Using Local Approaches to Fight Viral Hepatitis
Professor Bira Namdag became a physician in 1983 and specialist in gastroenterology in 1992. She chose to work in the gastroenterological field, because of the interesting research opportunities it provided in Mongolia, as well as treating people who suffer from hepatitis and liver cirrhosis. She participated in the team for the development of the national guidelines on hepatitis diagnosis, prevention and treatment, which was established in 2015, and also in the viral hepatitis treatment team of the hepatitis C working group in the Ministry of Health and Sports.
“Much of my work involved teaching and preparing young physicians and professionals at academic institutions. I really wanted to explore evidence-based treatment, not just teaching from books.”
-Professor Bira
The national guideline on viral hepatitis B and D (delta) was recently approved by the Ministry of Health and Sports. It has been updated based on the new WHO guideline for the prevention, care and treatment of people with chronic hepatitis B infection and will be updated annually. The development of the guideline is being supported and advised by the Professional Council under the Ministry of Health and Sports, the WHO Regional Office for the Western Pacific and WHO country office experts. The guideline includes why, where, how and to whom hepatitis B vaccination, prevention and treatment can be provided. It also includes a guideline on hepatitis D virus, since hepatitis D is common among people with hepatitis B in Mongolia.
Professor Bira says, “Much of my work involved teaching and preparing young physicians and professionals at academic institutions. I really wanted to explore evidence based treatment, not just teaching from books.”
Professor Bira emphasizes that “Compared with other countries, Mongolia has a high burden of viral hepatitis B, especially with hepatitis D virus coinfection and superinfection. Since the hepatitis B immunization programme started in 1991, the prevalence has declined among people born after 1991. However, people born before 1991 are at a higher risk, and the people already infected often have cirrhosis or hepatocellular carcinoma.”
Recent research studies show that 60% of the people who test positive for hepatitis B surface antigen are superinfected with hepatitis D in Mongolia. Aligned with the objective of the Regional Action Plan for Viral Hepatitis in the Western Pacific 2016–2020 of promoting viral hepatitis research, she believes that more research needs to be conducted for viral hepatitis in Mongolia, especially because of the high superinfection of hepatitis B and D. She says, “Conducting research and providing new information for future generations in Mongolia, as well as treating people with hepatitis, gives me great motivation to work in this field.”
Hepatitis B treatment, including standard interferon, pegIFN, nucleotide and nucleoside analogues have been available in Mongolia since the 1990s. Today, new treatment for hepatitis B, especially tenofovir, is available in Mongolia and creates a great opportunity to reduce the cost of medicine and provide it in a more sufficient way for patients. New hepatitis C drugs have been available in Mongolia since 2015 and have led to very high cure rates. Liver transplantation is the treatment of end-stage liver disease and is very expensive, that’s why it is so important that people with viral hepatitis have access to treatment before the disease advances to this late stage.
Do Your Part!
Across the Western Pacific Region, hugely important steps and actions are taking place to help to eliminate viral hepatitis as a public health threat by 2030. This collection of stories celebrates the heroes who are leading the fight against hepatitis.