Singapore - Health experts call on public to get tested for Hepatitis B and C

SINGAPORE: Health experts are urging the public to get tested for Hepatitis B and C. Collectively known as viral hepatitis, they are the leading causes of liver cirrhosis and liver cancer.

The calls from the Asian Pacific Association for the Study of Liver Diseases and the Coalition to Eradicate Viral Hepatitis In Asia Pacific come ahead of World Hepatitis Day this Saturday.

Doctors say the number of Hepatitis B carriers is decreasing in Singapore because of a nation-wide immunisation programme that started in 1987.

Still, some 120,000 to 140,000 adults here are Hepatitis B carriers, or about one in 35 adults. Of these, less than 30 per cent are under treatment.

Professor Lim Seng Gee, president of the Asian Pacific Association for the Study of Liver Diseases, said: "I think there's a complacency in the sense that we've got such a good vaccine and the proportion of patients who are infected are decreasing year by year that we feel 'ok, we don't need to do anything more'.

"But 2.8 per cent still represents a large group of people who may need to be actually treated. Now, how many of these 100,000 people are actually on treatment, or seeking treatment, or on follow-up, is questionable."

"So that leaves a large group of people who either don't go for follow-up, or who are not aware that they have Hepatitis B. This is the population we'd like to target to go and get tested," he added.

"We did do a survey a number of years ago. The survey indicated that patients themselves may have certain misconceptions about the disease. For instance, a lot of people feel well, but in actual fact, there are patients who have liver cirrhosis and cancer who are asymptomatic, so symptoms don't occur until the condition advances and by that time, it may not be too late but certainly difficult to treat."

Doctors say carriers can be treated and the condition can be controlled.

Prof Lim said: "Many of them do not want to know their results because of this fear. Consequently, they don't come for checkups or follow ups. Ultimately, these people could suffer the consequences of this disease when in fact, they could have been easily treated and complications prevented.

"Even cirrhosis can potentially be improved and liver cancer can be treated. So there's no reason not to come and get tested. It's better to know what you have than not to know at all."

"Ben", who doesn't want to be identified, has Hepatitis B and suffered from liver cirrhosis.

"When I passed the age of 55, I discovered the hardening (of the liver) was getting worse and because of the doctors' advice, I signed up for the liver transplant programme," he said.

"In year 2011, I underwent the liver transplant and that gave me a new lease of life."

It has been two years since the World Health Assembly came to an agreement on this issue and the World Health Organisation has recently launched a new global framework to tackle Hepatitis.

The framework sets out four key areas - raising awareness, transforming scientific evidence into policy and action, preventing transmission as well as screening and treatment.

Professor Stephen Locarnini, joint secretary of the Coalition to Eradicate Viral Hepatitis in Asia Pacific (CEVHAP), said: "The new global framework published by the WHO is an important milestone for the viral hepatitis community, and for the first time sets out what needs to be done from a public policy perspective to fight these devastating diseases.

He added that one of the most important first steps for any government is to undertake a consultation process with experts from across the country.

"This process should inform the development of a cohesive national strategy, which recognises the full scale of the regional and national epidemic," Prof Locarnini said.

"Viral hepatitis cuts across multiple areas of government policy, beyond just healthcare, and has a major social and economic impact on individuals infected but also society as a whole.

Poverty is inextricably linked to the viral hepatitis epidemic and compounds the heavy burden that treating the diseases already has on the healthcare costs of national governments."

"Hepatitis B and C leaves patients without jobs, children without parents and families without hope, and the international community can no longer afford to turn a blind eye to these diseases," Prof Locarnini added.

Speaking about the new WHO framework. Prof Lim said things have to be taken step by step.

"Now that it is recognised as a problem by WHO, we're now able to take the steps necessary to try and deal with the problem of viral Hepatitis on a global level," he said.

"The first thing we need to do is to mobilise resources because without any money we can't really do anything.

"The next thing we need to do is address policy issues and that needs to be done either globally or at national levels to put more emphasis on spending for Hepatitis B and C and for liver disease," Prof Lim added.

"And the next thing we need to do is to look at testing and screening so we can identify those who are infected and the last point is affordability of treatment. Those who are in fact positive and need therapy can access therapy.

"So, these four subjects are clearly big, big areas and they're not going to be solved overnight so, it's going to take 10, 20 years perhaps, to see substantial improvements in healthcare, but I think we need to take baby steps first."

Prof Lim says the association has written to the WHO to persuade it to inject more resources into fighting hepatitis.

Meanwhile, Prof Locarnini says the coalition is asking for the WHO to establish "a sustainable mechanism for international funding and implementation of the Global Hepatitis Programme" that is similar to those that exist for HIV, Tuberculosis and Malaria.

- CNA/cc/wm