Vietnam among countries with alarming hepatitis B infection rate

Vietnam is one of the countries whose hepatitis B infections have reached an alarming rate as 10-20 percent of its population has contracted the disease, local health authorities have warned.

The Preventive Health Department under the Ministry of Health on Wednesday said that Vietnam is among the nine Western Pacific countries to be placed by the World Health Organization (WHO) on the list of nations where hepatitis B infection is alarmingly high, according to the Vietnam News Agency.

The treatment of hepatitis B is very costly, the department said, elaborating that it costs a patient US$2,765-9,218 per year to treat the disease, which attacks the liver, during a period of one to two years, experts estimated. Even after that the success rate in western medicine is very low.

Hepatitis B is the leading cause of liver cancer, with 25 percent of patients developing cirrhosis and then liver cancer if untreated, the department said.

The hepatitis B virus is mainly transmitted through blood, from mother to children during birth, or via unprotected sexual intercourse, according to the department.

Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus, which can cause chronic infection and puts people at high risk of death from cirrhosis and liver cancer, according to the WHO.

Most people do not suffer any symptoms during the acute infection phase, but some people have acute illness with symptoms that last several weeks, including yellowing of the skin and eyes, dark urine, extreme fatigue, nausea, vomiting and abdominal pain, the health organization said.

Meanwhile, a small subset of persons with acute hepatitis can develop acute liver failure that can lead to death, the WHO warned.

A vaccine against hepatitis B has been available since 1982 and is 95 percent effective in preventing infection and the development of chronic disease and liver cancer due to hepatitis B, the WHO added.

The WHO recommends that all infants receive the hepatitis B vaccine as soon as possible after birth, preferably within 24 hours.

The birth dose should be followed by two or three shots to complete the primary series.

Hepatitis - a wide spread ticking time bomb

Compulsory HBV vaccination has been instituted in Malaysia since 1989. Nevertheless, hepatitis B remains an important cause of morbidity and mortality.

Chronic hepatitis B is a worldwide phenomenon, and it is estimated that there are more than 350 million hepatitis B virus (HBV) carriers in the world, with 75% of them living in the Asia Pacific region, where the majority of infections are acquired perinatally (period immediately before and after birth) or in early childhood.

Approximately one million people die from HBV-related liver disease every year. The implementation of effective vaccination programmes in many countries has resulted in a significant decrease in the incidence of acute hepatitis B.

Compulsory HBV vaccination has been instituted in Malaysia since 1989. Nevertheless, hepatitis B remains an important cause of morbidity and mortality, and many individuals who carry the virus (HBsAg-positive) remain undetected and unaware of the infection, and therefore, pose a danger to themselves and others close to them.

Patients with chronic hepatitis B seldom exhibit symptoms apart from fatigue, unless they have complications such as decompensated liver cirrhosis.

Physical examination may be completely normal. Those with end-stage liver disease may have jaundice, big spleen, ascites, leg swelling and encephalopathy.

Routine laboratory tests may be normal. There may be mild to moderate increase in liver enzymes (serum AST and ALT), which can increase dramatically and substantially in patients who develop exacerbations.

Doctors following up patients with apparent “silent” chronic hepatitis B will look for signs of progression to cirrhosis evidenced by hypersplenism (big spleen with decreased white blood cell and platelet counts) or impaired liver synthetic function, such as low serum albumin, prolonged prothrombin time and high serum bilirubin levels.

The natural course of chronic hepatitis B infection is determined by the interplay between virus replication and the host immune response.

Other factors that can influence the progression of HBV-related liver disease include gender, alcohol consumption and concomitant infection with other hepatitis viruses.

The outcome of chronic hepatitis B infection depends on how severe the liver disease is at the time HBV replication is suppressed.

Patients with this infection may be in an inactive carrier state, but can progress to cirrhosis, hepatic decompensation and liver cancer, which may prove fatal.

The prognosis is worse in HBV-infected patients from endemic areas like South-East Asia.

Twelve to 20% of patients with chronic hepatitis B may progress to cirrhosis; 20 to 23% of those with compensated cirrhosis can progress to hepatic decompensation; while 6 to 15% will progress to liver cancer within five years.

Patients with compensated cirrhosis have an 85% survival rate at five years, while those with decompensated cirrhosis have survival rates of 55 to 70% at one year and 14 to 35% at five years.

Presently, doctors may wish to know the viral genotype of their chronic hepatitis B patients. Traditionally, eight genotypes (A to H) have been identified, with genotypes B and C being more prevalent in East Asia and South-East Asia, where perinatal or vertical transmission plays an important role.

