Observing ‘World Hepatitis Day 2020’ during Covid-19 pandemic: Prof. Dr. Mamun Al Mahtab (Shwapnil)

Writer: Prof. Dr. Mamun Al Mahtab (Shwapnil)
-Chairman of Hepatology, BSMMU
-Chairman, Forum for the Study of the Liver Bangladesh

Today is July 28 – World Hepatitis Day. The day was first celebrated in 2011. Since then ten years have passed. World Hepatitis Day is among the eight days endorsed by the World Health Organization.

Hepatitis B virus was first discovered by a US Haematologist Professor Blumberg in the serum sample of an Australian aborigine in 1965. Later on, Professor Blumberg went on to discover the vaccine against hepatitis B virus, which is the first vaccine that prevents cancer.

Professor Blumberg received Nobel Prize in Medicine in 1975 for this discovery. He dedicated his discovery to the welfare of mankind and never patented the vaccine. For these very reasons 28 July, the birthday of Professor Blumberg, is celebrated globally as the World Hepatitis Day. As of today, more than 350 million people all over the world are infected with hepatitis B virus. On the other hand, hepatitis C virus infects approximately 200 million people globally. This virus was discovered much later than hepatitis B virus in 1989.

Hepatitis B virus spreads through blood and blood products and unsecured physical contact. On the other hand, hepatitis C principally spreads through infected blood. Prick of needle stick infected with hepatitis B virus is associated with thirty percent and that with hepatitis C virus three percent risk of transmission of the viruses respectively. Newborns born to hepatitis B positive mothers are at ninety percent risk of getting infected. However, breastfeeding does not spread hepatitis B or C. Similarly these viruses don’t spread by sharing glass, plate, spectacles, clothing, towel etc. used by patients of hepatitis B and C.

According to published literature, fifty to sixty million people in Bangladesh have been exposed to hepatitis B virus. Of them, eight to ten million are suffering from chronic hepatitis B. On the other hand, in this country approximately ten million are exposed to hepatitis C virus. Many of these hepatitis B and C exposed individuals are at risk of progressing to liver cirrhosis and primary liver cancer at some stage of their lives.

Besides, patients of hepatitis B and C remain as reservoirs of the two viruses. Healthy people can get infected from them. The risk is particularly high with hepatitis B virus in case of females, pregnant women and newborns. In Bangladesh many people are getting infected with hepatitis B and C viruses everyday in this way.

What is more important is that every year almost twenty thousand people die in Bangladesh because of hepatitis B and C related liver cirrhosis and primary liver cancers. According to published literature, the expenditure for treating ten percent of our hepatitis B virus infected population exceeds six thousand crores taka. It therefore needs no mention that hepatitis B and C are major health and socio-economic concerns for Bangladesh.

Approximately seventy percent patients infected with hepatitis B and C viruses do not have any history of jaundice. Around ten percent adults and ninety percent children exposed to hepatitis B virus clear the virus spontaneously, whereas this is seen with ten percent individuals exposed to hepatitis C virus. Those who are infected chronically with hepatitis B or C viruses frequently don’t have any symptom. Sometimes they complain of right upper abdominal pain, weakness and anorexia. Most of them get diagnosed during routine screening for employment, blood donation or vaccination.
Hepatitis B is the leading cause of liver cirrhosis and primary liver cancers in Bangladesh, like many other countries in the Asian Pacific region, which is followed by hepatitis C. However, the unfortunate thing is that most patients do not realise that they are infected unless they develop liver cirrhosis or primary liver cancer. This is the reason why little can be done to help these patients in most cases, although hepatitis B and C are treatable conditions if detected early.
As already mentioned there are effective vaccines for hepatitis B virus. These vaccines are produced and marketed in Bangladesh also. However, no vaccine for hepatitis C virus has yet been developed. Babies born to hepatitis B positive mothers, spouse of hepatitis B patients, healthcare workers, patients on haemodialysis and patients with haemolytic anaemia should be vaccinated on a priority basis.

However, in a country like Bangladesh where there is intermediate endemicity for hepatitis B, every citizen should get vaccinated against the virus.
Hepatitis B and C are no more incurable diseases. Like other countries of the world effective drugs for these two viruses are also available in Bangladesh. More importantly, these drugs are produced in Bangladesh, therefore affordable and even exported abroad.
Bangladeshi researchers have co-developed a novel drug against hepatitis B called NASVAC, which is showing new ray of hope to mankind. This new drug is more effective compared to the already available anti-virals and is free from side effects.

The drug is already commercially available in Cuba, Latin America and a few African countries. Clinical trial of the drug is underway in Japan. The Directorate General of Drug Administration of Bangladesh has already approved the recipe of NASVAC. This is the first drug to be developed and approved in Bangladesh. It is expected that NASVAC will be available in the Bangladesh market in the near future.

Although there are so many promising news for hepatitis B and C patients, unfortunately nine out of every ten of them do not know that they are harbouring such deadly diseases. Amidst such background, Sustainable Development Goal (SDG) 3.3 has been set to eliminate hepatitis B and C viruses from Bangladesh and elsewhere from the globe by 2030. We are celebrating World Hepatitis Day today as part of the global community under such circumstances. Covid-19 has re-educated us about many aspects of our lives.

We now know how an invisible virus can bring the world to a sudden halt. We have so far lost approximately two and a half thousands of our countrymen due to coronavirus, whereas in Bangladesh around twenty thousand people die annually from hepatitis B and C related liver diseases. The theme of World Hepatitis Day this year is to identify the ‘missing millions’ to ensure a ‘hepatitis free future’.

We have to make the population aware as well as develop public private partnership. This is not only necessary to achieve SDG 3.3, but also for our own interest. Otherwise, none can guarantee whether like SARS-CoV-2, hepatitis B and C viruses will also not bring us to a standstill someday.

Date: 27/07/20