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Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention

World Hepatitis Day in Ghana

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Ghanians lined up for a viral hepatitis screening at last year's World Hepatitis Day event in Tamale, Ghana (Northern Region)

HBF is pleased to share World Hepatitis Day plans of our friend Theobald Owusu-Ansah of the Theobald Hepatitis B Foundation in Ghana. The Foundation is also a voting member of the World Hepatitis Alliance. 

On July 28th, 2013, The Theobald Hepatitis B Foundation and the Hepatitis Coalition of Ghana will join the World with one voice to celebrate World Hepatitis Day in Sunyani at Victoria Park. In attendance will be the Chiefs, members of Parliament, District Chief Executives, Municipal Chief Executives, Assembly Members and all the Opinion Leaders of the Region.

The Theobald Hepatitis B Foundation is a non-profit organization whose main aim is to educate and create awareness of hepatitis B and C to the general public, ranging from the causes, and symptoms of viral hepatitis, to preventive measures.

On World Hepatitis Day, the activities will start with an early morning Float with music and dance throughout the principal streets of Sunyani, along with the members and volunteers of the Foundation and the Coalition distributing educational materials to the crowds. These leaflets, posters, banners and stickers are part of the ongoing media blast that will draw the public’s attention to problem of chronic hepatitis B among the people of Ghana.

Free screening and hepatitis B vaccinations will be ongoing throughout the day’s activities. Resource persons will be delivering their messages and educating the general public about viral hepatitis. It is important that the people learn and understand whether or not they are positive or negative for viral hepatitis, and if they are positive, what is next.

The Delegation of the Government and other health care professionals will educate the public on Viral Hepatitis Policies and the way forward. Dieticians will also take the general public through the kind of food and diet one needs to eat, and the importance of avoiding alcohol, in order to defuse the public cry of the cost of prevention and treatment of hepatitis B.

Participating organizations will then take the opportunity to appeal for funds from the government officials and the Chiefs of the region present, in order to enable us to successfully organize our last programme of the year.

At the end of the event, the public will be provided with advice, and directed to seek medical information from qualified health professionals, in order to avoid falling into wrong hands of those trying to sell false cures for those with hepatitis B.

Please join us for our World Hepatitis Day activities in Victoria Park if you are in Sunyani, Ghana.

Theobald Owusu Ansah
Theobald Hepatitis B Foundation
P.O. Box GP 21325 Accra-Ghana:

Phone: 00233-20-8269214
theobald2003@yahoo.com
Theobald Hepatitis B Foundation website

 

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World Hepatitis Day 2012 in Cairns, Queensland, Australia

WHD 2012 Cairns: Hep Day Out friends - Yvonne, Rhondda, Murph & Allana

A personal reflection on WHD events from Guest Blogger Yvonne Drazic

WHD was again promoted and celebrated in style in Cairns with lots of dedicated people making it a great success. The key organizers were Rhondda, the Viral Hepatitis Health Practitioner from the Cairns Sexual Health Service, and Alanna and Julie from the Queensland Injectors’ Health Network (QuIHN). At present, the bulk of hepatitis B health promotion and patient support is done through these organizations as part of hepatitis C and HIV services because sufficient separate government funding for hepatitis B is not yet forthcoming.

Last year, Rhondda organized a fabulous free lecture about hepatitis B which, while aimed at health care professionals and medical staff, was open to the public and especially to people affected by or living with hepatitis B. The speaker was Dr. Benjamin Cowie, an infectious diseases physician from Melbourne with a special interest in hepatitis B. His passionate and compelling presentation evoked great feedback from the audience, many stating it was a real eye-opener. This year’s lecture was presented by Dr. Joshua Davis who spoke equally engaging about his efforts to address hepatitis B in Indigenous communities in the Northern Territory. The talk attracted an audience of more than 100 people. As an add-on to the lecture, Aboriginal and Torres Straits Islander health workers could move on to an event/workshop called Yarnin up HepB where they were able to discuss anything hepB – and get expert advice – from Dr. Davis. This was very well received although many participants were quite disturbed about the statistics of hep B in Aboriginal and Torres Strait Islander people.

