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National Hepatitis Testing Day. Why Should I Get Tested?

Saturday, May 19th is the first National Hepatitis Testing Day.  Viral hepatitis partners will be working together with local health departments and other community partners in to bring viral hepatitis testing events to a neighborhood near you. Hep B United Philadelphia and the Hepatitis B Foundation and other partners will be holding screening events in downtown Philly.

Why is hepatitis testing necessary? Hepatitis B is largely asymptomatic – until it is too late, or caught with blood donation screening, or lab work.  There are clearly defined risk factors for hepatitis B, or groups that are at greater risk, but there are also less clearly defined risks, or just bad luck. Think about this list and ask yourself if you might want to think about getting tested. If you are young, or when you were younger, was your behavior ever wild or impulsive? Are you a little older and you’re still a little impulsive, or occasionally wild? Did you ever get drunk, or do drugs – even once, or perhaps “lose a night”? Did you have unprotected sex, or do you have multiple partners? If you are monogamous, are you sure your SO is equally monogamous? Does a friend or family member possibly have a known or even an unknown infection? Maybe they know, but they aren’t telling you. Do you like traveling the world?  Outside of the U.S. there are some really wonderful places that have an extremely high HBV prevalence. Roughly 40% of Americans have tattoos, or various piercings. Did you check out the shop- not for the artistry, but for infection control practices before you got your tatt? Ever borrowed a razor or nail clippers or other personal hygiene tools from someone else? How about the nail salon? Do enjoy a good pedicure? Things happen. People are different, they have different lifestyle choices. People make mistakes. They change. Things happen.

Sometimes I take calls from people that call HBF’s consult line. In the last couple of weeks I have spoken to a few consults that do not necessarily fit the standard at-risk profile for hepatitis B. One was an older, senior citizen, who is a regular blood donor, but just recently tested positive for hepatitis B during her most recent donation. Because her blood was being regularly screened, it appears clear that she has an acute case of hepatitis B. She can’t figure out how in the world it happened. She is not having sex, nor is she an injecting drug user. She lives in a small town, and does not have any family from other parts of the world where there is a high prevalence of HBV such as Asia, sub-Saharan Africa, parts of Central America. She is dumbfounded by this diagnosis.

Another consult was concerned about his wife who had also contracted an acute case of hepatitis B. They’re also a little older and in a monogamous, married relationship. After speaking with him, we determined she likely contracted her infection through her job. She works as a cleaning woman. Although most people are not symptomatic, this woman was quite symptomatic for HBV and required close monitoring. After discussing her case with her husband, I recommended that he also be tested, though he was sure he could not be infected since he had no symptoms. He called me last week to tell that he was in fact, acutely infected. He is stunned.

I am not here to judge anyone’s apparent risks or lack of risks.  I am only here to answer questions about their hepatitis B infection. Hepatitis B is not casually transmitted, but it is one-tenacious virus that can effectively be transmitted through infected blood and body fluids.

Fortunately, there is a safe and effective 3-shot vaccine series to protect us against hepatitis B. However, the vaccine doesn’t work if you are already infected.  Remember, HBV does not discriminate. B sure. B tested. If you are do not have HBV, then give yourself lifelong protection with the hepatitis B vaccine. If you find you do have hepatitis B, talk to your doctor about further testing. Don’t forget to check out those free, confidential hepatitis screenings this weekend!

Reflection on 2012 Viral Hepatitis Policy Summit Meetings in D.C.

L-R Daniel Raymond, NVHR Chair, Congressional Champion Staffers: Jirair Ratevosian (Congresswoman Barbara Lee), Philip Schmidt (Congressman Joe Serrano), Adrienne Hallett (Senate LHHS Appropriations Subcommittee, Senator Harkin)

Earlier this week, I attended the 2012 Viral Hepatitis Policy Summit held in Washington D.C. The audience at the summit is viral hepatitis advocates for both hepatitis B and C. With the recent data on deaths from HCV surpassing those from HIV, and with an arsenal of new, effective drugs, HCV is clearly in the forefront of discussions at this time. Since my personal experience is HBVpatient oriented, I always struggle with keeping up with the details of the meetings, but I suspect most people reading this blog are in the same place, so I’ll try to make the take home message as simple as possible.

