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Has Malaysia Bent The Curve? The Fight Against Hepatitis B & C
Hepatitis B and C are silent killers, often undiagnosed until complications arise, leading to significant health and economic burdens. These diseases progress undetected causing severe liver damage and even cancer. In Malaysia, concerted efforts to raise public awareness and ensure equitable access to healthcare are underway towards a future free from the shadows of hepatitis.
“Viral hepatitis is preventable and treatable. Thus, it is crucial that effective intervention measures are put in place. In Malaysia, three doses of the hepatitis B vaccine are administered to all newborns before they turn one. The Ministry of Health (MOH) has also implemented targeted health screenings for high-risk populations including pregnant women and those with family history,” shares Dr Philip Pang, Consultant Gastroenterologist and Hepatologist at Subang Jaya Medical Centre (SJMC).
He adds that wider access to affordable direct-acting antivirals (DAAs) has led to a significant drop in chronic hepatitis C cases. MOH has also developed the National Strategic Plan for Hepatitis B and C (NSPHBC) 2019-2023 with the aim of eliminating hepatitis B and C by 2030. This comprehensive plan outlines a structured approach to prevention, diagnosis, treatment, and care to combat viral hepatitis.
"More needs to be done to raise public awareness about hepatitis B transmission, prevention methods, and the importance of vaccination,” Dr Pang said.
Where Are We Now?
The World Health Organization (WHO) estimates that 254 million people are living with hepatitis B and 50 million people are living with hepatitis C worldwide. Each day, 6,000 people are newly infected with viral hepatitis, and 3,500 people are dying globally due to hepatitis B and C infections.
In Malaysia, an estimated 1.1% of the population is infected with hepatitis B virus and 2.5% with hepatitis C virus in 2017 and 2019, respectively. Viral hepatitis is the seventh most common cause of mortality with 94% of deaths due to chronic hepatitis B and C infections are caused by cirrhosis and liver cancer.
Hepatitis is an inflammation of the liver that is caused by several viruses, including hepatitis A, B and C. It is also caused by toxins, medications, and autoimmune disorders. Hepatitis B is most prevalent among newborns and young children due to mother-to-child transmission during birth or breastfeeding. Adults are also at risk of hepatitis B and C, showing a higher prevalence among those aged 27 to 40.
“The more you know about hepatitis, the better you are at preventing transmission. Hepatitis A is transmitted through contaminated food and water, while hepatitis B and C are transmitted through blood, semen, or bodily fluids. Therefore, hepatitis B and C are transmitted through contact with infected blood or blood products such as needles, blood transfusions, or sharing personal items,” Dr Pang said.
Many with hepatitis don’t experience any symptoms and when they do present with symptoms such as jaundice, abdominal pain, leg swelling and confusion, it is often in the late stages. While there is no cure for hepatitis B, most people can expect to live full, long lives with regular testing and treatment to manage the virus and prevent liver damage.
Practising good hygiene is vital to prevent all hepatitis types.
Strides For The Future
“An individual with hepatitis B is like having a neighbour who lives together in harmony, but you don’t know when your neighbour would one day go crazy. Regular visits to the doctor with blood test monitoring is crucial to detect this. If we can fight hepatitis B in this generation, we are well on our way to eliminating it by 2030. Yet, we are far from achieving this goal. More needs to be done to raise public awareness about hepatitis B transmission, prevention methods, and the importance of vaccination,” Dr Pang said.
While the availability of DAAs has provided hope in curing hepatitis C infections with a high cure rate of 97%, hepatitis B presents a more complex challenge. Vaccines are highly effective, but it does no guarantee complete protection. Many individuals with hepatitis B are unaware of their status and often go undiagnosed. This increases the risk of mother-to-child transmission. Routine blood tests during pregnancy can help identify these cases.
“Early detection allows for proper management where pregnant mothers may be given antiviral and newborns given an immunoglobulin injection, specifically hepatitis B immunoglobulin (HBIG). This injection provides a temporary protection against hepatitis B infection until the baby’s own immune system can develop immunity through vaccination. HBIG is most effective when given within 24 hours of birth,” Dr Pang explains.
Dr Pang recommends individuals with hepatitis B to see their doctors once a year and undergo a routine blood test, which monitors their viral load. Those who are 40 years old and above and present with symptoms should see their doctors more often, every six months, and undergo liver cancer surveillance.
Several forms of viral hepatitis are preventable. Vaccination is key for hepatitis A and B, while practising safe sex and good hygiene are vital for all types. Avoid sharing needles and personal care items and ensure safe practices during procedures like acupuncture or tattoos.
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