Genotype B patients are also associated with spontaneous seroconversion (HBeAg to antiHBe) at a younger age, have less active liver disease, and show slower progression to cirrhosis and less frequent liver cancer than genotype C.

Laboratory tests include a complete blood count, liver enzymes (AST, ALT), total bilirubin, alkaline phosphatase, albumin, prothrombin time and tests for HBV replication (HBeAg, anti-HBe, HBV DNA).

Hepatitis B infections in Kenya surpass HIV

The rate of Hepatitis B virus (HBV) infection in Kenya is currently three times higher than that of HIV, a study has revealed. The statistics indicate that the prevalence rate of HBV has risen and surpassed that of HIV three-fold in a span of two years.

A nationwide research conducted last year revealed that out of about 150,000 people who donated blood, 1,200 were found to be HIV-positive while 3,000 were diagnosed with HBV.

Like HIV, HBV is also transmitted through sexual intercourse, contaminated blood and from a mother to her child. If untreated, HBV could lead to liver cirrhosis and liver cancers. This should be cause for alarm, as similar high data is being registered among HIV infected persons, showing a rising prevalence of co-infection with HBV.

Co-infected persons have an increased rate of liver disease, higher HBV and HIV viral loads, and poor response to anti-retroviral drugs.

HBV is 50 to 100 times more infectious than HIV and health workers who accidentally get needle stick injuries have a much higher chance of infection from HBV than from HIV. Approximately ten per cent of pregnant women and over 30 per cent of liver patients in Kenya are HBV infected.

Given that blood donors are a very highly selected population, researchers and stakeholders now contend that the prevalence in the general population may be much higher. It is, therefore, important that HIV infected persons also seek HBV testing.

In an endeavour to control the virus’ increasingly worrying trends, the Ministry of Health intends to create awareness through educating people about the dangers of HBV infections ahead of World Hepatitis Day marked on July 28th each year.

Hepatitis B patient fully cured through 6 months of Kamalahar treatment

Mr. P. Sharma, a resident of New Delhi, was suffering from Hepatitis B. He has been through many different treatment and spend thousands of Rupees with no benefit. He came to know about Kamalahar, ayurvedic liver product. He was skeptical in the beginning and had lost all hope. When he started treatment through the ayurvedic product, he was almost sure that nothing will happen but he still decided to go ahead with the treatment as there was no other option left for him. There is currently no cure for hepatitis in allopathic world. As time progressed, his liver condition started improving. After 4 weeks of treatment, various parameters of liver showed a movement towards normal condition. His HsAg, SGPT, etc. were moving towards normal range.  Finally after 6 months of hepatitis treatment through Kamalahar, he is back to normal and he is hepatitis negative now. Along with taking Kamalahar, Mr. Sharma had to follow a diet control. He had to avoid alcohol completely and minimize the intake of fatty and oily food.

Patients suffering from Hepatitis B, C must take advice before fasting

Health experts believe that the patients with chronic hepatitis B or C must take advice from a qualified physician before going for fasting while patients who have already developed complications of hepatitis C should not fast.

Experts say that the patients suffering from hepatitis C complications including contraction of liver called cirrhosis or ascities (distension of abdomen due to accumulation of water) or liver cancer must avoid fasting as fasting may cause lowering of blood sugar in such patients that can be life threatening.

The experts are of the view that patients of hepatitis B or C who are being administered injections or taking oral medication can fast but they should consult their physicians to get schedule of medicines changed while fasting. Such patients should not discontinue medication including administration of injections. If patients who are fasting feel drowsiness or pain in stomach then they should instead break open fast and consult their physician to avoid complications.

Hepatitis C virus infection is the leading cause of cirrhosis, considered as the end-stage liver disease. Most of the people develop distension of abdomen due to accumulation of water, many present with vomiting of blood as the veins in the food passage rupture due to raised pressure of the portal circulation. Patients with chronic hepatitis B or C or those who are being treated through injections or oral medication, if fast, should not take food containing higher fats. 

Hepatitis B - One of the main causes of liver cancer in Thailand

In Thailand, chronic hepatitis B is the most significant factor leading to liver cancer. Up to 75 per cent of Thais with liver cancer had previously had chronic hepatitis B. 

The hepatitis B virus is the most commonly transmitted virus in the world. Two billion people have contracted this virus at one point in their lives, which means that one out of three have once had hepatitis B. More importantly, 350 million to 400 million people develop chronic hepatitis B. 

Between 6 and 12 per cent of Thais over 40 develop chronic hepatitis B. After the launch of a campaign to promote the anti-hepatitis B vaccination of new-born infants in 1992, the rate of infection fell to 4 to 6 per cent, or four million Thais. 

How do we catch the hepatitis B virus?

