Month: March 2018

Hepatitis

HEPATITIS

Hepatitis C is the leading cause of liver cancer deaths and liver transplants worldwide. Is alarming that most of those infected don’t know they have it!

Hepatitis is the inflammation of the liver that can be caused in a variety of ways. Most common cause of hepatitis is the viral infection of three different viruses, named A, B and C. Hepatitis can also be caused by heavy alcohol use and certain drugs. Hepatitis A is caused by the hepatitis A virus and hepatitis B is caused by the hepatitis B virus (HBV), while hepatitis C is caused by the hepatitis C virus (HCV). Worldwide, there are 1.45 million viral hepatitis deaths per year, mainly due to hepatitis B and hepatitis C (Hep C) as shown in the 2014 Lancet study with more deaths caused by viral hepatitis than HIV/AIDS. This is likely due to the fact that there are 400 million people living with hepatitis B or hepatitis C compared to HIV sufferers. InfoMed spoke to Professor Dr. Rosmawati Mohamed, the co-chairperson for WHO Strategic and Technical Advisory Committee for Viral Hepatitis (STAC-Hep) and founding member of the Coalition to Eradicate Viral Hepatitis in Asia Pacific.

Prof. Rosmawati and YB Sharizat

THE BURDEN OF UNDER-DIAGNOSED HEPATITIS C

In her opening comments, she made the point of how under-diagnosed hepatitis C is, with three out of four people living with hepatitis C being unaware of their condition. Considering hepatitis C is the leading cause of liver cancer deaths and liver transplants worldwide, it is alarming loophole of medical awareness. The problem she says is because chronic hepatitis C is a slow and silent process. There are no obvious symptoms, and by the time jaundice and water retention is noticeable, the liver disease is already too advance for treatment. Early detection is absolutely vital, she stresses, because even though no vaccine is available, unlike HIV or hepatitis B, hepatitis C can be cured. The key is early detection.

WORLDWIDE MORTALITY FROM VIRAL HEPATITIS (2012)

Asia Pacific

1,012,873

deaths per year

Rest of the World

431,681

deaths per year

 

You are more likely, by three times to die from viral hepatitis than HIV/AIDS

EXCERPTS OF THE INTERVIEW WITH PROF. DR. ROSMAWATI

In terms of global impact of hepatitis, definitely we are seeing lot more deaths due to hepatitis, mainly hepatitis B and hepatitis C, the two diseases that causes serious complications such as liver cirrhosis and liver cancer. The main reason for transmission of hepatitis B is mother to child transmission.

Good news for hepatitis B is that with the advent of universal neonatal vaccination for newborn since 1989, we are seeing less and less cases of hepatitis B for those born after 1989.

But for hepatitis C, we are still seeing new cases, mainly due to sharing of needles and equipment like tattoos and razors. Testing for hepatitis C was only available worldwide since the early 1990’s, and since 1993, transmission of hepatitis C through transfusion of blood or blood products does not arise at the hospital settings and is not an issue in Malaysia.

Treatment is available for hepatitis B and C. The aim of treatment for hepatitis B is to suppress the viral replication but for hepatitis C, we can achieve complete clearance of the virus with specific therapy. New drugs for hepatitis C, the direct antiviral agents, can achieve cure rates close to 100% with just 12 weeks of treatment and some are already available in Malaysia (these were only approved recently).
The standard treatment for all types of hepatitis C since 2003 is the combination of Pegylated Interferon, given as an injection once a week, and oral ribavirin.

Hepatitis C shows significant genetic variation, referred to as genotypes. There are at least 6 genotypes and the commonest in Malaysia is genotype 3 in about 60% of cases, followed by Genotype 1 in about 36%. The duration of treatment and the cure rates depend on the genotype. The standard duration of treatment for Genotype 3 is 24 weeks whereas for Genotype 1 is 48 weeks. The cure rate with the combination of Pegylated Interferon and ribavirin for genotype 3 is 80% but for genotype 1 the best at 40% to 50%. So with the new drugs we should expect cure rates of more than 90% and some approaching 100%. 

A priority action to address the hepatitis C disease burden is to enhance hepatitis C detection among those who are at risk. Possible risk factors and for hepatitis C would include those who had received blood transfusion before 1994, those who had shared needles or sharp instruments which may contain and those on haemodialysis. The prevalence of hepatitis C among the IV drug users can be as high as 60 to 70%. A lot more contagious then we thought. Strengthening harm reduction programs such as the needle exchange program has helped to reduce transmission of hepatitis C. The reduction program has to be optimised.

In Malaysia, the prevalence of hepatitis B is higher than hepatitis C and the former is the major cause of liver cancer. Although hepatitis B vaccination can reduce the prevalence of hepatitis B amongst the vaccinated group (those born after1989), the liver cancer prevalence among adults who are infected with hepatitis B is still high. Worldwide, hepatitis C is the leading cause of liver cancer deaths and liver transplant.

