World Hepatitis Day 2015; Scenario in Pakistan

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Hepatitis B and C are principal cause of liver infection that ultimately leads to many liver complications in the form of cirrhosis, liver failure and liver cancer (Hepatocellular carcinoma). July 28, 2011, marks the first official World Hepatitis Day, established by the World Health Organization (WHO). Center for Disease Control (CDC) joined with WHO in calling for a renewed commitment against a largely silent but persistent epidemic. The aim of world hepatitis day is to raise global awareness about Hepatitis B and C and to encourage diagnosis, prevention and treatment. Worldwide, more than 400 million people are living with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, which mean 1 in every 12 person is infected with either HBV or HCV and these infections cause approximately 1.4 million deaths annually. According to a latest report 7.4% Pakistani population is suffering from Hepatitis B and C, while around 5% population is suffering from Hepatitis C only (1 in every 8 person is infected in Pakistan), which is an alarming situation.In Pakistan around 20-30% admissions and 30% deaths in hospitals are due to Hepatitis. Most persons with chronic viral hepatitis are unaware of their infections due to silent nature of the disease. Effective tools are available to prevent infection with viral hepatitis, including hepatitis B vaccination, surveillance, education, screening, and treatment; the challenge is to build the capacity to extend these interventions globally. In 2010, the World Health Assembly passed a resolution urging greater control of viral hepatitis.

There is decline in new cases of HBV infection worldwide due to an effective vaccine again HBV but new cases of HCV infection are on the increasedue to the lack of resources as well as unawareness about the disease. According to WHO estimate an average person receive 4 injection per year in Southeast Asia and most of them are unnecessary, 75% of them are unsafe. Unnecessary injections are given in Pakistan due to general perception of the public that they will get well soon after injection as compared to oral medicine. So the unsafe injections are the single most significant cause of spread of HBV and HCV in Pakistan.

Around 1.5 million unit blood transfusions are done in Pakistan each year. In many blood transfusion settings, they lack proper screening and record procedure so there is dire need to have standardization and regulation of appropriate blood screening procedures. Blood transfusion related infections are also a major cause of spread of HBV and HCV. The number of intravenous drug users (IDUs) is quite high in Pakistani population and the prevalence of Hepatitis is very high among IDUs communities. In fact, the prevalence of HBV and HCV is highest among IDUs. There is also great occupational risk associated with Hepatitis infection and health care workers are at increased risk to acquire disease, so all the health care staff should be well trained to reduce the chances of acquiring infection. Shaving by barbers is also one of the factors for Hepatitis infection as they dont clean shaving or hair cutting instruments properly. There are very less chances of sexual transmission of Hepatitis and according to reports, the chances of sexual transmission of HBV is more than HCV. HBV vaccine has been included in expanded program for immunization (EPI) since 2002.It would be ideal if we immunize the general public of Pakistan again HBV but at least we should immunize all the health care workers and high risk groups.

Research work is going on to find better treatment for Hepatitis B and C. Modified form of interferon (Pegylated Interferon) gives much better response in Hepatitis patients. RecentlyFDA approved two new drug for treatment of Hepatitis C,telaprevir(Incivek) andboceprevir. Both are very effective against HCV and around 80% patients respond to new therapy, which is great news for Hepatitis C patients. A new Hepatitis C treatment drug Sovaldi (sofosbuvir) is available in Pakistan at much reduced price and has proved very effect for Hepatitis C treatment in combination with other drugs. In Pakistan Government is also opened liver clinics, where hepatitis patients are getting free checkup and medicines. In addition, two liver transplant centers are now working in Lahore and Islamabad. Initially good results were not obtained in these centers and mostly people used to go to India for liver transplant but recently some successful liver transplant operations were done in Sheikh Zayed Hospital Lahore and there is great hope that successful liver transplant operations will be done now in Pakistan. Due to high patient load, there is need to increase the number of such centers. There is also need of a working group for Hepatitis, which should work at national level. It should consist of basic scientists and researchers as well as specialist doctors working on Hepatitis to find out causes of Hepatitis in Pakistan and figure out better and new ways of treatment. There is also great need of standardization in diagnostic labs at national level. A country wise prevalence study was done by Pakistan Medical Research Council (PMRC) in 2007-08 which was about 8 years ago, there is need to do a recent countrywide prevalence study. NAYS Pakistan wants to launch “Screen Pakistan” project this year and initially a large scale prevalence study will be done for Hepatitis B and C.

As there is great need of public awareness about Hepatitis B and C so I wrote abook entitled Hepatitis C, Symptoms, Diagnosis and Treatment (Hepatitis C, Allamaat, Tashkhees aur Illaj). This book is written in Urdu language, in a very simplified form so that majority of people in Pakistan can understand and read it. The book was published by Urdu Science Board, Government of Pakistan and is available from Urdu Science Board offices as well as from some major book stores in the country. A book on Hepatitis B in Urdu language is accepted for publication by Urdu Science Board and hopefully it will be published till the end of this year.To spread the message more promptly and effectively National Academy of Young Scientists (NAYS) Pakistan prepared a short introductory booklet on Hepatitis B and C (written by Dr. Alvina Zaineb and Aftab Ahmad) which we are distributing in schools, colleges and public hospital. Initially in 2011 3,000 copies of booklets were produced for distribution (Soft copy of booklet is available on NAYS website ( In 2014, NAYS published 10,000 booklets on Hepatitis B and C which was sponsored by Cancer Care Hospital and Research Center and most of them are distributed all over the country for free. On World Hepatitis Day 2015 NAYS is arranging free screening camp in different cities of Pakistan and will also distribute Hepatitis B and C booklets. NAYS has a plan to publish 3rd edition (10,000 copies) of Hepatitis B and C booklets at the end of this year.


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