India can learn a lesson or two from Egypt on how to deal with hepatitis

In 2006, when Egypt formed a national committee to control the spread of Hepatitis, the country was known to have the highest burden of the disease globally. India, at the time, had still not acknowledged its growing Hepatitis numbers, while focusing on HIV and Tuberculosis.

Over the past decade, Egypt has come a long way, reducing Hepatitis prevalence from 4.5 per cent then to 1 per cent now, and, in the process, has provided a roadmap for the World Health Organisation (WHO) and countries like India, which is grappling with an estimated 6 million Hepatitis C (HCV) and 40 million Hepatitis B (HBV) cases.

The syringe culture is similar in Egypt and India. People take less oral medication and prefer injections. Syringe safety is necessary to prevent new cases. Egypt raised awareness on the use of sterile razors in barber shops, use of new instruments for pedicure and manicure and on the use of disposable syringes for patients. It’s all about advocacy. There should be multiple stakeholders like the government, politicians, the media and individuals from different sectors who wish to bring this health problem into the limelight.

The Egyptian government also urged Hepatitis drug manufacturing companies to lower costs. Direct cost of hepatitis treatment there was estimated at $ 670 million and the country was able to treat its patients at 1/10 the global price of the drugs.

The Hepatitis pool grew in Egypt in the 1950s and 1960s due to the reuse of glass syringes after boiling. It is believed that similar unsafe syringe practices have led to the increased cases in India. 

Egypt has now introduced a birth-dose policy to prevent new infections. The prevalence of HCV in Egyptian children has dropped to 0.8 percent from the 1.5 percent a decade ago.

The Union Ministry of Health and Family Welfare has begun a vaccination drive for newborns against HBV under Mission Indradhanush, that is aimed to prevent seven diseases in infants. Since 2014, over 40 lakh children have been covered under the scheme. But there still stands no active diagnosis or free treatment programme for Hepatitis adult patients unlike AIDS or Tuberculosis.

The Health ministry has also roped in Bollywood actor Amitabh Bachchan to become the face of the campaign. Although delayed, the government is slowly moving towards disposable syringes with Maharashtra becoming one of first states to embrace one-time usable syringes.

Hopefully, in due course we can learn and implement many of the policies that have been successful in Egypt

Khatore Pharmaceuticals and other organisations work to spread awareness about hepatitis

With over 3/4 of people in India being unaware about the existence of Hepatitis, many medical exerts of the country have decided to start an online data registry detailing the rising number of hepatitis patients. Khatore Pharmaceuticals also ran a campaign in Delhi to make people aware of liver disorders including distributing pamphlets to people near metro stations.

Hepatitis is an inflammation of the liver. The aim is to make people aware of problem and precaution that they can take to prevent it from spreading. 

The registry will be part of the newly formed Indian National Association for Study of Liver and Current Perspective in Liver Disease constituted by the leading gastroenterologists of the country. The association will also disseminate information to the regional hospitals and help the health centres located in remote areas of the country get the medicine supply.

Talking about lack of awareness about the deadly disease, the experts said that Hepatitis was 28 times more dangerous than AIDS due to the absence of symptoms, even as the disease spreads gradually in the patient.

Four lakh people die due to liver diseases, a result of hepatitis, in India every year. The states most affected by the disease are Punjab, Haryana, Odisha, Uttrakhand and Himachal Pradesh among few others, they said.

75% of the hepatitis, may it be B or C, is curable at the initial stage. However, as the symptoms are not felt, the person gets to know about it only when the virus causes liver cancer.

Through the registry, the hot spots of Hepatitis across the country can be brought into lime light and accordingly medical healthcare in those areas can be improved, precisely the treatment for liver diseases.

World Hepatitis Day: Mass awareness, immunisation needed to help curb spread of hepatitis

Mass awareness, universal guideline for immunization and hygienic handling of food and water will help curb hepatitis, said experts on Tuesday while observing world Hepatitis Day. About, two million people contract hepatitis every year from unsafe injections. These infections can be averted through the use of sterile syringes that are specifically designed to prevent reuse. Eliminating unnecessary injections is also an effective strategy.

 Experts stressed on the urgent need to enhance action to prevent viral hepatitis infection and to ensure that people who have been infected are diagnosed and offered treatment. The WHO this year, is focusing particularly on hepatitis B and C, which together cause approximately 80% of all liver cancer deaths and kill close to 1.4 million people every year. In addition to hepatitis B and C, hepatitis A and E viruses also cause viral hepatitis. These two viruses are primarily transmitted through contact with contaminated food and water and are responsible for less than 1% of all hepatitis-related deaths.

