“The hepatitis virus is very durable,” points out Dr. Berkman. “It can remain infectious on environmental surfaces for at least a month if left at room temperature. Most people who get it fight off the infection by themselves, but the virus antibodies will be present in their blood for the rest of their lives.” – Dr. Alan Berkman, author of Hepatitis A to G: The Facts You Need to Know About All the Forms of This Dangerous Disease.
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Michelle, a lady executive, was totally devastated when her obstetrician told her she had hepatitis B. She was not ready to receive the bad news as she was in the third month of her first pregnancy.
“Your family physician sent me over copies of your blood tests,” her obstetrician said. “As she told you, the tests show that you carry the hepatitis B virus (HBV). Fortunately, the tests of your liver function are totally normal, and there’s no indication that there’s been any significant damage to your liver.”
“That’s great,” she answered sarcastically. “But most of my family members have died of liver disease or liver cancer. And what about my baby?” she wondered. “Will I give my baby the disease, too?”
Michelle is not alone in her dilemma. Worldwide, some 300 million people are living with the deadly HBV, according to the World Health Organization (WHO). In the Philippines, 40 out of every 100,000 Filipinos are suffering from the disease.
Expectant mothers who carry the virus can transmit it to their children. Since 1992, the United Nations health agency has recommended a first dose of the vaccine against HBV within 24 hours of birth, but only half of newborns are vaccinated that quickly, a study reported in “The Lancet Gastroenterology & Hepatology” medical journal pointed out.
“Most mother-to-child transmission occurs within days of birth, so the birth dose is vital,” Dr. Homie Razavi, the lead investigator and virologist at the Center for Disease Analysis outside Denver in Colorado, was quoted as saying. “All children need to receive this life-saving vaccine at birth, not just half of them.”
The word hepatitis simply means “inflammation of the liver”. So far, medical scientists have discovered six different kinds of hepatitis. A different virus causes each but the most important in terms of public health is hepatitis B virus (HBV).
Like most hepatitis viruses, HBV is all too easy to catch. In fact, it is more common than the human immunodeficiency virus (HIV), the microorganism that causes AIDS and far more infectious. If left untreated, HBV can cause serious diseases of the liver, including cancer.
“While 90% of the people who get hepatitis B recover spontaneously with their body’s defenses, the 10% who maintain the infection for six months or longer and who do not produce an effective antibody response are considered chronic carriers,” said Dr. Ernesto Domingo, a hepatologist who received a Ramon Magsaysay Award for raising awareness on the disease.
A small percentage of these chronic carriers will ultimately develop cirrhosis (scarring of the liver) or liver cancer. “Hepatitis B virus is the most common cause of liver cancer around the world,” says Professor Mei-Hwei Chang, chairman of the Department of Pediatrics at the National Taiwan University Hospital in Taipei. “Although hepatitis C virus is the most prevalent cause of liver cancer in some countries where HBV infection is not prevalent, HBV is still the most prevalent cause worldwide.”
Transmission
The HBV may be found in blood, semen, vaginal fluids, tears, and saliva. The virus, however, is not spread by contaminated food or water, and cannot be spread casually in the workplace. You can’t also get HBV from a mosquito bite.
“All viruses transmitted by a mosquito must go through a replication before sufficient viruses is available for infection,” explains Professor John S. Tam, of the Department of Microbiology at the Chinese University of Hong Kong. “HBV doesn’t grow in mosquitoes.”
The main ways of getting infected with HBV are perinatal (from mother to baby at birth), child-to-child transmission, unsafe injections and transfusions, and sexual contact. “Most infections occur from infected mother to child, from child to child contact in household settings, and from reuse of unsterilized needles and syringes,” the WHO says.
There are some reports that HBV may also be transmitted by puncturing the skin with sharp instruments – such as those used for acupuncture, dental, and medical procedures, even for ear piercing and manicures – that have been contaminated. “But the most effective means of transmission is sexual contact other than kissing,” says Dr. Dominic Garcia, an infectious disease specialist. “The scary thing is that a lot of people don’t know they have it.”
Intravenous drug users are among the most susceptible people to HBV “because of their exposure to other people’s blood,” points out Prof. Tam.
