SPEECH BY YB DATO’ DR. CHUA SOI LEK, MINISTER OF HEALTH MALAYSIA,
AT THE 6TH LIVER UPDATE, SUNWAY LAGOON RESORT HOTEL, PETALING
JAYA, 21 JULY 2005 AT 8.30 AM
Y. Bhg Datuk Dr. Haji Mohd. Ismail Merican,
Director General of Health, cum
President, Malaysian Liver Foundation and
Organising Chairman, 6th Liver Update.
Distinguished guests, invited speakers, delegates,
Ladies and gentlemen.
1.
I am pleased to be with you here this morning at the invitation of the
Malaysian Liver Foundation (MLF), on the occasion of the launching of their 6th Liver
Update, jointly organized with the Ministry of Health Malaysia. I understand that
“Liver Update” is a series of international, biennial scientific meetings on diseases of
the liver, gall bladder, bile ducts and pancreas. This initiative was started by MLF in
1997 as part of their education program to assist the Ministry of Health in increasing
public awareness of the wide spectrum of liver diseases, particularly viral hepatitis,
and the preventive and control measures that can be taken to keep them at bay.
2.
The Ministry of Health has identified infectious diseases, including viral
hepatitis, as one of the priority diseases to be addressed under the Ninth Malaysia
Plan. Our thrust for the Ninth Malaysia plan will be towards achieving greater health
through consolidation of services. This will be achieved through various efforts,
including the wellness paradigm and a change of mindset to the acceptance of
health as the responsibility of all. In addition to this, our resolve to consolidate health
services will require, among others, tight partnerships with non governmental
organizations. Indeed, the successful relationship between MLF and the Ministry is
testimony to the value of such public-private partnerships.
Ladies and Gentlemen,
3.
As you are all aware, several types of viral hepatitis i.e. A, B, C, D, E and G
have now been recognized. However, the 3 commonest in Malaysia are hepatitis A,
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B and C. They are different in terms of severity of disease, epidemic features, nature
of spread, treatment and preventive measures taken.
4.
Hepatitis A is an infectious, food and water borne viral disease which is
especially common in children aged 5-14 years residing in developing countries. The
reported national incidence rate had dropped steadily from 2.24/100,000 population
in 2000 to 0.42/100,000 population in 2004. This decrease in reported cases from
497 in the year 2000 to 107 cases in 2004 is due to the various preventive and
control measures and strategies taken by the Government to control food and water
borne diseases by improving sanitation, providing safe water supply and
encouraging personal hygiene .
5.
Paradoxically as we become more affluent and less of the population get
infected at an early age, we are actually more susceptible to hepatitis A infection in
adulthood, as most of us will not have antibodies to hepatitis A. This scenario of
increasing incidence among adults has already been seen occurring in the more
developed countries like the United States of America, United Kingdom and others in
Europe. In Malaysia, It is now estimated that 50% of Malaysians less than 30 years
of age do not have antibodies to hepatitis A and are therefore susceptible to the
disease. Such people will benefit from hepatitis A vaccination, which will confer
protection for up to 10 years.
6.
Hepatitis A in adults may lead to severe liver disease. There is no specific
treatment for hepatitis A, except for rest, avoidance of alcohol consumption and
avoidance of heavy exertion. Once a person has recovered from this disease, they
are immune for life.
7.
In order to decrease the risk of contamination by hepatitis A virus specifically,
and all food borne pathogens generally, we have to rely on education of food
handlers and the public in our efforts to curb the disease. Good food sanitation and
general cleanliness of food premises are important. Protection of food handlers as
well as sewage workers from the disease by vaccination will also be beneficial as
they can be sources of contamination of food and water supplies.
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Ladies and Gentlemen,
8.
Hepatitis B, on the other hand, is transmitted from infected mother to child,
and through sexual contact, transfusion of infected blood and blood products, and
sharing of contaminated needles, razors and toothbrushes. It is present in all ages,
and can lead to chronic liver diseases, especially cirrhosis and liver cancer. Of the
350 million carriers of hepatitis B around the world, 75% are found in Asia. Hepatitis
B is therefore very much an Asian disease.
9.