This year the open day at Cairns Sexual Health Service was called “Hep Day Out”. It was designed to be fun with funky, colourful posters (created by the talented Murph) and a music jam session. Like last year, the day featured tours of the premises with screening opportunities, as well as the famous QuIHN van offering information, a scrumptious lunch and fun activities. Every visitor who took the tour and completed a short quiz received a cool t-shirt courtesy of Hepatitis Queensland (see photos) and a health pack. In addition, the resident psychologist was on site for people who wanted a chat and I was available for brain-picking for everyone who wanted to know more about hepatitis B. Invitations were distributed to migrant services and communities but unfortunately did not attract any visitors from these groups. Possibly the time was unsuitable due to work commitments but it could also be due to fear of stigmatization which may be increased in these populations. I am currently conducting research to explore barriers and other issues that may keep people from engaging in health-protective actions such as screening and monitoring. It will also help to find more effective ways of engaging with migrant communities and get a better turnout for next year’s WHD.

Overall, plenty of awareness was raised, many people were educated about viral hepatitis, and a fun time was had by all.

Hepatitis B Diagnosis & Monitoring

World Hepatitis Day Reflection: Asian Institute of Medical Sciences, Hyderabad Pakistan

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Thank you to Prof., Dr. Muhammad Sadik Memon, MBBS, FCPS (Gastro), FCPS (Med), MACP, MAGA,  for his personal reflection from World Hepatitis Day, 2012 events in Pakistan.

In order to raise awareness on World Hepatitis  Day, Saturday, 28th of July 2012, the Department of Gastroenterology and Hepatology of the Asian Institute Of Medical Sciences, organized a public awareness and open discussion seminar.

Gastroenterologists, family physicians, GPs, postgraduate students and para- medical staff all participated in the open discussion.

The program was started in the name of “Almighty Allah” and a recitation from the Holy Quran.

Dr Iqbal Haroon, Director of Hajiyani Hospital, was the moderator of the open discussion.

“It  is closer than you think” was the theme of this year’s World Hepatitis Day, and the open discussion focused on raising awareness on the different forms of viral  hepatitis: what they are, how they are transmitted, who is at risk, and the various methods of prevention and treatment.

Professor, Dr. Sadik  Memon, organizer of this event,  said that in Pakistan, many patients have lost their lives at the hands of quacks, so Pakistan needs the strictest possible laws to fight against these quacks, and must eradicate these deadly liver diseases.

Dr. Sadik Memon further described how in Pakistan millions of people are infected with HBV . He added that every 10th to 12th individual in the Pakistani population is infected with hepatitis B or C ,which far exceeds the numbers from the last big earthquake  in Pakistan. It is essential that Pakistani doctors unite to save human lives and spare them of these deadly diseases.

The most important aspects of prevention are hepatitis B vaccination, the screening of blood products, sterilized equipments and better hygiene standards in barber shops.

Dr. Waqar, focal person of the Government Hepatitis Program, discussed the efforts of the Sindh government regarding the hepatitis program.  He said that thousands of peoples from Sindh are receiving free interferon and anti- viral therapy from Zakat and Bait-ul-mal funds.

Before the end of open discussion Dr. Aamir Ghouri gave thanks to the audience, the guests of honor, and also the Roche Pharmaceutical company for sponsoring such a wonderful event in this blessed Month of Razman.

After completing the open discussion, DUA, (prayer) was performed for patients who are suffering from liver diseases by the Asian  Institute of Medical Sciences staff. Another open discussion was followed by Iftaar dinner. It was a memorable World Hepatitis Day.

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Raising awareness and Enabling Protective Action in an Affected Community in Australia: A work in progress…

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Welcome Guest Blogger Yvonne Drazic. She is a PhD candidate at James Cook University in Cairns, Far North Queensland, Australia. Her research focus is on reducing the rate of undiagnosed and untreated chronic hepatitis B, in migrant communities from endemic areas, particularly the local Hmong community. Yvonne lives with chronic hepatitis B, and feels privileged to be one of the less than 3% of hepatitis B cases treated in Australia. She gives back in so many ways, and is also a list parent on the HB-List, an online patient forum. 

As a research student from tropical Far North Queensland in Australia, I am grateful that today’s technology allows me to be part of the global hepatitis B community. My goal is to help our local Hmong community of about 700 people to prevent future repercussions of undetected and untreated chronic hepatitis B (CHB). Having CHB myself, I was amazed to learn how many people miss out on vital medical care because they are unaware of their infection, or of its potential consequences. At present, the incidence of hepatitis B-related liver cancer is rising in Australia because undiagnosed CHB is doing much more harm than newly acquired infections in adults. The majority of affected people in Australia are migrants from endemic areas and Aboriginal and Torres Straits Islander people who were mostly infected at birth or in early childhood. Yet, less than 3% of cases are currently receiving antiviral therapy (Carville & Cowie, 2012).