The first day was held at NASTAD with visits from Dr. John Ward of the CDC, Division of Viral Hepatitis, and from Dr. Ron Valdiserri and Corinna Dan of the Health and Human Services (HSS) Office of the Assistant Secretary for Health, Infectious Diseases.  Everyone is anxiously awaiting the release of the CDCs updated hepatitis C screening recommendations. They will be coming out later than expected, and that is unfortunate because it is hoped they will be released in time to help drive the guidelines written by (US Preventive Services  Task Force)USPSTF, which helps determine what procedures will ultimately be covered by Medicare (and paid for by private insurance  companies as well.) As of now, it doesn’t look like the USPSTF guidelines will include HCV testing for high-risk individuals, so it is hoped that the CDC recommendations will counter these guidelines to help improve future HCV screening rates in the U.S. This potential time bomb was a source of conflict throughout the entire two days of the summit.

The other hot button was the $10million that was allotted to the Division of Viral Hepatitis  to carry out all tasks viral hepatitis oriented. I’m no accountant, but there’s a lot of work to be done and $10M is not that much money in the scheme of things. How will this money best be put to use – collecting surveillance data, running screening programs, linkage to care for those who test positive, HBV vaccinations…the list goes on. And the money must be carefully monitored and be associated with a successful program if we are to warrant additional future funding. One message was made clear – advocate groups had best collaborate and be very creative in order to make things happen on the viral hepatitis front. I believe this is true, but it’s hard to make things happen without money to build the infrastructure or put these programs into place.

The second day was held at the Rayburn building, which is one of the Congressional office buildings. There was a full day of presentations, starting with visits from some of viral hepatitis’s champions in Congress including Congressman Honda (CA), Congressman Dent (PA) and Congresswoman Judy Chu (CA). There are other champions in Congress, but we need more if we are to make a dent in the viral hepatitis problems. That’s where the work of the advocates and those living with hepatitis come into play. You need to get involved and make your state Representative understand how serious viral hepatitis is in his or her district.

There were various panels throughout the day including a panel of staff from some of the viral hepatitis Congressional champions, guests from the Office of Management and Budget (OMB), and an informal discussion with DC based policy experts on working with the Administration and Congress. Then there were the discussions of fiscal year 2013, appropriations discussions, a discussion of viral hepatitis testing and health care reform and how it applies to viral hepatitis. That’s a mouth full. I spent a lot of the day trying to figure out what money was really available, where it came from, and which pots of money were in jeopardy of disappearing. It’s complicated, and I’m not going to pretend to really understand it. There’s the President’s budget and what he recommends.  Budgets need to be passed by the House and the Senate, which is very tough these days with the political and fiscal climate on the Hill.

I don’t believe it’s necessary for the average American living with viral hepatitis to talk-the-talk and track the pots of money that may or may not ever be dedicated to viral hepatitis. Your Congress person is under a lot of pressure to make fiscal decisions based on the needs of his or her constituents.  We were told they literally enter their top picks into the computer on where they think money should be spent. It is our job to see that viral hepatitis is on the list. One of the staff members noted how important a number of small splashes are compared to a big splash that may occur with large, media driven events. He gave a take home message that even I can understand. As viral hepatitis advocates or patients living with hepatitis, if just one person from each district were to contact his Representative and drive home the importance of funding for viral hepatitis, it would make a difference. We need to put viral hepatitis on the radar of our Representatives and our Senators. Few politicians are knowledgeable about viral hepatitis. Individual efforts would go a long way towards educating and raising awareness of the people that are representing us in office. Make the story personal. Let them know the cost of treatment is nothing compared to the cost and burden of transplantation.  Make viral hepatitis part of their vocabulary and put a face on it.

