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Jombo GTA et al.

, IJSID, 2013, 3 (4), 102-111



International Journal of Science Innovations and Discoveries

Review Article

An International peer Review Journal for Science

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Makurdi, Nigeria 2Department of Mathematics and computer science, Faculty of Science, Benue state UniversityPMB 102119 Makurdi, Nigeria. 3Department of Anatomical Pathology, College of Health Sciences, Bemue State University PMB 102119 Makurdi, Nigeria. ABSTRACT

Department of Medical Microbiology and Parasitology, College of Health Sciences, Benue State University PMB 102119

Received: 10-08-2013 Accepted: 30-09-2013

*Corresponding Author

Background: Hepatitis viruses though discovered at different times of human existence up to review the origin of the viruses to the present global distribution of the disease in epidemiology of viral hepatitis from original articles, letters, short communications and

have continued to increasingly infect a large number of human populations in the midst

of different control measures put in place to contain the disease. Aim: The study was set general and that of Nigeria in particular. Methods: The study was based on literature search on viral hepatitis over the past century (1913-2012). Research works on Central, eJManager, JournalTOCs, ResearchBib, ScieLo, Googlescolar, NCBI, MLS, PubMed, reports on viral hepatitis in humans from medical websites such as: Open J-Gate, Science African Journals Online (AJOL), PMC International, Open access Subset, E utilities, NLM LiitArch, ScienceDirect, and PMC citation Search were carried. Data obtained was analysed using simple descriptive methods. Results: Of the 7.04 billion people worldwide, 80.2% (5.613 billion), 10.3% (711.173 million), 2.3% (157.879 million), 0.21% (15.026 million) and 35.9% (2.511 billion) of the people were respectively infected with Hepatitis A, B, C, D and E viruses with Africa and Asia contributing over 60% of the global viral hepatitis burden. In Nigeria 95% (153.90 million), 12.0% (19.44 million), 7.6% (12.312 million), 1.4% (874,000), and 27% (44.01 million) of her 163 million people are respectively that cuts across all continents of the world. The present control measures should be entire universe in no distant future.

Address: Name: Jombo GTA Place: Nigeria E-mail:

infected with Hepatitis A, B, C, D and E. Conclusion: Viral hepatitis is a global epidemic reviewed, revived and strengthened to avert the possibility of this disease conquering the

International Journal of Science Innovations and Discoveries, Volume 3, Issue 4, July-August 2013


Jombo GTA et al., IJSID, 2013, 3 (4), 102-111 INTRODUCTION there has not been unanimous views among scholars on the issue 1,2. Medical historians and paleontologists both have not been able to come to conclusion on the issue as well as archeological evidences from ancient Egyptian, Chinese, Babylonian and Greek excavations dating as far back as 25,000 BC are yet to come to any reliable conclusion. Hippocrates of Cos (460-370BC) in some of his writings painted a graphic picture of what could be ascribed to todays Hepatitis A virus disease appears to be the earliest vivid mention of the disease3-5. Viral hepatitis is presently grouped into at least five types-Hepatitis A, B, C, D, E and that of the other agents is parenteral routes (B,C,D and G). While the viral agents causing viral hepatitis were discovered at different times, the combined global impact of the disease is at present probably been underestimated even among health G caused by Hepatitis A, B, C, D, E and G viruses respectively. While transmission of some (A, and E) are basically faeco-oral personnel6-8. Hepatitis A for instance is estimated to afflict at least 850 million of the Africas over 1 billion people while over The origin of viral hepatitis in the history of human existence on planet earth is perharps deeply buried in antiquity as

