Call for mandatory hepatitis B, C screening for CNIC issuance

In a country where around 15 million people are affected by hepatitis B and C, the National Database & Registration Authority (Nadra) should make hepatitis B and C screening mandatory for the registration and renewal of computerised national identity cards (CNICs), leading gastroenterologists demanded on Saturday.

They also demanded that all the union committees and Nadra link the issuance of birth certificates and B Forms with mandatory administration of hepatitis B vaccine within 24 hours of a child’s birth, deploring that hardly three per cent are administered the vaccine at birth in Pakistan.

“Around 10 million people are living with the hepatitis C virus [HCV] while around five million are affected by the hepatitis B virus [HBV] in Pakistan,” gastroenterologist Dr Lubna Kamani said during the concluding session of a conference on stomach and liver diseases.

“Unfortunately, most of these people are undiagnosed and spreading the deadly disease unknowingly to others. Nadra should not issue or renew CNICs without checking the hepatitis B and C screening status of people.”

The two-day sixth annual conference of the Pakistan GI & Liver Disease Society (PGLDS) had been attended by leading gastroenterologists and hepatologists from Middle Eastern, Far Eastern and European countries as well as from the US and different Pakistani cities.

The experts who spoke at the conference discussed the challenges and the advancements made in the field of gastroenterology and hepatology around the world and in the country.

Dr Lubna, who is also the PGLDS president, deplored that unnecessary injections, the use of contaminated razors and needles, and unsafe medical practices are major contributors to the spread of hepatitis B and C in Pakistan.

She said that intravenous drug users are also at a significantly higher risk of contracting hepatitis B and C. “The annual death toll due to complications from HBV and HCV infections is substantial. Estimates suggest around 12,100 people die from HBV and 19,000 from HCV every year.”

She also said that achieving elimination requires overcoming obstacles like a lack of comprehensive national data on the issue, limited access to testing and treatment facilities, and inadequate public awareness.

“Hepatitis B and C are major public health concerns in Pakistan. While the government has committed to eliminating these diseases, significant challenges remain. Increased access to testing, treatment and public education campaigns are crucial for achieving this goal.”

PGLDS Patron-in-chief Prof Dr Shahid Ahmed called for learning from Egypt for the elimination of viral hepatitis, especially hepatitis C, saying that in 2018 Egyptian authorities had launched the ‘100 Million Healthy Lives’ campaign, which was aimed at screening the entire adult population for HCV.

Dr Ahmed explained that this ambitious project utilised a massive network of over 6,000 fixed testing sites and 8,000 mobile teams, reaching even the remote areas.

“Testing and treatment were made widely accessible and free of charge. This eliminated financial barriers and encouraged participation in the programme. Egypt negotiated lower prices for direct-acting antiviral [DAA] treatments, the most effective drugs for HCV. This not only improved affordability but also drove down global DAA prices, benefiting other countries.”

He said hepatitis C is curable, as new and highly effective medications called DAAs have revolutionised treatment. DAAs offer short treatment courses, typically eight to 12 weeks, with cure rates exceeding 95 per cent in most cases, he added.

On the other hand, he pointed out, although there is currently no cure for hepatitis B, there are very effective antiviral medications that can suppress the virus, prevent liver damage, and reduce the risk of complications like cirrhosis and liver cancer.

“These medications can be highly effective in controlling the virus, with some people achieving undetectable viral loads for years, significantly reducing the risk of transmission.”

Dr Sajjad Jamil, another leading gastroenterologist, said both hepatitis B and C have effective treatment options available. He said hepatitis B treatment focuses on suppressing viral replication and preventing liver damage, while hepatitis C treatment with DAAs offers high cure rates and improved outcomes for patients with chronic HCV infection.

Treatment decisions should be made in consultation with healthcare providers, based on individual factors such as viral genotype, liver health and presence of other medical conditions, he added.

At another session on ‘Women in GI’, Dr Nazish Butt from the Jinnah Postgraduate Medical Centre and Dr Lubna said that half of the patients suffering from gastrointestinal and liver diseases in Pakistan are women, but the number of trained and qualified female gastroenterologists is very small.

They said that these days a large number of female physicians are training in the field of gastroenterology. They hoped that soon female patients would be approaching female physicians more freely to seek treatments like endoscopy and colonoscopy.