HEALTH CONCERN

WHO issues new proposal in fight against Hepatitis B

Liver cancer is among the top 10 most common solid tumours in Kenya and diagnosis with liver cancer is invariably fatal

In Summary

• WHO already recommends routine testing of all pregnant women for HPV, as well as HIV and syphilis as early as possible in their pregnancy. 

• Hepatitis B, a viral infection affecting the liver, is the leading cause of liver cancer in Africa, accounting for up to 80 per cent of liver cancer cases.

A medical practitioner holds a red tube that contains blood specimen set aside to test for HIV, syphilis ,and Hepatitis B and C during a blood donation drive on June 12,2020
A medical practitioner holds a red tube that contains blood specimen set aside to test for HIV, syphilis ,and Hepatitis B and C during a blood donation drive on June 12,2020

Pregnant women who test positive for hepatitis B infection and have a high level of HBV viral load in the blood will now be required to receive preventive antiviral therapy with Tenofovir from the 28th week.

The World Health Organization issued the new recommendations during the World Hepatitis B Day on Tuesday in an effort to combat the disease. 

Tenofovir is used along other medications to treat HIV infection among adults and in children aged above two years.   

 

It is also used to treat chronic HBV in adults and children two years of age and above weighing 10kg or more.

In settings where HBV viral load testing is not available, the global agency recommends the use of an alternative low-cost test (HBeAg) to determine whether a woman is eligible for preventive antiviral therapy.

WHO already recommends routine testing of all pregnant women for HBV, as well as HIV and syphilis as early as possible in their pregnancy. 

Kenya has been classified by the WHO as a highly endemic area with a prevalence of more than eight per cent. 

Hepatitis B, a viral infection affecting the liver, is the leading cause of liver cancer in Africa, accounting for up to 80 per cent of liver cancer cases. 

In Kenya, up to 60 per cent of chronic liver disease and 80 per cent of hepatocellular carcinoma is due to chronic infection of the hepatitis B virus. 

Liver cancer is among the top 10 commonest solid tumours in Kenya and diagnosis with liver cancer is invariably fatal. 

 

“Stopping vertical transmission of HBV is a key pillar of the global ‘triple elimination’ initiative, which seeks to eliminate mother-to-child transmission of three infections that are prevalent in low and middle-income countries: HIV, syphilis and hepatitis B virus,” Director of Global HIV, Hepatitis and STI Programmes Meg Doherty said. 

Hepatitis B is highly infectious and is spread from mother to child during birth, during transfusion with infected blood and blood products, during dialysis and through sexual intercourse with multiple partners. 

Others include sharing syringes among injectable drug users and during prolonged close contact with infected people.

The Hepatitis B virus is 100 times more infectious than the HIV and 30 times more than the Hepatitis C virus. 

There is no specific treatment or cure for acute Hepatitis B, and most adults do not progress to chronic disease. 

Chronic infection is characterised by abdominal pain, yellow eyes, dark urine or abnormal liver tests, but in some cases, there are no symptoms. 

The vaccine was introduced in the early 1980s and was incorporated into the Kenya Expanded Programme on Immunisation (KEPI) in 2002, through which newborns are vaccinated at six, 10 and 14 weeks. 

Even though the vaccine has a protection rate of 95 per cent, most people born prior to the introduction of the vaccine were not immunised hence stand a high chance of being chronic carriers. 

Some of these patients will eventually develop chronic liver diseases and hepatocellular carcinoma. 

“No infant should grow up only to die of Hepatitis B because they were not vaccinated ─ today’s milestone means that we have dramatically reduced the number of cases of liver damage and liver cancer in future generations," WHO director-general Tedros Ghebreyesus said. 

"Preventing mother-to-child transmission of hepatitis B is the most important strategy for controlling the disease and saving lives. Even in the midst of the Covid-19 pandemic, we must ensure that mothers and newborns have access to life-saving services including hepatitis B vaccinations.” 

According to WHO, globally, more than 250 million people are living with chronic HBV infection. Infants are especially vulnerable - about 90 per cent of children infected with HBV in their first year of life become chronic carriers.

HBV attacks the liver and claims the lives of nearly 900,000 people each year.

In 2019, coverage of three doses of the Hepatitis B vaccine during childhood reached 85 per cent worldwide, up from around 30 per cent in 2000. 

However, access to the first critical dose within 24 hours of birth remains uneven. According to WHO, global coverage of this birth dose is 43 per cent, but this drops to only six per cent in the WHO African region. 

Edited by R.Wamochie