Hepatitis B and C cases rise in Malaysia with low public awareness, prompting calls for screening and better health campaigns.
KUALA LUMPUR: Aware that many people are reluctant to reveal their hepatitis diagnosis or share information about the disease, Rowen (not his real name) decided to create a Facebook group dedicated to raising public awareness about liver-related illnesses.
Diagnosed with hepatitis B about eight years ago and now in the cirrhosis stage (liver damage), the 49-year-old from Sabah admitted that he was initially disheartened before finding the strength to move forward and actively share information about hepatitis B and C, both of which can lead to liver cancer.
He founded the HEPATITIS A/B/C SUPPORT GROUP (MALAYSIA) on Facebook in January 2021, which has since gained more than 2,000 followers. Rowen said he first began experiencing symptoms in 2007 but was only officially diagnosed in 2017.
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“This disease is hereditary… I inherited it from my mother. Three of my siblings and I are carriers. The main factors that cause a carrier to develop the disease, leading to liver cirrhosis, include alcohol consumption, painkillers and the use of prohibited substances to build muscle.
“Cirrhosis is the final stage before it progresses to liver cancer, so when the doctor told me that I had developed cirrhosis, it was very hard for me to accept,” he told Bernama. “I was overwhelmed by extreme anxiety and insomnia. Every night as I tried to fall asleep, I would think about the disease and worry about the future of my wife and children.”
Unable to cope with the situation, Rowen began learning more about hepatitis, which eventually led him to establish a community for hepatitis patients to share their experiences and offer mutual support and motivation.
FEW ARE AWARE
Based on his experience, Rowen said unlike HIV/AIDS, heart disease, hypertension or diabetes, public awareness of hepatitis remains low, likely due to the lack of health campaigns about the disease.
“The symptoms of hepatitis B and C, in particular, usually become noticeable only at the stage of cirrhosis or liver cancer. However, even if you are diagnosed at the cirrhosis stage, it doesn’t mean life is over. With proper treatment and regular monitoring, the progression of liver damage can still be controlled,” he said.
Rowen said his treatment routine includes blood tests every six months, a liver scan every six months and an endoscopy (OGSD) once a year.
“The endoscopy is the most challenging but also the most crucial procedure (for cirrhosis patients). Through the camera inserted into the digestive tract, doctors can check for swollen blood vessels and determine whether small rubber bands need to be placed to prevent them from rupturing,” he said, advising the public to undergo regular hepatitis screening.
Regular check-ups are important because hepatitis shows no obvious symptoms until it reaches a serious stage, he stressed, adding that he now focuses on maintaining a healthy lifestyle while adhering strictly to his prescribed treatment plan.
HEPATITIS B MOST COMMON
Statistics from the Ministry of Health show that between 2013 and 2023, Malaysia recorded 49,992 cases of hepatitis B and 34,573 cases of hepatitis C.
Explaining the disease further, gastroenterology and hepatology specialist at Tawakkal Specialist Hospital Dr Melvin Raj said hepatitis B is a common infection and has the highest prevalence among Southeast Asian countries compared to regions such as Europe.
“In Malaysia, hepatitis B accounts for the highest number of cases (compared to other types of hepatitis). For that reason, the government made it mandatory in 1989 for all newborns to receive the hepatitis vaccination to control the spread of the infection,” he told Bernama.
“However, despite this preventive step, the number of cases continues to rise. In my view, this is partly due to foreign workers, such as those from Myanmar and Indonesia, who come to work here without receiving hepatitis vaccinations, making them vulnerable to hepatitis B infection.”
He added that public awareness about the importance of hepatitis screening remains low, leaving many at risk of developing chronic hepatitis B and C infections.
“For instance, some people only discover they have hepatitis after donating blood, when the donated blood is tested for diseases,” he said.
HEPATITIS A, B, C, D, E
Explaining from a medical perspective, Dr Melvin said hepatitis generally refers to inflammation of the liver, which is not always caused by the hepatitis B or C viruses, but can also result from medications that interfere with liver function and subsequently cause inflammation.
“For example, cholesterol-lowering drugs can cause liver dysfunction in some patients. Such cases are known as ‘drug-induced hepatitis’, a condition in which the liver becomes inflamed or damaged due to certain medications or substances. Tuberculosis medication can also cause liver inflammation,” he said.
