Sunday, 23 April 2017

New WHO ‘Global Hepatitis’ report highlights the impact of viral hepatitis

New WHO ‘Global Hepatitis’ report highlights the impact of viral hepatitis While the world focused on tackling the HIV/AIDS epidemic, another viral infection, viral hepatitis, has slowly gained foothold and has now become a major public health problem. This week, the World Health Organization (WHO) released a ‘Global Hepatitis’ report, which elaborates on the global burden of viral hepatitis and for the first time includes global and regional estimates on viral hepatitis in 2015. According to the report, globally, about 325 million people worldwide have chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. Many among these are at risk of progression to chronic liver disease, cancer, and eventually death as they lack access to diagnostic tests and treatment. Viral hepatitis caused 1.34 million deaths in 2015, a number comparable to deaths caused by tuberculosis and higher than those caused by HIV. Of the five types of viral hepatitis, hepatitis B and C together account for 96% of overall mortality due to hepatitis. While deaths due to TB and HIV are declining, those due to viral hepatitis are increasing. Globally, countries in the WHO African and the Western Pacific Regions have the highest prevalence of hepatitis B. The WHO Eastern Mediterranean and the European Regions have the highest reported prevalence of hepatitis C. Here are some key points about viral hepatitis: • Hepatitis B is the most infectious of the three blood-borne viruses: Hepatitis B, hepatitis C and HIV. • Absence of jaundice does not rule out acute hepatitis infection, can just present with constitutional symptoms such as fever, vomiting, poor appetite, lethargy with high liver enzymes. • Because of their shared routes of transmission - infected body fluids such as blood, semen and vaginal fluid, or from a mother to her baby during pregnancy or delivery - people at risk for HIV infection are also at risk for HBV or HCV infection. • All people with HIV infection should be tested for hepatitis B and C infections. • Progression of liver disease is faster in viral hepatitis and HIV coinfection, which also increases the risk of serious, life-threatening health complications. • Hepatitis B can also be transmitted by fomites such as such as finger-stick devices used to obtain blood for glucose measurements, multi-dose medication vials, jet gun injectors, and endoscopes. • Hepatitis B is 10 times more infectious than HCV and 50–100 times more infectious than HIV. The HBV can survive in dried blood for up to 7 days and remains capable of causing infection. This makes hepatitis B a more dangerous infection than HIV. • Hence, any blood spills from a person with hepatitis B should be cleaned up with appropriate infection control procedures e.g. wearing gloves, and using an appropriate cleaning product for the surface, such as diluted bleach or detergent and warm water • The first step after being exposed to blood or bodily fluids is to wash the area well with soap and water and covered with a waterproof dressing or plaster. Expressing fluid by squeezing the wound will not reduce the risk of blood-borne infection. All unvaccinated persons should be administered hepatitis B vaccine after exposure to blood. If the exposed blood is positive for HBV and the exposed person is unvaccinated, treatment with hepatitis B immune globulin is recommended. • Hepatitis C virus can survive on environmental surfaces for up to 16 hours. It can also spread from infected fluid splashes to the conjunctiva. Dr KK Aggarwal National President IMA & HCFI

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