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Hepatitis C: a major challenge in Pakistan

The number of patients suffering from Hepatitis C virus (HCV) disease continues to rise and the disease is becoming a major health hazard. Pakistan has the world’s second highest prevalence of Hepatitis C while Egypt occupies the first position in the prevalence of Hepatitis C.

According to the World Health Organization (WHO) data, an estimated 325 million people worldwide are living with chronic Hepatitis B virus (HBV) or Hepatitis C virus (HCV) infection. The WHO Global Hepatitis Report, 2017 indicates that the large majority of these people lack access to life-saving testing and treatment. Thousands of people are at risk of a slow advancement to long life liver disease, cancer, and death.

Without quick control to contain the spread of the disease, the death rate from Hepatitis C will surpass that from AIDS. The disease has witnessed a frightening increase which could cause an epidemic like situation if immediate precautionary measures are not taken.

Hepatitis is generally described by a disease of the liver. It ranges from curable liver infections in some to liver cancer in others. Countries with high rates of people chronically infected with Hepatitis C are Egypt (22 percent), Pakistan (4.8 percent) and China (3.2 percent).

Pakistan observes the World Hepatitis Day every year aimed at raising awareness about prevention, control and treatment of the dangerous disease. Unfortunately the number of patients suffering from the disease is persistently increasing, which is disgusting.

According to reliable information obtained from Polyclinic, over 2,000 Hepatitis C patients sought treatment at the hospital during the last 12 months. As a total of 2,059 tested positive with Hepatitis C. Due to absence of preventive measures and treatment facilities, hepatitis prevalence in Pakistan is the highest on the globe, as million hepatitis patients die annually, while over 400 people loose life to hepatitis every day.

According to WHO, about 8 million people are exposed to Hepatitis C virus in Pakistan. The information obtained from Institute of Medical Sciences (PIMS) reveals that around two and half thousand Hepatitis C patients sought treatment at the hospital every year. During the current year, 2,300 new Hepatitis C patients started receiving treatment from the hospital.

Out of a total 4,556 health blood donor in Polyclinic, 177 donors were diagnosed with Hepatitis C. The most of the people are unaware of their disease and could not test or else the number could be increase recklessly. The main reasons for prevalence of hepatitis are unscreened blood transfusions, reuse of needles and syringes and sharing of needles by drug addicts. Also is the use of unsterilized surgical and dental instruments, roadside dentists and barbers.

The expert advice is that people should avoid administration of unnecessary injections, drips, and should follow careful dental treatment, proper disposal of clinical waste, surgeries and use only screened blood for transfusion and avoid roadside dentists. The government is well-aware of the importance of the diseases because the country has an estimated 12 million cases of hepatitis.

Considering that Pakistan has one of the highest burden of disease with regard to Hepatitis B and C in the EMRO region comprising 22 countries, there is a need to have in place an accord National Strategic framework to control the spread of the disease.

Pakistan Ministry in partnership with the provinces launched Pakistan National Hepatitis Strategy Framework to eliminate the disease by the year 2030. The first step is to enhance Hepatitis B vaccination in all ages including the birth dose. Second is to ensure safe blood transfusion and the third is to ensure strict adherence to infection control practices in the health care facilities. For this purpose we must encourage people to get tested and treat those who are infected. For the effective prevention and control of hepatitis in the country the Technical Advisory Group on hepatitis is constituted. This body guides the Federal government and Provincial hepatitis programmes on way forward to achieve disease control.

 

The Technical Advisory Group, government has introduced the new oral hepatitis drugs in the country and negotiated with the pharmaceutical companies to bring the cost down. The Technical Advisory Group also developed new Hepatitis C treatment guidelines, which have been handed over to the provinces for use.

It is estimated that today 350 million humans worldwide are chronically infected with HBV. Around 600,000 deaths are reported each year as a result of HBV infection, and 350,000 deaths are linked with HCV infection. As developing world face food security issues, it also confronts with the drug insecurity challenges. There is a need of cost-effective strategies for drug development, Prof Dr Muhammad Iqbal Chaudhry, Director International Center for Chemical and Biological Sciences (ICCBS), University of Karachi, and a German scientist Dr. Bertram Flehmig expressed these views while delivering their lectures in the 6th International Symposium-Cum-Training Course on Molecular Medicine and Drug Research (November 6 to 9, 2017) held at the ICCBS University of Karachi. There is a need of cost-effective strategies for drug development, which must be based on indigenous knowledge resource base, S&T capacity, and people-friendly approval process.

Dr. Bertram Flehmig said that Pakistan has the second largest burden of HCV in the world with an estimated number of 8 to 10 million cases of chronically infected persons with HCV. It is estimated that today 350 million humans worldwide are chronically infected with HBV, 75 per cent were infected at birth, and 170 millions chronically infected with HCV, he mentioned. He said that about 2 billion people have been infected with HBV worldwide with 600,000 deaths each year as a result of HBV infection, and 350,000 deaths each year as a result of HCV infection.

Treatment of chronically infected Hepatitis B patients with interferon and nucleoside analoga is beneficial for the patients however so far the elimination of the virus and the infection cannot be achieved.

Pakistan Viral Hepatitis is the eighth highest cause of mortality globally and was responsible for an estimated 1.34 million deaths in 2015, a toll comparable to that of HIV and tuberculosis.

Globally, approximately 257 million persons are chronically infected with Hepatitis B and 71 million with Hepatitis C. At this rate, an estimated 20 million deaths will occur between 2015 and 2030. The disease a quiet killer because many patients remain undiagnosed and untreated for many years before developing complications and dying.

Key challenges for an effective national response include limited timely and reliable data availability on coverage and quality of essential hepatitis services. Unnecessary injection practices, capacity of staff on safe injection practices and effective sharp and waste management; unregulated blood transfusions in general as well as inadequate screening.

In the absence, of a national programme, the Pakistan Health Research Council, under Ministry of National Health Services, Regulation and Coordination, is coordinating the hepatitis response at federal and the provincial level, through a ‘Technical Advisory Group’. Further the private sector is also playing a significant role in hepatitis treatment.

A Field Epidemiology and Laboratory Testing Programme has established a surveillance system of acute viral hepatitis, in 5 public sector tertiary-care hospitals located in Lahore, Peshawar, Karachi, Quetta, and Islamabad, and generates quarterly reports. Recently, in line with the Global Health Sector Strategy for Viral Hepatitis 2016-2021 and the WHO Regional Action Plan 2017-2021, a National Hepatitis Strategic Framework has been developed, with consensus of national and the provincial stakeholders.

Government of Pakistan provides free diagnosis, treatment and care to hepatitis patients in all provinces through four Hepatitis Prevention and Control programmes. Hepatitis C patients now have free access to new oral medicines. The National Technical Advisory Group of hepatitis experts, have down the cost of drugs for Hepatitis C treatment to less than 1 percent of the cost paid in the USA.

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