I chose to focus on the Hmong community because studies in the U.S. show a particularly high CHB prevalence (~15%) in this population (Kowdley, Wang, Welch, Roberts, & Brosgart, 2011). And sure enough, when talking to members of the community, I heard sad stories of family members getting sick or dying from liver disease. Hepatitis B as a threat to public health has long been neglected in Australia, compared to the attention given to HIV and hepatitis C. However, based on a National Hepatitis B Needs assessment (Wallace, McNally, & Richmond, 2008) and other reports that showed an urgent need for a co-ordinated public health response, the first National Hepatitis B Strategy was finally released in 2010. The strategy highlights priority action areas such as raising awareness in patients and doctors, improving screening and diagnosis practices, and removing barriers in culturally and linguistically diverse (CALD) populations.

In Australia, pregnant women are routinely screened for hepatitis B. However, research suggests that many who test positive during pregnancy do not receive adequate follow-up care (Guirgis, Zekry, Yan, Bu, & Lee, 2009). In addition, recent studies indicate that CHB awareness is still low in Australian general practitioners (GPs), and that many patients are not managed according to guidelines (Dev, Nguyen, Munafo, Hardie, & Iacono, 2011; Guirgis, Yan, Bu, & Zekry, 2011). Therefore, in order to achieve improvements in early detection and timely referral for treatment, increasing GP involvement is a priority.

My project comprises (1) an assessment of knowledge, current practice, awareness of resources and educational preferences of local GPs; (2) assessments (pre- and post) and an appropriate intervention in the Hmong community (all based on behavioural theory); and (3) an assessment of pregnant women and new mothers. At the time of writing, data collection from GPs is under way.

Community engagement is, of course, an ongoing process. The project has the support of a community leader who is providing invaluable information about what may and may not work in his community. Initial information about the project was recently distributed. Building trust and showing that my motives are genuine takes time and it is important to let things develop instead of pushing ahead too fast. The fact that I have CHB myself may help to convey the message that it is okay and even necessary to talk about hepatitis B. Normalization assists in the removal of stigma.

More of my work to be shared in another blog. A big thank you to the special people who have been inspiring and encouraging me to do this work and keep offering tremendous, ongoing support.

Yvonne

References:

Carville, K. S., & Cowie, B. C. (2012). Recognising the role of infection: preventing liver cancer in special populations. Cancer Forum, 36(1), 21-24.

Dev, A., Nguyen, J., Munafo, L., Hardie, E., & Iacono, L. (2011). Chronic hepatitis B: A clinical audit of GP management. Australian Family Physician, 40(7), 533-537.

Guirgis, M., Yan, K., Bu, Y. M., & Zekry, A. (2011). A study into general practitioners’ knowledge and management of viral hepatitis in the migrant population. Internal Medicine Journal, Accepted article. doi: 10.1111/j.1445-5994.2011.02440.x

Guirgis, M., Zekry, A., Yan, K., Bu, Y. M., & Lee, A. (2009). Chronic hepatitis B infection in an Australian antenatal population: Seroprevalence and opportunities for better outcomes. Journal of Gastroenterology and Hepatology, 24(6), 998-1001. doi: 10.1111/j.1440-1746.2009.05841.x

Kowdley, K., Wang, C., Welch, S., Roberts, H., & Brosgart, C. (2011). Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin. Hepatology, Accepted preprint.

Wallace, J., McNally, S., & Richmond, J. (2008). National hepatitis B needs assessment. Melbourne: Australian Research Centre in Sex, Health, and Society, La Trobe University.

 

 

Living with Hepatitis B

Join CDC and HBF for a World Hepatitis Day Twitter Chat

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Are you planning to join us for the World Hepatitis Day Twitter Chat on Friday, July 27th? The CDC and HBF will be hosting a Twitter Chat at 2 pm EDT.  Are you thinking, “What… me??  I don’t know how to use twitter!!” Well, get-on- board with twitter before July 27th and join us!

What is twitter?  Twitter allows you to stay connected or exchange short messages called tweets with friends, family, co-workers, organizations and partners, and the world at large. You can tweet from your computer, your laptop, i-pad or smartphone. You can use it to update your status on the go, or in HBF’s case, use it to educate and raise hepatitis B awareness.  We also use it to send out current or new information on hepatitis B and to make our resources available to others.  If you are a hepatitis B advocate, twitter is a great outlet to get your message out there.

What is a handle? Your twitter username is your handle. For example HBF’s twitter handle is @HepBFoundation. Handles are preceded with a @symbol. You can find us at www.twitter.com/HepBFoundation.

