Early detection and treatment key to fighting hepatitis in UAE and beyond

Reintroducing hepatitis B and C screening for work permit applicants could help save lives.

What more can the UAE do to reduce hepatitis deaths? That was the question being asked earlier this week on World Hepatitis Day.

Around the globe, about 240 million people are infected with viral hepatitis B, which kills about 600,000 each year, and about 150 million more have hepatitis C, 350,000 of whom die annually, according to the World Health Organisation (WHO), the sponsor of the event.

In its global report on the disease, the WHO stated: "The fact that many infections are silent, causing no symptoms until there is irreversible damage to the liver, points to the urgent need for universal access to immunisation, screening, diagnosis and antiviral therapy.

"As hepatitis viruses show great diversity in their prevalence and modes of transmission in different parts of the world, policies and strategies for prevention and control need to be tailored to the specific national or sub-national context."

Hepatitis B is transmitted through exposure to contaminated blood and other fluids such as sweat, tears, semen, saliva and breast milk, while hepatitis C is transmitted mainly by blood-to-blood contact.

Both hepatitis B, for which there is a vaccine, and hepatitis C can lead to cancer or cirrhosis, but are highly treatable if they are diagnosed early. However, because they are asymptomatic, most people who are infected are unaware of it, often until successful treatment is no longer possible.

Last year, 665 new cases of hepatitis B and 527 new cases of hepatitis C were diagnosed in Abu Dhabi, according to the emirate's health authority. However, the number of cases diagnosed would perhaps be higher if the more stringent disease-screening process for work permit applicants that existed a few years ago was still in place.

In 2010, the Ministry of Health overhauled the residency medical law, which means that hepatitis B and hepatitis C screening are no longer mandatory for every expatriate wishing to live and work in the country.

Under the new regulations, screening for hepatitis B is only required for expats working in employment categories where there may be a significant risk of transmission to other people, including childcare workers, maids and those working in the food industry and at health clubs, beauty centres and hair salons. Hepatitis C screening is no longer required for anyone entering the country.

Before the 2010 overhaul, those infected with hepatitis C were required to undergo medical treatment, while those infected with hepatitis B were deported. The regulatory reform was a progressive move on the part of the health authorities, because it means the majority of infected people, who generally pose no significant infection threat to others, are no longer prevented from living and working in the UAE.

However, if universal hepatitis B and C testing were to be reintroduced for expatriates on a voluntary basis when they arrive as part of the general disease-screening programme when blood is taken, it could potentially reduce, in the long-term, the number of deaths from these viruses while at the same time reducing the risk of new infections.

This could be a costly exercise for the government, but given that many of the country's workers come from less developed countries where infection rates are very high - Pakistan has the second-highest infection rate in the world, according to the WHO - the one-off cost would arguably be justified in improving the health of the workforce. The cost could be offset by an additional charge imposed on those entering the country to work in higher-paying jobs.

The WHO is asking for measures to tackle the "silent epidemic" and using the UAE's existing screening programme to help those affected seek effective treatment is arguably a step in the right direction.