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.
Hepatitis factsheet
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.
Source: WHO
Teressa Warianto
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