While explaining about poor target achieved in case of administration of Hepatitis-B0, the experts say "About 30-33% deliveries take place at sub-centres which do not have round-the-clock vaccination facility. Moreover, deliveries at private hospitals most of the time go unrecorded; hence the first dose of vaccination to the newborn within 24 hours remains unattended."

Viral hepatitis is caused by five distinct hepatitis viruses. Infection from these viruses results in approximately 1.45 million deaths each year. These viruses are transmitted through contaminated water and food, as well as by contact with blood or bodily fluids, through unsafe injections or transfusions. Infection also occurs from mother to child, or through sexual contact. Infection through all these routes of transmission can be prevented through proven and effective interventions. It is important for everyone to be aware of hepatitis and to learn how they can protect themselves from being infected.

Focusing on this year's theme - 'Prevent hepatitis. Act now', the workshop discussed various preventive measures.

Medicines are now available that can cure or help control in most people with hepatitis C and hepatitis B infection. People who receive these medicines are less likely to die from liver cancer and cirrhosis and also less likely to transmit the virus to others.

Patients should demand safe injection. Approximately, two million people per year contract hepatitis from unsafe injections. These infections can be averted through the use of sterile syringes that are specifically designed to prevent reuse. Eliminating unnecessary injections is also an effective strategy to protect against hepatitis transmission.

The WHO recommends vaccinating all children against hepatitis B infection, from which approximately 7.8 lakh people die each year.

As per Government of India, the vaccination schedule under the Universal Immunisation Programme for Hepatitis B vaccine is of 4 doses; 0 dose within 24 hours of birth and three doses at 6, 10 and 14 weeks of age. 

World Hepatitis Day 2015: Prevent hepatitis. Act now

On World Hepatitis Day, 28 July, the World Health Organisation (WHO) is highlighting the urgent need for countries to enhance action to prevent viral hepatitis infection and to ensure that people who have been infected are diagnosed and offered treatment.

This year, the Organization is focusing particularly on hepatitis B and C, which together causes approximately 80% of all liver cancer deaths and kills close to 1.4 million people every year.

The theme for this year’s World Hepatitis Day is “Prevent hepatitis. Act now”.

In India, it is estimated that prevalence of hepatitis C infection is more than 6 times the prevalence of HIV infection. The World Health Organisation has called the HCV a “viral time bomb”, which signifies that the policy makers must pay the required attention towards this health issue.

WHO is alerting people to the risk of contracting hepatitis from infected blood, infected injections, and sharing drug-injection equipment.

Risk factors, symptoms and causes

Hepatitis A: This form of hepatitis is commonly found in children and is usually spread by fecal-oral contact or fecal-infected food and water.

A baby could get hepatitis A by consuming food/water contaminated with HAV-infected stool.

Parents might not even know that their children have caught the disease as hepatitis A can be a mild infection. However, in serious cases of infection, symptoms include fever, vomiting, fatigue, loss of appetite, abdominal discomfort, dark-colored urine, and jaundice.

Hepatitis A usually causes mild illness, but it can also cause prolonged illness for upto six months

Hepatitis B: The hepatitis B virus is spread by contact with blood and other body fluids of an infected person. Infants may contract hepatitis B if they are born to a mother who has the virus.

In adults, it can be transmitted through unprotected sex with an HBV-infected person and sharing of contaminated needles or syringes for injecting drugs.

Symptoms may range from a mild illness to more serious chronic liver disease that can result in liver failure. Common symptoms may include fever, vomiting, loss of appetite, jaundice, etc.

Hepatitis C: It is more common in adults than in children. Hepatitis C is transmitted through direct contact with human blood and other body fluids. A baby can also get hepatitis C from his/her infected mother.

In adults, it can also be acquired through sexual contact with an infected person or through intravenous drug use.

Symptoms are usually mild and children often show no symptoms at all and therefore, parents get to know about their kid's disease at a later stage.

Hepatitis C leads to chronic liver disease in a majority of people infected with the virus. HCV is also considered to be the leading cause for liver transplantation in adults. Chronic hepatitis C virus infection is also linked with cancer.

