New Hepatitis B trend unsettles Lamu health experts, researchers

Hepatitis C screening at King Fahad Hospital in Lamu. [Mercy Kahenda, Standard]

He walked into the screening clinic simply wanting to know his health status. But after tests, 48-year-old seaman and fisherman received news he had not expected: He had tested positive for Hepatitis B.

He was counselled and linked to care. Moments later, he walked out of the Lamu County Referral Hospital determined to face the diagnosis and manage his condition. “I am not shocked. This is a disease that can catch anyone,” he said.

He suspects he contracted the virus through unprotected sex. He said seeing other people living with Hepatitis B while on medication had given him hope he, too, could live with the infection. “I am happy to know my status. Not knowing would risk infecting other people. Hepatitis B is not a death sentence. With medication adherence, I shall prevent the disease from advancing.”

For Beatrice*, however, the diagnosis came as a shock. The healthcare worker at a hospital in Lamu went for screening after colleagues encouraged her to get tested. To her surprise, the results were positive. “I cannot tell how I acquired the virus.”

She suspects her work may have exposed her to the infection. As a cleaner, some of her duties involve handling and washing garments contaminated with blood. “Though I am encouraged I shall be well, I am somehow stressed. Living with a disease is not easy,” she said.

Despite the shock, Beatrice plans to enrol for care and treatment.

Her case is part of an emerging trend that has caught the attention of scientists. Preliminary findings from an ongoing mass screening exercise in Lamu suggest Hepatitis B may be more prevalent than previously thought, particularly among people who inject drugs.

The screening is being conducted by the National Aids and STI Control Programme (Nascop) and Kenya Medical Research Institute.

Lamu was selected because of its historically high Hepatitis C burden. At least three in every 10 people tested for Hepatitis C have been positive, representing a prevalence of 29 per cent.

But the latest findings are surprising. Kemri medical research scientist Dr Missiani Ochwoto said researchers expected to find more active Hepatitis C infections among those who inject drugs due to risks associated with sharing needles.

About 300 have been tested, with a majority of those testing positive found to have Hepatitis B. “People who inject drugs by sharing needles are being found to have no Hepatitis C, and instead are found to have Hepatitis B,” said Nascop Viral Hepatitis and STI lead Dr Khadija Hassan.

The finding could signal a shift in the pattern of viral hepatitis in Lamu, although scientists caution the investigation is still at an early stage.

Antibody tests showed some people had previously been exposed to Hepatitis C. But further viral-load and confirmatory tests found they were not currently carrying the virus.

One possible explanation is the impact of harm-reduction interventions, including Medically Assisted Treatment such as methadone programmes for people who use drugs.

Scientists are also investigating whether Hepatitis B could be spreading through other forms of contact, including STIs, contaminated equipment and mother-to-child transmission. “It could be that Hepatitis B is higher in this population because of contact transmission that was not detected previously,” said Ochwoto.

Researchers are examining the demographics and risk factors of those testing positive to determine whether there are identifiable clusters.

Hepatitis B and C mainly affect the liver and can remain silent for years. Chronic infections can eventually cause severe liver damage, cirrhosis and liver cancer.

Nascop is urging people to know their status, practise safer sex and, among people who inject drugs, use sterile syringes and seek harm-reduction services.