Hepatitis swells liver cancer cases – Virologists call for screening

Many liver cancer cases reported in the country are due to hepatitis B and C infection, two virologists have revealed. While the Program Manager of the Ghana Health Service (GHS) National Viral Hepatitis Control Program Dr. Atsu Godwin Seake-Kwawu.

Hepatitis B and C constitute two-thirds of all liver cancer cases reported in healthcare facilities nationwide, a senior researcher in the Department of Virology at the Noguchi Memorial Institute for Medical Research (NMIMR), Dr Joseph Humphrey Bonney puts viral hepatitis contributing more than 25 percent of all liver cancer cases.

Liver cancer cases have increased due to better reporting in Ghana Health Service hospitals. The number rose from 637 reported cases in 2019 to 873 in 2020 and 1,316 last year.

The number excludes those reported in academic, private and Christian health facilities. Virologists spoke in separate interviews with the Daily Graphic about the management and prevalence of hepatitis in the country.

They explained that once hepatitis B and C had reached the stage where the liver developed cancer, the chances of survival were limited.

“Liver cancer actually only gives you a maximum of six months to live. If you don’t get liver cancer and go for radiation or chemotherapy, it will kill you. It kills,” Dr. Seake-Kwawu said.

For his part, Dr. Bonney explained that while cancerous liver replacement could be done, the success rate was negligible. “It’s quite difficult because only a few cases survive even though the patient will have to take a lot of medication to ensure that the body accepts the organ that has been placed. In some cases, the body naturally rejects the transplant. Sometimes even the color of the body changes,” he said.

Know your status

The two virologists called on the adult population to avail themselves of hepatitis screening in order to access early care.

“When you look at liver cancer, you are looking at the end of a disease that started many years ago where the possibility of prevention existed, but those were missed and the result is what you will see. “, said Dr. Seake-Kwawu. added.

Vaccination

They said the introduction of childhood vaccination against the disease in 2002 resulted in 98% coverage of children.

According to experts, the situation was not the same for adults who had to screen for the virus before being vaccinated.

Low adult screening

Dr Seake-Kwawu and Dr Bonney agreed that adults are not coming forward to be tested for the disease.

“Screening programs have not reached the masses of our population. Currently, very few people know their hepatitis status,” Dr Seake-Kwawu added.

The generally low level of testing among the adult population and the fact that testing for the virus is not free, except in the case of voluntary blood donation, are some of the reasons for adults’ reluctance to get tested. .

“It’s not something that people intentionally go to the hospital to get tested, unless there’s a group or someone doing medical outreach and then they’re going to take a test to find out their status or when a doctor suspects the virus is present and calls the test,” Dr. Bonney added.

The head of the National Viral Hepatitis Program has appealed to the National Health Insurance Authority (NHIA) to expand coverage for hepatitis testing and medication, adding that the private sector could also do free screening exercises for its employees.

He said the cost of testing in a lab averaged GH¢30, adding that for uptake of testing by adults to increase there needs to be a sustained campaign to encourage people to get tested to find out their status and when they came back positive, they could be listed to care.

“It shouldn’t be a lonely journey that only the person with the disease carries as a burden. You don’t have money to eat, let alone buy medicine. I know the NHIS is called upon to include one thing or the other, but we need to know that this is a scheme we are building for ourselves. If we are to invest more money as Ghanaians, that is what we must do,” said Dr Seake-Kwawu.

Screening

National service member Grace Asantewaa Asamoah said she was pushed to get tested and vaccinated for the disease because she became aware of its effects on the liver. She said she did it during her usual visit to the hospital.

“I was tested because it’s important to know your status and protect yourself from it,” she said. For Isaac Manu, a teacher, even though he knew what hepatitis was, he didn’t go for the test.

“I don’t feel the need. As I think it’s deadly, I didn’t feel the need to do it,” Mr Manu said.

Differences

Hepatitis is the condition that occurs when the liver is inflamed or when the liver becomes infected with disease-causing microorganisms.

