Dr Raman (third right), Dr Nerenthran (second right) and those involved in the program yesterday.
KOTA KINABALU: There is a need for Sabahans to get themselves screened for the Hepatitis B and Hepatitis C viruses, said medical experts.
This is because Sabah and Sarawak have the highest number of carriers for Hepatitis B in Malaysia.
Through screening, the disease can be detected and treated, said Datuk Dr Raman Muthukaruppan C., Consultant Physician and Gastroenterologist, with the Queen Elizabeth Hospital (QEH) Department of Medicine.
Speaking to reporters at the state-level World Hepatitis day celebration here yesterday, Dr Raman disclosed that based on the Ministry of Health’s record in 2017, the Hepatitis B prevalence in Sabah was 42 per 100,000 population while Hepatitis C was two per 100,000.
The ministry’s Health Facts 2017 also showed the national census in 2016 recorded the incident rate for Hepatitis B at 12.2 per 100,000 population while the mortality rate was 0.18 per 100,000 population.
For Hepatitis C the incident rate was 8.4 per 100,000 population and the mortality is 0.3 per 100,00 population, he said, adding that the incident rate for TB was 81 per 100,000 population, HFMD at 147 per 100,000 population and HIV was 10.7 per 100,000 population with a 0.5 mortality rate.
On Sabah and Sarawak having the highest number of carriers for Hepatitis B in Malaysia, Dr Raman said that the transmission of the virus was mostly from mother to baby.
This means that the mother is the carrier and transmitted the virus to the child as babies get infected ante-natal, intra-natal (during delivery when they come in contact with the mother’s blood) and peri-natal (when they are in close contact with their mothers).
“And we are in the area where there are more incidents of Hepatitis B than anywhere in the world, the Asia Pacific and the Oriental is where the virus is endemic. This means countries like China, Korea, Taiwan, Malaysia, Singapore and Hong Kong.
“In Europe and America there is not much of Hepatitis B – if there are cases, it is usually due to immigrants from Asia and the Orient who are residing there,” he said.
“Immigrants coming to Sabah in the past could be one of the factors too but the main one is that we have a lot of people who are descendants of people from southern part of China who could have been carriers,” he said, adding that the late implementation of the vaccination program and lack of awareness in the interior area are among other contributing factors.
Dr Raman said that the program yesterday was to educate people about the disease and to provide them with screening facilities for the disease that is affecting people worldwide.
The theme for the celebration this year is ‘Finding the Missing Millions’ meaning the people who have the disease but are unaware of their condition, or those who know but are not doing anything about it.
Hepatitis, Dr Raman pointed out, is a disease caused by a virus that attacks the liver and causes the organ to fail and also causes liver cancer. It is a silent disease.
“Hepatitis B and C carries more problems than the other viruses. These virus affected the individual(s) and the disease goes on for long periods of time. A lot of them do not know they actually have the virus and after 20 or 30 years later they have liver failure, jaundice, then they come in with symptoms. They can also die of liver cancer and liver related diseases like cirrhosis and end stage liver disease,” he said.
Dr Raman explained that a lot of these patients do not have any symptoms as Hepatitis B and C are not like malaria or HIV where they have symptoms and can come in (for medical assistance) at the initial stages.
Hepatitis B, he said is usually maternal and transmission, meaning that the mother carries the virus and transmits to the newborn.
“Of course some transmission are from blood transfusion, some from sexual contact but it is not as high as Hepatitis C. So if we can cut down the transmission from the mother, then we actually prevent the infection to the babies,” he said.
“Hepatitis B vaccination started in 1989 in Malaysia and as a result of this, we saw the number of people in the younger population diagnosed with hepatitis B has gone down tremendously. The chances of finding an individual with Hepatitis B in the 25-year-old age group is virtually nil because of the vaccination program.
“In other words you will not see anymore Hepatitis B in the next generation. If there are cases, it means they have not gone through the vaccination or they are someone who was infected by the mother and not treated. In the future Hepatitis B will be a disease of the past.
WHO said that there will not be anymore cases of viral Hepatitis B and C by 2030,” he said.
