Hepatitis B: The Silent Killer

HEALTH:

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). -- ###