In a bid to eliminate the disease by 2030, WHO has called on countries to embrace goals that include reducing new infections by 90%, as well as ensuring at least 80% of those with chronic hepatitis B and C, who are eligible for treatment, will receive it by 2030.
Malaysia is among those that have committed to combat viral hepatitis by that year, and has since developed the National Strategic Plan for Hepatitis B and C (2019 to 2023) to achieve this. As such, it is good to look back and see just how far the country has progressed when it comes to hepatitis.
In conjunction with World Hepatitis Day today, FMT spoke with Dr Haniza Omar, secretary of the Malaysian Society of Gastroenterology and Hepatology, for her insights.
Haniza, 52, explained that hepatitis is an inflammation of the liver that can be caused by viruses, drugs, alcohol, as well as autoimmune disease. There are five types of viral hepatitis: A, B, C, D, and E.
“However, it is hepatitis B and C that can lead to chronic diseases such as cirrhosis, a condition where the liver hardens and shrinks,” she said. “In Malaysia, the incidence rate for chronic hepatitis B and C is around 12.6 and 10.3, respectively, across a population of 100,000.”
The incidence rate refers to the number of new cases that develop in a population over a specified period.
Looking back, there has been an increase in awareness of the disease. Haniza, who has been specialising in gastroenterology and hepatology since 2010, said that even as recently as a decade ago, many wrongly perceived that hepatitis could be transmitted by kissing, hugging, or sharing food or utensils with an infected person.
“We now know it’s not true, as viral hepatitis is transmitted through the blood or body fluids. So, with greater awareness in society, the stigma has reduced. Compared with 10 years ago, more people have come forward to be screened and treated.”
Progress in treatment
Back then, she said, only hospitals could treat viral hepatitis. Over the past three years, though, general practitioners and family-medicine specialists have also begun providing care, especially since treatment for hepatitis C has become less complex. “In fact, there are family-medicine specialists based in most government health clinics,” she said.
Haniza added that initiatives are in place to bring hepatitis care to prisons and remote areas, making treatment more accessible to a larger group of patients.
When it comes to testing for hepatitis B and C, previously the process included drawing blood, sending it to the laboratory, and waiting for the results, which could be dependent on the workload of said laboratory.
These days, it can easily be done through a finger prick test, with results provided in about 10 minutes.
“In the past, hepatitis B and C were treated with interferon injections, which caused side effects including biochemical changes such as low platelets and anaemia, hair loss, and even depression,” she said. Interferon is an immunomodulator – a natural substance that helps the body’s immune system fight infection and diseases.
Today, hepatitis B and C can be treated with tablets that cause only minimal side effects such as nausea, headaches, and sometimes skin rashes.
“In 2018, Malaysia also started using direct-acting antiviral treatment for hepatitis C, which subsequently brought the success rate of treating it to around 80-95%,” she further shared.
On the new hepatitis-C treatment that Malaysia helped develop in conjunction with the Drugs for Neglected Diseases Initiative, Haniza said: “Ravidasvir, a pangenotypic regime, has shown efficacy and safety when used in combination with Sofosbuvir.”
Mission possible?
According to Haniza, unlike hepatitis C, there is no cure for hepatitis B. “We just try to suppress the virus to prevent complications. Still, there is research being conducted in the hope of finding an absolute cure in the near future.”
She emphasised, however, that hepatitis B is one of the top five vaccine-preventable diseases in the country.
On her thoughts on Malaysia’s goal of combating viral hepatitis by 2030, she said: “I believe we can either achieve it or get somewhere close, with a lot of hard work.”
In the meantime, does she have any advice for the general public? “In most cases, viral hepatitis is asymptomatic. If you are unsure, come forward and get your blood tested, especially if you are living with someone with viral hepatitis, or have a family history of viral hepatitis and liver cancer.
“Get yourself vaccinated for hepatitis B if you haven’t. Unfortunately, there is no vaccine for hepatitis C, so always maintain a healthy lifestyle by exercising frequently and ensuring a balanced diet.
“Reduce or even stop smoking and consuming alcohol. These are little things you can do to look after yourself.”