The silent dragon: the urgent battle against hepatitis

Many people, including Thais, do not take liver health seriously. Hepatitis wreaks havoc silently, often going unnoticed until it is too late.

Dr John Ward, a prominent voice at the recent APAC IRIDS conference on infectious diseases, compared hepatitis to a “silent dragon”, infecting the liver with minimal symptoms before silently progressing to severe stages.

“The liver is a very stoic organ; it doesn’t cause many symptoms. So you live for years without knowing that you have this chronic viral infection that slowly destroys your liver until it reaches its terminal stage. Eighty percent of all liver cancers worldwide are caused by hepatitis B and C. The survival rate for liver cancer is low,” he said.

Globally, hepatitis claims one million lives each year, even surpassing the mortality rate of HIV in the Asia-Pacific region.

Despite these alarming statistics, awareness and prevention efforts fall far short of reality. Liver cancer, mainly caused by viral hepatitis, is the third leading cause of cancer deaths worldwide, with Thailand being the worst affected.

The APAC Liver Disease Alliance 2023 report reveals that the region witnesses 63% of liver disease-related deaths globally, with viral hepatitis and liver cancer, mainly hepatocellular carcinoma or HCC, being the major contributors. In 2020, the region reported 610,000 cases of liver cancer.

“The tragedy is that almost all infections are preventable,” Dr. Ward said.

Fast forward to 2030

By 2030, the World Health Organization (WHO) is aiming for a 90% reduction in hepatitis cases, but the path is strewn with pitfalls.

Roberta Sarno of the APAC Liver Disease Alliance said the figures showed that the Asia-Pacific region lacked an optimal national action plan to eliminate viral hepatitis.

Many countries have no plan or have incomplete and inadequate plans, leading to uncoordinated efforts and insufficient prevention.

Political commitment is also essential to sustainably reduce disease prevalence.

“Taiwan and Japan are good examples. Both are on track to eliminate deaths from the virus,” Sarno emphasized.

Professor Saeed Hamid of the Aga Khan University said that in the case of Pakistan, a national plan exists but it is not fully implemented. He stressed the need for emergency declarations in the most affected countries, similar to the successful responses seen during Covid-19, to curb the escalation of hepatitis cases.

“At the current rate, most countries in the Asia-Pacific region will not reach the 2030 elimination target. We need to declare a state of emergency in all these countries,” said Professor Hamid, adding that declaring hepatitis control an emergency could help the region reach the WHO target.

Policymakers sometimes lose focus as other diseases compete for attention. In the case of Pakistan, Professor Hamid noted that the country suffers the most from hepatitis C, but also faces high rates of diabetes, which affects 25-30% of the population. total.

Since hepatitis B vaccines became available in 1981, most infants are vaccinated and so the disease occurs mainly in people aged over 35 to 40 years.

The most effective solution is to test everyone for hepatitis B and C and treat those who are positive.

Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV), transmitted through bodily fluids such as blood, semen and vaginal secretions.

It can spread from an infected person to others through unprotected sex, sharing needles or syringes, sharing personal care items like razors or toothbrushes if they are contaminated with blood, and from mother to child during childbirth if the mother is not vaccinated.

The cost of inaction

“Early detection is essential,” said Dr. Ward, calling for widespread screening and vaccination programs.

Professor Hamid also mentioned that there are currently no effective vaccine candidates against hepatitis C, although there is interest and work underway, including from the US National Institutes of Health .

The cost of prevention pales in comparison to the economic and human consequences of inaction. “The cost of eliminating liver disease is far less than the cost of inaction,” Sarno said.

“Cost perception remains problematic. If hepatitis is not defeated, direct health care costs will increase and the productive workforce will decline.

In Thailand, the Ministry of Public Health is encouraging everyone born before 1992 to get tested, which represents around 42 million people.

In Thailand, newborns have been receiving the hepatitis vaccine since 1992. “We have made efforts to reduce the cost of testing and now the cost is very low, less than $2 per test,” said a Thai doctor at Siriraj Hospital.

He added that currently, the National Health Security Bureau offers free HepB testing to every Thai aged 34 and over.

The APAC-IRIDS 2024 Symposium brought together experts who echoed a call for strong national strategies, sustained political commitment and equitable access to health care.

As countries grapple with health disparities, the Asia-Pacific region is at a critical juncture. Investment in comprehensive liver disease management, aligned with global expertise and resources, remains paramount to changing the trajectory of the disease.

“Let us not lose sight of the lives at stake. Together, we can rewrite the hepatitis narrative in the Asia-Pacific,” Professor Hamid stressed.

By Veena Thoopkrajae