KEY FACTS HEPATITIS C
  • Hepatitis c is a liver disease caused by the hepatitis C virus: the virus can cause both acute and chronic hepatitis infection, ranging in severity from a mild illness lasting few weeks to a serious, lifelong illness.
  • The hepatitis C virus is a bloodborne virus and the most common modes of infection are through unsafe injection practices; inadequate sterilization of medical equipment; and the transfusion of unscreened blood and blood products.
  • 130-150 million people globally have chronic hepatitis C infection.
  • A significant number of those who are chronically infected will develop liver cirrhosis or liver cancer.
  • Approximately 500,000 people die each year from hepatitis C-related liver disease.
  • Antiviral medicines can cure approximately 90% of persons with hepatitis C infection, therby reducing the risk of death from liver cancer and cirrhosis, but access to diagnosis and treatment is low.
  • There is currently no vaccine for hepatitis C; however research in this area is ongoing.

(Media Centre World Health Organisation)

WITH THAT IN MIND, PROF. DR. ROSMAWATI GAVE INFOMED A DEEPER LOOK INTO HEPATITIS C IN MALAYSIA.

InfoMed: What is the most up-to-date number of prevalence and incidence of hepatitis C in Malaysia?

Rosmawati: The estimated prevalence is 2.5% of the population aged 15 to 64 years (which is more than 500,000 individuals) based on a recent study, and 60% are related to IV drug use.

InfoMed: How does the Ministry track these numbers? Rosmawati: Data from the Ministry is based on notified cases, as it is compulsory to report all cases of hepatitis B and hepatitis C in Malaysia.

InfoMed: Are there any active campaigns being done that seek to reduce the problem?

Rosmawati: Most campaigns are in conjunction with WHO designated World Hepatitis Day on 28 July. There is a need for a coordinated national response to address issues relating to viral hepatitis. A National Strategic Plan for Viral Hepatitis is required to ensure specific policies and tools are incorporated to reduce the burden related to viral hepatitis.

InfoMed: What makes the disease/ infection a cause for serious concern?

Rosmawati: High prevalence and the rising disease burden for hepatitis C.

InfoMed: Who are the most vulnerable groups in Malaysia to hepatitis C?

Rosmawati: Hepatitis C is mainly transmitted through contaminated blood. Those who had received blood transfusion before 1994 are at risk of contracting hepatitis C. Other ways of hepatitis C transmission include sharing of infected needles, unsafe practices such as tattooing and sharing of sharp instruments such as razors and patients with kidney failure who are on haemodialysis. Mother to child and sexual transmission are uncommon modes of transmission.

InfoMed: What are some easy prevention methods that people can do (in Malaysia)?

Rosmawati: Knowing the risk factors for hepatitis C is an important step to prevent new infections.

InfoMed: How often do you get checked?

Rosmawati: Only one time test is required for those at risk.

InfoMed: Where can people do so?

Rosmawati: You can get checked at any general practitioners (GP) clinic or hospital.

InfoMed: If you are infected, what treatment options are available in Malaysia?

Rosmawati: Pegylated interferon and ribavirin. New treatment options are now available for Genotype 1.

InfoMed: Based on the current prevalence of hepatitis C, where would Malaysia be in five years in terms of new cases and management of the disease? Rosmawati: The prevalence of hepatitis C virus (HCV) infection in Malaysia has been estimated at

2.5% of the adult population. A recent research article by McDonald SA, Dahlui M, Mohamed R, Naning H, Shabaruddin FH, Kamarulzaman

A (2015) titled, “Projections of the current and future disease burden of hepatitis C virus infection in Malaysia” concluded, “The HCV-related disease burden is already high and is forecast to rise steeply over the coming decades under current levels of antiviral treatment. Increased governmental resources to improve HCV screening and treatment rates and to reduce transmission are essential to address the high projected HCV disease burden in Malaysia”

InfoMed: What can the general public do now to reduce the incidence?

Rosmawati: Avoid the risk factors.

InfoMed: What about general practitioners, what is their role in managing hepatitis C in Malaysia? Rosmawati: Counsel and take the test on their patients at risk for Hepatitis C.

HCV INFECTION IS DIAGNOSED IN 2 STEPS:

Screening for anti-HCV antibodies with a serological test identifies people who have been infected with the virus. If the test is positive for anti-HCV antibodies, a nucleic acid test for HCV RNA is needed to confirm chronic HCV infection because about 15–45% of people infected with HCV spontaneously clear the infection by a strong immune response without the need for treatment. Although no longer infected, they will still test positive for anti-HCV antibodies.

(Media Centre World Health Organisation)

Credits: InfoMed ( Malaysia )

Website: Infomed.com.my

Healthcare Today

Healthcare Today

-An Overview

Facing the challenges and getting to the core of the policy issue and implementation
By Mohan Manthiry

Currently the estimated annual global healthcare spending is more than USD$4.2 trillion and is increasing every year. There exists a wide variation in terms of spending for healthcare. Developed countries are spending more than 10% of their GDP, with the highest being USA at almost 18% and the majority of developing and poor countries spend less than 4% of their GDP for healthcare. Malaysia allocated 4.4% of the GDP for healthcare in 2013.