Hepatitis is very broad, which Dr. Bonney says includes viral hepatitis, alcoholic hepatitis, and pathogens that cause hepatitis. Viral hepatitis is prevalent in the country and in this category were hepatitis A, B, C, D and E.

When the virus affects the liver, it hardens it and eventually turns into cancer. Dr. Bonney said hepatitis A and E were infectious hepatitis, while B and C were serum hepatitis.

Providing further explanation, he said Hepatitis A and E were generally not heard because they were self-limiting, meaning when they attacked, they went away from them. themselves, without rigorous treatment. He said hepatitis A was usually detected in children and the virus was present in contaminated food or water.

Hepatitis E, on the other hand, Dr. Bonney explained, is dangerous for pregnant women, especially those in their second and third trimesters, because it can cause spontaneous abortion. The researcher explained that hepatitis B and C are the ones that can lead to cancer and pointed out that they are usually transmitted through sexual intercourse, exposure or sharing of objects contaminated with the virus, mother-to-child transmission during childbirth and blood transfusion. of an infected person.

Hepatitis C is usually common among people who inject drugs, said Dr. Bonney, explaining that if the instruments used in this exercise were contaminated with the virus, a person could contract the disease.

For Hepatitis D, the virus is innate and can only be present in someone who has Hepatitis B, which means that without B, one cannot catch it. If B and D were present, the disease would be severe, Dr Bonney said.

Prevalence rate in Ghana

The head of the national viral hepatitis program said an estimate published in 2016 put the prevalence rate of hepatitis in the country at 12.3%, which was well above the prevalence threshold. by 8%.

Dr Seake-Kwawu said a large proportion of hepatitis infections occur from mother to child, from an infected pregnant mother to the baby during childbirth.

For reasons still under investigation, hepatitis B and C were dominant in the northern regions, which he suggests could be due to factors such as inadequate access to care and situations that allowed the exchange bodily fluids of infected people.

“What we have realized is that in Ghana, as you move from south to north, the prevalence increases. In the past, we thought it was the result of ‘wanzams’ who circumcised and scarred people’s faces with instruments that weren’t properly sterilized,” said Dr Bonney, who has done studies on the hepatitis in the country.

For Hepatitis C, Dr Seake-Kwawu said it is currently curable while for B the infection can be suppressed to the stage where those infected can lead normal lives.

Treatment

He explained that for hepatitis B, not everyone who gets it needs treatment, adding that only 10-25% of people with the virus need treatment.

This, Dr. Seake-Kwawu explained, was because the disease comes in stages and not all stages require medication.

“It’s when the liver is actively destroyed that treatment becomes crucial because any delay will damage the liver,” he said.

Eradication

Dr Bonney said that initially, when you were infected with the virus, you might not have any symptoms.

Later, unspecified symptoms such as flu-like symptoms, headaches and increased temperature may occur and can all be confused with other conditions unless a test is performed.

Regarding the efforts made by the GHS to eradicate the disease, Dr Seake-Kwawu said that the GHS is leading in ensuring that all children are protected and immunized against all diseases, including hepatitis.

He added that the service was also working on adding the birth dose of vaccination and that once the studies were completed and the evidence was presented, the birth dose would be implemented.

The National Viral Hepatitis Control Program Manager said the GHS is also looking for partners to ensure that care reaches various parts of the country and not just Accra.

world hepatitis day

World Hepatitis Day is celebrated annually on July 28 to bring the world together under a single theme to raise awareness of the global burden of viral hepatitis and influence change.

“I Can’t Wait,” this year’s theme, highlighted the need to accelerate the fight against viral hepatitis and the importance of testing and treatment for the real people who need it.

The country observation also highlighted the fact that people living with hepatitis could not wait for life-saving treatment; that pregnant women could not wait for hepatitis testing and treatment; that newborns could not wait to be vaccinated at birth; and that people affected by hepatitis could not wait to end stigma and discrimination.

Likewise, policy makers cannot wait and must act now with the political will and funding to make hepatitis elimination a reality.

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