Hepatitis C — the silent killer

'Pakistan and Egypt have the highest disease burden of Hepatitis C in the world'

More than two decades ago, I lost two of my aunts in quick succession, probably due to hepatitis C. At that time it was not called hepatitis C but our medical books described the condition as non-A, non-B hepatitis (NANB). Diagnostic tests were only available for hepatitis A and B but doctors started to identify a more relentless form of liver infection which was not due to hepatitis A or B, and called it NANB. Even then it was understood that this liver disease is more dangerous and results in liver cirrhosis and death in many cases.

Pakistan and Egypt have the highest disease burden of hepatitis C. Hepatitis C and B are not caused by dirty water or lack of sanitation as is wrongly believed by many. Unsafe and unnecessary injections are a major reason for their spread, including unscreened blood transfusions. According to one estimate, nearly 15 million people in Pakistan are suffering from hepatitis B or C but most people remain undiagnosed. The Economist Intelligence Unit estimated that Pakistan will need $3 billion to screen and treat its population for hepatitis in the next 10 years. This is a huge amount and while hoping we can acquire it, there’s still a lot that can be done to change the current situation.

Hepatitis C does not cause any symptoms in 80% of the cases and shows mild symptoms in the remainder. Hence, most people do not opt for a diagnostic test. However, like a silent killing machine, it damages the body irreversibly until it’s too late. About 70% are chronically infected and around 30% of these will have cirrhosis in 20 years’ time. In many instances, a liver transplant — a risky and costly procedure — is the only option left by the time patients become aware of their condition.

The first thing to do is protect yourself. This concept of the necessity of injections must change. When I started my clinical practice in Lahore, I decided to avoid administering injections, and if it was required, I would only use high-quality disposable syringes. Most health practitioners then were using reusable syringes with no control on sterilisation. Because I was not administering too many injections, there was only a small cost increase for me. So ensure that you critically need an injection or ask for an oral alternative if available.

Secondly, all surgical procedures need to be cleaned with good infection-control practices. When flexible gastroscopy became available, many well-known medical consultants started doing it, mainly for quick money. However, it also spread hepatitis C as the instruments used were very difficult to clean and sterilise because they needed more time than was being given to sterilise them. Dentists with unsterilised equipment could also spread this disease along with barbers. So don’t feel embarrassed to ask your health provider to explain their sterilisation process. This is your life and you have every right to ensure your health and safety.

A good vaccine is available for hepatitis B and is now part of many childhood immunisation programmes. However, there is no vaccine available for hepatitis C. So if you think that you have been exposed to unsterilised equipment, get tested for hepatitis C and B (if you haven’t been vaccinated against B). Fortunately, very effective treatment is now available for hepatitis C as successive political governments made international agreements which reduced the price to make it affordable. I saw a young cousin of my friend dying of internal bleeding due to complications of hepatitis C as back then, treatment was not available. Now that it is, we just need to know what steps to take.

Published in The Express Tribune, December 8^th, 2019.

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