90% of Indias and Chinese populations are similarly infected by the same virus with infection rates ranging from 40-80% among other countries including western Europe and North America. Similar rates of infections have been documented with Hepatitis D virus (HDV) and Hepatitis G virus (HGV) similarly have widespread global and regional spread with immense Hepatitis E virus (HEV). Also it has been estimated that there are over 350 million Hepatitis B virus (HBV)infections globally, at least 70% of the cases in Africa, China and India, along with over 150 million Hepatitis C virus (HCV) infections globally. public health benefits. This makes the combined effect of all the Hepatitis virures on humans a serious global health problem even in the midst of all the control and preventive measures available in most countries 9-12. This study was therefore set up to appropriate recommendations on the modalities to effectively control this global disease. MATERIALS AND METHODS review the current global burden of viral hepatitis and that in Nigeria, and to further raise awareness of the disease, and make The study was based on systematic random sampling of literatures on prevalence and incidences of viral hepatitis

from published works from the past century (1913-2012).This involved works from medical archives that existed on hard copy materials as well as those that existed only in the soft copy forms on the internet. Reputable Medical websites were

consulted which include: EMBASE, Cas/Chemical abstracts, CAB Abstracts, Scopus, Science Citation Index (SCI) Expanded,

Directory of Open Access Journals (DOAJ), ScopeMed, CrossRef, Index Scholar, Ulrichsweb, Journal Index, Open J-Gate, Science Central, eJManager, JournalTOCs, ResearchBib, ScieLo, Googlescolar, NCBI, MLS, PubMed, African Journals Online (AJOL), PMC International, Open access Subset, E utilities, NLM LiitArch, ScienceDirect, and PMC citation Search, among others. Reports on epidemiology, letters to editors and short communications on viral hepatitis were considered. A minimum of six relevant reports on the topic were randomly selected for each year where available while the geopgraphical spread of the reports were descriptive methods of arithmetic sum and mean. useful in determining the suitability of articles for this study. Data obtained from the articles was the prevalence and incidence RESULTS

of viral hepatitis and case reports and notifications. Data Management and analysis. Data obtained was analysed using simple A total of 768 literature reviews from 1913 to 2012 were carried out (average 7, range 2-26) As at 70,000BC the

global population is estimated to have been 15,000 people and in 10, 000BC 1 Million, and at AD 0000 300 Million. Table 1 Billion in 2012. (Table 1). International Journal of Science Innovations and Discoveries, Volume 3, Issue 4, July-August 2013

shows the global population from antiquity to date. The global population reached 1 Billion in 1804AD, 5 Billion in 1987 and 7


Jombo GTA et al., IJSID, 2013, 3 (4), 102-111 As at the end of 2012 the world population stood at about 7.003 Billion people with Asia accounting for 60.31%

(4.166 Billion) of the people and followed by Africa with 14.95% (1.033) of the global population. Other continents contributed as follows: Europe 10.61% (732.759 Million), Latin America and Caribbean 8.52% (588.649 Million), North America 5.09% (351.659 Million) and Oceania/ Australia 0.52% (35.838 Million). (Figure 1). 1947, 1965, 1975, 1975 and 1978. Hepatitis A virus, Hepatitis B virus, Hepatitis C virus, Hepatitis D virus and Hepatitis E virus were respectively discovered in population are infected with hepatitis A (HA), 85.9% (887.38 M) of Africas 1.003 Billion people are infected and Asias 3.56 with Oceania accounting for 41.8% (14.98 Million) of her 35.838 Million population. (Table 2). Continental distribution of viral hepatitis showed that, among the various types: 80.2% (5.61 Billion) of the global

out of 4.166 Billion (85.5%) of her population are also infected. The global load of HA presently stands at 80.2% (5.613 Billion) infected with at least 350 million with chronic infection. Among these 14.0% (144.62 Million), 12.3% (72.403 Million) and 10.5% (437.507 Million) of Africans, Latin Americans and Caribbean and Asians are respectively infected. (Table 2). Similarly a review of global Hepatitis B (HB) load showed that at least 711.173 (10.3%) Million people are currently An analysis of the rate of Hepatitis C (HC) disease showed that at least 2.3% (157.879 Million) people globally are

currently infected with 0.30% (3.10 Million), 0.30% (1.60 Million) and 0.23% (9.832 Million) of respectively Africans, Latin Americans and Caribbean and Asians having the highest rates among their populations and North America with 0.80% (2.813 Million) having the least. (Table 2). (Table 2).

world population in infected by HD with 3.10 Million (0.30%) and 6,000 (0.02%) of Africans and Oceanians respectively. infected by HE with 1.44 Billion (34.6%), 602.442 Million (58.3%) and 220.200 Million (37.4%) affecting African, Asian and Latin American and Caribbean populations respectively. (Table 2). and HE.(Figure 2).

