10 lakh hepatitis-B patients prone to 

liver cirrhosis, cancer

Naimul Haq

An estimated ten lakh people out of some 50 lakh chronic hepatitis-B patients in Bangladesh are at risk of dying from liver cirrhosis and cancer, the World Health Organisation (WHO) told The Daily Star last week.

Nearly five per cent of the population is chronically infected with the hepatitis-B virus and 30 to 40 per cent has had infection at one time or the other, according to the latest WHO report on Bangladesh.

Almost 20 per cent of the chronic carriers could die from primary liver cancer and cirrhosis, the report, recently released from the WHO headquarters in Geneva, said. A copy of the report was made available for The Daily Star last week.

Meanwhile, the country's top experts, studying hepatitis-B infection, put the figure of chronic patients at no less than eight per cent of the population. They maintain that the infection rate is increasing at an "alarming rate".

Worryingly still, they say, nearly two-thirds of the infected, mostly children, do not even know that they are carriers while less than one-third of the chronic patients report to hospitals for treatment. Less than five per cent of them stand the chance of surviving, they said.

According to the WHO report, prevalence is higher in adult male (5.7 per cent) than in adult female (2.9 per cent).

Twenty-nine per cent of professional blood donors in the country are hepatitis-B carriers, says the report.

"The earliest study on positive cases among general population showed 2.6 per cent infection rate. A five-year study from 1992 showed the infection rate reaching nine per cent. The most recent data puts infection rate among adult population at 22 per cent," said Professor Mobin Khan, leading liver disease specialist in the country.

Professor Khan's conclusion, however, is based on blood samples of adult patients admitted in six leading hospitals in the country, including the Bangabandhu Sheikh Mujib Medical University Hospital (formerly PG hospital) and the Dhaka Medical College Hospital.

Another hospital-based study, jointly conducted with Shinshu University School of Medicine, Japan and supervised by Professor Khan, found about 40.5 per cent adult population suffering from chronic liver diseases or hepatitis-B and 36.5 per cent from liver cancer. The study was based on different groups of patients admitted in various hospitals.

"The government must immediately initiate a national-level survey to find out the magnitude of the problem. The situation is quite frightening and we must do something about it."

Professor Nazrul Islam, head of virology department at the BSMMUH, shares his concerns.

"Our studies show a 6-10 per cent prevalence rate with intravenous drug users and commercial blood donors having the highest rate," he said. "Considering the high prevalence rate, hepatitis-B virus is no less deadlier than the HIV (virus that causes AIDS)."

Dr Shawkat Hossain, principal research officer of the immunology department at the BIRDEM who has led a number of investigations to find out the prevalence rate, said, "We tested blood samples of 45,000 migrant workers and found 4.2 per cent of them positive. Out of 1,800 pregnant women at the DMCH we found 3.5 per cent positive."

"Among 513 jaundice patients 25 per cent were hepatitis-B positive and 28 per cent of a household population of 550 were found carrying the virus. And lastly for exposure to the virus among hospital staff the figure is 63 per cent," added.

Dr M Anwar Hossain, head of clinical laboratory and services programme of the International Centre for Diarrhoeal Diseases Research, Bangladesh, said, "Among those tested at our centre last year, we found 15.76 per cent positive and the percentage till August this year jumped to 21.39 per cent."

Khondokar Zakaria Khaled, director of the blood programme of the Bangladesh Red Crescent Society, said, "Out of 15,000 units of blood that we receive as voluntary donation annually, at least two per cent is infected with hepatitis-B."

He also said that most of the donors are 'reserve donors' and are well aware of the highly infectious disease.

Dr M Mahbubur Rahman, programme manager of the government's child health and curative care programme at the health directorate, agreed that the situation was quite alarming. "The infection rate has gone up fast over the past few years."

The hepatitis-B virus is transmitted through body fluids, most commonly by sexual acts, unsafe blood transfusion and sharing of needles for injections. Sweat, saliva and other body secretions do not pose any serious threat but could prove dangerous if one did not practise safety measures.

Usually, if one is infected and at an acute stage he experiences vomiting tendency and chest pains. Colour of the patient's urine also turns dark yellow. He may also have internal bleeding and high bilirubin count.

The virus can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure and death. However, vaccine is available for all age groups.

Some people become carriers of the virus for the rest of their lives, infecting others. Others go on to have chronic liver disease. If someone becomes a carrier, he or she may develop cirrhosis or liver cancer.

"The acute and chronic consequences of hepatitis-B infection are major public health problems in Bangladesh," said Dr David Sniadack, a WHO consultant working with the country's Expanded Programme of Immunisation (EPI).

"Nevertheless, the government has expressed its desire to introduce a hepatitis-B vaccination programme. So on the basis of this the Global Alliance for Vaccines and Immunisation (GAVI) has committed to provide hepatitis-B vaccines worth approximately 40 million US dollars for five years for all children under one year of age to be given free of cost."

The vaccination programme is expected to start in June 2002 on pilot basis in six districts, still undecided, and would later be expanded nation wide and eventually incorporated into the National Immunisation Programme.

The hepatitis-B vaccine has now been used extensively throughout the world and is currently being incorporated into the EPI of the WHO.

The vaccines have been available globally since 1982 and currently 90 countries are using them as part of their national immunisation programme.

Both plasma derived and DNA recombinant vaccines are available and both are safe, efficient and meet the WHO requirements.

Although there is no effective cure the only treatment for hepatitis B is rest with a high protein diet to repair damaged liver cells and a high carbohydrate diet to protect the liver.


Source: The Daily Star, Dhaka, September 11,  2001
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