World Hepatitis Day has arrived! Check out this YouTube video from the World Health Organization (WHO)
Don’t let hepatitis tear your life apart
Hepatitis affects everyone, everywhere. KNOW IT. CONFRONT IT.
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…
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
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!
Last Thursday, May 12th, I attended the Congressional Briefing, and the Press Conference releasing the U.S. Department of Health and Human Services (HHS) Action Plan to Prevent, Care and Treat Viral Hepatitis, in Washington D.C.. The HHS Action Plan is in response to the 2010 Institute of Medicine (IOM) report on viral hepatitis.
I have been involved with viral hepatitis, specifically hepatitis B, from a patient perspective for over a decade, but my recent involvement in the political arena is new. So, I’m still struggling with the numerous acronyms, political calendars and jargon…
It was encouraging to see members of Congress in attendance at the Congressional Briefing – hosted by U.S. Senator John Kerry (D-MA) and Rep. Mike Honda (D-CA), but it is clear that viral hepatitis needs more champions in Congress. Congressional leaders who spoke included Rep. Honda (D-CA) , Rep. Cassidy (R-LA), Rep. Judy Chu (D-CA), Rep. Dr. Christensen (D-VI), Rep. Barbara Lee (D-CA), and Rep. Dent (R-PA). Federal public health leaders Dr. Howard Koh, Assistant Secretary of Health, and Dr. Kevin Fenton, Director, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention of the CDC spoke regarding the direction and implementation of the plan.
Congressman Honda’s message was loud and clear to the audience: “You need to be the megaphone.” As advocates we need to educate and get our representatives on-board. The other, clear message is that the plan is a strategy with the tactics not yet clearly defined. More importantly, there is no clear funding dedicated to the roll-out. Rep. Bill Cassidy, a hepatologist, tells us we must be “fiscally responsible”, and yet he also said “Sometimes you have to increase the budget to reduce the deficit”. Rep. Donna Christensen, also a doctor, states: “We can save money and reduce the debt” with the viral hepatitis plan. As a hepatologist and physician, these representatives understand that money spent on patient education, screening, prevention and treatment will be cost effective over time. I wonder how many Representatives truly understand the ticking time bomb of this silent epidemic.
The representation at the press conference in D.C. was encouraging –everyone in the room with the same goals. Dr. Susan Wang, a doctor in NYC spoke of her patient base where one in eight patients are infected with HBV. Michael Ninburg told his personal story with his fight with hepatitis C, and the successful prevention of HBV from his chronically infected wife to their newborn son. Michael was cured with the new HCV drugs, and his son was protected by a safe vaccine. All good.
The HHS Action Plan for Viral Hepatitis will roll out through 2013. Some of the goals are more attainable than others, such as delivering the first birth dose of the HBV vaccine to infants prior to discharge. Dr. Koh describes this as the “first shot of life.” Administering prophylaxis and vaccination to infants born to HBV infected mothers is also feasible. Other goals are loftier, less clearly defined, and will require significant funding.
Dr. Fenton, of the CDC, tells us the viral hepatitis plan will be implemented as a collaborative effort, leveraging resources between government agencies such as HHS, HRSA (Health Resources and Services Adminstration , CDC (Centers for Disease Control), and CMS (Centers for Medicare and Medicaid Services).
Portions of the plan are dependent on the Affordable Care Act (ACA) and Health Care Reform, which are under attack. It will be important for these programs remain intact for the plan to be successful.
We are all well aware of shrinking budgets and the need to be fiscally responsible, keeping in mind the human component. This plan cannot be implemented without collaboration and cooperation between government and community organizations and efforts, and most importantly – funding.
That’s where we, as voting Americans, fit into the equation. We need to get educate our Representatives and Senators by raising their awareness of viral hepatitis. We need to tell them there is a plan to combat viral hepatitis. We need to personalize this, tell our stories, and let them know that we do NOT want funding for viral hepatitis cut from the budget.
Was your Representative present at the briefing? Mine was not…
Visit your Representative during Constituent Work Week. Write a letter, send an email, call and speak to a health staffer, or tweet your Representative, today.
Prevention funding in Health Care Reform is under attack.
Tell your representative to vote NO on H.R. 1217
On April 5th, the assault on the Affordable Care Act continued when the House Energy and Commerce Committee voted along partisan lines in favor of H.R. 1217, which would repeal the Prevention and Public Health Fund. This fund, part of the health care reform law, 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 offers a great opportunity to get some of the money targeted to viral hepatitis prevention, screening, and testing programs. We cannot advocate for that money if the entire fund is repealed. We also must protect this fund as part of defeating the ongoing strategy by those who oppose the Affordable Care Act to attack the law by repealing and de-funding its important pieces.
The full House of Representatives is expected to vote on H.R. 1217 as early as this week. Please take a few minutes to call your Representative and tell him/her to vote NO.
Here’s what YOU can DO:
Please call your U.S. House Representative 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 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 voice mail, tell him/her:
“My name is _______________ and I live in (city/state). I am calling to urge Representative ____________ to vote no on H.R. 1217. This bill would repeal 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.”
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.
· Follow Hepatitis Health Action’s blog for news and commentary: http://hephealthaction.wordpress.com
Hepatitis Health Action is a new campaign led by viral hepatitis advocates working to make sure that health care reform addresses hepatitis B and C.