Wednesday, November 2, 2016
Indonesia - Hepatitis B Act now for a Hepatitis-free Indonesia
Hepatitis was the world’s 7th leading cause of death in 2013, killing more people than malaria and tuberculosis. As the World Health Organization (WHO) aims to globally combat the disease, experts say that awareness and prevention may be the only weapons we need to achieve a hepatitis-free Indonesia.
Hepatitis is often underestimated. As an infection of the liver, the contagious disease has become a health problem in many developing countries. Around the world, currently 400 million people are infected with hepatitis B and C, more than 10 times the number of people living with HIV.
Despite the startling facts and statistics, this disease is still rarely talked about.
“When the Ebola virus broke out, people panicked as it managed to kill around 10,000 people. But hepatitis kills more than 1 million people each year, and yet people aren’t treating it with the same seriousness as other deadly diseases,” said David Hadojo Muljono of the Indonesian Hepatitis Experts Committee at the Ministry of Health.
Compared to other deadly diseases like HIV, tuberculosis and malaria, only hepatitis has had an increasing fatality rate since 2000, something that is deeply concerning not only for the world, but also for Indonesia as well.
In the archipelago, hepatitis B is a virus that affects around 28 million people, or roughly around 10 percent of the population, with 14 million people at risk of the virus developing into chronic cirrhosis or liver failure. Before it develops into a chronic disease, however, it has no noticeable symptoms.
“Like many other viruses around us, this virus is virtually undetectable, especially in children. Only around 10 percent of people carrying hepatitis B virus are aware of it. The other 90 percent will only know they’re carrying the virus when it has developed into chronic cirrhosis or liver cancer,” pediatrician Hanifah Oswari from the Indonesian Pediatricians Association (IDAI) said.
A person has hepatitis B if they test positive for the virus HBsAg, but he or she may likely be unaware they carry the virus. The virus itself enters the body through the blood, then it travels to the liver and becomes part of the liver’s cell nucleus. Once the virus enters, 95 percent of the time, it will forever become part of the body’s DNA.
While transmission between adults are possible through the transfusion of blood and other bodily fluids, vertical transmission between mother and baby is a lot more common.
“The transmission process from mother to baby can happen during pregnancy, but 95 percent of the time, it happens during labor. A baby that is infected will grow up without showing any symptoms, potentially infecting others in the future,” said Hanifah.
“Therefore, pregnant mothers with risk of hepatitis are strongly advised to undergo regular check-ups to test whether she is HBsAg positive or negative.”
Thus, the best way to combat the virus is through prevention, especially at an early stage. Immunization for babies less than 24 hours after they are born is crucial in the fight against hepatitis B.
Hanifah says babies with mothers testing HBsAg negative (without the hepatitis B virus) or are unknown about their status should be given an active HB immunization along with vitamin K-1, less than 24 hours after being born.
On the other hand, babies from mothers who positively carry the hepatitis B virus should be given an immunoglobulin immunization less than 24 hours after being born, along with HB 0 shots on different thighs, followed by regular hepatitis B immunization shots at two, three and four months old, according to the national immunization program. The baby should then be tested for the virus at nine to 12 months old.
Since 1997, the Indonesian government has included hepatitis B immunization for all babies under the age of one year old as part of its national program. This means that all babies born in state hospitals will receive full hepatitis B immunization for free. The government has also implemented screenings for blood donors to prevent hepatitis B and hepatitis C infections through the Indonesian Red Cross (PMI) since 1997.
David says among other developing countries, Indonesia has done remarkably well in the fight against Hepatitis, although it still has a long way to go in terms of achieving a hepatitis-free future.
“We can be proud to say that our mandatory hepatitis B vaccination [program] has reached 80 percent of the population. However, we should remember that we continuously find new cases for hepatitis B-positive infants because the program is not quite effective in regions outside of Java,” he said.
Irsan Hasan from the Indonesian Association for the Study of Liver said prevention should always be prioritized in dealing with hepatitis B. While there was currently an antiviral drug for the chance of a 100-percent recovery from hepatitis C, no such cure had yet be found for hepatitis B.
“For those with hepatitis B, the only available medical treatment is to stop the virus from developing into further liver disease or to hinder the development of liver damage. It’s almost impossible to cure the hepatitis B virus itself — once you’re affected, you have to treat it for the rest of your life,” Irsan said.
Once a patient is tested positive for hepatitis B, the best treatment is to go for regular check-ups to monitor the liver’s condition.
“I advise that my patients go for check-ups every six months using a USG to monitor their liver. If the virus has not yet progressed into chronic liver disease, a patient can go on for years without having to take any medication despite having the virus,” Irsan said.
Only 1 in 20 people with viral hepatitis know they have it
Just 1 in 100 with the disease is being treated.
An estimated 1.45 million people died of the disease in 2013 — up from less than a million in 1990.