He added that other causes of hepatitis include viral infections and immune system disorders. “The immune system is meant to protect us, but when it weakens, it can mistakenly attack the liver as though it were a threat,” he explained.
According to Dr Melvin, there are five main types of hepatitis – A, B, C, D and E. However, in Malaysia, hepatitis A, B and C are the most common, while types D and E are relatively rare.
Discussing the modes of transmission, he said each type spreads differently. Hepatitis A is transmitted through contaminated food and water, while hepatitis B and C spread through body fluids, including blood.
“A person can contract hepatitis B or C through blood transfusions, sexual contact or the use of contaminated needles, which is common among injection drug users or people getting tattoos. Sharing personal items such as razors and toothbrushes can also spread hepatitis B, particularly in prison settings where such items are often shared,” he said.
SEVERITY OF DISEASE
Dr Melvin added that compared to hepatitis B and C, patients with hepatitis A have a recovery rate of about 95 to 97 percent.
“For hepatitis A, the inflammation is short-term and patients usually recover. They may experience fever and feel unwell before getting better.
“For hepatitis B and C, however, the acute phase is brief but can develop into a chronic condition. A pregnant woman with hepatitis B faces a high risk of transmitting the virus to her baby during childbirth. Because the infant’s immune system is weak, it cannot fight the virus effectively.
“As a result, about 90 percent of babies infected with hepatitis B at birth will develop a chronic condition. To reduce this risk, infants (born to mothers with chronic hepatitis B) are given an additional injection of immunoglobulin, along with the hepatitis B vaccine,” he said, adding that both hepatitis B and C can cause liver damage and increase the risk of liver cancer.
However, Dr Melvin noted that there is hope for patients with hepatitis C as effective treatments are now available. Hepatitis B, meanwhile, can be managed through long-term treatment involving medication and injections.
“In the past, injections were the main treatment, but now we have oral medication. The difference is that injections are usually prescribed for a fixed period, such as six to 12 months, and are very costly. Oral medication, taken over the long term, helps control hepatitis B by reducing the viral load. When the virus is reduced, liver inflammation decreases, lowering the risk of liver cancer.
“For hepatitis C, treatment duration typically ranges from three to six months. Patients who are still healthy usually need three months of treatment, while those with cirrhosis may require treatment for up to six months,” he said.
On treatment costs, Dr Melvin said prices have dropped significantly compared to 15 years ago.
“In private hospitals, treatment for hepatitis C now costs around RM5,000 to RM7,000 for a three-month course, compared to over RM50,000 just five years ago.
“When I treated my first hepatitis C patient 15 years ago, the three-month course cost about RM150,000. Prices later dropped to around RM50,000, and now, thanks to access to affordable, high-quality medication from India, costs have fallen further. At government hospitals, treatment may cost only a few hundred ringgit, while private hospitals charge between RM5,000 and RM7,000,” he said.
IMPORTANCE OF SCREENING
Dr Melvin advised the public to undergo hepatitis screening, particularly young people aged between 18 and 20 preparing for higher education.
“Even if you were vaccinated as a child, it’s best to get screened again after finishing school. This allows for early intervention if needed, before any liver damage occurs,” he said.
On symptoms, Dr Melvin explained that since hepatitis A, B and C are viral in nature, common signs include fatigue, fever and body aches, though not all patients develop jaundice.
“When people hear the word ‘hepatitis’, they often associate it with yellowing of the eyes (jaundice). But not all hepatitis B and C patients develop that symptom. Many assume their fever and body aches are caused by dengue or influenza and never see a doctor. The majority of hepatitis symptoms are quite general, resembling those of common viral infections,” he said.
Acknowledging that hepatitis remains a neglected disease, Dr Melvin expressed hope for greater public awareness about the importance of early prevention of hepatitis.
“Health promotion activities related to hepatitis usually happen only once a year, around World Hepatitis Day. Many people take it lightly and only start paying attention when they fall seriously ill,” he said, stressing the importance of a healthy lifestyle.
Dr Melvin also cautioned against taking products that could harm the liver, especially slimming remedies.
“These products can damage the liver, as can many supplements sold in stores or online. We can’t always be sure if their ingredients are genuine, so it’s important to be cautious. Continuous alcohol consumption also poses a serious risk to liver health,” he added. – Bernama
