Why hepatitis remains an uphill battle for Africa

Viral hepatitis is a silent disease with devastating consequences

- WENDY SPEARMAN

GLOBALLY, viral hepatitis remains an unrecognised burden of disease, with the World Health Organisation estimating that in 2022, 254 million people were living with hepatitis B and 50 million people living with hepatitis C worldwide.

Six thousand people were newly infected with hepatitis B and C each day, resulting in 3 500 deaths per day. This is despite hepatitis B being entirely vaccine preventable, and treatable with the nucleotide analogue tenofovir costing less than $32 per year. Hepatitis C is now curable with an 8or 12-week course of direct acting antivirals.

The Global Viral Hepatitis response is offtrack towards World Health Organisation 2030 goals: 90% of people living with hepatitis B and C should be diagnosed and 80% treated; and 90% of newborns should have received timeous Hepatitis B birth dose vaccine with 90% coverage of Universal Hepatitis B 3-dose vaccine.

Hepatitis B is 100 times more infectious than HIV and 10 times more infectious than hepatitis C and is transmissible as a result of exposure to Hepatitis B Virus (HBV) infected body fluids via perinatal, percutaneous or sexual routes.

In Africa, including South Africa, hepatitis B is mainly acquired as a result of mother-to-child transmission or early childhood acquisition under the age of 5 from infected siblings or playmates with adult sexual acquisition being uncommon.

Individuals with chronic hepatitis B infection have a 15-40% risk of developing cirrhosis, liver failure or hepatocellular carcinoma, and 15-25% risk of dying from HBV-related liver diseases.

The risk of chronicity is dependent on the age of acute infection: 70-90% for infants exposed perinatally (HBeAg positive mother); 25-50% for children aged 1-5 years; 6-10% for 5-20 years and 1-3% for adults >20 years.

HBV remains endemic in Africa,