Official Launch Of The NUH Hepatitis B Total Care Programme

15 Nov 2003

By Dr Balaji Sadasivan

Venue: Sheraton Towers Hotel

Thank you for inviting me here today for the launch of the NUH Hepatitis B Total Care Programme.

Viral hepatitis is a common cause of liver disease in Asia. Hepatitis B is the most common form, with a prevalence of 4.1% in Singapore. Hepatitis C is less common and occurs in less than 0.2% of the population. Hepatitis B is endemic in many Asian countries such as China, Hong Kong and Taiwan, and is usually transmitted from mother to child at birth.

In the long term, viral hepatitis is devastating. Complications of hepatitis B include liver cirrhosis, bleeding from stomach varices, liver and kidney failure, liver cancer and early death. Liver cirrhosis and other chronic liver diseases are the tenth commonest cause of death in Singapore today. Liver cancer is the fourth commonest cancer in Singapore males.

The key component of hepatitis B control in Singapore is immunisation to prevent the susceptible population from being infected. To protect infants and young children at an early age, hepatitis B vaccination was integrated into the Childhood Immunisation Programme in 1987. Beginning in 2001, a four-year hepatitis B immunisation programme for students born before 1987 was started. In addition, the immunisation programme was offered to all polytechnic, ITE and university students. Adults are also encouraged to be vaccinated if they do not have immunity against the disease.

Ongoing health education is carried out through printed materials and the mass media to increase public awareness on the effects of the disease, its mode of transmission and effectiveness of vaccination. Healthcare establishments are also encouraged to adhere to infection control guidelines in the healthcare setting to prevent transmission of the disease.

Screening is another measure that can be taken and all pregnant women should be tested for hepatitis B during their early antenatal visits. If positive, measures can be taken to minimize the risk of perinatal transmission, such as administering hepatitis B immunoglobulin to the newborn. Screening high risk individuals like those with a family history of infection, liver cancer or those at high behavioural risk should also be carried out.

When screening detects someone with hepatitis B infection, we need to manage the disease. It should be appreciated that problems associated with the disease are not symptomatic until late in the disease. Therefore, surveillance through regular check-ups and blood tests are important for the accurate assessment of liver damage. Complications of liver disease can be delayed and even prevented if treatment is started early enough.

The treatment and follow-up of patients with hepatitis B may need to be long-term. Treatment of viral hepatitis is expensive and costs may run up to thousands of dollars annually. With complicated liver disease, frequent hospitalisation and investigation may be necessary, leading to additional medical expenses.

Unfortunately, many patients are unaware of the risk of progression or the availability of treatment, and default their regular follow-up with their doctors. A recent survey done by NUH revealed that 64% of chronic hepatitis B patients were not on regular follow-up and some 40% of patients had dropped out of their regular surveillance programme. These patients may later develop liver cirrhosis, liver failure or liver cancer. These complications are avoidable and can be treated if detected early.

The National University Hospital's Hepatitis B Total Care Programme is an excellent patient care intiative with a holistic approach to the management of this disease. The programme aims to empower patients with resources to enable them to take charge of their health and prevent disease. Through its focus on education, treatment, participation in research and clinical trials, and social support, patients and their caregivers will be better equipped to manage their health.

One of the components of the Hepatitis B Total Care Programme is a pilot project funded under my Ministry's Health Service Development Programme (HSDP). This HSDP project provides for enhanced treatment and follow-up of patients with viral hepatitis. I am pleased to see that NUH has built on this project for its total care programme.

In addition to HSDP funding, my Ministry has also supported medical research in hepatitis B. Almost $3 million in National Medical Research Council (NMRC) funds has been granted to date, to support research ranging from treatment regimens for chronic active hepatitis, to studies of serological markers for hepatitis B in liver cancer.

In closing, I congratulate NUH on launching this holistic disease management programme. A key component of the programme is that it empowers patients to take control of their health through their education and provision of counselling and emotional support. I would like to encourage the healthcare delivery clusters to adopt more of such innovative and integrated approaches in their disease management programmes.

Thank You.