HEPATITIS VIRUSES
Introduction
Viral infections are infections caused by a pathogenic virus. The exposure to and infection from pathogenic microorganisms present in human blood or simply blood-borne pathogens could lead to serious conditions. Exposure occurs when the pathogen is introduced directly into the body through a contaminated object. For instance, hepatitis viruses, specifically Hepatitis C, are among the main blood-borne viral infections of public health importance. Once an individual is contaminated, the condition could lead to cirrhosis or liver cancer. Unfortunately, there is no vaccine yet discovered for Hepatitis C unlike with Hepatitis B where antibody injections are already available. This paper will discuss the extent of the Hepatitis C problem with reference to Hong Kong and internationally. Further, safety in the workplace, necessity of a vaccine and raising public awareness will be also discussed.
The size of the problem
According to the Hong Kong Red Cross Blood Transfusion Service (HKRCBTS), Hepatitis C is a relatively rare infectious disease in Hong Kong where only 1 in about 200 of the local population is a Hepatitis C carrier. According to World Health Organization, in 2006, there are a total of 32, 500 people who are affected by Hepatitis C, which is 0.5% of the total population in Hong Kong. All the infected individuals became infected without their knowledge, and the body could not completely get rid of the virus after infection. The majority of the infected individuals show no signs or symptoms of the illness and remains healthy for years although some carriers show abnormal findings on their liver function testing from time to time.
Nevertheless, it was discovered that just like Hepatitis B, they are more likely to develop serious liver diseases including cirrhosis and liver cancer. Further, the individuals who are infected acquire the virus mainly through usage of tainted and improper sterilized instruments in acupuncture, injections and tattoo hence through blood. It was also believed that the virus is transmitted via unprotected sexual intercourse with an infected individual. Because blood tested positive Hepatitis C carrier are discarded, (HKRCBTS), as the leading non-profit organisation in combating hepatitis viruses in Hong Kong, the organisation is helping infected people through finding donors. Appropriate medical counseling is also provided.
The Hepatitis Foundation International relates significant statistics relating to the status of Hepatitis C. According to them, 3% of the world’s population is infected with Hepatitis C or approximately 170 million people. What is more saddening is the fact that 90% of the affected people are in need of treatment but cannot afford to do so. Further, 80% of the population can become chronically infected and risks serious long-term clinical disease including cirrhosis and liver cancer. There are a total of 8 countries which have HCV prevalence of above 10% including Bolivia, Burundi, Cameroon, Egypt, Guinea, Mongolia, Rwanda and Tanzania. While, there are 7 countries/areas that have a prevalence of between 5 to 10% as Gabon, Libya, Papua New Guinea, Suriname, Vietnam, Zaire and Palestine in the Near East.
Nonetheless, the primary sources of Hepatitis C in developing countries are different from those in developed countries. In developing countries, transfusion of blood or blood products from unscreened donors, transfusion of blood products which have not undergone viral inactivation, parenteral exposure to contaminated blood or inadequately sterilized instruments such as needles used in medical and dental procedures, usage of unsterilized objects for rituals such as circumcision and scarification, traditional medicine and intravenous drug use. Those that are marginally at risk are household and sexual contacts of HCV-infected persons. In developed countries, on the other hand, the persons at higher risks include those recipients of previously unscreened blood, blood products and organs, intravenous drug users, individuals undertaking hemodialysis, health care workers with percutaneous exposure to contaminated objects as needles and sharps, persons who are undergoing medical or dental procedures with inadequately sterilized instruments and persons who participate in high risks sexual acts (Hepatitis Foundation International).
Pathophysiology methods of diagnosis
As already mentioned, Hepatitis C is a slow-progressing disease. It may take 10 to 40 years to cause liver damage to people and it shows no signs or symptoms. If there are symptoms, these will be mild and flu-like only including nausea, fatigue, loss of appetite, fever, headaches and abdominal pain. There are very few who exhibited jaundice although it can sometimes occur along dark urine. Important to note is that 1 in 10 people who are infected by Hepatitis C has had no identifiable exposure to HCV. Since Hepatitis C is considerably easy to transmit, there are specific people who may be at high risk in acquiring the disease.
