, and lives will be lost. That is why it is crucial to promote screening for viral hepatitis. 

Introduction to Viral Hepatitis

Hepatitis is the inflammation of the liver. It can have a viral or non-viral origin. Particularly, a viral hepatitis can be spread via viral transmission from one individual to another.

There are four types of viral hepatitis known to humankind: hepatitis A, B, C, D and E, each caused by different strains of hepatitis viruses. Among them, hepatitis B and C (Hep B and Hep C) poses a public health concern in Malaysia's society. As part of the national’s combat strategy against hepatitis B and C, the Ministry of Health has published the National Strategic Plan for Hepatitis B and C (NSPHBC) 2019 - 2023.

Image credit:https://www.webmd.com/hepatitis/ss/slideshow-hepatitis-overview

Both Hep B and Hep C are viral infections that can lead to acute and chronic liver diseases. Hep B is a potentially life-threatening infection caused by Hepatitis B virus (HBV). Fortunately there is a safe and effective vaccine against HBV available. In Malaysia, Hep B vaccination has been mandated for infants since 1989. The three doses vaccination are, respectively, within 24 hours of birth, one month and six months of age. 

Image credit: http://www.myhealth.gov.my/en/immunisation-schedule/. Image shows the mandatory immunisation schedule for infants in Malaysia.

In highly endemic areas, Hep B is most commonly spread from mother to child at birth or through exposure to infected blood, especially from an infected child to an uninfected child during the first 5 years of life. Hep B is also spread by needlestick injury, tattooing, piercing and exposure to infected blood and body fluids, such as saliva and, menstrual, vaginal, and seminal fluids. Sexual transmission of Hep B may occur, particularly in unvaccinated men who have sex with men and heterosexual persons with multiple sex partners or contact with sex workers.

Image credit: https://www.thestar.com.my/opinion/letters/2018/01/08/malaysians-need-to-be-more-aware-of-hepatitis-b-infection

On the other hand, Hep C is caused by Hepatitis C virus (HCV) and is usually not life-threatening. The majority of HCV-infected individuals are asymptomatic (i.e. does not show any symptoms) and remain as chronic infection. 15% to 30% of them may develop cirrhosis within 20 years. Around 30% (15–45%) of infected persons spontaneously clear the virus within 6 months of infection without any treatment. Unlike Hep B, here is currently no effective vaccine against Hep C. 

Image credit: https://www.facebook.com/DGHisham/photos/a.656071844416707/1921701244520421/?type=3&theater

Both Hep B and Hep C are treatable. Treatment currently listed in the Ministry of Health drug formulary for Hep B are tenofovir, entecavir, telbivudine, lamivudine, and adefovir. Hep C is not only treatable but curable ---the treatment includes once daily direct-acting antiviral (DAA) medication taken orally for a duration of only 12 weeks, and only chronic HCV-infected individuals are required to take the treatment.

Screening of Hep B and Hep C in Malaysia

Viral hepatitis is the seventh most common cause of mortality and of all the viral hepatitis-related deaths, approximately 48% are attributable to Hep B and Hep C. In Malaysia, more than 330,000 individuals are estimated to be chronically infected with HCV, but less than 2% have been treated to date. This is perhaps due to the asymptomatic nature of Hep C. Therefore, individuals who are at high risk for viral hepatitis infection, especially Hep B and Hep C, must be screened. 

In Malaysia, both Hep B and Hep C screening have been performed mainly at hospitals and pathology laboratories. Apart from those who shows signs and symptoms of viral hepatitis, the following groups are considered high risks and must be screened for Hep B and Hep C:

• Blood donors

• Healthcare workers

• People who inject drugs (PWID) who enrolled in the needle- and syringe-exchange programme and/or receive methadone maintenance treatment (MMT) as an effort to manage drug addiction.

• Foreign workers (only Hep B screening)

Image credit: https://www.everydayhealth.com/news/what-when-its-both-hepatitis-b-c/

If you are someone, or know someone who falls under one of those categories and have yet to get screened, kindly advise them to get Hep B and Hep C screenings as soon as possible. If you are not included in those categories but interested to know your Hep B and C status, you can always visit a clinic or private blood test center to get screened. 

A hepatitis-free future is achievable with a united effort

In conjunction with World Hepatitis Day 2020, the World Health Organization (WHO) is calling on all countries to work together to eliminate viral hepatitis as a public health threat by 2030 through the following actions:

• PREVENT infection among infants by undergoing the mandatory immunisation schedule.

• STOP TRANSMISSION from MOTHER to CHILD. All pregnant women should be routinely tested for hepatitis B, HIV and syphilis and receive treatment if needed. Speak to your doctor if you are pregnant and are concerned about hepatitis risk.

• LEAVE NO ONE BEHIND. Everyone should have access to hepatitis prevention, testing and treatment services, including people who inject drugs, people in prisons, foreign workers, and other highly-affected populations.

• EXPAND access to testing and treatment. Timely testing and treatment of viral hepatitis can prevent liver cancer and other severe liver diseases. 

• MAINTAIN essential hepatitis services during COVID-19. Prevention and care services for hepatitis - such as infant immunization, harm reduction services and continuous treatment of chronic hepatitis B - are essential even during the pandemic.

As an individual, you can contribute to a hepatitis-free future by getting routine screening, ensuring your children are vaccinated (and yourself vaccinated if necessary) and helping other high risk groups to access these health services. 

Cover image credit: https://www.webmd.com/hepatitis/ss/slideshow-hepatitis-overview

Written by

Ms Joyce Toh