The government is going to launch a nation-wide programme to control hepatitis. The programme aims to provide the hepatitis-B vaccination to every new-born child in the country. The project - research and vaccination programmes, spanned over five years - will hopefully start functioning in next six months. A comprehensive vaccination campaign against the disease for children as well as adults is the need of the day. Vaccination for infants has been incorporated in EPI that covers almost 60 percent of the population. High-risk groups like rural areas of the country are going to be covered under the programme first. And blood banks must make sure the blood is screened for hepatitis B and C.
Prevalence of hepatitis is on the rise all over the world especially in third world countries. If not guarded against through proper planning, hepatitis would emerge as a major global health problem and will engulf half of the world population in about 10 to 15 years.
About 350 million people are suffering from hepatitis B and C around the world, with a large percentage in the Asian sub-continent.
The disease is also widespread in Pakistan particularly in rural areas. About 10 million people are suffering from hepatitis B and C. It has been estimated that every 10th Pakistani is hepatitis carrier. Over five percent of our population is hepatitis B sufferers and near same percentage is suffering from hepatitis C. That is around five to six million people in Pakistan are suffering from hepatitis B and about four to six million from hepatitis C.
In the year 2000 over two million new cases of hepatitis B (30 percent of all cases) and two million new cases of hepatitis C were registered due to unsafe injecting practices, that is reuse of syringes and use of contaminated injection devices.
TYPES OF HEPATITIS: There are many types of hepatitis - A, B, C, D, E, F, G, H. But three types - A, B & C are more common. The types A, E, F, G, H are transmitted through water whereas, hepatitis B, C and D, are transmitted through blood and blood products.
In Pakistan about 90 percent children suffer from hepatitis A. Adults' suffering rate is very low. Hepatitis E affects both children and adults. Mortality rate of about 20 percent occurs in later stage of pregnancy due to hepatitis E.
Hepatitis B sufferers have 90 percent chance while hepatitis C sufferers have only 20 percent chance of recovery. Therefore, hepatitis C is a lethal disease and about 80 percent adults are its victims. Hepatitis C, though incurable, its complications can be controlled to an extent as medical treatment options now available are helping to fight this disease better than ever before.
There is no way to diagnose hepatitis other than tests. Tests like ALT, LFT, ultrasound, alpha-fetoproteins test, HBs Ag and Hbe Ag test. Biopsy is not mandatory. PCR test should be done in the last when there is no other way to detect the disease.
The tests and ultrasound reveals whether a person is healthy carrier or has chronic hepatitis. The carriers are likely to develop chronic hepatitis B more easily than a normal person is.
There are two types of chronic hepatitis B; wild type and mutant type.
Wild type is common. In this type HBs Ag (Haemoglobin antigen) and Hbe Ag both are positive whereas in mutant type which occurs rarely, HBs Ag is positive and Hbe Ag is negative.
MAIN CAUSES OF HEPATITIS: One of the main causes of hepatitis is lack of awareness. Pricking in a drip bottle, reuse of syringes, blood transfusion, ear-nose piercing equipment, use of non sterilised dental instruments, reuse of razor at barber shop.
Other than these if you have underwent any surgery including oral surgery, kidney dialysis, cesarean delivery or other obstetric or gynaecological surgical intervention you are at risk of hepatitis.
SYMPTOMS: Loss of diet, vomiting, pain on the right side of stomach under ribs, chronic fatigue or tiredness and weakness. If any of these symptoms prevails, have a thorough check-up for detection of the disease.
PREVENTION AND CURE: If not diagnosed at right time hepatitis could give rise to many serious complications like liver cirrhosis and liver cancer. If affected by hepatitis, liver is unable to function normally and swells. Vaccination against the disease is the most appropriate intervention. Therefore, vaccinating children is very important because the infants who acquire the infection very early in the life become chronic carriers of hepatitis B. And if the child acquired the infection before the age of one year, it results in chronic liver disease and liver cancer in adolescents.
Only 10 percent adults may become carriers of hepatitis if they acquire the infection. About ten percent people below the age of 20 years and 50 percent people above the age of 40 years fell prey to the disease. Near 25 percent of the people have been afflicted the disease due to blood transfusion, so screening of blood before transfusion is necessary.
There are many misconceptions about the disease like getting it through touching, shaking hands, or eating in the same utensils etc. But this disease can not be transmitted by such interaction.
MISUSE OF DRUGS: It is advised that doctors must have follow up check ups of the patient and then prescribe a drug or recommend tests. If a patient has chronic hepatitis he/she must follow up check-ups for six months then if the tests have upper limit of normal 1.5 times no treatment is needed but if two times then treatment must be started.
According to Asia Pacific guidelines for management of hepatitis B a patient is treated by antiviral immuno modulation drugs because toxic drugs are useless and have dangerous side effects.
Age, gender, genotype variable also affect the treatment. Children recover faster than adults. Male response to the drugs is less than females. Patients above 50 years of age do well without being treated.
If anti HCV is positive it will remain positive for life even if the patient recovers. Ultrasound and serum tests must be done on yearly basis even after the patient is recovered to check the relapse of the disease. The therapy costs Rs 70,000 to Rs 80,000.