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Greater awareness of hepatitis A, B and C needed

World Hepatitis Day, 28 July, is an international event to increase awareness of the dangers of viral hepatitis. Today, about 500 million people (one in 12 world-wide) are victims of viral hepatitis B or C with many unaware of its danger. It is a day to encourage people around the world, to adopt precautionary measures before it is too late.

For 2013, the overall theme continues to be "This is hepatitis. Know it. Confront it." The campaign emphasises the fact that hepatitis is a health threat in much of the world just like other communicable diseases such as HIV/AIDS, tuberculosis and malaria.

THE A B C OF HEPATITIS: The word "hepatitis" stands for inflammation of the liver. There are five main hepatitis viruses, symbolised as types A, B, C, D and E. These five types cause severe illness and death. Many persons with viral hepatitis experience no obvious symptoms until serious liver damage has occurred. Hepatitis viruses have potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and together are the most common cause of damage to the liver and liver cancer.

CAUSES OF HEPATITIS: Intake of contaminated, raw, undercooked foods, water contaminated by animal or human wastes, transfusion of contaminated blood or blood products, re-use / suspect quality syringes, sharing of tainted needles, and poorly sterilised medical equipments are common causes of Hepatitis spread. The illness can transmit from mother to baby at birth, from family member to child.

SYMPTOMS OF HEPATITIS: The primary stage of hepatitis is the acute phase. The symptoms are like a mild flu, jaundice (yellowing of the skin and eyes), and dark urine. It may include Diarrhea, Fatigue, loss of appetite, mild fever, muscle or joint aches, nausea, Slight abdominal pain Vomiting and Weight loss. The acute phase is not usually dangerous, unless it develops into the "rapidly progressing form", which can be fatal.

Physicians warned that patients with chronic hepatitis 'C' can develop many extra hepatic symptoms like rheumatoid arthritis, dryness of mouth, eyes, and lymphoma, which are possibly due to altered immune response. Psychological disorders like depression are seen in about 20 to 30 percent patients.

Liver failure (Cirrhosis) may lead to portal hypertension, accumulation of fluid in the abdomen, easy bruising or bleeding, enlarged veins, especially in the stomach and esophagus, jaundice, and a syndrome of cognitive impairment known as hepatic encephalopathy (Wikipedia).

TYPES OF HEPATITIS: According to the World Health organisation report, globally, there are an estimated 1.4 million cases of Hepatitis A every year. Two billion people world-wide have infected with the Hepatitis virus B and about 600 000 people die every year due to the consequences of Hepatitis B. About 150 million people chronically infected with Hepatitis C virus, and more than 350 000 people die every year from Hepatitis C-related liver diseases. In Pakistan, Hepatitis A is a childhood disease. In cases of hepatitis under ten 60 percent of the cases are due to Hepatitis A, 30 percent Hepatitis E virus, 10 percent Hepatitis B virus.

Hepatitis A virus (HAV) is present in the faeces of infected persons and most often transmitted through consumption of contaminated water or food. Infections are in many cases unruffled, with most people making a full recovery and remain resistant from further HAV infections. However, negligence can make HAV infections severe and life threatening. Most people in areas of the world with poor sanitation infected with this virus. Safe and effective vaccines are available to prevent HAV.

Hepatitis B virus (HBV) transmitted through exposure to infective blood, semen, and other body fluids. HBV can transmit from infected mothers to infants at the time of birth or from family member to infant in early childhood. Transmission may also occur through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. Medical staffs are at risk of HBV in case of accidental needle stick injuries while caring for infected-HBV patients. A safe and effective vaccine is available to prevent HBV. Hepatitis B can also cause kidney problems, and infected adults likely to experience kidney failure.

Hepatitis C virus (HCV) mostly also transmitted through exposure to infective blood. This may happen through transfusions of HCV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. Cirrhosis due to hepatitis C is a common reason for liver transplantations.

Hepatitis D virus (HDV) also known as the delta virus is a small virus. HDV infections occur only in those who are infected with HBV. HDV cannot survive on its own because it requires a protein that the hepatitis B virus makes (the envelope protein, also called surface antigen) to enable it to infect liver cells. The dual infection of HDV and HBV can result in a more serious disease and worse outcome. Safe and effective hepatitis B vaccines provide protection from HDV infection.

HEPATITIS RATE IN PAKISTAN: Pakistan is the second country having high rates of chronic infections. Hepatitis is one of the 10 reportable diseases in Pakistan. Around 15 million citizens of the country are suffering from hepatitis. The annual liver admissions and mortalities in established GI & Liver Centers ranges from 25-35% in various parts of the country. With overall prevalence of Hepatitis B and C is 3-4 (6 million infections) and 6-8 (7 million infections) respectively, Pakistan is currently facing an epidemic of viral hepatitis.

About 66% population of Pakistan is living in rural areas. Regretfully, unavailability of basic health facilities, illiteracy, poverty and unhygienic way of living and presence of untrained medical staffs and quacks are increasing the cases of viral hepatitis in rural areas.

In urban and suburban areas, Drug addicts that commonly share needles and syringes are harbours of hepatitis C or B viruses. Therefore, drug injection is an important risk factor in hepatitis C transmission. As indicated by statistics, intravenous drug use accounts for around 50 percent of overall cases of hepatitis C transmission. Statistics also reveal that intra-nasal drug use (especially cocaine) accounts for around 5-10 percent of overall cases of hepatitis C transmission. Improper disposal of hospital wastes is one of the most common contributing factors associated with the spread of hepatitis C in Pakistan.

A new study conducted by Pakistan Council of Research in Water Resources PCRWR after tests of water sources across 24 districts in the country found that over 80 percent of the provided water was unsafe for drinking. PCRWR says 250,000 children die each year in Pakistan because of water borne illnesses.

PRECAUTIONS: All types of Hepatitis accept "Hepatitis C" is preventable by vaccination.

The risk of infection can reduce by taking following precautionary measures:

Avoid sharing personal items such as razors or toothbrushes. Do not share drug needles or other drug paraphernalia (such as straws for snorting drugs). Clean blood spills with a solution containing 1 part household bleach to 10 parts water.

People who infected with the hepatitis C virus should avoid drinking alcohol as this can accelerate the liver damage associated with hepatitis C. People who infected with hepatitis C should also receive vaccinations for hepatitis A and B.

Eat cooked foods; eat hot foods hot and cold foods cold. Drink and use ice from only purified water that boiled or disinfected with chlorine or iodine, or commercially bottled water in sealed containers. Avoid unpasteurized dairy products. Avoid swimming in polluted or contaminated water.

Avoid tattoos, piercings and acupuncture performed with contaminated equipment. Only eat fruits that you can peel if you are somewhere where sanitation is unreliable. Always Wash your hands with soap after using the toilet. The control of the transmission of viral hepatitis can reduce the mortality caused by the disease. It is important to educate public about the mode of transmission and precautions of disease. Patients from poor and rural areas should get free treatment and vaccination facilities.

Copyright Business Recorder, 2013


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