What is a tweet? A tweet is basically a short message or status that you post to twitter. You can compose a tweet by clicking on the blue compose button in the top right corner, or from the “Compose New Tweet” box (top left after you login) Tweets are kept at 140 characters or less. If you make your tweets about 10 characters shorter, you’ll leave room for others to easily retweet your messages.  Don’t worry. Twitter does the counting for you.

Your message can be just that – a message: “2 billion people in the world have been infected with #hepatitis B”, or you can add a reference to the source such as HBF’s website where you can find this quote  A URL shortener will be invoked to take that long URLs like  http://www.hepb.org/hepb/statistics.htm  and turn it into: http://ow.ly/ciWvu

What is a retweet? A retweet or RT is when you repost someone else’s tweet so it will be shared with your followers. It lets everyone know you like that message and lets you spread the word.  Retweeting is a great way to get started if you’re a little nervous about composing your own tweets.  To retweet, all you need to do is put your cursor over a tweet that you like, and you’ll see retweet highlighted. Click and you’ve just done your first retweet!

What’s a hashtag? A hashtag allows you to categorize messages in twitter.  You precede a keyword with a hashtag, or the “#” symbol, to note a topic of interest. I typically use simple twitter hashtags such as #hepatitis B, or #HBV in my messages so that others interested in HBV topics will see my tweets. Rather than put them at the end of a tweet, I typically work them into my message. For example: “There are 400 million people chronically infected with #hepatitis B in the world.” Lots of viral hepatitis followers are using the #hepatitis hashtag, so they are sure to see my posted tweet. The hashtag will allow them to easily search twitter from the search box (top right) in twitter and retweet my message.  It might also encourage them to follow me since hepatitis B is an interest that we share. When I see tweeps tweeting with the #hepatitis hashtag, I tend to follow them, and if they continue to post good content, I might even add them to one of my twitter lists.

What is a Tweep? A tweep is a twitter user.

Getting Started.  All you need to get started is an email account, a picture or logo (though twitter will assign you their default image if you don’t upload one, so don’t let that stop you.), and a statement about you or your organization.

Go to www.twitter.com and sign up for a new account. It’s really pretty simple. If you have your email and image ready to upload, you can be in and out in a few minutes. Twitter will walk you through the whole thing – nothing tricky!

So what should you do to become familiar with twitter? Assuming you plan to follow what’s new in the world of hepatitis B, our twitter chat on the 27th and viral hepatitis events beyond World Hepatitis Day, then consider a few things:

Who do you want to follow? Consider following viral hepatitis organizations like the Hepatitis B Foundation (@HepBfoundation), CDCs Division of Viral Hepatitis (@cdchep), World Hepatitis Alliance (@Hep_Alliance) or other favorite viral hepatitis orgs you may know. You may also consider following medical doctors, journalists, or viral hepatitis advocates you find out there in the big-virtual world. Don’t forget about the community at large. You’ll find others interested in hepatitis B by using the #hepatitis, #HBV or #worldhepday hashtags in the search box. Part of the goal is to educate and raise HBV awareness. At HBF, The world is our target audience. We are happy to follow, or be followed by anyone that is interested in hepatitis B.

Who will follow you? In the beginning, you’re not going to have a lot of followers. Don’t worry about it! Building a following takes time. Slowly but surely as you start participating, you will gain new followers. Start by “retweeting” someone you are following, and most likely they will follow you back if you are helping them get their message out.

The World Hepatitis Day Twitter Chat sounds great! How do I join the conversation? It’s simple. The Twitter Chat starts at 2 pm EDT on Friday, July 27th. Login to your twitter account and be ready to contribute. We will be using the #WHDchat hashtag for this chat. All you need to do is search twitter for the #WHDchat and it will generate a list with all of the tweets from the conversation. If you see a tweet that you like, retweet it.  If you’d like to contribute to the conversation with your own message, compose your tweet and be sure to add the #WHDchat at the end of your tweet or no one will see it.

That’s it! Join the conversation on July 27th at 2 pm EDT!

Living with Hepatitis B

What Are Your Plans for World Hepatitis Day?

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World Hepatitis Day is July 28th. Organizations and advocates around the globe are organizing viral hepatitis events to educate, screen, and raise viral hepatitis awareness in their communities.

World hepatitis Day was launched by the World Hepatitis Alliance in 2008. Last year, July 28th, the birthday of Dr. Baruch Blumberg was designated as the official World Hepatitis Day. Dr. Blumberg won the Nobel Prize in 1976 for his discovery of the hepatitis B virus, and development of the first hepatitis B vaccine. He was also an inspirational friend to the Hepatitis B Foundation.

