The New Nation - Internet Edition

Mohammad Mazibur Rahman, MD

Hepatitis B is a more deadly disease than HIV/AIDS. In fact, this disease takes two lives every minute. Moreover, one out of three of the 6 billion people in this world are infected with Hepatitis B and around 400 million people of the entire planet earth carry the virus of Hepatitis B. Furthermore, the number of new cases of Hepatitis B is between 10 to 30 millions and number of death due to Hepatitis B and its complications is around one million each year. The infectious potential of Hepatitis B is hundred times stronger than HIV and both the diseases transmit almost in a similar way. In addition, the long-term effect of Hepatitis B is more severe amongst children and under aged people than adults. Even though Hepatitis B is more dangerous than HIV, the good news is that there is very effective vaccine available in the market to prevent it.

Hepatitis is a kind of inflammation of the Liver, which lies on the upper right quadrant of the belly under the ribcage. Hepatitis infection can be acute, duration of which is less than six months and chronic the duration of which is more then six months.

The liver can be infected mostly with virus and sometimes, bacteria, fungi and many other organisms and insults due to injury and medications. While Hepatitis B is a DNA virus, there are five other different types of virus such as A, C, D, E and G. In our country, in particular, Hepatitis A infection is the most common, which in turn, is due to poor sanitation and consumption of contaminated water.

Hepatitis B is very prevalent in the underdeveloped and developing countries like Sub Saharan Africa, most of the Asia, Pacific Islands and in certain areas of Alaska. Patients having repeated blood transfusion for severe bleeding or for treatment of severe anemia for different reasons and patients on hemodialysis due to kidney failure are also susceptible to Hepatitis B. Individuals involved in promiscuous sexual behavior, involved in sex between same gender, having multiple sexual partners and having sexual intercourse with someone carrying Hepatitis B virus are also in great risk to catch hepatitis B. Intravenous drug abuse, snoring cocaine causing nasal septal injury and perforation, sharing same syringe and needle by multiple drug abusers, using un-sterile syringe and needles to collect blood from patients are also important way Hepatitis B is transmitted.

Health worker are also at great risk of contacting Hepatitis B, possibly from accidental needle injury while collecting blood from patients and while inserting intravenous line for saline or infusing medication. Laboratory technician too can contact Hepatitis B due to accidental exposure to contaminated blood or body fluids during laboratory procedures. Hepatitis B can also transmit from the infected mother to her baby while in the mother's womb or during delivery. Staying in an area for more than six months where Hepatitis B is very common, residents of long-term care institutions like nursing homes, dorms, hostels are also at increase risk of accruing Hepatitis B. It takes around one to six months to develop symptoms of hepatitis after been exposing to the virus and that period is called incubation period. Symptoms of acute and chronic Hepatitis B differ from each other. Children and young kids usually does not manifest significant symptoms, but in some cases symptoms varies from very minimum to liver failure that leads to death. Acute Hepatitis B can be silent, especially in children and young adults. Symptoms vary from mild illness to fulminant liver failure. Malaise, fatigue, pruritus, headache, abdominal pain specially on the right upper quadrant, myalgias-muslce pain, arthralgias-joint pain, nausea, vomiting, anorexia, fever, yellow discoloration of the eyes and urine and fever are also common but nonspecific symptoms of Hepatitis B.

Chronic Hepatitis B runs an indolent course, sometimes for decades. Fatigue is a common symptom. The disease can be apparent and diagnosed in an advanced stage and can manifest symptoms of end stage liver disease, like liver cirrhosis and liver cancer. Other organs of the body like kidney, skin, bone marrow and blood vessels can be involved because of the Hepatitis B infection.

It is very important to see a doctor once some one experiences symptoms of Hepatitis B, otherwise it can end up in liver failure in a very short period of time. If there is a suspicion of acute Hepatitis B, patients blood should be tested for Hepatitis B surface antigen (HBSAg), Hepatitis B core IgM antigen, Hepatitis B e antigen and elevated liver enzymes, all of which can confirm acute Hepatitis B. Persistent presence of Hepatitis B surface antigen, presence of Hepatitis B core IgG antigen, Hepatitis B e antigen and elevated liver enzymes identifies chronic Hepatitis B infection. Liver biopsy usually not required for diagnosis, but it can tell you the degree of inflammation and fibrosis resulting from chronic Hepatitis B.

The clinical course of Hepatitis B infection depends on the age of the person infected. Ninety percent of the children infected with the virus before age five and five to ten percent of the adults develop chronic Hepatitis. From the one percent of the chronic carrier cleared of the virus each year, thirty percent develops liver cirrhosis. Five to ten percent of the chronic carrier may develop liver cancer with or without preceding cirrhosis and the risk of liver cancer can depends on the degree of viral replication.

Prevention is better than cure; this proverb is very much appropriate in case of Hepatitis B. There are very few options for effective medical treatment and it is very costly. The goal of treatment is to clear the Hepatitis B virus from the body, disappearance of Hepatitis B surface antigen and Hepatitis e antigen and appearance of antibodies against these two antigens, normalization of liver enzymes and architecture of the liver tissue. Medications like interferon Alfa 2a and 2b, Lamivudine, adefovir, Entecavir and Telbivudine, which are approved by Federal drug Administration of USA and needs to be used for 4-6 months for the treatment of Hepatitis B. These medications are effective only in 10 to 30 percent cases. If the liver disease turns to advanced stage, Liver transplantation is the only option, which is very costly and not readily available.

However there is good news. The best way to protect someone from Hepatitis B is prevention and vaccination plays a very pivotal role in this regard. Hepatitis B vaccine can be administered in two different ways. In the developed country, it is a routine part of childhood vaccination program.

The first dose is administered usually on day two or three after birth, second dose in 2 months and the third dose is administered after 6 months of the first dose. Glaxo SmithKline has Twinrix vaccine's second dose is given on day 7 and third dose between 21 to 30th day of the first dose and a booster dose after one year. In this system, no further booster is necessary in future unless there is poor immune status.

Blood should be screened properly for all kinds of hepatitis viruses before transfusion. Also, it is better to avoid transfusing blood of professional donors.

Refrain from using illicit nasal and intravenous drugs, sharing no needles, using sterile and disposable syringe and needles to collect blood, injecting medication through muscle and intravenously. Moreover, be extra careful while drawing blood or handling blood or body fluids of infected patients while working in the laboratory as technicians and make sure not recap needles after drawing blood or pushing injections.

In addition, Health care providers like dentists and surgeons must use sterile instruments. As an individual following healthy and clean life style, it is very important not to engage in sexual promiscuity, not having multiple sex partners, not adopting homosexual behaviors and having protected sex with condoms even with legal married partners, if the legal married partner happens to carry Hepatitis B virus.

Government and private media, healthcare facilities should launch a campaign to educate our people about the consequence of hepatitis B and the way of protection from it. Moreover government can take an initiative to make the hepatitis B vaccine accessible and affordable to our people and can incorporate it as a part of childhood vaccination. Furthermore, quite interestingly, if we understand and follow the religious teachings, we can protect ourselves from many deadly diseases like Hepatitis B, HIV/AIDS and many other sexually transmitted diseases.