Scientists puzzled as Hepatitis B emerges in Lamu, where Hepatitis C has dominated

Screening and testing for hepatitis B and C at Lamu Referral Hospital. [Mercy Kahenda, Standard]

Scientists are reporting a spike in Hepatitis B infections in Lamu County.

The findings are against the predominant infection of Hepatitis C, which has been high nationally and is linked to drug injections.

The finding has raised concern among scientists and health officials.

Lamu is leading in Hepatitis C infections, with at least three out of 10 people being infected, representing a prevalence of 29 per cent.

The preliminary findings were discovered during the ongoing mass screening of the general population and people who inject drugs by the National AIDS and STI Control Programme (NASCOP), with support from scientists at the Kenya Medical Research Institute (KEMRI).

KEMRI medical research scientist Dr Missiani Ochwoto said the finding was not what the team expected.

“We know that Hepatitis C has been prevalent among people who inject drugs because of sharing needles,” said Ochwoto.

In an interview with The Standard, the scientist said the team expected to find more cases of Hepatitis C among people who inject drugs because of the risk associated with sharing needles and syringes.

Antibody tests showed that some of those screened had been exposed to Hepatitis C at some point in their lives.

However, further testing found that they were not currently carrying the virus.

Screening and testing for hepatitis B and C at Lamu Referral Hospital. [Mercy Kahenda, Standard]

“We did the viral load and confirmatory testing, and the confirmatory test was not positive. This means we are not seeing the virus in these people,” added the scientist.

At least 300 samples have been tested, with the majority of individuals testing positive for Hepatitis B.

NASCOP Viral Hepatitis and STI Lead Dr Khadija Hassan said the findings were particularly concerning because they differ from the pattern previously documented in Lamu.

Lamu was selected for the screening because of its high burden of Hepatitis C.

“People who inject drugs by sharing needles are being found to have no Hepatitis C, and instead are found to have Hepatitis B,” said Hassan.

The findings, she said, could have implications for Kenya’s efforts to eliminate viral hepatitis.

“Together with scientists, we are digging deeper to see why we have a shift in the Hepatitis disease trend and what could be the underlying reasons,” added Dr Hassan.

The screening is still ongoing, with scientists analysing samples to establish the extent of the infections and possible risk factors.

According to a NASCOP official, one possibility of the discovery could be that interventions targeting injection drug use could be reducing Hepatitis C transmission.

Lamu has been implementing the Medically Assisted Treatment (MAT) programme, including methadone treatment, for people who use drugs.

With the interventions, Hassan observed that the findings could mean Hepatitis C infections could be declining.

Additionally, according to Kemri, the discovery could mean Hepatitis B is spreading through other forms of contact that had previously gone undetected.

Hepatitis is spread through contaminated equipment like needles, sexual contact, mother-to-child transmission, and other bodily fluid exchange with an infected person.

“It could be that Hepatitis B is higher in this population because of contact transmission that was not detected previously,” added Ochwoto.

Another possibility, according to KEMRI transmission among people who inject drugs could be shifting from Hepatitis C to Hepatitis B.

However, the scientists say it is too early to conclude.

“We need to look at the distribution and demographics of the people testing positive, their risk factors and whether there are any clusters,” emphasised Ochwoto.

Hassan said NASCOP would continue working with scientists to understand the emerging trend and guide the next response.

“We are continuing with screening and testing so that we can understand the burden and the risk factors better,” she said.