Please take a look at the proposed World Hepatitis Day events occurring around the globe.  The chart is a work in progress, so let me know your activates for the day or days preceding World Hepatitis Day, and a contact point, and I’ll be sure to update the chart ASAP. Leave a comment or send your info to contact@hepb.org.  If you’re not planning an event, but would like to get involved, check out any events that may be near you. Countries are listed alphabetically.

Don’t forget to take advantage of the promotional campaign materials provided by the World Hepatitis Alliance. World Hepatitis Day really is “closer than you think”.

 

 

Country Event Contact
Australia Queensland:

  • Free lecture presented by Dr. Joshua Davis, speaking about his work with HBV in indigenous communities in the Northern Territory. Cairns.
  • Yarnin up HepB for Aboriginal and Torres Straits Islander health workers to discuss all things HBV with Dr. Davis. Cairns.
  • “Hep Day Out” at CSHS features tours of the QuIHN van, an acoustic jam and more. Cairns
  • Hepatitis Indigenous Community Awareness Event, organized by Hepatitis Queensland. Brisbane.

Australian Capital Territory (ACT): WHD Community & Stakeholder Forum. Canberra.

New South Wales (NSW): Numerous community events, including Love your Liver or Healthy liver themed lunches and breakfast events; art themed events and workshops; general hepatitis health promotion events; and targeted events focussing on Indigenous communities, youths, prisoners, injecting drug users, culturally and linguistically diverse communities, and tattooing.

Victoria (VIC): Spotlight on hepatitis B aiming to increase the capacity of community and health workers to include hepatitis B in their work; Street Shot photo exhibition and Love your liver lunch, using photography to educate young people about viral hepatitis

Western Australia (WA): Street Art exhibition targeted at youths; Love your Liver educational workshop and lunch; WHD Redbacks Basketball Game; CALD Community hepatitis B Workshop

 Cairns events:

Rhondda Lewis,

Ph. 0061742264761

Email:

 

rhondda.lewis@health.qld.gov.au
Bangladesh
  • Round Table discussion meeting held at National Press Club in Dhaka
  • Publication of awareness articles in national news dailies
  • Talk show on one of the local satellite TV channels
  • Printing and nationwide distribution of posters bearing logos of Viral Hepatitis Foundation Bangladesh, CEVHAP and WHA.
 Dr. Mamun-Al-Mahtab

www.drmahtab.org
Ghana Public disease awareness campaigns on radio and TV using KE drawn from the Theobald hepatitis B foundation Lectures and presentations targeting high schools, Market places and churches

Events will occur in Tamale 23-July, Kumasi 25-July, Accra 28-July

  • Floats through the principal street
  • Public disease awareness campaigns on radio and/or TV,
  • Free HBV screening for school age children and the public
  • Hepatitis B education presentation and materials
  • Possible fundraising through entertainment

Media programs to include:

  • Articles on hepatitis
  • Distribution of stickers, flyers and posters to hospitals, clinics, lorry stations and other public places
  • Press releases to all media houses
  • Interviews on Radio stations
  • Use of social media to educate people on hepatitis  (twitter, facebook)
 Theobald Owusu-Ansah

theobald2003@yahoo.com

+233-20-8269214 /  +233-247093893
Hong Kong Hepatitis B

  • Asiahep HK LTD will have a week-long promotion in public for HBV awareness with support from celebrities
  • A press conference is scheduled on 27 July with arrangement by FH. We will be launching our liver APPS and revamped website
  • Talks to doctors and public late June, and in Macau for a talk on 28 July

Hepatitis C:

  • Press Conference to introduce CEVHAP organization and announcement of World Hepatitis Day (July 22)
  • TV / Radio interview program to promote WHD (July to October)
  • Newspaper / Magazine health featuring articles on HCV (July – Nov)
  • Mini-Education video on chronic hepatitis C
 Dr. Nancy Leung

dr_nancyleung@yahoo.com.hk

 

 

 

Prof CL Lai

hrmelcl@hku.hk
New Zealand
  • A national campaign, beginning early July will have screen printed advertisements displayed on the back of public buses in all major cities of both the North and South Island.
  • Week before July 28th there will be a national radio campaign as well as advertisements in national publications including GP magazine.
  • July 26th there will be a rally on the grounds of the parliament. 1000 helium balloons, each representing NZers infected with viral hepatitis
 Hepatitis Foundation of New Zealand

www.hepfoundation.org.nz

 
Sweden
  • Manifestation: 580 Roses, Place Sweden, Jppsala University Hospital; Main entrance: Sjukhusgatan; Time: 28 July 10 a.m. to 5 p.m.
 Kaj Johansson RN

http://www.facebook.com/hepatitisday.sweden.5
United States NYC – community orgs and hepatitis advocates celebrate WHD by hosting events across all 5 boroughs of NYC