Dr Raman added that screening is equally as important as vaccination and the target group is pregnant mothers because if we can treat or prevent the virus from being passed down to the child, then you are actually preventing a trans-patient thereby curing the disease.
“In Malaysia, we have the Maternal to Child Transmission program. On going for a number of years not only in the big hospitals but also in Klinik Kesihatan throughout Sabah.
“Pregnant mothers are screened and those who tested positive for Hepatitis B will be sent to the relevant doctors for treatment to prevent the disease being transmitted to the babies.
“Babies born of Hepatitis B carriers will be immunized in two ways, passive immunization which is the normal vaccine and the active immunization which is only available in the hospitals. That is why these mothers have to deliver their babies in hospitals.
“The immunization is in the form of Hepatitis B immunoglobins which will prevent transmission of Hepatitis B and must be given 24 hours after birth,” he said, adding that these babies will be screened when they are a bit older to see if they still have the Hepatitis B virus.
However not all patients with the Hepatitis B virus need treatment, some are just carriers. They do not show symptoms, all they need is monitoring for liver cirrhosis and liver cancer.
“Through the ‘Finding the Missing Millions’ theme, we are addressing Hepatitis C more than anything else. It is also a silent disease that can only be detected in a blood test.
“This is a higher risk group, including those who have been given blood transfusion before 1992 as Malaysia only started to screen donated blood for Hepatitis C then,” he said, adding that the virus was discovered in 1989.
He said that many Hepatitis C patients now were those who received blood transfusion before 1992 and in Malaysia alone it is estimated that there are about 500,000 people infected with Hepatitis C but not diagnosed and treated.
Hepatitis C is treatable to the extent of cure unlike Hepatitis B, he stressed.
Treatment is with a drug known as Direct Acting Anti Virals (DAAS) which the patient has to take for 12 to 24 weeks and cure rate is about 97 per cent.
The drug, according to Dr Raman, has been around for about five years but there was difficulty in obtaining it because it is very expensive.
“When first launched about two years ago, it would cost a patient about RM200,000 for a three-month treatment. Now the Ministry of Health has made the drug available at a cheaper cost, now it’s only RM1,300 per treatment of three months,” he said, adding that now it is better medication, better accessibility to the patients and shorter period of time with a high curable rate.
In Sabah the treatment is available in all the major district government hospitals like in Sandakan and Keningau.
Meanwhile, Dr Nerenthran Loganathan who gave a talk about Hepatitis during the program, urged the public to get screened.
The risk groups are people who have received blood transfusion, those who have used intravenous drugs in the past one year, those who had tattoos or piercings, homosexuals, prisoners and pregnant mothers to a certain extent, he said.
A Consultant Physician and Gastroenterologist with KPJ Sabah, Dr Nerenthran who was also at the press conference disclosed that sometimes screened blood from the blood bank do not show the Hepatitis B or C virus which may manifest after a six-month ‘window period’.
“If you received blood transfusion for whatever reasons then please get yourself screened as you are still at risk now. If you test negative after six months of a blood transfusion, then you are in the clear,” he said.
Dr Nerenthran also lamented that a lot of people who tested positive for Hepatitis B ignore the condition because they are well and do not have any symptoms.
He stressed that if they are carriers, they must come and seek medical advice.
“In fact 90 per cent of the time you do not have to do anything because the disease is dormant but you must check your blood and scan your liver every six months for the rest of your life. If there is any problem with their blood or liver investigation they will be referred to a gastreoentologist for treatment,” he pointed out.
Treatment is available free in the government hospital and chargable in private hospitals, he said, adding that all cases should be treated and with the vaccination for Hepatitis B and treatment for Hepatitis C, the cases are reducing and it is possible to achieve complete disease eradication by 2030 as projected by WHO.
He also said that most health screening packages include Hepatitis B but not Hepatitis C so it is important to include this when you go for your health screening.
“If you are dealing in high risk occupation like doctors, paramedics, nurses, you have to screen yourself regularly because you are exposed. If you don’t have the risk factors as mentioned, one-off screening is enough,” he said.