Tests and diagnosis

All of the above conditions can be diagnosed through blood tests. A healthcare provider may also ask for liver function tests in order to determine the extent of the damage. A liver biopsy may be asked to do to further check for organ damage. Other tests and diagnostic procedures to determine the extent of the disease include CT scans and MRI.

Prevention

Like any other diseases, practising a good hygiene can help prevent the risk of getting as well as spreading hepatitis. Other preventive measures include:

Vaccinations - vaccinations are available for HAV and HBV, unfortunately, there's no vaccine for HCV.

WHO recommends vaccinating all children against hepatitis B infection. The vaccine should be given as soon as possible after birth, preferably within 24 hours. The birth dose should be followed by 2 or 3 doses to complete the vaccine series. A safe and effective vaccine can protect from hepatitis B infection for life.

WHO also recommends vaccinating adults who are at increased risk of acquiring hepatitis B.

Blood transfusion – to reduce the risk of infection, blood transfusion is routinely screened for hepatitis B and C.

Europe especially Eastern Europe unaware of the hepatitis crisis

The number Europeans living with hepatitis B and C is growing, particularly in Eastern Europe. But access to treatments remains scarce, due to funding problems and a lack of awareness of the problem, say patient groups.

Over the past four decades, there has been a significant increase in Europeans affected by hepatitis B and C. These diseases kill around 120,000 people in Europe every year. However, in the case of hepatitis C, many are unaware that they have the disease, caused by a virus that primarily affects the liver, as hepatitis is often asymptomatic and progresses slowly.

While experts say that parts of Europe have good practice in terms of intervention, most countries face major challenges in delivering high-quality hepatitis care.

The World Health Organisation (WHO) has recommended that the EU and its member states develop and implement a hepatitis action plan that encompasses awareness, prevention and treatment across all relevant policy areas.

Therefore, in 2014, patient organisations such as the European Association for the Study of the Liver, the World Hepatitis Alliance and the European Liver Patients Association, and the pharmaceutical industry met and agreed to recommendations on how to combat hepatitis, and compiled them into a new report.

Currently, no global funding mechanism exists for hepatitis, as opposed to AIDS/HIV, tuberculosis and malaria, governments will have to find a lot of their funding for the disease domestically.

The report suggests that education and awareness raising among lawmakers, the general public and healthcare professionals is pivotal to improve the prevention and management of hepatitis C.

The links between hepatitis C and liver cancer should also be highlighted.

Concerns over Eastern Europe

In Europe, 13.3 million have hepatitis B, and 14 million are living with hepatitis C.

The European region is very diverse both in terms of the prevalence, with over 60% of the infected living in Eastern Europe and regarding recent infections. The rates are still going up there.

France and Romania are two good examples of the extreme situation in Europe, regarding the management of hepatitis C.

While France has implemented three consecutive national plans that call for efforts to prevent transmission, increase detection rates and access to treatment, Romania has no national plan, and detection and treatment rates are low.

Hepatitis yields a wide range of symptoms

Hepatitis literally means inflammation of the liver (hepat-= liver; “itis”=inflammation). The liver is a hard-working, usually silent, warrior. The liver controls many body functions, processes proteins and fats, and stores glycogen. When it gets infected and inflamed, the complications come in a rainbow of colors and can be deadly. You have only one liver and you can’t live without it.

The most common types of hepatitis are A, B, and C. Each of these affects the liver, but they are separate viruses. Each has its unique characteristics.

Hepatitis A typically lasts a few weeks and comes from ingesting the hepatitis A virus. Have you noticed signs in restaurant bathrooms “Employee Must Wash Hands”? That is because the virus comes from stool, so an unwashed hand can carry the germ right to the food and into your body. It can make you mighty sick, but healthy people usually recover within a month.

Hepatitis A symptoms are colorful because the infected liver cannot process hemoglobin and bilirubin well. Your skin and eyes turn yellow, urine gets dark, stools come out white, and the nausea makes you feel green. Other symptoms are fever, fatigue and no appetite. Symptoms occur two to six weeks after exposure.

Hepatitis B comes through blood and body secretions. Intimacy, dirty injections, and injuries lead the list of pathways. Hepatitis B can also be transmitted from mother to baby during birth, which is why babies are given the hepatitis B vaccine in their first days.

Half of infected adults have no hepatitis B symptoms. Some have symptoms similar to the hepatitis A symptoms, six weeks or six months after exposure. Unlike hepatitis A, hepatitis B infection can become chronic, causing chronic inflammation of the liver, cirrhosis, end-stage liver disease, liver cancer and death.

