Hepatitis B: The silent killer

by Henrylito D. Tacio 

In 1998, Rene Cayetano was diagnosed of carrying the hepatitis B virus (HBV). But it was not four years later that alarming symptoms started to appear. The senator would feel tired despite having enough sleep and his skin gradually turning yellow.

As the disease threatened to develop into cancer, friends, family, and even members of the senator’s staff volunteered to donate part of their livers to save his life.

In 2003, the entire family went to the United States, where the senator underwent a successful liver transplant operation at the University of Southern California University Hospital. There was no evidence of liver cancer at the time of the transplant.

But the Lord had other plans for the senator. In June 24, 2003, he passed away, succumbing to abdominal cancer, which was diagnosed by doctors three months after his successful liver operation. Doctors diagnosed the cancer as having come from his previous liver.

Hepatitis B is a viral infection of the liver. According to the Geneva-based World Health Organization (WHO), more than two thousand million people alive today have been infected with HBV. Approximately 350 million are chronically infected and are at high risk of serious illness and death from cirrhosis of the liver and primary liver cancer, diseases that kill 500,000 to 750,000 persons a year.

Hepatitis B is very common in Asia. In Southeast Asia, more than half the population becomes infected with the virus. About 130,000 people are chronic (lifelong) carriers of hepatitis B in Singapore. In the Philippines, one in 10 Filipinos is suffering from the disease.

“Hepatitis B is endemic in most countries in Southeast Asia and the Western Pacific region with carrier rates between 5 and 35 percent,” disclosed Prof. Ding-Shinn Chen, a medical professor and head of the gastroenterology division at the Department of Internal Medicine in the National Taiwan University Hospital.

The Philippine Cancer Society (PCS) estimates some eight million Filipinos are HBV carriers. Of those who are infected, around two million would die of liver failure, according to studies by the Philippine Society of Gastroenterology. About 7,477 people will die from liver cancer this year, PCS projects.

“I call HBV a silent epidemic and a silent killer in the Asian community because many Filipinos and other Asians don’t even know they have been infected because there are usually no symptoms. By the time they develop symptoms, it is usually too late,” deplores Professor Samuel So, director of the Asian Liver Center and Liver Cancer Program of the Stanford University.

Unknowingly, hepatitis B is all too easy to catch. It is more common than the dreaded Acquired Immune Deficiency Syndrome (AIDS) and far more infectious. “While 90 percent of the people who get hepatitis B recover spontaneously with their body’s defenses, the 10 percent who maintain the infection for six months or longer and who do not produce an effective antibody response are considered chronic carriers,” explains Dr. Ernesto Domingo, head of the Liver Study Group of the University of the Philippines in Manila.

A small percentage of these chronic carriers will serve 30-40 years later, ultimately develop cirrhosis (scarring of the liver) or liver cancer. “Hepatitis B is the most common cause of liver cancer worldwide, and liver cancer is the third most common cancer in the world,” declares Dr. Dominic Garcia, an infectious disease specialist.

The HBV may be found in blood, semen, tears, and saliva. It is transmitted the same way as the human immunodeficiency virus (HIV), the microorganism that causes AIDS. That is, through sexual intercourse, use of contaminated needles, blood transfusion, and from mother to child.

“Hepatitis B is a disease with many similarities to HIV/AIDS,” commented British singer Elton John, who has been in the forefront of curtailing the disease. “They are both highly infectious, placing us all at risk whether we live in the developing or industrialized world. They both cause death many years after the infection.”

There are warnings that HBV may also be transmitted by puncturing the skin with instruments – such as those used for acupuncture, dental, and medical procedures, even for ear piercing and manicures – that have been contaminated. “But the most effective means of transmission is sexual contact other than kissing,” says Dr. Garcia. “The scary thing is that a lot of people don’t know they have it.”

People who are at high risk of the HBV are children below five years old, health care professionals who are usually exposed to blood, blood donors, army personnel, prisoners, men having sex with men, sexual workers and intravenous drug users. People with kidney diseases that require dialysis and those undergoing treatment of leukemia are also at high risk of contacting HBV.

“If you are between the ages of 18 and 34, and are sexually active with more than one partner in a six-month period or if you’ve been diagnosed with another sexually transmitted disease, you are at a greater risk,” says Dr. Garcia.

According to the United Nations health agency, almost all children in many developing countries become infected with HBV, “and the younger they are, the more likely they will become a chronic carrier,” it points out. “This is also why we need to use the vaccine in young children in most of the world.”

Among adolescents and adults, who constitute a much larger part of the infected population, HBV is transmitted in various ways: sexual contact; injection drug use; occupational exposure (among health care workers, for example); household contact with someone who has an acute infection or is a chronic carrier of the virus (this can be by some inadvertent contact with blood, such as that left on a razor or toothbrush); and blood or blood product transfusion.

“There is still considerable mystery about hepatitis B infection: despite what is known about these routes of transmission, almost one-third of people with the virus do not have identifiable risk factor at all,” notes Dr. Alan Berkman, author of Hepatitis A to G: The Facts You Need to Know About All the Forms of This Dangerous Disease.

By the way, there are no documented cases of hepatitis B being transmitted by a person being breathed on by someone with the illness, catching it from an insect bite (mosquito, for instance), or getting it through contaminated water. “Hepatitis B is not spread by contaminated food or water, and cannot be spread casually in the workplace,” the UN health agency maintains.

“The hepatitis virus is very durable,” points out Dr. Berkman. “It can remain infectious on environmental surfaces for at least a month if left at room temperature. Most people who get it fight off the infection by themselves, but the virus antibodies will be present in their blood for the rest of their lives.”

The WHO said that the incubation period of the HBV takes a long 45 to 160 days usually without any manifestations or symptoms. Thus, people infected with hepatitis B may not even realize that they have it until the latter stages of the disease. And even when symptoms are present, they are vague, often mimicking other, less life threatening diseases.

“Sometimes, people infected with HIV have what looks like the flu, with symptoms including loss of appetite, nausea and vomiting, fever, and weakness,” explains Dr. Berkman. “They may also develop symptoms more directly related to their livers: abdominal pain, dark urine, and yellowing of the eyes and skin. That kind of hepatitis B infection is usually harmless, even if it can be a little unpleasant for a period of time.”

But, as stated earlier, about 8-10 percent of people who are infected develop chronic hepatitis B. “There are two forms of hepatitis B, one acute and the other chronic,” says Dr. Berkman. The acute disease is very unpleasant, but if you recover from it you are likely to be immune from then on. Unfortunately, sometimes the acute disease progresses to the chronic form. A blood test can determine if you have the acute form of the disease.”

There are several ways you can avoid getting the HBV. The initial protection is having your child immunize against hepatitis B at birth. If you were not immunized at birth, go for a blood test to check if you have been previously infected with hepatitis B without realizing it. It is important to have yourself immunized as soon as possible.

Here are more: Avoid unprotected sexual contact with someone who may be infected. Wash your hands after touching any bodily fluids. Cover any cuts or open sores with a bandage. Avoid drug abuse and sharing of needles. Avoid sharing personal items such as toothbrushes, razors and shavers, and wash clothes. Refuse the use of unsterilized needles and other instruments (e.g. when having acupuncture, ear piercing or having a tattoo done). — ###

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