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Impact of COVID-19 on viral hepatitis in Nigeria

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Unarguably, COVID-19 has placed significant strain on national healthcare systems at a critical moment in the context of hepatitis elimination, across the world.

The pandemic has resulted in a myriad of interventions with the urgent aim of reducing the public health impact of the disease.

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However, evidence both from high-income and low-income countries show broader consequences of such interventions on economic and public health inequalities, as well as on pre-existing programmes targeting endemic pathogens.

Some health experts have provided an overview of the impact of the ongoing COVID-19 pandemic on hepatitis B virus (HBV) programmes globally, focusing on the possible consequences for prevention, diagnosis and treatment.

Hepatitis is the inflammation of the liver. The five most common viral hepatitis are A, B, C, D and E. Recently, the hepatitis G virus was identified. Hepatitis A and E are transmitted through contaminated food, water, poor hygiene and close contact with carriers of the virus.

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Hepatitis B, C and D are transmitted through blood, sexual intercourse, bodily fluids, kissing, sharing syringes and blades, and touching wounds of infected persons.

Hepatitis G being the newly discovered viral hepatitis’ route of transmission is no different from that of B, C and D.

Studies revealed that hepatitis A and E are acute; lasts for a short time – less than six months and hepatitis B, C, D and G may progress to chronicity; more than six months.

Symptoms of viral hepatitis start from absence of symptoms (asymptotic) to mild or moderate features such as jaundice- yellowish discolouration of the skin and eyes, poor appetite, malaise and progressing to a chronic liver failure.

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Ongoing disruptions of infrastructure, supply chains, services and interventions for HBV are likely to contribute disproportionately to the short-term incidence of chronic hepatitis B.

Thus providing a long-term source of onward transmission to future generations that threaten progress towards the 2030 elimination goals.

Together, hepatitis B and C are the most common cause of death, with 1.3 million lives lost each year, according to the World Health Organisation (WHO).

Amid the COVID-19 pandemic, viral hepatitis continues to claim thousands of lives.

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Across the world, 290 million people are living with viral hepatitis unaware. Only 10 per cent of people living with hepatitis B and 19 per cent living with hepatitis C know their hepatitis status.

Meanwhile, the COVID-19 impact is global and the WHO is now contemplating that the world might not meet the 2030 elimination target for viral hepatitis.

Although the global burden of viral hepatitis is huge, WHO has set global goals to address it. These goals include reducing the number of new infections by 90 per cent and the number of deaths from viral hepatitis infections worldwide by 65 per cent by 2030.

In an effort to meet these global goals, the Federal Ministry of Health said that the government was articulating strategies that would lead to a reduction in the number of more than 22 million Nigerians infected with hepatitis B and more than four million with hepatitis C.

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The National Goodwill Ambassador for Viral Hepatitis in Nigeria, former Head of State, Yakubu Gowon, revealed recently that hepatitis B and C have reached an epidemic level at various Internally Displaced Persons (IDP) camps located in the North-East.

Some health experts, however, decried the decreased diagnostic capability in the country. They said that even before COVID-19, only approximately one per cent of viral hepatitis cases were diagnosed in sub-Saharan Africa.

However, Dr Adesigbin Clement, Head, Prevention Branch National Coordinator, National AIDS/STI Control Programme (NASCP), says the Federal Government has put a policy in place to ensure health services go on in emergency situations like COVID-19.

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Clement said that the viral hepatitis services benefited from the policy guide during the COVID-19 lockdown in the country.

He noted that the pandemic provided an opportunity for the strengthening of laboratories across the country, especially Polymerase Chain Reaction (PCR), laboratory.

“Viral hepatitis response in some states latch on the platforms to provide viral load services,” he explained. latch

“These include awareness creation, using covid platforms, likewise learning from COVID-19 robust surveillance system.

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“Above all, the response of the private sector and government at all tiers to fund COVID-19 was unprecedented. This year’s world hepatitis day is a call for such a response. Hepatitis can’t wait to be eliminated.

“We will achieve this if the private sector and government at all levels will fund this response,” he said.

Dr Paul Oboro a Hepatologist, said that decrease in hepatitis diagnoses was observed in the country even before the first case of COVID-19 was announced on Feb.27, 2020.

“The COVID‐19 pandemic resulted in decreases in hepatitis prevention, testing and treatment, slowing or halting, in the immediate term, progress toward goals for hepatitis elimination,” he said.

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The hepatologist said that programmes to tackle HBV were weak, particularly in a country like Nigeria, as funding was frequently not embedded in the country’s health budget and the programmes were not supported.

Oboro noted that the most vulnerable members of society were more likely to be affected by HBV, and the COVID-19 pandemic was amplifying pre-existing economic and public health inequalities.

“Historical data clearly illustrate the disruptive legacy of political and economic crises on HBV vaccination programmes.

“Evidence is slowly emerging on the greater health impacts of COVID-19 public health interventions on current HBV initiatives, both in high-income and low-income countries, with disruptions to infrastructure, services and supply chains for diagnosis, vaccination and treatment.

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“ Ongoing short-term disruptions to HBV programmes can have strong repercussions on early childhood incidence, fuelling an increase in the global burden of chronic infection in the long term and providing a source of onward transmission to future generations that threaten progress towards the 2030 elimination,” he explained.

Addressing the issue, Dr Abigail Banji, a Health Economist, said that the National AIDs Indicator and Impact Survey – NAIIS, 2018, not only reported national prevalence for HBV and HCV, it also talked about confection between HIV, HBV and HCV.

Banji said that the survey gulped billions of taxpayers’ money, stressing that it was important for the government to use the information provided.

“HIV/HBV is 8.1 per cent and HIV/HCV 1.1 per cent. We can start micro elimination of viral hepatitis within people living with HIV by providing testing and treatment.

“HCV is curable. Also, HBV vaccine can be given to this group who are negative. This is an opportunity and the government can start small,” she added.

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