V

iral hepatitis kills approximately half a million people every year in the 11 member states of WHO'€™s Southeast Asia region. An estimated 100 million people are currently infected with hepatitis B and another 30 million with chronic hepatitis C.

Since these infections can go undetected for years, many people do not know they are infected until much later, when treatment may be too late.

There are several different viruses that cause viral hepatitis. The most common cause is infection with one of four viruses '€” hepatitis A, B, C, or E. Possible symptoms include yellowing of the skin and eyes (known as jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

Acute hepatitis infections can take weeks to months to fully subside. In rare cases, they can progress to liver failure, which can be deadly. Complications of chronic hepatitis, which can be caused by hepatitis B or C infections, include scarring of the liver (known as cirrhosis), liver cancer, and even death. Most of these deaths however, are preventable.

Viral hepatitis B and C are the most common causes of liver cirrhosis and cancer worldwide. They are spread most commonly through contact with contaminated blood. Hepatitis A and E are endemic to Southeast Asia, where most people are infected during childhood.

They are spread through the fecal-oral route, most commonly when food or drinking water is contaminated by the fecal matter of an infected person.

Lack of proper sanitation contributes greatly to this problem. Children, who tend to present with only mild symptoms, carry the infection and can spread it to others.

The most important thing we can do to prevent the spread of hepatitis is arm the public with information to protect themselves and their families. Since each virus is unique and transmitted in a different way, prevention approaches must be multidimensional. To prevent the spread of hepatitis A and E, proper hygiene is essential.

At the cornerstone of prevention are vaccines. Though a vaccine against hepatitis A is available, it is not yet widely used in the region. All countries of the region, however, have included hepatitis B vaccines in their immunization programmes for children. Indonesia and Thailand use the tetravalent form, and other countries use the pentavalent form of the vaccine.

An additional dose at birth is administered in Bhutan, the Democratic People'€™s Republic of Korea, India, Indonesia, Myanmar, Maldives and Thailand. More than 24 million doses of the hepatitis vaccine are being administered in the region annually.

This year on 22 May, the World Health Assembly adopted a resolution to improve the prevention, diagnosis and treatment of viral hepatitis. The resolution highlights the importance of expanding hepatitis A and B vaccination programmes and considers a range of measures to strengthen infection control and improve access to quality and affordable hepatitis medicines and diagnostics.

There are several challenges to translating this resolution into action. In most countries in the region, surveillance systems for viral hepatitis are inadequate and do not enable evidence-based policy decisions. Preventive measures are not universally implemented.

Treatment for hepatitis is not widely available. While there are new medicines that bring the promise of a cure, such treatments come at a significant cost. A combination of approaches is essential to make these new hepatitis medications accessible in low-and middle-income countries.

The provision and integration of viral hepatitis services into settings that serve high-risk populations are also challenging. Administration of treatment on a larger scale would require an expansion of the role of primary health care and training of primary health care personnel, which is a huge undertaking.

Because hepatitis viruses differ in their distribution and routes of transmission, coordinated national strategies based on the local epidemiological context must be adopted. Special attention must be paid to the transmission of hepatitis B from mother to fetus during pregnancy, by encouraging mothers to get tested for hepatitis B while pregnant and promoting the hepatitis B vaccine for all newborns at birth.

National blood donation systems must develop quality-assured screening of all donated blood, tissues and organs for prevention of hepatitis B and hepatitis C. Healthcare workers must be counseled on the importance of needle safety and glove use when working with blood products.

Emphasis must be placed on adequate sanitation, to improve food and drinking water safety, and control the spread of hepatitis A and E. National policies need to provide equitable access to the prevention, diagnosis and treatment of viral hepatitis.

None of this can be achieved by ministries of health alone. These national strategies must have the support of other sectors, both public and private. To win the battle against this silent killer, a coordinated, multisectoral effort is urgently needed.