The Gastroenterology and Hepatology Association of sub-Saharan Africa (GHASSA), a non-profit Association, launched its programme of action on World Hepatitis Day on 28 July 2023.
Viral hepatitis is caused by five viruses, hepatitis A, B, C, D and E – hepatitis B and C may cause chronic infection – usually silent and without symptoms. People only manifest symptoms when they develop liver disease or liver cancer. Approximately 82 million Africans have chronic hepatitis B and there are nine million with chronic hepatitis C infection. In South Africa, two million people are silently infected with hepatitis B and 300 000 with hepatitis C.
Hepatitis B and C account for over 70% of liver cancer in Africa – the second most frequent cancer in men and third in women in Africa.
Over 70% of all children under five with chronic hepatitis B live in Africa. Those with chronic infection, including pregnant women, can unknowingly infect others (including their unborn child).
Hepatitis B is fully vaccine preventable starting with a birth dose in the vaccine schedule and effective long-term treatment is available for those identified with chronic hepatitis B. Hepatitis C is curable – it requires 12 weeks of treatment with tenofovir taken daily.
GHASSA’s message is that we must raise awareness and upscale simple screening for hepatitis B and C. Fingerpick point of care testing is available, but it hasn’t been rolled out yet. The vaccine is safe at any age and safe in pregnancy.
We need to link patients to care. GPs should routinely offer hepatitis B screening. An annual physical should include hep B testing, for example. The panel of speakers emphasised that we need to screen pregnant women for hepatitis B and offer effective prevention of mother-to-child transmission. It is also crucial to provide a hepatitis B birth dose vaccination.
Patients are presenting as young adults, in their prime and don’t survive. “When patients present with multifocal liver cancer we can’t operate,” said Dr Bilal Bobat, hepatologist at Wits Donald Gordon Medical Centre. “Median survival 2.5 months.” Interestingly, Prof Mashiko Setshedi, head of Gastroenterology Division at UCT, commented that in SA, we have a unique clinical expression of hepatitis, compared to the western world. More research is needed to explain why. “We need accurate registries, clinical studies and trials, so we can see what drugs can be offered in our patients,” she said.
“We are dealing with a dismal situation. We need advocacy, which I hope will culminate in a position statement at the combined congress in Cape Town, in May 2024,” said Prof Eduard Jones, head of the Surgical Gastroenterology/ Hepatopancreatobiliary Unit at UCT.
In 2016, the World Health Assembly, of which most countries in the WHO Africa region participate, agreed to the global elimination of viral hepatitis by 2030. Several countries globally are on track to achieve this. Except for champion countries such as Rwanda and Egypt, most African countries, including South Africa, lag behind. In May 2024, GHASSA will host the African Viral Hepatitis Convention at the CTICC, in Cape Town. It will partner with the International Hepato-Pancreatico-Biliary Association (IHPBA) meeting occurring simultaneously.