You can be vaccinated for both hepatitis A and B, with separate or combined immunizations. We still do not have a vaccine for hepatitis C. The good news is that hepatitis B vaccinations have become routine for children since 1991, so young adults and children are likely to be protected. Health workers who are frequently exposed to blood are routinely offered the hepatitis B vaccine. With the broad use of the vaccine, hepatitis B infections have declined more than 80 percent. But many adults remain unimmunized and at risk.

Hepatitis C is also spread by blood. It is the most common chronic infection spread by blood in the United States. Hepatitis C can cause a mild infection that lasts only a few weeks, but more commonly, it damages the liver and causes lifelong illness. Hepatitis C can go undetected for years. Sixty to 70 percent of persons with new hepatitis C infections have no symptoms or have mild symptoms. As many as 85 percent of those infected with hepatitis C can develop chronic liver disease. Hepatitis C can be detected by a blood test.

So how do you protect yourself? Being as healthy as possible gives you the best fighting chance against any infection. Routine checkups and blood tests can detect an infection you don’t know you have.

World Hepatitis Day 2013 and Hepatitis Awareness Week was very successful the world over

Health Experts and NGOs world over have urged people to act swiftly and see their general practitioner for check-up and testing hepatitis. The call came as World Hepatitis Day 2013 and Hepatitis Awareness Week in many places came to an end.

Many campaigns tried to convey the message that hepatitis is nothing to be ashamed of. The week was all about informing the people about methods to avoid catching the virus as well as advice for those who have it. The main message is prevention and not being afraid to access the services that are out here. People should go to their doctor and get tested and necessary treatments.

The Hepatitis Awareness Week had been a huge success at many places with the exposure gained through several community engagement projects. It’s been very positive. There’s been many promotional events that have gone on all over the world based on increasing the awareness of hepatitis and also advocating for people that if they have any concerns that they should see their GP.

The campaign also tried to convey the message that there are now clinics that are open in many places and they involve specialist teams of doctors, nurses and allied health staff that can help in all aspects of caring for our health.

The most important and effective way to prevent new hepatitis C transmissions was not sharing equipment used to inject drugs. Many countries are supporting this by the continued expansion of needle and syringe programs (NSPs) to ensure all people who need to access sterile injecting equipment can do so. Younger people should also avoid sharing equipment used for tattooing and body piercing, including at backyard parties and by friends, because blood-to-blood contact is also possible in these circumstances.

Even though the concerted campaign to make people aware of Hepatitis has ended but the fight will continue till the disease and its menace is eradicated from the world.

Hepatitis C cases increasing in Iran

The number of people infected with Hepatitis C is increasing in Iran and it is estimated that about 0.5 percent of the Iranian population has Hepatitis C virus, which has come to the top of virus-induced liver diseases in many parts of the world. About 40 percent of the drug addicts have Hepatitis C and the number of injecting drug users in the country has grown as well.

The infection is emerging mostly due to the problem of intravenous drug abuse and needle-sharing. Most of the time both Hepatitis B and C develop in single men and those who serve prison sentences. There are more than 100,000 prisoners in Iran serving sentences for drug-related crimes. According to official statistics, there are about 2 million drug addicts in Iran.

Hepatitis C infection is now the most common cause of end-stage liver disease in many countries. Every year, about 1.4 million people experience chronic illness from their infection with hepatitis A, approximately 2 billion suffer from Hepatitis B and around 150 million from Hepatitis C.

Getting hepatitis on the policy agenda in Asia

Viral hepatitis causes 1 million deaths a year in the Asia Pacific region, the equivalent of one death every 30 seconds and more than three times as many as HIV. Of the 350 million people in the world living with hepatitis B, 74% of them live in Asia.

There is a vaccine for hepatitis B that could save millions of lives if the governments make it a priority. What we need is for governments across the region to approach viral hepatitis in the same way that most have HIV/Aids, TB and malaria. This starts with the development of a national action plan.

Despite the sizeable liver cancer wards in many of Asia's major hospitals, a general lack of understanding of liver disease both among the public and health professionals and no systematic screening for those at risk has left the epidemic unchecked.

There should be a campaign on liver disease education for the public and healthcare workers and an expansion of countrywide screening, hepatitis B vaccination and treatment of chronic hepatitis. These measures coupled with long-term surveillance for liver cancer, enhanced infection control to prevent transmission in health care settings and ongoing prevalence data analysis can help bring the epidemic of liver disease under control.

