Hepatitis is a liver disease which causes chronic and acute infections. It is transmitted through infected blood and other body fluids. In Pakistan, there are estimated 7-9 million people who are infected with hepatitis B with carrier rate of 3-5%.It is a life threatening process and it is caused by HBV (Hepatitis B virus).It can cause global health problems. Due to hepatitis B, chronic infections are caused which can lead to the death of individuals.
Hepatitis B prevalence is the highest in East Asia and sub-Saharan Africa from 5 to 10 percent with adults having chronic infections. Its prevalence rate is higher in Amazon and southern parts of central Europe with chronic infection.2.5% of the population is infected in Middle East and Indian subcontinent. Less than 1% of the population is infected with chronic hepatitis in Western Europe and North America. About the third of the world’s population, 240-350 million people are having with chronic infections.129 new infections are occurred in 2013.750,000 people died with this disease in each year. About 500,000 people died with liver cancer. 80-90% of the infants are infected with HBV.30-50% of the children are at the risk of infection before age 6 years. Less than 5% adults having infection that lead to chronic hepatitis.20-30% of the chronic infections in adults results in liver cancer or liver cirrhosis.
HBV live outside the body for 7 days. Its incubation period is about 75 days (varied 30-180 days. It is detected within 30-60 days after the infection and can cause chronic infection. Its symptoms appeared within 30-180 days. In endemic areas, HBV is transmitted through perinatal and horizontally. It is also transmitted by percutaneous or mucosal exposure to infected blood and various body fluids such as saliva, vaginal and seminal fluids. Homosexual persons having sex with each other can results in chronic infection. Heterosexual persons having sex with multiple partners can lead to the chronic hepatitis.
During surgical, medical and dental procedures infection can be caused. Reuse of needles can lead to severe disturbances.
During the infection phase of Hepatitis B, most of the people don’t face any symptom. Acute illness will be seen in some people including jaundice, dark urine, fatigue, vomiting, nausea and abdominal pain. Acute hepatitis can lead to the liver failure. HBV can also results in liver cancer or cirrhosis of liver.
Hepatitis disease burden in Pakistan:
Nearly 3% of the population is affected with Hepatitis B in Pakistan .In towns and villages of Sindh and Punjab 20% of the people are affected with HBV. Approximately 100,000 new people are affected with this life threatening disease. Thousands of people are died of this disease each year.
The first ever national survey was conducted on 2011 which showed that 12.3 million people are affected with Hep.B and C.47,043 men, women and children were tested and the majority of infected were males having 7.6% of the positive sample results. Punjab has the highest 6.7% for Hep.B while the Baluchistan has the highest 4.3% Hep.B positive sample results. WHO recommends 3.5 injections for hepatitis per person per year but in Pakistan, due to increasing prevalence, 13.6 injections are administered per person per year which showed a high risk of hepatitis B and C.
There are Assays for the detection of HBV that involves serum and blood tests. HBV virus can be detected by viral antigens or antibodies produced by the host. Hepatitis B surface antigen HbsAg is most frequently used technique to screen for the presence of such infection.
Prevention or control and WHO response:
Hepatitis B vaccine must be given from childhood to prevent such disease. Vaccines for HBV has been available since 1982.World health organization(WHO) recommends Hepatitis B vaccine within 24 hours of birth followed by 2-3 doses for primary series.
3-dose schedule for hepatitis B vaccine, with the first dose (monovalent) will be given at the birth and second and third dose will be given at same time of first and third doses of pertussis, diphtheria and DTP vaccine.
A fore dose schedule includes monovalent followed by monovalent or combined doses of vaccine will be given with other routine infant vaccines.
WHO is working on the following areas to achieve global hepatitis goals till 2030
- Raising awareness among the people
- Evidence based policy formulation
- Preventing transmission
- Maintenance of screening
WHO organizes awareness programs for HBV on 28 July every year.