 

Philadelphia- Viral Hepatitis Symposium for patients, families and members of the general public. http://www.liverfoundation.org/chapters/midatlantic/events/823/ Register today.

 http://www.facebook.com/NYCWorldHepDay

 

Delval@liverfoundation.org or Erica Stein at 215-425-8080
World Hepatitis Alliance
  • Join World Hepatitis Alliance as they celebrate World Hepatitis Day 2012 with their Guinness World Record: WHD 2012 by having the most people performing the “See no evil, hear no evil, speak no evil” actions in 24 hours at multiple venues around the world.  Check out the details and get a group together for the
 http://worldhepatitisalliance.org/WorldHepatitisDay/GuinnessWorldRecord.aspx

 

 

 

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A World Hepatitis Day Message from Dr. Philanbangchang, WHO South-East Asia

This World Hepatitis Day message by Dr. Philanbangchang, WHO South-East Asia addresses some of the many challenges of viral hepatitis in the South-East Asia region, and also applies to other areas of the world.

However, it is interesting to first note some fast facts specifically about hepatitis B…

 

 

  • The statistics on hepatitis B are staggering.  Two billion people worldwide have been infected with HBV.  That’s one in three people globally, and one in twenty in the U.S..  Four hundred million are chronically infected, and approximately two people die each minute as a result of hepatitis B.
  • Hepatitis B is transmitted through blood and bodily fluids.  It is readily transmitted from mother to child at birth, and children born with HBV have a 90% chance of life-long infection.
  • HBV is called the silent epidemic because it is often asymptomatic. Many have no idea how they acquired the virus.
  • Sadly, HBV leads to terrible discrimination and stigma throughout the world.  Family members, workers, and children are shunned and opportunities are denied.
  • Hepatitis B is not curable, but there are excellent treatments available. However, not everyone needs to be treated, but everyone needs to be monitored.
  • The good news is that hepatitis B is vaccine preventable.  Children must be vaccinated at birth to prevent the transmission from mother to child, and people at high risk must be screened before they are vaccinated.  The HBV vaccine does not work if you are already infected with HBV, but it will protect family, sexual partners and household members.  It would be great if the HBV vaccine were universally recommended, available and funded…
  • Practicing simple standard precautions is another way to prevent the transmission of infectious disease – especially those diseases for which there are no vaccines.  If you have hepatitis B, it is best to avoid coinfection with other infectious diseases such as HCV and HIV.  Practice safe sex.  Do not share needles and follow basic prevention methods.
  • With a safe and effective HBV vaccine, good treatments with new treatment protocols on the horizon, it is our hope that hepatitis B will soon be eradicated.
  • It is essential that everyone know the FAQs about hepatitis B.  It is a preventable disease, and we all need to do our part to ensure we prevent the spread of HBV, and treat those living with hepatitis B with the compassion they deserve.

And now a message from Dr. Philanbangchang…

Viral hepatitis kills more people than any other communicable disease in the South-East Asia Region. In the next 10 years, over five million people in the region is projected to die from this disease and its consequences.

Today, more than 130 million people in South-East Asia alone, carry the hepatitis B or C virus, even though they may appear healthy. It usually strikes people at their most productive age.

The hepatitis B virus is 50 to 100 times more infectious than HIV, and just as lethal. Hepatitis E results in 2700 still births every year. For such a major public health threat, hepatitis has a low profile, among policy-makers and the public.

Recognising hepatitis as a threat to public health, the World Health Assembly passed a resolution to prevent and control the disease last year. The World Health Organization has decided to observe July 28 this year as the world’s first ever World Hepatitis Day.

It is thus an opportune time to ask if we are doing enough to protect ourselves from this disease?

Many people recognise the symptoms of jaundice by the yellowing of the eyes and skin. Yet, jaundice is only the face of the disease and the common symptom for any of the four common types of viral hepatitis. These are easily contracted from drinking water to casual contact to sexual intercourse. Even then, not every infected person shows symptoms.

WHO is developing guidelines, strategies and tools for surveillance, prevention and control of this disease. Prevention and focussing on the source and mode of spread of the virus, is crucial to control this disease.