* Mother to unborn child

This form of transmission is the most common cause of infection in Thailand. It is expected that 90 per cent of pregnant women who are infected with hepatitis B will pass the virus on to their unborn baby. 

* Sexual contact

Hepatitis B can be contracted via sexual activities. A married person whose spouse has a chronic infection of the virus should take a test to see if they have contracted the virus. In case that no virus is found, it is advised that they take a course of three vaccine injections. 

* Sharing syringes or needles

This form of transmission can be caused by the use of syringes, tattooing, acupuncture, or the use of shared contaminated items, including toothbrushes, razor blades, etc.

* Infection from the lymph of an infected person through open wounds or conjunctiva 

Once the hepatitis B virus has attacked the cells of the liver, it will split and cause acute hepatitis. Patients will have low fever, feel tired, lose their appetite, and experience pain in the lower right side of the abdomen. 

After having these symptoms for five to seven days, the patient will pass dark urine and develop jaundice. At this stage, the patient will recover from the jaundice and the hepatitis B virus, and will also recover from the acute hepatitis within one to three months. If the disease develops in the liver for over six months, it will become chronic hepatitis B. 

Statistically, around 3.5 per cent of adults with acute hepatitis B virus have a tendency to develop chronic hepatitis B, while over 90 per cent of newborn babies who catch the disease will become chronic hepatitis B virus carriers. 

More importantly, over 90 per cent of babies with the hepatitis B virus will not display the symptoms of acute hepatitis. The disease will not heal. Instead, it will develop into chronic hepatitis B virus, damaging liver cells and causing scar tissue, which will eventually lead to cirrhosis in 20 to 25 per cent of cases within eight to 10 years. 

Annually, cirrhosis is found to result in a lung failure in 3 to 5 per cent of those infected and develops into liver cancer in around 3.8 per cent of the infected population. In Thailand, chronic hepatitis B is the leading cause of liver cancer. Around 70 to 75 per cent of Thai patients with liver cancer have a history of chronic hepatitis B. 

More importantly, the hepatitis B virus can cause liver cancer regardless of whether patients develop cirrhosis. However, such a possibility is lower than in patients who develop cirrhosis.

Hepatitis B leading to high rate of liver cancer among Asian Americans

Cancer is the leading cause of death for Asian Americans. The most common types of cancer for Asian Americans are liver cancer, stomach cancer and cervical cancer. Breast cancer has also been increasing among Asian Americans. 

Approximately 1 in 12 Asian Americans live with a chronic hepatitis B infection, but too few Asian Americans know that chronic hepatitis B infection is a risk factor for liver cancer.

Hepatitis B is most commonly transmitted from mother to child, which is why vaccination of infants is most important. Hepatitis B can also be transmitted through sexual intercourse with someone who is infected.

Centers for Disease Control and Prevention (CDCP) has launched a campaign to educate the Asian American and Pacific Islander (AAPI) community on the risks of hepatitis B infection. The Know Hepatitis B campaign is the first national multilingual, multi-year communications campaign to increase hepatitis B testing among AAPIs. The campaign aims to improve awareness, advocate for improved testing, improve care and treatment and improve health outcomes for AAPIs. 

Hepatitis B affects ones livelihood and mental health. Many individuals who have hepatitis B perceive the effects of stigma from the disease, which affects their contributions and impact in one’s family and community. Not addressing hepatitis B could have grave societal and cost implications and further isolate the AAPI community. It is important to implement culturally appropriate programs and outreach so that more AAPIs will be aware of the disease and get screened. Many nonprofit organizations works directly with community members to hold screenings, public events and educational receptions. After the free screenings, the organizations pass on the results of the blood tests and if any are found positive, the organization connects patients to care or treatment. It is important for the outreach organizations to use the native language, especially among older generations. 

One of the obstacles some AAPIs, including Vietnamese, face is that they either do not have health insurance or they do not have access to primary care doctors. They want to come but they don’t have the means to come. The organizations have to ask support from local agencies and also private donors to help them out with that.

Hepatitis b affects many Asian communities and it’s known to be a silent killer. As many of the people that are part of these communities come from countries where there’s a high prevalence rate for hepatitis and so that’s why the awareness program is so important. 

The National Cancer Institute advises everyone to get a blood test from their health care provider to see if   they are infected. If the blood test comes back positive, the health care provider will conduct further tests and recommend treatment.

Treatment for those with hepatitis B is available to slow liver damage. The hepatitis B infection is also preventable with a vaccine that involves three shots given over six months.

Hepatitis B treatment testimonial

Kamalahar is an ayurvedic product which is proven to be very effective in the treatment of hepatitis, cirrhosis, ascites, fatty liver, jaundice.