Medical patients such as those who have diabetes are perceived to be at higher risk to Hepatitis C. Healthcare workers are also at risk at 2% because of contacts with HCV positive blood. It is also discovered that HCV-infected mother could transmit the disease to a newborn but the probability appears to only 5%. There are also those who don’t have direct blood contact but could be also at high risk. These people are those intravenous drug users even those users in the distant past and those with multiple sex partners or with sex partners who have other sexually transmitted diseases. Included are those with tattoos or body piercing done with unsterile instruments (Hepatitis Foundation International).
Hepatitis C is not spread through kissing or casual contact, but is spread through a sexual intercourse. Sexual transmission is more common among sexually active people who embrace multiple partnering. What remains to be controversial and unconfirmed is the sexual transmission of Hepatitis C through a person with a history of sexually transmitted disease. It is also not reported that transmission from HCV RNA negative individuals and also no evidences are found that HCV is transmittable through breastfeeding. Confirmed, however, are those transmissions of Hepatitis C through the use of contaminated razors, needles, toothbrushes, nail files, barber’s scissors, tattooing equipment and body piercing or acupuncture needles.
Moreover, illegal drug users are could spread among them Hepatitis C especially that they are sharing paraphernalia. Injection drug users account for the new cases of Hepatitis C. Frequent users, specifically, are 50 to 80% are infected by HCV within the first 12 months of beginning injecting. Straws used in snorting drugs are usually shared during drug sessions and may serve as a carrier of HCV. Fundamentally, the current transmission rate of Hepatitis C is estimated at less than 1 in 1, 000, 000 units transfused (Hepatitis Foundation International).
Incubation period may take from 2 to 6 weeks. There are specific diagnoses to make sure that a person is affected. The first is through testing for HCV antibodies. As such, Hepatitis C infection could be determined using a very simple and specific blood test in order to detect antibodies against HCV. This is known as the enzyme immunoassay test (EIA) which detects anti-HCV with a sensitivity of about 95% in chronic HCV. As early as five weeks after exposure, HCV infection could be identified using this test in approximately 80% of the people. Since the test is not a part of a routine medical test, if an individual suspects that s/he may be positive with Hepatitis C infection, s/he should approach a doctor specializing in this area for a Hepatitis C antibody test (Hepatitis Foundation International).
If the test result is positive, it should be repeated in order that the diagnosis will be confirmed. When it is negative, an individual may ask his/her doctor to repeat the process or for alternative test methods or better yet, ask for second opinion. There are instances that infection could have occurred in the last six months and antibody may not be high enough yet to be detected or, unfortunately, a person may lack immune response. Another tests that could be conducted is testing the liver enzyme levels. If the condition is already chronic, two tests will be employed: alanine aminotransferase (ALT) and aspartate aminotrasferase (AST). These enzymes are released when liver cells are injured or die, with levels which may disappear or appear throughout the course of the HCV infection. Because of this, it should be rechecked several times over a 6 to 12 month period. When normalized, the frequency of checking could be lessened.
With proper treatment, 20 to 30% of the Hepatitis C sufferers could be virus-free. The sad part is that 70 to 80% of the infected individuals each year become classified as chronic. Hepatitis C becomes chronic when the infection do not clear up within 6 months after the acute infection. About 20% of the chronically infected individuals will likely to develop into cirrhosis or the scarring of the liver. Although it will take 30 to 40 years, 25% of this group will continually to develop liver failure. The longer period of materialization of liver cancer is because cirrhosis slows the blood flow through the liver. Such condition causes the increased pressure in the vein the carries blood from the stomach and the intestines to the liver, leading to complications of Hepatitis C. Examples of this is the presence of varices which may break, causing a person to vomit blood or have black, tarry tools. Each year, an estimated 8, 000 to 10, 000 people deaths occur because of complications (Hepatitis Foundation International).