In Malaysia, the reported incidence of hepatitis B had decreased from
12.9/100,000 population in 2000 to 7.7/100,000 in 2004. Compared to 2,863 cases in
2000, there were only 1,795 cases reported in 2004. About 5 – 8 percent of the
Malaysian population is chronically infected with hepatitis B, i.e. they are positive for
the hepatitis B virus surface antigen. In a survey of almost 900 patients with chronic
hepatitis B carried out by MLF, 50% of the hepatitis B carriers are infective, and of
these, 30-40% of them have evidence of liver disease and requires treatment. There
are two forms of treatment currently listed in the Ministry of Health drug formulary for
hepatitis B.
10.
The concern is that a large number of these carriers do not know that they
have the disease unless they have their blood screened for hepatitis B and C. This is
because the majority of patients with chronic hepatitis B and C do not exhibit specific
symptoms and they often come too late with manifestations of cirrhosis or liver
cancer. In this respect, I am happy that MLF have been working closely with the
Ministry of Health to help identify all those who have been infected, by screening the
blood of as many Malaysians as possible through their nationwide ‘hepatitis day’
campaigns. Those who have been infected will be put on long-term follow-up
surveillance for early detection of serious complications like liver cancer, while those
who have not been exposed will be educated on the preventive and control
measures available.
11.
In this regard, I am happy to say that Malaysia is amongst the first few
countries in this region to offer free vaccination against hepatitis B for all newborns
since 1989. This vaccination, which requires 3 doses to be given, is also readily
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available to the public at most of the private medical facilities. Immunization against
hepatitis B is recommended for those at special risk, for example intravenous drug
users, high risk health personnel, patients with haemophilia or on dialysis, sexual
contacts of hepatitis B carriers, and others involved in activities where direct contact
with blood or body fluids like semen is involved.
12.
I understand that 80% of liver cancer in Malaysia can be attributed to
Hepatitis B. In Malaysia, liver cancer is the 10th most common cancer amongst
Malaysian males. Of the 530 cases diagnosed in 2003, 57% were among the
Chinese, 32% in Malays and 6% in Indians. The overall male: female ratio of patients
is about 2.5:1.
13.
Last year (2004), the Hepatology Unit in Selayang saw 50 HIV patients co-
infected with Hepatitis B and Hepatitis C. This is one of the reasons why my Ministry
will be embarking on a ‘harm reduction’ needle and syringe exchange programme for
injecting drug users, whereby sterile injecting equipment will be exchanged for used
equipment. This will serve as an entry point for providing them with education and
referrals for health care as well as counseling, HIV testing and drug treatment. In this
way, we hope to effectively reduce the transmission of HIV, Hepatitis B and Hepatitis
C.
14.
Hepatitis C is a growing problem in Malaysia as more and more people are
found to have antibodies to hepatitis C through routine screening. In 2000, there
were 550 reported cases of hepatitis C in Malaysia, with an incidence rate of
2.5/100,000 population; and in 2004 there were 741 cases with an incidence rate of
2.9/100,000 population. The majority of these cases would have had transfusions of
blood or blood products in the past. Like hepatitis B, this disease has a propensity to
cause chronic liver disease, including cirrhosis and liver cancer, in up to 85% of
cases.
Ladies and gentlemen,
15.
I am pleased to learn that MLF have initiated a Liver Registry of patients with
all forms of liver diseases in the country. This will help to throw light on the
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magnitude and epidemiology of liver diseases in the country, which in turn will assist
us in health planning, particularly in the identification of target populations for health
education and treatment.
16.
The Ministry of Health has always been mindful and supportive of health and
educational strategies that will help to reduce the burden of liver diseases in the
country. In line with this, the Ministry of Health welcomes and appreciates the efforts
of NGOs like MLF in complementing the Ministry’s efforts to reduce the prevalence
of the various types of viral hepatitis prevailing in the country. All of us have only one
liver. Let us therefore support MLF in their efforts to help us take care of our liver.
17.
Let me end with the following quote:
"The service we render to others is really the rent we pay for our room
on this earth. It is obvious that man is himself a traveler; that the
purpose of this world is not 'to have and to hold' but 'to give and to
serve."
--Sir Wilfred T. Grinfell
18.
With this, it gives me great pleasure to officially launch the 6th Liver Update.
Thank you.
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