The world celebrates World Hepatitis Day - a "silent disease" that kills more than 1.1 million people annually. Insufficient information about the disease, risks and mode of transmission, as well as the prevention of hepatitis B and C and treatment options result in the infected often not being aware that they are carriers of the virus, which leads to the possibility of spreading the infection.
Every year, July 28 is celebrated worldwide as World Hepatitis Day to raise public awareness of the importance of prevention, early detection and treatment of viral hepatitis. Viral hepatitis, with a particular focus on hepatitis B and C, still pose a global public health challenge.
Hepatitis is an inflammation of the liver, most often caused by a viral infection. There are five main hepatitis viruses, called types A, B, C, D and E. Hepatitis affects hundreds of millions of people worldwide, causing acute and chronic diseases and killing nearly 1.1 million people each year.
Chronic hepatitis B and C are life-threatening infectious diseases that cause serious liver damage, cancer and premature death. In some countries, hepatitis B is the most common cause of cirrhosis and can also cause liver cancer, according to the FBiH Public Health Institute.
Viral hepatitis a public health problem in BiH
Rozalija Nedić, from the Department of Epidemiology of Infectious Diseases of the FBiH Public Health Institute, confirms that viral hepatitis is a public health problem in Bosnia and Herzegovina. According to her, in this BiH’s entity in 2022 are registered 97 new cases of viral hepatitis, mostly types B and C.
"If we compare this with data from previous years, we had a milder decline in cases in 2020 and 2021, but this is most likely the result of activities carried out due to the coronavirus pandemic," Nedić said, adding that no cases of deaths from hepatitis B and C had been reported in the previous year.
She added that due to the lack of reliable epidemiological data, it is difficult to compare the epidemiological situation in BiH with the countries of the region.
"In general, as in other Balkan countries, it is difficult to do these comparisons, because we do not have reliable epidemiological data. It's hard to say we have a better or worse situation than other countries," she said.
The vaccination rate against hepatitis B in FBiH is declining
He explains that viral hepatitis affects people who behave at risk, who often change partners, have unprotected sex, then marginalized population, migrants, prisoners, people who use intravenous drugs, and a special group are children who get hepatitis from infected mothers.
The doctor points out that there is not enough awareness of the disease itself, its transmission, prevention, but also treatment.
"Consciousness is not sufficiently represented to achieve a result in relation to the disease. It is difficult for people to understand the severity of the disease, do not assess whether they are behaving at risk in terms of whether they belong to risk groups and therefore do not carry out activities in terms of testing, which is extremely important in detecting these diseases," she said.
With the availability of effective vaccines and drugs against hepatitis B and hepatitis C, the elimination of viral hepatitis is achievable and attainable, but requires greater awareness and understanding of the disease and risks, as well as access to diagnosis and treatment.
Nedić points out that in recent years in the FBiH there has been a decrease in the vaccination rate against hepatitis B and that the rate in 2022 was 70.4 percent, which is significantly lower compared to the recommended 95 percent.
He argues that it is necessary to further promote preventive measures in the fight against hepatitis, such as testing for the disease.
"It is important to know the determinants of hepatitis, the way it is transmitted, that it can be transmitted through unprotected sexual intercourse, through blood, through the use of common needles, that it can be transmitted from mother to child, and I think it is important to work on measures, avoid risky behaviors. It is very important for people to get tested, to find out if they have hepatitis or not, because it is important primarily for their health, as well as for the health of others. Also, one aspect that is important for pregnant women is to be tested for hepatitis B and for children to receive a hepatitis B vaccine that will protect their health," Nedić said.
Viral hepatitis is successfully treated in BiH, important early diagnosis
Viral hepatitis is successfully treated in Bosnia and Herzegovina, but early diagnosis is important. Hepatitis B and hepatitis C virus infection can play a role in the formation of liver cancer, which is why prevention and timely treatment is of utmost importance.
Patients with hepatitis B and C in Bosnia and Herzegovina have reached the list of those who are treated free of charge, but as a big problem is the insufficient information of citizens to the right and the possibility of treatment.
The FBiH Health Insurance and Reinsurance Institute, within its competences for patients with viral hepatitis B and C in the Federation of BiH, has enabled the financing and procurement of medicines for the treatment of this disease. Also, thanks to the new therapies funded by the Health Insurance Fund of the Republic of Srpska, all patients with hepatitis C are also successfully treated in this entity.
Hepatitis C can be cured
Zdenko Simonović, president of the Association of Patients with Chronic Viral Hepatitis "B18" based in Banja Luka, said that treatment and diagnostics are done at the expense of health insurance funds and that drugs of the latest generation are extremely successful.
The goal of hepatitis C treatment is to achieve a permanent virological response, which means that the virus can no longer be detected in the blood for 24 weeks, and now more and more often for 12 weeks, after the end of treatment. This can be considered a cure because the virus does not return, if the person does not become infected again. With new drugs, this success rate of therapy reaches 100 percent.
"There are drugs in BiH. For the treatment of hepatitis C there are drugs of the latest generation. They're extremely effective. The success rate of treatment is 100%. Whoever needs therapy, within two to three months, would be cured. The key is to be informed and that it should be tested," Simonović said.
He explains that if hepatitis B enters the chronic phase, it becomes an incurable disease, which is lived with lifelong therapy.
"For hepatitis B, there is an extremely high-quality vaccine that is included in the vaccination calendar. Since 2001, all children have been vaccinated in three doses and they should be protected, while adults have the opportunity to be vaccinated voluntarily," he said.
More than 350 million people are living with chronic viral hepatitis infection.
According to official data, more people die from hepatitis B and C each year than from HIV/AIDS, malaria and tuberculosis. Hepatitis B and C are responsible for two of the three deaths from liver cancer.
More than 350 million people are living with chronic viral hepatitis infection, while 1.1 million deaths are recorded annually, predominantly in low- and middle-income countries.
A study by the World Health Organization found that by 2030 vaccination, diagnostic tests, medications and educational campaigns could prevent 4.5 million premature deaths in low- and middle-income countries by 2030.
The WHO's global strategy for hepatitis, approved by all member states of organizations, aims to reduce new hepatitis infections by 90 percent and deaths by 65 percent by 2030.