Chronic hepatitis B and C are among the leading causes of preventable deaths in 11 countries of the region. About 100 million hepatitis B carriers, and 30 million hepatitis C carriers, live in South-East Asia.

However, about 60 percent of the infected are unaware of their status until the disease manifests as cirrhosis or liver cancer – an aggressive cancer without a cure. Hepatitis C, in particular, has no vaccine or effective cure. Those who undergo blood transfusion, as well as injecting drug users, are at risk.

Due to lack of knowledge and resources among healthcare workers, many providers in the region do not comply with WHO’s and national guidelines and recommendations for hepatitis B and C screening, prevention, treatment and follow-up services. A patient requiring transfusion may receive blood that has been screened for HIV, but not for hepatitis B or C.

The hepatitis B vaccine can go a long way to prevent hepatitis B. It is more than 95 percent effective in preventing infections and their chronic consequences, and is the first vaccine that protects against a major human cancer. In WHO’s South-Asia Region, more than 130 million infants have received the three required doses of hepatitis B vaccine.

Hepatitis infection is also linked to personal hygiene, sanitation and urban health – hepatitis A and E are both commonly spread through eating or drinking contaminated food or water. Pregnant women are at high risk of hepatitis E. Hepatitis E acquired during pregnancy is also associated with prematurity, low birth weight and an increased risk of perinatal mortality.

In countries of WHO’s South-East Asia Region, more than 6.5 million people are infected with hepatitis E annually accounting for half the cases worldwide, leading to an estimated 160 000 deaths.

Hepatitis E outbreaks often occur in urban areas when leaky underground water pipes are contaminated with sewage. In developing countries, with increasing population pressure and rapid urbanisation leading to people living in close, unsanitary conditions, such diseases are likely to increase rapidly.

So what can be done to prevent and control hepatitis?

To begin with, all countries, especially those urbanising rapidly, need to make hepatitis a health priority. Lives could be saved through simple preventive measures such as hand washing, eating cooked food and boiled water, using condoms and not sharing needles.

Countries need to make screening of all blood and blood products for hepatitis B and C mandatory. Governments should ensure that children are adequately immunised against hepatitis B. Healthcare workers, and the public, need to be educated on the risks and the surveillance system for hepatitis needs to be strengthened.

Unless we act now to create greater awareness among policymakers, healthcare workers, and the public, viral hepatitis will remain a major public health threat.

Dr Samlee Plianbangchang
Regional Director
WHO South-East Asia

 

Living with Hepatitis B

A Personal Reflection on China for World Hepatitis Day – Part II

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(If you missed it, see part I) The second trip entailed the training of rural doctors.  During the training course, we used a number of simple visuals to better get some basic ideas across.  We wanted to drive home how common HBV was in China, and the number of Chinese people infected. We asked 10 people to stand up.  They smiled with pride, having been selected, until they realized they were being identified as one of those possibly infected with HBV.  The numbers dwindled as we went through the process of asking some to sit down representing those that had been infected, but resolved the virus, until finally, the last one standing represented someone with chronic HBV. This person was clearly horrified. This visual certainly drove the point home, but perhaps we were the ones educated by this process.

The Chinese people love children. I had a photo album of my children, which many enjoyed during the break.  There was one photo with a picture of both my two children and my colleague’s two children. My colleague and I were traveling with two of the children and had not identified if either were infected.  (As a result, we sat at every meal where most assuredly there was a large serving spoon in every dish…)  There was only one child that could be “safely” identified. When I pointed the child out to them, I could hear them, speaking in English, saying “Yes, I knew it.  Look at her.  She’s sick… doesn’t look well.”  I can’t even imagine what was said in Chinese.  HBV is nearly always asymptomatic in children.  All four children in the photo appeared equally healthy.  At that moment, I was grateful these children were spared the taunts.

During the course of the visit, we made an impromptu stop at a hospital on the outskirts of one of the cities.  We were shocked when we were permitted to enter the compound without pre-approval.  It was not a sanitized visit like all of the other stops we made.  We were traveling with a U.S. doctor, and I think the Chinese doctor we met was interested in speaking with her.  The facility was well below the standards we had encountered elsewhere. The largest building on the compound was the “women’s facility”.  We were not allowed in the building, nor were any pictures permitted of that particular building.

In another city we met with a conventionally trained doctor who had grown up in a very rural province, and was sometimes requested due to her rural background and familiarity.  She told us of a recent rural visit, where hundreds of women had been infected with an STD.  As a result of migration of workers into the cities, these women villagers are more often victims of diseases previously not seen in these areas.  Sadly, many of the women were being infected due to the lack of precautions taken during the annual examination of women.  The major culprit was the reuse of speculums that were not disinfected.