Also an analysis of the rate the of burden of Hepatitis D (HD) showed that at least 0.21% (15.026 Million) of the entire A review of the global burden of Hepatitis E (HE) showed at least 2.511 Billion (35.90%) of the world population are An analysis of the burden of viral hepatitis among the 163 Million Nigerians showed that: 95% 153.9 Million), 12.0%

(19.44 Million), 7.6% (12.31 Million), 1.4% (874,000) and 27.0% (44.01 Million) are respectively infected with HA, HB, HC, HD,

International Journal of Science Innovations and Discoveries, Volume 3, Issue 4, July-August 2013


Jombo GTA et al., IJSID, 2013, 3 (4), 102-111

International Journal of Science Innovations and Discoveries, Volume 3, Issue 4, July-August 2013


Jombo GTA et al., IJSID, 2013, 3 (4), 102-111

DISCUSSION breakthroughs that characterized the century. However, a retrospective analysis of specimens and clinical conditions of immunopaleontological evidences could go13-15. All the agents of viral hepatitis were discovered and isolated in the 20 th century, a reflection of the technological

patients show that all the viral diseases probably have been with man as far back as archeological and more than half of the entire viral hepatitis burden globally. With Asia contributing about 60% of the entire world population also contributes proportionate proportion of various forms of viral hepatitis to the global community. HA, International Journal of Science Innovations and Discoveries, Volume 3, Issue 4, July-August 2013 HE and HC are however not so common in Japan, Singapore and Taiwan as compared to India and China. Also in Africa HA, HB and HC are lower in Egypt, Morroco and Tunisia compared to Liberia, Gabon, Angola and Zimbabwe. HE is higher Reports have however shown at present that Africa and Asia with their leading populations have contributed


Jombo GTA et al., IJSID, 2013, 3 (4), 102-111 in several parts of Egypt, Ethiopia, Eritrea compared to South Africa, Nigeria and Kenya. These variations have been quality of healthcare service delivery16-19.

shown to be multifactorial especially the levels of personal and environmental hygiene, socio-economic and . level and parts of the world. The reasons for this polar endemicity are not farfetched. Contrary to the developed parts of the world like Canada and Sweden with a high level of healthcare awareness in the general population, adequate supply of healthcare world often lack both economic, technological and managerial competence needed to procure facilities for the proper investigation and treatment of these viral infections. This clearly paints the picture of a weak control and preventive sub-Saharan Africa especially there is lack of synergy and proper co-ordination of such complimentary roles20-23. facilities and personnel, the situation is different in most of the developing parts of the world. The developing countries of the mechanism among the major key players being at the level of individual who are at risk of infection, group of persons or The level of illiteracy has severally been implicated in the spread of these infections in the developing World. Of the 350 million chronic HBV and 170 million HCV carriers worldwide, over 70% of them reside in the developing

institutions saddled with this tasks of treatment, prevention and control as well as their regulatory agencies. Often times in Illiteracy may give rise to ignorance occasioned by a low level of healthcare awareness and low or lack of appropriate

knowledge of personal hygiene and preventive health. While the target for the attainment of milleneum development goals addicts, sharing of unsterile needles and sharp instruments, transfusion of unscreened blood, ingestion of food and water polluted with fecal matter are few of such24-26 HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION AND VIRAL HEPATITIS

(MDGs) 2015 is by the corner this is probably another call for a re-intensification of efforts by concerned governments of the

challenge posed by viral hepatitis towards realizing it. Risk factors for transmission include intravenous drug injection in drug

by either HBV, HCV or both while over 97% (29 million) are infected by at least one form of hepatitis, serum or infectious. Apart from the higher likelihood of patients with HIV to be infected by HBV/HDV and HCV due to the similarity of the modes of is due to the inability of the diseased livers to adequately metabolize these drugs through cytochrome p450 and subsequently eliminate them, hence leading to toxicity with additional liver injuries27-30. VIRAL HEPATITIS IN NIGERIA Nigeria with a population of about163 million has 153.9, 19.44, 12.32, 44.01 Million people living with HAV, HBV, transmission; the severe liver injury in viral hepatitis makes anti-retroviral medication difficult with increased mortality. This