The final message I got, which is more patient oriented, was based on a side discussion about what happens after testing guidelines are established. For example, there are testing guidelines for HBV, and yet even those in high risk groups may not be getting tested, nor are they vaccinated. One physician recommended that as advocates, we need to stress the importance of these guidelines to the professional associations to which our doctors belong. That is the job of advocacy organizations like the Hepatitis B Foundation and others. However, ask around and see if you, or friends and loved ones are being screened for diseases such as HBV, HIV or HCV.  Does your doctor ask you if you are foreign born, or if you travel frequently to developing nations?  Does he spend enough time with you to know about your lifestyle and whether it might put you at risk? Most likely, your doctor does not know if you are willingly or unwillingly involved in activities that may increase your risk for HBV. It’s yet another reason why it’s so important for patients to get involved in their own care and offer up information that might make your doctor consider preventive screening. And if all else fails, ask your doctor about being screened for HBV, HCV or HIV if you believe you are at risk.

 

Considering the Transmission of HBV Through Tattooing or Piercing

This month’s Clinical Infectious Diseases evaluated the transmission of HCV through tattooing and piercing. It is important to note that HBV is also of great concern when considering a tattoo or piercing. Unless you are vaccinated against hepatitis B, you are at risk for HBV if you are tattooed or pierced under unsterile conditions. The net-net is if you have a tattoo or piercing in a professional parlor – one that follows infection control practices and uses single-use items whenever possible and sterilizes re-used equipment using ultrasonic cleaning and sterilization with an autoclave , there does not appear to be an increased risk, though additional study is warranted. However, tattoos or piercings in prisons, or other settings that are not performed under sterile conditions are a serious danger.

The process of tattooing entails repeated injections of tiny drops of ink. That’s thousands of tiny needle sticks per minute, and a very effective transmission route for blood borne pathogens like HBV, HCV and HIV. This does not mean getting a tattoo will expose you to infectious disease, but if you choose a tattoo parlor that is not well regulated and safely follows all infection control practices, then you greatly increase your risk of infection.

Here’s the problem with tattoo parlors in the United States. They are not carefully or consistently regulated. There are no federal regulations. For the most part they are state regulated, with each state having its own rules and regulations.  Regulated states require that tattoo parlors have permits, and be inspected. Who inspects the parlor? – Sometimes it’s the State Department of Health, and sometimes it’s the local health department, so the inspections vary. There are some states with local regulations within the state, and even a few states with NO regulations. That is worrisome and dangerous. What are the rules and regulations for your state on this unofficial list? (Please read the site disclaimer) Do the research on the rules in regulations in your state, or city before looking for a tattoo parlor.

What does this mean if you’re considering a tattoo? Your tattoo is a personal decision that will live with you for the rest of your life. You don’t want to contract an infectious disease that may also live with you for the rest of your life and potentially threatens your life.  Shop for a clean, parlor that treats each tattoo like a mini, out-patient procedure – with all infection control practices followed. You want a tattoo parlor that uses single-use needles, ink, ink cups, and gloves. You want to see these tools come out of their sterile packaging –right in front of your eyes. You want a tattoo parlor with a functioning, inspected autoclave so that re-usable tools such as tattoo machines and needle bars can be properly sterilized. You want a tattoo parlor that is clean and an artist that washes his hands and wears gloves. If the shop is dirty, keep looking.  Speak up and ask the artist questions about his shop and his infection control practices. Don’t forget to ask to see the autoclave. If anything makes you wary about the visit, look else-where.

 

Hepatitis Health Action Alert: Stop the Attacks on Prevention and Public Health Fund

Action Alert! The Hepatitis Community Responds to Health Care Reform. Tell Congress Not To Cut The Prevention and Public Health Fund

The Prevention and Public Health Fund is under attack in Congress once again. Some leaders in the House of Representatives would like to make drastic cuts to the Fund as part of negotiations on a long-term deal on the payroll tax cut and Medicare payments rates to medical providers.

The Prevention and Public Health Fund, part of the Affordable Care Act, provides money each year for vital prevention and public health services. The fund will grow each year until it eventually provides $2 billion/year.