Vaccination for children is quite prevalent in many countries but vaccination for adults is far less widespread. But progress is stunted in parts of Asia where hepatitis is accompanied by discrimination. In many places the stigma attached to hepatitis B is severe. Pre-employment tests for the disease screen out those who test positive. Overseas workers from the Asia face similar discrimination notably in Middle Eastern countries. People with hepatitis are blatantly discriminated against and workplace discrimination is a huge problem that deters people from getting voluntarily tested.

India Hepatitis Awareness: Be aware of hepatitis, get tested today

July 28 was World Hepatitis Day 2013, and it is time we woke up to the fact the Hepatitis is as much a danger as HIV. Hepatitis is a largely overlooked disease, we need to create awareness amongst people, to make them understand that it is as important to weed out hepatitis as it was to wipe out polio or to spread awareness about HIV.

Here are a few things you might not know about Hepatitis:
Get tested if you have had a blood transfusion: Blood transfusion can transmit hepatitis C. If you have had a blood transfusion before the year 2002, get yourself tested for the condition. This is because, blood banks all over India started testing blood for the presence of Hepatitis C only after 2002. That being said, anyone who was transfused before that should get tested immediately.

Pregnant mothers beware: If you are pregnant or are planning to conceive anytime soon, get tested for hepatitis. This is because the virus that causes Hepatitis B can be transmitted from mother to child. A number of mothers in India are unaware that they should get tested. Some don’t even know they have contracted the condition and unknowingly pass it on to their babies. If a mother is found to have hepatitis B she and her child can be treated. The earlier the better. Babies can be saved from the infection if they are given the vaccine right after birth. In most cases it becomes difficult to save the baby if he/she is not treated immediately. Those who have hepatitis are at great risk of liver cancer and liver disease.

 

Don’t wait for the symptoms: By the time any symptoms manifest, it is usually too late to do anything. A person must get tested early on, or on a regular basis if they are at risk of contracting the disease. If hepatitis is detected early, it can be treated and managed well. People can live full lives. Hepatitis progress to cause irreparable damage to the liver, leading to liver cirrhosis and cancer. So don’t wait, prevention is always better than cure.

Be aware of the types: There are four types of hepatitis. Hepatitis A is commonly called jaundice. Caused due to a food borne virus, it leads to excess bile secretion, and malfunctioning of the liver. In most cases patients make a full recovery. Common symptoms include yellowing of eyes and skin, pale coloured stools, fatigue and in some cases vomiting. Hepatitis B is a viral infection that is spread through blood or body fluids. Either by having unprotected sex or sharing infected needles etc. It infects the liver, and its symptoms do not manifest in most people. This type can be transmitted from mother to child. Hepatitis C is a type that can be spread through blood and rarely through bodily fluids. It infects the liver and in most cases the symptoms do not show up until the liver is beyond repair. Symptoms are usually vague and commonly misdiagnosed. Hepatitis D is a mutated form of the virus causing other forms of hepatitis. It has been recognised by the WHO (World Health Organisation) as the hepatitis delta virus. It is transmitted through infected blood, blood products and unprotected sexual contact. People with Hepatitis B are at the greater risk of contracting this type of hepatitis.
Get vaccinated: There are vaccines for hepatitis A and B, but not for C. One can get the vaccine at any age, and it is freely available for administration in both government and private hospitals and clinics. Talk to your local physician about getting vaccinated.

World Hepatitis Day: Hepatitis kills about 2 people per minute

Hepatitis is a silent epidemic that kills two people per minute. In lead up to World Hepatitis Day, the Pan American Health Organisation and the World Health Organisation are urging the public to learn about the disease and get screened and treated, if necessary.

According to a joint news release issued by the health organisations Monday, viral hepatitis affects some 424 million people throughout the world, killing 1.4 million per year as a result of complications, such as acute liver failure, cirrhosis or liver cancer.

Hepatitis is sometimes called a “silent epidemic” because most people with the disease don’t realise they are infected.

World Hepatitis Day will be observed on Sunday, 28 July. This year’s theme is “This is the hepatitis. Know It. Confront it.”

People know very little about hepatitis, its potential severity, and its serious consequences for health and quality of life, therefore there is a need to intensify our information, education and communication initiatives around this disease and take action to promote prevention and early detection so people can get the treatment they need.