It is estimated that of the over 30 million people presently infected by HIV, at least 60% (20 million) are also infected

HCV, HEV respectively and 874,800 people living with HDV. This clearly places Nigeria in a very prominent position among primary healthcare services in the country which has denied the teeming rural dwellers which account for over 70% of the roads and high costs of telecommunications making collaborative health services and effective referral system almost

countries endemic for viral hepatitis. The predisposing and contributory factors are enormous: First, the virtual collapse of the Nigerian population access to qualitative and affordable healthcare services. Second, large infrastructural deficit whereby the little available healthcare facilities lack basic facilities such as uninterrupted power supply to store drugs and reagents, bad impossible with non or sparse ambulance services. Third, Unequal distribution of qualified health personnel between the population. And fourth, lack of adequate funds, logistics and budgetary provisions to finance interventionists programs in the International Journal of Science Innovations and Discoveries, Volume 3, Issue 4, July-August 2013 urban and rural centres where over 70% of the qualified health personel reside in the cities and towns serving only 30% of the


Jombo GTA et al., IJSID, 2013, 3 (4), 102-111 health sector31-33. Nigeria, hence appear not to have seriously taken head on the war against viral hepatitis and hence there is need to re-assess and strengthen the present effort. i) General 1. 2. 3. 4. 5. 6. 7. There should be increase in enlightenment campaign and health education on the existence of these viral agents , their developing parts of the world34,35. rural health centers. Strict measures should be put in place by governments to prevent further transfusion of unscreened blood in the Governments should be advised to step up budgetary allocation to the health sector diseases prevention programmes. and hence infectious modes of transmission as well as methods of preventing their transmission especially in sub-saharan Africa and other RECOMMENDATIONS

There should be increased training of appropriate manpower in health centres in the limited resource countries, chain of prevention of hepatitis in the country. The practice of environmental sanitation in the limited resource countries should be reviewed and properly

such as Pathologists, Technologists, Technicians and other ancillary staff and health personnel relevant in the restructured. There should be proper legislation on sanitation in these countries and enforced for strict compliance. orally transmitted hepatitis viruses.

Water sanitation should be generally emphasized and drinking water should be properly treated to prevent faecoDisposal of human wastes and excretions should be controlled and properly planned to prevent both surface and underground water contamination by human excreta36-38.

ii) Specific 1. 2. 3. 1. 2. 3. 4.

Hepatitis A virus

Pre-exposure prophylaxis- Hepatitis A virus immunoglobulin (HAVIg) should be given to travelers to intermediate and high HAV endemic regions. Post-exposure prophylaxis (within 14 days)- This should be given routinely to households and other intimate contacts in situations such as day care centres. The common source of exposure should be traced such as food prepared by infected food handlers39-41. Vaccination- There are presently highly effective recombinant vaccines. These should be given to those at increased vaccination. Hepatitis B immunoglobulin (HBIg) should be given to those exposed to hepatitis B. This is particularly more mothers are HBsAg and HBeAg positive may also be given. Blood donors should be adequately screened as well as organs for transplantation. risk to HBV infection such as healthcare workers. It should also be given routinely to neonates as universal efficacious if given within 48 hours of the incident. Neonates at increased risk of contracting hepatitis B such as whose Safety precautions should be enforced in handling blood and other body fluids 42-44..

Hepatitis B and D virus

Hepatitis E virus Recombinant hepatitis E virus vaccine is available and is about 98% efficacious 45. International Journal of Science Innovations and Discoveries, Volume 3, Issue 4, July-August 2013


Jombo GTA et al., IJSID, 2013, 3 (4), 102-111 LIMITATION varying intervals of their respective discoveries among humans over the period. The study however strives to present the current burden of the disease in Nigeria and the world. CONCLUSION This study could not chronicle the burden of various forms of viral hepatitis over the past century to date due to the

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International Journal of Science Innovations and Discoveries, Volume 3, Issue 4, July-August 2013