This fund is extremely important to the nation’s fight against the viral hepatitis epidemic. Later this year, the Department of Health and Human Services is expected to allocate $10 million from the Fund for viral hepatitis screening, testing, and education programs. This initiative will greatly help efforts to identify the millions of Americans who have chronic hepatitis B or C and link them to care and treatment.

Please take a few minutes to call Congress in support of this lifesaving program!

What YOU can DO:

Please call your U.S. House Representative and two U.S. Senators immediately. We are hearing directly from Congressional staff that phone calls are the most effective form of communication. 

Call the Capitol Switchboard toll-free at 1-888-876-6242 and ask to be connected to your United States Representative. When you reach your Representative’s office, tell whoever answers the phone that you are a constituent and that you would like to speak to the staff person who handles health care issues. Whether you speak to the staff person live or leave a voicemail, tell him/her:

“My name is _______________ and I live in (city/state). I am calling in strong support of the Prevention and Public Health Fund, which is an important part of the Affordable Care Act. This Fund is a great opportunity to provide badly needed funding for viral hepatitis prevention, testing, and screening programs and must be preserved. I urge Representative_____________ to oppose any efforts to cut the Fund as part of the payroll tax/Medicare physician reimbursement negotiations.”

After you speak to your Representative’s office, call the Capitol Switchboard again and deliver the same message to the health care staff person in your two U.S. Senators’ office.

Thank you for taking the time to make a difference! Please spread the word.

Get involved with Hepatitis Health Action!

  • Join Hepatitis Health Action’s Facebook group:  http://tinyurl.com/hephealthfacebook where you can participate in discussions with other advocates and share your ideas and strategies.

Hepatitis Health Action is a campaign led by viral hepatitis advocates working to make sure that health care reform addresses hepatitis B and C.

China Approves Hepatitis E Vaccine – What that means if you have HBV

It was an interesting couple of weeks for viral hepatitis vaccines.  A potential vaccine for Hepatitis C appears to be on the horizon, and China announced it has approved a vaccine for use for hepatitis E virus (HEV).

What does this mean if you have hepatitis B?  I’m not sure. If you are living with HBV, it is clear that it is best to avoid coinfection with another hepatitis virus or infectious agent.  Coinfection will likely hasten liver disease progression and increase the risk for liver cancer.  At this time, the hepatitis A vaccine is recommended for those who are infected with HBV in order to avoid additional stress to the liver. Please keep in mind that the mode of transmission is the same for HBV and HCV, but is different for HAV and HEV.  It’s important to keep your viral hepatitis ABC’s straight!

Hepatitis E is a self-limiting disease, which is shed in the feces and transmitted via contaminated water and food – very much like HAV.  Although HEV is an acute infection like hepatitis A (HAV), it has about a 3% overall mortality rate and a much higher rate among pregnant women, and solid organ transplant recipients. It predominantly affects those between the ages of 15 and 40 years. HEV is endemic in Central and South-East Asia,  North and West Africa, Mexico and developing nations where there may not be access to clean water and proper sanitation and hygiene.  At this time, it is not prevalent in the U.S., but we are a traveling nation, and it’s something to think about when traveling abroad.

The HEV vaccine, developed by Xiamen University and Xiamen Innovax Biotech Co. Ltd. is a three-shot series : shot one followed one month later by shot 2, followed by shot 3 six-months after the third shot. The phase III trial results were found to be well tolerated and safe for the general adult population.  This would make the HEV vaccine a good choice for travelers in endemic areas who can receive adequate protection with a 2-shot series in one month.

However, these results for the phase III study were for the general population only and did not include children, adults over 65 years, pregnant women and those living with chronic liver diseases such as HBV or HCV.  If you are infected with HBV, it would make sense to be vaccinated against a virus that can cause additional harm to the liver, but at this time, additional research needs to be done ensuring the vaccine will benefit those living with hepatitis B or C.

Viral Hepatitis Meetings in D.C.

Last week was an eventful week for this HBV blogger.  I was fortunate to be able to attend the National Viral Hepatitis Technical Assistance and the National Viral Hepatitis Round Table (NVHR) meetings in Washington D.C. last Tuesday and Wednesday. These meetings were followed by Capitol Hill visits on Thursday by viral hepatitis advocates to their legislative offices.