The treatment of Hepatitis C is a costly undertaking. Particularly, there are three types of interferon, in addition to a combination of interferon and ribavirin which are used to treat the disease. As well, there are series of blood tests and liver biopsy which will determine the need for treatment. Interferon is given by injection but may inhibit side effects. Side effects include headaches, fever, fatigue, loss of appetite, nausea, vomiting and thinning of hair. Ribavirin, however, is taken by mouth and may also have additional side effects such as depression, severe anemia and birth defects. As such, pregnancy should not be attempted until six months after the treatment. Ribavirin, further, could also interfere with the production of red blood cells and platelets by means of depressing the bone marrow. Therefore, there is the necessity to monitor the patients regularly especially that it is not confirmed when the treatment should begin, for how long it should continue and how effective it can get. There are instances that while 50 to 60% of the infected individuals who are treated initially, the sustained response only occurs to just 40% of this population (Hepatitis Foundation International).
Safety in the workplace
In my work area, I noticed that the institution is serious in preventing occupational exposure to blood-borne viruses. In our workplace, there are clear guidelines regarding the proper handling and disposal of sharps safely, safe disposal of wastes and decontamination of equipment including cleaning, disinfection and sterilization. The institution also conforms to local standards and where available innovative products that reduce the risks of injuries are used. A written policy is also in place regarding waste disposal and persons accountable are well-trained. They conduct local risk assessment for the purpose of determining the most appropriate storage, collection, transport and disposal arrangements. Aside from policies compliances, processes are also based in benchmark practices.
For me, there are no changes required but there are additional requirements especially in the management of spillage. Although the institution is firm in making people follow written policies, there must be punishment for those who will not follow especially because within the workplace a close interaction is inevitable. So, if there is a single person who is not serious in obeying rules, all of those s/he may came in contact with will be at risk, spreading the communicable diseases as possible. In addition, so as the people will not forget, or intentionally neglect, the actions that must be taken when exposures happen, an ongoing deliberation must be accomplished involving all the employees. Specifically, people must be trained with first-aid procedures and risk assessment of all the employees must be also carried out in an ongoing basis as well.
The necessity of Hepatitis C vaccine
Based on what I have read, there are vaccines readily available for Hepatitis C because the disease has various genotypes and that the virus undergoes mutations, making it difficult to develop a vaccine. More devastating, is the fact that if a person has Hepatitis C, it will make him/her vulnerable in acquiring Hepatitis A or Hepatitis B (Inchauspe and Feinstone, 2003). In recent years, however, the scientific community intensifies the experimentation of vaccines which will trigger immune responses and helps control Hepatitis C. A study conducted by the National Institutes of Health (NIH), a potential Hepatitis C vaccine with virus-like particle that mimic the virus was developed. Such a vaccine contains important viral proteins and is pre-tested with chimpanzees, the only animal that is known to become infected by Hepatitis C virus (Contie, 2007).
The creation of vaccines which will block the virus altogether is far from becoming real, a vaccine that will prevent long-term infections from taking hold is a more realistic goal. Considering the recent progress relating to Hepatitis C vaccine development, the likelihood of having vaccines is very high. In making a successful vaccine a reality, monoclonal antibodies are also being developed. A significant milestone is the possibility of inducing broadly reactive neutralizing antibodies. But since the creation of a vaccine is relatively far from reality, the HCV infected community must be given ‘protective immunity’ in order for them to become resistant to persistent infection. There must be a medical team who will study the protective arm of the immune system, perhaps through T cells which is active in fighting hepatitis viruses and other viral infections (Science Daily, 2004). In simpler terms, the academia shall focus on specific areas where immune response in general is strong.
