M.A. Jabbar :
Every year on 28 July, WHO and member countries observe World Hepatitis Day to create awareness and understanding of viral hepatitis, a group of infectious diseases known as Hepatitis A, B, C, D and E and the diseases they cause. Hepatitis simply means inflammation of the liver and one of the most common causes of chronic hepatitis is viral infection. According to World Hepatitis Alliance, about 500 million people are currently infected with chronic hepatitis B or C and 1 in 3 people have been exposed to one or both viruses. The World Hepatitis Alliance first launched World Hepatitis Day in 2008. However, the UN declared official recognition of the event in 2010. “Hepatitis : Think Again” is the theme of the day this year is timely and appropriate for taking action against the deadly diseases. WHO and member countries urge policy-makers, health workers and the public to combat the hepatitis, the silent killer that affects hundreds of millions of people worldwide, causing acute and chronic liver diseases and killing close to 1.4 million people every year. Nevertheless, hepatitis remains largely ignored and unknown.
Let us discuss about different types of hepatitis. Hepatitis A virus is one of the most frequent causes of food borne infection. Epidemics related to contaminated food or water can erupt explosively, such as the epidemic in Shanghai in 1988 that affected about 300000 people. Hepatitis A virus persist in the environment and can resist food-production processes routinely used to inactivate and or control bacterial pathogens.
The disease can lead to significant economic and social consequences in communities. It can take weeks or months for people recovering from the illness to return to work, school, or daily life. Risk factors of the disease include i. poor sanitation, ii. lack of safe water iii. Injecting drugs iv. living in a household with an infected person v. being a sexual partner of someone with acute hepatitis A infection vi. travelling to areas of high endemicity without being immunized. Improved sanitation, food safety, and immunization are the most effective ways to combat hepatitis A. Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.
The virus is transmitted through contact with blood or other body fluids of an infected person. The virus is not spread by contaminated food or water and cannot be spread casually in the workplace.More than 780000 people die every year due to the consequences of hepatitis B. Hepatitis B vaccine has been available since 1982 and is 95% effective in preventing infection and its chronic consequences. WHO recommends that all infants should receive hepatitis B vaccine as soon possible after birth, preferably within 24 hours to avoid fatal consequences? All children and adolescents younger than 18 years old and not previously vaccinated should receive the vaccine.
As on 2012, 183 member states vaccinate infants against hepatitis B as part of their vaccination schedules and 79% of children received the hepatitis B vaccine. This is a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution that recommended global vaccination against hepatitis B. In addition implementation of blood safety strategies, including quality assured screening of all donated blood and blood components used for transfusion can prevent transmission of HBV. Hepatitis C virus is a blood borne virus and the most common modes of infections are through unsafe injection practices, inadequate sterilization of medical equipment in some health-care settings, and unscreened blood and blood products. 350000 to 500000 people die each year from hepatitis C related liver diseases.
WHO recommends : hand hygiene, including surgical and hand preparation, hand washing, and use of gloves, safe handing, and disposal of sharps and waste, safer cleaning of equipment, testing of donated blood, improved access to safe blood and training of health personnel for prevention. Every year there are an estimated 20 million hepatitis E infections, over 3 million acute cases of hepatitis E and 56600 hepatitis related deaths.
The virus is transmitted through the faecal-oral route, principally via contaminated water. This is found worldwide, but the prevalence is highest in East and South Asia. China has produced and licensed the first vaccine to prevent hepatitis E virus infection, but it is not yet available globally. Typical signs and symptoms include jaundice, anorexia (loss of appetite), an enlarged, tender liver, abdominal pain and tenderness, nausea and vomiting and fever.
World Hepatitis Day provides an opportunity to focus on specific actions, such as: i. strengthening prevention, screening and control of viral hepatitis and its related diseases. ii. increasing hepatitis B vaccine coverage and integration of the vaccine into national immunization programmes and iii. coordinating a global response to viral hepatitis. WHO is working in the area viz. raising awareness, promoting partnerships and mobilizing resources, formulating evidence-based policy and data for action, preventing of transmission and promoting access to screening, care, and treatment services.
Bangladesh perspective: The country has a high population density with 1074 people per square km. with poor socio-economic hygienic condition. The incidence of different kinds of liver diseases like hepatitis, cirrhosis, and liver cancers is common in our country. Data found from Liver Foundation of Bangladesh shows that about 4-7 percent of our population have hepatitis B and 1-3 percent has hepatitis C infections. About 3.5 percent of pregnant women have hepatitis B viral infection.
They are potential source of transmission of hepatitis B virus to their newborn. National Prof Dr M R Khan said that people infected with hepatitis B and C would suffer from different chronic diseases including liver cirrhosis and liver failure. Among the patients coming to hospitals with jaundice, 43 percent were suffering from hepatitis E, 22 percent from hepatitis B and 8 percent from hepatitis A. Former VC of BSMMU Prof Nazrul Islam said that 85 percent possibility of transmitting hepatitis B and C virus to the newborn are from the infected mothers. Experts emphasized on safe blood transfusion to prevent the disease.
In addition, alcoholic liver disease also increasing. Contaminated food and drinks with many kinds of chemicals and preservative also continuously contributing to various kinds of diseases of liver. Drug abuse in various forms poses a threat to public health.
These threats to public health have led the international community to call for a stronger and more coordinated response, Compounding this public health risk is the fact that the supply chain for medicines operates at a global level, and therefore, a concerted effort at the international level is required to effectively detect and combat drug abuse as well as supply chain.
For effective control of hepatitis virus all arrangements may be made for public awareness, combat drug abuse and counseling of liver disease patients. Liver clinic service, e-liver service, website liver service, postal service, screening, and vaccination service, mass media service, information service (i.e. issuance of free leaflets, seminars, and discussion meetings etc) will help combat spread of hepatitis related diseases. Diagnostic facilities be extended in all health care centers at affordable cost. Setting up of hospitals and research center for the treatment and research needed for long-term management of the disease. University and college students may be involved; seminar, survey, workshop, and class campaign media campaign via website, face book, twitter, newspaper, online news portal, and radio can create awareness and help prevent the diseases. As Multiple factors are responsible for the cause and spread of liver disease in
Bangladesh, prevention well ahead and extending facilities to patients in time may help prevent many deaths. Government of Bangladesh is cordial to combat hepatitis. Bangladesh Hepatology Society and Liver Foundation of Bangladesh are working in this respect.
Along with government efforts, health personnel, public representatives, social workers, NGOs, religious leaders, schoolteachers, and individuals may work to prevent and raise awareness about the threat posed by hepatitis virus. Working together, victory over hepatitis will not be far distance to save million of lives.
(M.A.Jabbar writes on health and environment issues and is executive secretary of ADHUNIK, national anti-tobacco organization of Bangladesh.)