In attendance at the meeting were state viral hepatitis coordinators from around the country, other state health department personnel, government representatives from various agencies and organizations, and numerous viral hepatitis advocates from various non-profit organizations. It was a great opportunity to meet colleagues from all over the country dedicated to combating viral hepatitis in the United States.

Please keep in mind that my background is patient oriented, and that I do not have a master’s degree in public health, nor do I have experience working in the public health system.  Keeping up with the political front is challenging as is keeping up with the public health system. I’m still trying to figure it all out. Both have their own language and acronyms. After a couple of days of meetings, I have a great deal of respect for those working in public health at both the federal and state level.  I also have a great deal of respect for those working to push policy on behalf of viral hepatitis. There’s always more to learn, but you can still make an impact by jumping in and getting involved at a number of different levels.

A couple of messages were loud and clear at the meeting and you didn’t need to be an expert to understand them. Perhaps the biggest message is that funding for viral hepatitis public health programs is very limited and the burden is well beyond the level of funding.  This comes as no surprise since these are difficult times for both state and federal government programs.  This lack of funding will require that all health departments, government organizations and agencies, advocacy groups and non-profits pull together using what I call the 3-C’s:  communication, coordination, and collaboration.  Don’t forget to be creative, resourceful and wrap it all up with a coordinated IT system.

What was nice about this forum is that people were able to see what was going on in other states.  Bringing people together infuses new information into the group, while creating relationships where people want to help one another.  This is imperative if we are to address viral hepatitis needs with a minimal budget. One viral hepatitis coordinator reminded people during a break-out session that there are small pots-of-money out there, but you’re going to have to be creative when looking for grant opportunities.

Chris Taylor from the National Alliance of State & Territorial Aids Directors (NASTAD) asked me, and others to do a video-taped interview where I was asked about my personal hepatitis B story. This was a great way for me to make a contribution, and I was happy to help. Telling your story can be a compelling way to raise awareness and get involved.

Natalie Cole was in D.C. doing a press conference promoting her “Tune In to Hep C” campaign. NASTAD arranged for her to make an appearance at the NVHR meeting.  It’s always great to have a celebrity figure to promote a cause and raise awareness with the general public. They are able to reach so many people at one time!

Thursday’s Capitol Hill visits were a great opportunity for viral hepatitis advocates to get in front of their own Representatives in Congress, or their state Senators. Each person on the visit brought her talents to the table.  Some were up on politics, policy and the process, while others dealt with the hepatitis at the public health level.  Finally, there are people like me that are most familiar with hepatitis B on a personal level.

The meetings made it clear that we all need to collaborate and be creative if we are going to combat viral hepatitis.  Americans living with viral hepatitis may be wondering what Washington or their home-state is doing about viral hepatitis.  Things are being accomplished.  Based on the Institute of Medicine (IOM) report, we have the HHS Action Plan for the Prevention, Care & Treatment of Viral Hepatitis that was introduced last May.  Planning and process is currently being written around the plan.  People are in place and they are working hard, but the system and its processes are huge, complicated, and slow moving.  It is certainly not a perfect system, but we can all contribute at some level to make this an issue important to those that do drive policy, and ultimately fund programs.

Where do you fit in?  If you are in policy or public health you know you have a big job ahead of you, but it is essential that you keep looking for ways to move the system more effectively and efficiently. If you’re living with HBV, you might think you can’t make a contribution, but that is not true. This is where “arm-chair advocacy” comes in.  Not everyone is going to head to D.C. to meet with their Senator or Congress person. However, you can make your voice heard.  Visit your representative when she is home for constituent work week.  A simpler, but equally effective alternative is to write, call, email or tweet your Representative or Senator.  Let your Representative know that you are living with hepatitis B, and that you want him to support viral hepatitis legislation. Use your voice and make your vote work for those living with HBV in your state!

Distinguished Doctor and Contributor to the Viral Hepatitis Community Dies

Dr. Emmet B. Keeffe, Professor of Medicine Emeritus at Stanford University in Hepatology, passed away unexpectedly on August 8, 2011 after a distinguished career in hepatology. He was sixty-nine years old.