Finally, we met so many interesting, young Chinese, and heard so many wonderful stories like the one about a young university graduate who started the first online community of hbvers (that’s what they like to call themselves.)  It would turn out to be the biggest in the world, and would provide much needed support for many isolated Chinese, living with HBV.  There were also other stories, too, of how Chinese hbvers fought against discrimination by using a stand-in – either a paid “professional”, or other, loyal friends for their compulsory medical blood tests.  Imagine living with the fear of losing everything just because of the results of a simple blood test.

I went to China, naively thinking I would make a difference.  I was overwhelmed with the dire situation of those living with HBV.  The experiences and stories were sobering and haunted me for months after returning.  It was so personal. I certainly cannot  fix this global problem on my own, but I will do everything possible, so that others may understand, just a little, the impact of living with hepatitis B in China.

Living with Hepatitis B

A Personal Reflection on China for World Hepatitis Day – Part I

Sadly, like many Americans, until I came face-to-face with hepatitis B, I had no idea of the global implications.  Over the years, raising HBV awareness has been a quiet mission.  In 2002 and 2003 I was fortunate to travel to China, and help present train-the-trainer programs that were to be used in Chinese orphanages, presented to Chinese foster families, and used as training sessions for rural doctors.  The training programs were successful, and well received, but of course they were only a small contribution in a country where HBV infection is endemic.  In fact one in ten Chinese are chronically infected with hepatitis B.  Nearly one half-million die per year from HBV related liver cancer, or one Chinese person every 60 seconds.  As an American, I was aware of the discrimination faced by those living with HBV in the U. S., but I had no idea how widespread discrimination was throughout China.  For some naïve reason, I thought HBV infection would be better accepted in a country where so many are living with HBV.  I was very wrong.

Training participants listened with earnest as we reviewed infection control techniques and modes of transmission.  All were interested in the details.  Perhaps what was more sobering were the interactions in between and following these training sessions.   I found myself quietly met by a number of tentative women with downcast eyes.  They waited in the bathrooms, and stepped out of tiny alley-ways as we walked back to our hotel. They quickly surveyed the area, their eyes darting back and forth, before they asked their questions about HBV treatment, and outcomes.  The despair was was palpable.

We were invited to visit a local city orphanage.  The rooms were somewhat sterile, but cheerful and the care takers were very good with the children.  However, when we met with the staff, we learned of their concern of HBV infection among the children under their care.  They were concerned about transmission. However, they continued to treat infant illnesses with injections and IV drugs, rather than an alternate, oral medication. An orphanage is often a world unto it’s own, yet children with HBV are often segregated from the other children.   Children diagnosed with HBV outside of the orphanage environment may also be refused entry into school, although this practice may vary with the province, the city, or even the official in charge.  That doesn’t leave a child identified with HBV much of a future.

Perhaps one of the most sobering experiences was meeting with HBV-listserve members at a local tea house.  We were seated upstairs, away from other guests, which is not uncommon when foreigners are present, but it was clear this was more for their privacy.  They scanned the room and were careful not to speak when the server entered the room.  This was the first time they had met in person, and it was clear their hearts were heavy with the burden of living with HBV.  Throughout the evening, no names were used, and all members referred to one another by their screen names.  Most felt very isolated with their illness and were desperate for information.  Many were shunned by family and friends, were humiliated and forced to eat separately, or carry their own bowl and chopsticks. They lived alone with the knowledge of their infection, as widespread discrimination loses jobs and ruins families. There were a number of treatment questions.  Many were interested to know how long they needed to take the antiviral drugs, and whether or not they could stop for a while – if they were feeling better.  We told them that stopping and  re-starting treatment was not good, and they should speak with their doctor.  We didn’t realize that few were under the care of a doctor for their HBV.

Later, while traveling in Shanghai, we visited a lavish pharmacy.  All oral, prescription medications were available in China without being prescribed by a doctor.  Only injectable drugs required a physician’s prescription.  As a result, it was likely my listserve friends were self-medicating without the advice of a liver specialist.  The drugs were likely cost prohibitive, so the need to start and stop antiviral treatment was more a function of expense.  It was apparent that most were not being treated and monitored by a specialist.  The prospect was sad, all the way around.

Please join us as Thursday’s blog concludes “A Personal Reflection on China for World Hepatitis Day….

Baruch S. Blumberg Institute