If vaccines will not be developed, the society must face the consequences. Hepatitis C treatment, as already noted, is expensive and is only successful not even to half of the total population undergoing treatments. According to Science Daily (2007), untreated or unresponsive patients will continue to develop cirrhosis and liver cancer and may cost the states and governments even more that the cost of funding a research in developing a vaccine as well as the cost that the state will devote to treatment. A decade ago, in the US, the estimated annual costs of acute and chronic Hepatitis C was above billion including medical and work loss (Wong, 2000). Liver transplantation is likewise costly, and not all could afford the medical process. Vaccination is a public health measure, meaning more people have access on it. If there will be vaccines against Hepatitis C, the greater public will benefit compared to the inexistence of treatment which only those who are well-off could afford, providing the impetus of developing a vaccine. According to Di Bisceglie (2007), vaccines must be also treatment-inclined aside from being preventive.
Raising public awareness
In efforts to raise public awareness about Hepatitis C, specific strategies must be considered. The emphasis is given on the department of health in various states and governments, which will work in conjunction with the local authorities and with existing health awareness programs for similar at-risk populations. Some of the strategies that can be utilized are: an outreach campaign which will make use of print, radio and television public announcements, advertisements, posters and other visual materials as well as brochures and videotapes; community forums (could be online also); health information and risk factor assessment at public events; targeting at risk populations; providing reliable information to policy-makers; distributing information though local health agencies, schools, employer wellness programs, physicians, hospitals, health maintenance organizations, prisons, sports leagues, nonprofit organizations, community- based organizations, state fairs and department of health and senior services offices; and build statewide capacity to provide information (Justia).
Provided that there are no vaccine yet discovered for Hepatitis C and the vaccines for Hepatitis A and B do not provide immunity for it, the best cure is still prevention. While working, especially in the medical premises, handling of anything that may have the blood of an infected person on it must be avoided. Though not proven, it is believed that detergent and a 10% solution of household bleach could kill the virus. It is also necessary that a person infected must notify his/her physician, or even a person just suspects that s/he has it. If known to be infected with Hepatitis C, a person shall refrain from drinking alcohol because it cam exacerbate the condition of the liver as it accelerates liver damage. A reality is that there are millions of drug users and who are engaged in premarital sex. If it is no use to say to not do drugs or sex, then this report advice not to share drug needles or cocaine straws or any drug paraphernalia and practice safe sex. If possible, prefer latex condoms.
Conclusion
Hepatitis C is now in the forefront of medical challenges. One process of responding to the global health dilemma is through a proactive approach a combination of prevention and treatment. There is no single strategy or government which can combat the phenomenon. A necessity is an ongoing, hand-in-hand initiative to fight the disease.
References
Contie, V 2007, Hepatitis C Vaccine Shows Promise in Chimpanzees, NIH Research Matters, National Institutes of Health.
Di Bisceglie, A M 2007, Hepatitis C Virus? Medscape Today.
Hepatitis C, HKRCBTS, retrieved on 2 December 2008, from http://www5.ha.org.hk/rcbts/e_hepatitisc.asp.
Hepatitis C – Global Infection Rate, 2006, PKIDS and WHO, retrieved on 2 December 2008, from http://www.pkids.org/pdf/phr/03-06hcvglobal.pdf.
Hepatitis C: Surprise Finding Could Lead to Vaccine, 2004, Science Daily.
Inchauspe G and Feinstone S 2003, Development of a hepatitis C virus vaccine. Clinical Liver Disease, vol. 7, no. 1, pp. 243–59.
Possible Hepatitis C Vaccine, 2007, Science Daily.
Strategies in Raising Public Awareness on Hepatitis C, retrieved on 3 December 2008, from http://law.justia.com/missouri/codes/t12/1920000033.html.
The ABCs of Hepatitis, Hepatitis Foundation International, retrieved on 3 December 2008, from http://www.hepfi.org/living/liv_abc.html.
Wong J B 2000, Estimating future hepatitis C morbidity, mortality, and costs in the United States, American Journal of Public Health, vol. 90, no. 10, pp. 1562–1569.
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