Please join us in extending our condolences to the family, and many friends, colleagues and patients of Dr. Emmet Keeffe.  We are all saddened by his death. Dr. Keeffe was a major contributor in the viral hepatitis community and made significant contributions throughout his 42 years practicing medicine.  Dr. Keeffe had an impressive list of professional achievements, administrative appointments, honors and awards. His clinical research interests focused on the treatment of chronic hepatitis B and C, where he was a principle investigator for many clinical trials treating numerous patients.  Dr. Keeffe has been published extensively throughout his career.

Dr. Keeffe was a true thought leader in the field of hepatitis B who grasped all aspects of this liver disease. He created bridges of understanding between the science, medicine and patient experiences for the entire hepatitis B community. We will miss his active involvement and support of the Hepatitis B Foundation, but most importantly, we will miss his vital contributions to the science and medicine of chronic viral hepatitis.

Emmet B. Keeffe, MD

April 12, 1942 – August 8, 2011

 

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 staggeringTwo 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

 

Hepatitis B and Your Neighborhood Pool

Photo by Sheila http://ht.ly/6eRlt

Memorial Day marks the unofficial beginning of the summer, and with it, the opening of the community pool.  Every summer, questions regarding hepatitis B and the public pool are asked.  Typically it is those that are infected, or have children that are infected with HBV, that have concerns.  Hepatitis B is 100 times more infectious than HIV.  Does that mean you should be worried about contracting or spreading a blood borne pathogen like hepatitis B at the community pool?  Personally I don’t believe so, but there are a couple of things to consider.

If you’re concerned about a blood spill in the pool water than do not worry.  As long as you are frequenting a well-maintained pool that follows guidelines for consistently monitoring chlorine and pH levels in the pool, you’ll be fine.

Use common sense when at the pool.  Check that the water is clear, and the sides aren’t slimy. If the odor of your pool is too strong, something may be off.  Speak with management if you have concerns.  Pool staff are responsible for keeping water safe.  There are strict guidelines that must be followed.  Still have doubts?  Purchase your own pool test strips to confirm disinfecting quality of the pool.

Blood spills on the deck are a plausible transmission route for blood borne pathogens like HBV, but this hazard can be readily averted with proper cleanup.  Chlorine is a very effective agent against hepatitis B and other pathogens.  When made fresh and used in the correct concentrations, (nine parts water to one part chlorine) it kills pathogens like HBV.  As a team manager of a neighborhood swim team, I found the lifeguard slow to clean up a blood spill on deck.  The protocols are in place, but everyone needs to be vigilant to ensure they are followed.  If you have HBV and are bleeding on deck, don’t be afraid to insist that the blood spill be properly disinfected.  There’s no need to disclose your status.  These are standard precautions that should be followed for all blood and other body fluid spills.

The big culprit at the pool is swimmers with diarrhea.  Diarrhea causing germs may survive even in a well-maintained pool.    Chlorine resistant Cryptosporidium, also known as “Crypto”, is one such microbe.  One inadvertent gulp of contaminated pool water and it’s possible you, too, will contract diarrhea.  The good news is HBV is not spread via contaminated water, or the oral-fecal route.  Know the ABC’s of viral hepatitis!  Keep little ones out of the pool if they have diarrhea, make frequent swim-diaper changes, and don’t count on the plastic swim pants to keep everything in.  Oh, and don’t let the kids drink the pool water.  Parents, good luck with that one!

There are legitimate dangers lurking at the pool – a recent recall on pool drain covers jeopardize the safety of children, the risk of drowning and injury always exists, and of course there’s the risk of diarrhea causing illnesses.  Fortunately the odds of transmitting or contracting HBV are infinitesimal in a well maintained pool.  As always, remember that HBV has a safe and effective vaccine. Be sure those you know and love are vaccinated.

Beat the heat at your neighborhood pool this summer.  And finally, if your public pool looks like this… well, common sense would tell you there’s a lot more to worry about than hepatitis B!