28 July 2020
On World Hepatitis Day, the Academy of Medicine of Malaysia seeks to raise awareness on this disease.
The adoption of the World Health Organisation’s Global Hepatitis Strategy at the World Health Assembly in 2016 commit all Member States to eliminate viral hepatitis by 2030. A survey undertaken by WHO between April and June this year showed disruption in hepatitis services in the majority of countries. Key hepatitis services were not carried out, particularly among higher-risk groups. The main reasons cited for these disruptions include diversion of health systems, lack of access to health facilities during movement restrictions and stock out of drugs.
Viral hepatitis is a communicable disease that can cause serious liver damage and liver cancer. Deaths from viral hepatitis, the majority (96%) are due to hepatitis B and C, are rising worldwide compared to the downward trend for the other three most common causes of communicable diseases. However, hepatitis is preventable, treatable, and for Hepatitis C, curable with timely treatment.
It is estimated that less than 10% of Malaysians living with Hepatitis C (HCV) are aware that they are infected, while only 17% of those with Hepatitis B (HBV) has been diagnosed, and as a consequence, only a minority of individuals with HCV and HBV have been treated. This shows that we have a long way to go before achieving the goal of elimination.
We recommend that everyone undergo Hepatitis B testing at least once in their lifetime, especially those who were born before 1989, i.e. before the HBV vaccination programme for newborns was introduced. There has been a clear decline in HBV prevalence since the programme was implemented. Unfortunately, there is not yet a vaccine to combat HCV. People who received transfusion of blood and blood products prior to 1994 (before the availability of HCV testing worldwide) are at risk of HCV and should get tested for the virus.
Destigmatization is an important part of the public health effort in eliminating hepatitis as fear of discrimination and stigma can prevent people from getting tested and treated. There is a stigma attached to the disease due to its perceived association with drug use and sexual activity, as hepatitis is transmitted through blood or other body fluids. There must be an all-of-society effort led by health professionals to educate the public on the facts and myths of this disease.
From a structural perspective, there must be a concerted effort to close the gap between testing and treatment. Testing and treatment services must be expanded to achieve elimination of hepatitis.
Without doubt, COVID-19 pandemic has accelerated digital health solutions. Telehealth is now widely deployed to replace in-person consults. Telemedicine can also be used for training and mentorship of non-specialists and nurses to enable task shifting or role delegation. Decentralization of testing and treatment services to primary care providers will need to be supported by a differential triage strategy to identify priorities and assess level of care needs, leaving specialist referrals only for those with complex problems.
In managing the COVID-19 pandemic, we must balance our resources and not forget our commitment to other important health goals. We are on the right track in preventing hepatitis B, but there is much more to be done until elimination becomes a reality.
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