Finding the missing millions

Millions of people across the world are infected with hepatitis without knowing and without receiving treatment. This lack of awareness leads to progressive liver damage, causing life-threatening conditions and ultimately millions of deaths.

Hepatitis is an inflammation of the liver that can cause a range of health problems and can be fatal, quite ravaging, particularly in developing countries, causing both acute (short-term) and chronic (long-term) liver disease with more than one million deaths each year. The causes however vary, from autoimmune disorders to excessive intake of alcohol and most commonly due to viral infections. There are five main strains of the hepatitis virus, referred to as types A, B, C, D and E. While they all cause liver disease, they differ in important ways including modes of transmission, severity of the illness as well as prevention methods.

Hepatitis B and C are major health problems worldwide, being major causes of liver cancer, which is the second leading cause of cancer related mortality in the world. Over half a million new cases are diagnosed annually. Data from the World Health organization (WHO) reveals that up to 325 million people are living with chronic Hepatitis B and C infection.

Unlike Hepatitis B and C, Hepatitis A does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and fulminant hepatitis (acute liver failure), which is often fatal. The risk of Hepatitis A infection is associated with a lack of safe water, poor sanitation and hygiene, which are risk factors that can be adequately addressed.

Hepatitis A is transmitted when an uninfected person ingests food or water that has been contaminated with the faeces of an infected person. Hepatitis B and C on the other hand, can spread from mother to child at birth, or by needle stick injury, tattooing, piercing and exposure to infected blood and body fluids, such as vaginal and seminal fluids. Interestingly, Hepatitis D only occurs in people who are also infected with the hepatitis B virus while Hepatitis E virus is found in the stool of an infected person and spread in likewise fashion as Hepatitis A.

Optimizing sanitation and food safety, improving supply of safe drinking water and proper sewage disposal will help prevent both Hepatitis A and E while implementation of blood safety strategies, including quality-assured screening of all donated blood and blood components used for transfusion, can prevent transmission of HBV and HCV as well as safe injection and safer sex practices. It is noteworthy to mention that both Hepatitis A and B are vaccine-preventable.

Over 300 million people living with viral hepatitis are unaware. Without finding the undiagnosed and linking them to care, millions will continue to suffer, and lives will be lost. The novel coronavirus disease (COVID-19) pandemic has demonstrated the importance of working together to confront public health challenges, hence alerting us to the need to embrace effective preventive measures to mitigate this menace, get tested and treated if need be and vaccinated where applicable, so we can uncover and address the missing millions.

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