Within the countries, we are witnessing the increasing inequalities in income levels and access to social services, healthcare being a major component. The current trend globally in countries is the depleting middle class and the recent Oxfam report on wealth distribution gave us some startling statistics – “The combined wealth of the richest 1 percent will overtake that of the other 99 percent of people next year unless the current trend of rising inequality is checked, Oxfam warned in January 2015 ahead of the annual World Economic Forum meeting in Davos”. Excerpts from the 2015 Oxfam report:

“Oxfam made headlines at Davos last year with the revelation that the 85 richest people on the planet have the same wealth as the poorest 50 percent (3.5 billion people). That figure is now 80 – a dramatic fall from 388 people in 2010. The wealth of the richest 80 doubled in cash terms between 2009-14. Billionaires listed as having interests in the pharmaceutical and healthcare sectors saw their collective net worth increase by 47  percent. During 2013, they spent more than $500 million lobbying policy makers in Washington and Brussels”.

The recent Ebola outbreak laid bare the weakness in the healthcare systems in the poor countries. The current trend and experiences globally tells us that the health will not automatically evolve to become fair and equitable for all naturally. Governments need concerted and deliberate policy decisions to tackle this issue.

In the words of the Director General of World Health Organisation on 10 February 2015 in Singapore, “Universal health coverage is one of the most powerful social equalizers among all policy options. It is the ultimate expression of fairness. If public health has something that can help our troubled, out-of-balance world, it is this: growing evidence that well-functioning and inclusive health systems contribute to social cohesion, equity, and stability. They hold societies together and help reduce social tensions.”

“The rise of NCDs (non-communicable diseases) adds considerably to the costs of health care. The costs of cancer care, for example, are becoming unaffordable for even the wealthiest countries in the world. In 2012, the US Food and Drug Administration approved 12 drugs for various cancer indications. Of these 12, 11 were priced above $100,000 per patient per year. How many countries can afford this cost?

Prevention is by far the better option, but this, too, is more problematic than for infectious diseases, many of which can be prevented by vaccines or cured by medicines, all delivered by the health sector.”

The latest WHO report identified chronic disease as the leading cause of death and accounts for 70% of all mortality globally. These chronic or non-communicable diseases which include heart disease, obesity, diabetes and cancer which can be attributed directly to negligent health behaviours are preventable. The challenge to nations is on how to address this difficult task of getting their citizens to maintain healthy habits. And also how to effectively address the increasing healthcare needs of the population at an affordable cost level.

The most probable and perhaps the only way forward is to get every individual to take charge of their own personal health. Motivating people to take responsibility for their own health is now a global initiative and has become a strategy for patient engagement. By closely associating and taking an active role in your own health, would reduce negligent and risky health behaviours and encourage patients to keep their health in check.

Now, how do we build this strategy and bring about the required change management in the attitude and behaviour of the individuals towards their healthcare? The good news is we have now the technology to assist and support this difficult lifestyle modification. The numerous strategies are all hovering around the mobile technology that has permeated the society and our daily lives. Some of the interesting developments are:

 

  • Healthcare apps to be connected real time with your healthcare providers, to receive healthcare news, services, advise, information and to monitor personal health risks;
  • Receive notification and reminders on medication and health checks;
  • Reach out to your doctors online for advise, second opinion and follow-ups;
  • Manage your own personal health record on the mobile. This eventually develops your close understanding of your own health conditions, enabling you better management of your health outcomes. At the same time be able to reach out to your doctor with accurate and detail historical information on your personal health condition. This eventually reduces medical errors and better diagnosis and treatment plan; 
  • Wearable technologies. Innovations in healthcare, capitalising on the mobile technologies is one way-forward. However, long term strategies are needed and instilling good healthy behaviour should start from the young. Education plays an important part. Introducing healthcare as a subject in the curriculum of schools from the primary level will be an excellent way to ensure that the long term strategies on healthcare geared towards prevention and wellness materialises. This would be a cost-effective strategy and would ensure the next generation of Malaysians have better control and shall take charge of their healthcare.

Instilling good habits from young is a noble and cost-effective method than trying to bring behavioural changes to adults who are already prone to unhealthy lifestyle.

Health is very important for the development and well-being of a nation and its people. It requires political leadership and highly committed public-private partnership and investment.

SOME STARTLING STATISTICS ON NCD FROM MINISTRY OF HEALTH MALAYSIA

Malaysia – NCD
(non-communicable disease)
accounts for 70% of total deaths

Total deaths

146,000

Cost of Managing
Diabetes in Malaysia

RM 19,000

PER PATIENT PER YEAR

NHMS (National Health and Morbidity Survey) 2011 estimated 1.1 million diabetes patients with MOH hospitals (1.1 m x RM 19k)

RM 20.9 

billion

NHMS 2011 data estimates 63.3% (18 years and above) are high risk and at risk factors for NCD

Credits: InfoMed ( Malaysia )

Website: Infomed.com.my