Managing hepatitis in Malaysia: Prevention, diagnosis, and treatment challenges

September 9, 2024
Dr Sheikh Anwar Abdullah, Consultant Gastroenterologist and Hepatology,
​Sunway Medical Center, Sunway City.
​​Hepatitis, an inflammation of the liver caused by a variety of infectious viruses and non-infectious agents, leads to a range of health problems including chronic disease and severe liver complications including liver failure. According to the World Health Organization (WHO), an estimated 354 million people worldwide live with Hepatitis B or C. In Malaysia, approximately one million people are infected with the Hepatitis B virus (HBV), and an estimated 2.5% of adults have been infected by the Hepatitis C virus.

Hepatitis in Malaysia
The most common types of hepatitis in Malaysia are B and C, which can cause chronic disease, liver cirrhosis, and liver cancer. Hepatitis A and E are transmitted through contaminated food or water, whereas B, C, and D spread through blood and bodily fluids. The prevalence of Hepatitis B in Malaysia stands at 1%, while Hepatitis C affects 2.5% of the population. Understanding these transmission modes is crucial for effective prevention. 

Challenges in diagnosis and treatment
A significant challenge in managing Hepatitis C is its asymptomatic nature, often leading to late diagnosis when the disease has progressed to a severe stage, potentially causing cirrhosis or cancer. The majority are asymptomatic, and if you don't check, you don't know you have it until it's already chronic.

Treatment for chronic Hepatitis B is aimed at suppressing the virus and preventing disease progression while treatment for Hepatitis C involves the advancement of antiviral drugs and treatment plan. The treatment for Hepatitis B is not a cure, it is just to suppress the virus and slow it down, which is a lifelong battle for patients. For Hepatitis C, antiviral drugs can now cure the infection in 98% of cases in as short as three months.

Early screening and diagnosis are critical to preventing complications of Hepatitis C, while regular follow-ups are essential for Hepatitis B patients to monitor liver function and detect early signs of liver cancer.

The importance of screening
Screening is crucial to detect the disease early, especially for high-risk groups such as healthcare workers, individuals with high-risk behaviors, and those with a family history of hepatitis. Antenatal screening for pregnant women is just as crucial to prevent vertical transmission from mother to child. 

Addressing stigma and misconceptions
One of the barriers to effective hepatitis management is the stigma associated with the disease which makes people reluctant to get screened. 

Lifestyle modifications and management
For individuals living with hepatitis, lifestyle modifications play a crucial role in managing the disease. Avoid alcohol and traditional medicines that can harm the liver. Maintaining a healthy diet and avoiding infections are also essential to prevent liver complications.

The impact of vaccination
One significant success in combating Hepatitis B has been vaccination programs. Since 1989, newborns have been vaccinated, dramatically reducing the transmission rate. Among school children, the prevalence of hepatitis B virus in Malaysia has steadily declined from 2.5% in 1985 to 0.4% in 1996 with 92.7% vaccinated being protected under the Expanded Programme of Immunisation by WHO and the Malaysian government.

However, many believe that the initial vaccination provides lifelong protection, but some may need booster shots if their antibody levels drop. While Malaysia has made strides in reducing Hepatitis B prevalence through vaccination, challenges remain in screening, early diagnosis, and public awareness.

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