In the Americas, between eight million and 11 million people suffer from chronic hepatitis B infection, and seven million have chronic hepatitis C.

The disease puts a heavy burden on healthcare systems because of the high cost of treatment and, in many countries, it is the main cause for liver transplants.

The fact that most people do not have symptoms – and tend not to have them for decades until they develop chronic liver disease – has contributed to the problem of poor diagnosis and inadequate treatment.

The number of deaths throughout the world each year from causes associated with hepatitis is about equal to the number of traffic deaths, that is, more than two deaths every minute.

Hepatitis can be controlled by maintaining good hygiene, avoiding consumption of contaminated food and water, getting vaccinated for hepatitis B, practising safe sex and not sharing injections or piercing equipment.

PAHO/WHO has been collaborating with its member states on strategies to prevent and control viral hepatitis. All the countries of Latin America and the Caribbean, including the Cayman Islands, have officially introduced the hepatitis B vaccine into their child immunisation programmes, and more than 99 per cent of donated blood units are screened for the hepatitis B and C viruses.
PAHO also promotes hepatitis B vaccination of health workers and the expanded use of sterilised, disposable injecting, cutting and piercing tools and instruments to prevent cross infections, including needles used both in health facilities and in cosmetic procedures, such as tattooing.

New South Wales launches Hepatitis awareness campaign

The Lightning Ridge Sexual Health has teamed up with the AMS to present hepatitis health education with sti prevention for the 14-18 year old pupils at Collarenebri school on Friday July 26 to raise awareness of hepatitis and available treatments: this is to aid more people to present at clinic, get tested, seek treatment and help to de stigmatise the infection with in the local communities.

As part of NSW Hepatitis Awareness Week, which runs from July 21 and ends on World  Hepatitis Day on July 28, people living in local health districts of Far West and Western NSW are urged to remember key hepatitis C messages.

2010-11 NSW notifications data shows that Western NSW and Far West LHDs had the second highest and third highest notification rates, respectively, of all geographic based LHDs.

This is part of an overall trend since 2002/03 whereby hepatitis C notification rates for people in outer regional and remote areas of NSW are now higher than for people living in major cities (58.3 per 100,000 in 2010-11 versus 40.9 per 100,000).

There could be a variety of reasons for these results, including greater awareness of  hepatitis C in remote and outer regional areas, more people coming forward for testing or better health staff engagement with people at risk. However, the notifications data also reinforces that people residing in Far West and Western NSW regions need to remember the key hepatitis C prevention measures. The single most important, and single most effective, way to prevent new hepatitis C transmissions is not sharing equipment used to inject drugs. This should be supported by the continuing expansion of Needle and Syringe Programs (NSP)  to ensure all people who need to access sterile injecting equipment can do so. Younger people should also avoid sharing equipment used for tattooing and body piercing, including at ‘backyard’ parties and by friends, because blood-to-blood contact is also possible in these circumstances.

Adequate public awareness can be a great way to fight hepatitis

Experts have called for adequate public awareness on the prevention and treatment of hepatitis in Nigeria especially given that vaccination of children is one of the preventive measures aimed at tackling hepatitis and that early vaccination is a key to preventing hepatitis.

The increasing number of liver cancer cases in Nigeria has resulted from undetected and untreated hepatitis. 

 

Hepatitis B virus is transmitted between people through direct blood to blood contact or semen and vaginal fluid of an infected person. Modes of transmission are the same as those for HIV, but the Hepatitis B virus is 50 to 100 times more infectious as it can survive outside the body for at least seven days. During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine.

Since Hepatitis B has acute and chronic stages with few or no symptoms during the former stage. If acute hepatitis is not treated as soon as possible, it can cause chronic liver infection that can later develop into liver cancer.

Also, prevention of hepatitis was cheaper than its treatment, given the fact that liver transplant is very expensive and very difficult to obtain. Although people with chronic Hepatitis B could be treated with medicine especially alternative medicine; the treatment could cost thousands of dollars per year and also the medicine are not available in many developing countries.

It is also advised that people with high risk of sexual behaviour, injecting drug users and people at occupational risk of Hepatitis B virus infection such as health workers should be vaccinated. Through awareness campaign people should be told that they should avoid sharing sharp objects and toothbrushes; not even couples, as they are at a high risk of getting infected. People should also get tested regularly, so that if they have the disease, they can be treated early before it degenerates into the chronic stage. Mothers should vaccinate their children at birth as prenatal transmission was common among them.