Also high risks of developing the disease include institutionalized children or adults, sexually active people, and men-having-sex-with-men, among others. People with kidney diseases that require dialysis and those undergoing treatment of leukemia are also at high risk of contracting HBV.
HBV is not transmitted casually but is remarkably persistent. “The hepatitis virus is very durable,” points out Dr. Alan Berkman, author of “Hepatitis A to G: The Facts You Need to Know About All the Forms of This Dangerous Disease.” “It can remain infectious on environmental surfaces for at least a month if left at room temperature. Most people who get it fight off the infection by themselves, but the virus antibodies will be present in their blood for the rest of their lives.”
Symptoms
The UN health agency says that the incubation period of the HBV takes a long 45-180 days usually without any manifestations or symptoms. Thus, people infected with hepatitis B may not even realize that they have it until the latter stages of the disease. And even when symptoms are present, they are vague, often mimicking other, less life threatening diseases.
“Sometimes, people infected with HIV have what looks like the flu, with symptoms including loss of appetite, nausea and vomiting, fever, and weakness,” explains Dr. Berkman. “They may also develop symptoms more directly related to their livers: abdominal pain, dark urine, and yellowing of the eyes and skin. That kind of hepatitis B infection is usually harmless, even if it can be a little unpleasant for a period of time.”
But about 8-10% of people who are infected develop chronic hepatitis B. “There are two forms of hepatitis B, one acute and the other chronic,” says Dr. Berkman. The acute disease is very unpleasant, but if you recover from it you are likely to be immune from then on. Unfortunately, sometimes the acute disease progresses to the chronic form. A blood test can determine if you have the acute form of the disease.”
What happens to a person infected with HBV? “When a person becomes infected by the hepatitis B, the virus travels to the liver where it enters individual liver cells,” said Prof. Nancy Leung, consultant and honorary associate professor and chief of hepatology at the Prince of Wales Hospital in the Chinese University of Hong Kong. “Here, it replicates and may reenter the blood stream or reinfect other liver cells. Symptoms of initial infection with hepatitis B result from the body’s attempt to defend itself against infection.
Prof. Leung continues: “Those individuals with the most severe of symptoms are therefore most likely to eliminate the virus from their body while those with no symptoms or have very mild complaints – typically children – are most likely to retain the virus and become long-term carriers.”
Prof. Leung added that the HBV may remain in some individuals after the initial infection and the patients are said to be chronic hepatitis B carriers when part of the surface of the virus remains in the blood for more than six months. “The result of long-term carriage of the HBV is continuing inflammation of the liver, which may lead to serious liver damage and cancer,” she said.
Liver cancer is almost always fatal, and usually develops between the age of 35 and 65 years of age, when people are maximally productive and are trying to raise their own children. It occurs more commonly among Asians. In Singapore, for instance, liver cancer is the third most common cancer and the second most common cancer among males. “The risk of liver cancer increases with smoking and consumption of alcohol,” says Professor Mei-Hwei Chang, chairman of the Department of Pediatrics at the National Taiwan University Hospital in Taipei.
Incurable
Like the dreaded AIDS, hepatitis B is incurable. An estimated 600,000 people die every year from hepatitis-B related liver diseases, making HBV a bigger killer than malaria. Fortunately, there are anti-viral drugs which have proven to be effective in coping with symptoms.
Since the early 1980s, a test for HBV has been available but recent studies show that only one in 10 sufferers around the world has been diagnosed.
Being vaccinated immediately against the disease is especially important for those who are at high risk. Susan, a dentist, can attest to this. She was struck with a needle only once on the job, but because she was not vaccinated, she came down with a severe case of hepatitis B that kept her in bed for more than two months.
Today, Susan is no longer infectious. Nevertheless, the quality of her life has been significantly altered in several ways. “The whole thing has made my husband very nervous,» she said. Now, he insists on using a condom, which puts a damper on our once-perfect sex life. And I constantly worry about getting stuck with a needle again. Next time, it could be AIDS.”
Because of the previous experience, Susan is already wearing gloves and a surgical mask on the job, as should all health-care workers. “Doctors and dentists, who are exposed to the blood and mouth fluids of many patients, are much more at risk than their patients,” she stressed.
