TMC Medical Facts: Hepatitis

For the world’s 8th leading cause of death, viral hepatitis is remarkably neglected. It kills 1.5 million people worldwide per year.

World Hepatitis Day is an annual event on the 28th July that provides international focus for patient groups and people living with viral hepatitis. This date was chosen to mark the birthday of Professor Baruch Blumberg, awarded the Nobel Prize for his work in discovering the hepatitis B virus.

It is an opportunity to raise awareness and influence real change in disease prevention and access to testing and treatment.

Every year World Hepatitis Day gets bigger and bigger, with more countries and organisations taking part. Since its launch in 2008, thousands of events have taken place, from rock concerts and press briefings to ministerial meetings and fundraising events. In 2012 the World Hepatitis Alliance organised a Guinness World Record attempt for the most people performing the ‘see no evil, hear no evil, speak no evil’ actions within 24 hours.

For more information about what’s going on this year and to get inspiration from previous events, visit the World Hepatitis Day site.

FACTS ON HEPATITIS B INFECTION

Hepatitis B is infectious:

• Hepatitis B virus is present in body fluids
• Can survive outside the body for up to 7 days
• Transmission risk from needlestick (HBV 30%)

Who should undergo hepatitis B screening?

• Persons from endemic countries like the Philippines
• Pregnant women and children of HBsAg (+) mothers
• Sexual, household contracts & family of infected persons
• Persons with behavioral exposures to HBV
• Injection drug use, history of STI, multiple sexual partners
• Persons at risk of exposure to blood or needlestick injury
• Health care workers
• Hemodialysis patients
• HIV or Hepatitis C infected persons
• Persons with elevated ALT of an unknown etiology
• Persons receiving chemotherapy and immunosuppression

Complications of Hepatitis B

• Chronic HBV infection can have serious complications
  -Scarring of the liver (cirrhosis)
  >may cause inflarmmation that leads to extensive scarring of the liver
  >scarring in the liver may impair the liver’s ability to function

• Liver failure
• Extra-hepatic manifestations: kidneys, blood vessels (vasculitis), joints (arthritis), skin (dermatitis)
• Liver cancer
  -risk for HCC: 12-300x more in CHB patients

Counseling Patients with Chronic Hepatitis B

• Prevent transmission
• Ensure family/ household/ sexual contacts screened & vaccinated
• Do not share toothbrushes, razors
• Cover blood spills with bleach
• Inform healthcare providers of Hepatitis B status

Live normally

• No food restriction or special diet required
• No activity restrictions
• No need to separate food, eating utensils from others
• No need to isolate from others
• Hugging and kissing will not transmit HBV
• Tylenol for pain or fever is safe if taken
• Limit alcohol to 2-3 drinks per week

Source: Centers for Disease and Prevention

Hepatitis B is an infection caused by the Hepatitis B virus. The virus stays inside the liver cells and causes damage to the liver. It can lead to acute liver failure, chronic liver disease, cirrhosis, liver cancer, or an asymptomatic carrier state. It can be prevented by vaccination and avoiding exposure to the virus.

The prevalence of Hepatitis B infection varies according to geographic region. The Asia-Pacific Region has the highest prevalence of Hepatitis B infection.

The geographic variation in Hepatitis B prevalence (from WHO)

The prevalence of Hepatitis B infection in the Philippines is estimated to be 16.7% among adults over 20 years old. One in every seven Filipino adults has Hepatitis B infection.

Hepatitis B affects all ages particularly those in the working age group.

Hepatitis B causes Cirrhosis (scarring of the liver) and Hepatocellular Carcinoma (cancer that arises from liver cells) in up to 30% of infected persons.

Hepatitis is believed to cause more than 1.4 million deaths around the world in 2010, which are as many deaths as HIV/AIDS and Diarrhea.
Worldwide, liver cancer is the 5th leading cause of cancer in men and the 9th leading cause of cancer in women in 2012. It is the 2nd leading cause of cancer death overall in 2012.

In the Philippines, liver cancer is the 3rd leading cause of cancer overall and the 2nd leading cause of cancer deaths.

In the Asia-Pacific region and also in the Philippines, Hepatitis B infection is the leading cause of liver cancer.

References:
2010 Philippine Cancer Facts and Estimates
Philippine Cancer Society – Manila Cancer Registry
Department of Health
World Health Organization
Cancer in the Philippines Vol. IV Part 1-Cancer Incidence 1998-2002
Wong, S.N., Ong, J.P., et al. (2013). Hepatitis B infection among adults in the Philippines: A national seroprevalence study


FACTS ON HEPATITIS C INFECTION

Who should be screened?

• Users of prohibited drugs
• Sex partners of those with hepatitis C
• Sex with more than one partner
• Living with someone with chronic hepatitis C
• Transfusions, dialysis

Complications
Chronic hepatitis C infection can cause significant complications:

• Scarring of the liver tissue (cirrhosis)
  -after 20 to 30 years of hepatitis C infection, cirrhosis may occur.
  -scarring in your liver makes it difficult to your liver to function

• Liver failure
• Liver cancer
• Extrahepatic manifestations: vasculitis, dermatitis, membranoproliferative glomerulonephritis

Source: Centers for Disease and Prevention

Global Response

The World Health Organization in the 63rd World Health Assembly in 2010 passed resolution WHA 63.18 on viral hepatitis that urges all member states to adopt a comprehensive approach to the prevention and control of viral hepatitis. The Global Hepatitis Programme was established with headquarters in Geneva. The Global Hepatitis Programme has issued a Framework for Global Action whichutilizes four axes to address viral hepatitis.

• Axis 1 – Raising awareness, promoting partnerships and mobilizing resources
• Axis 2 – Data for policy and action
• Axis 3 – Prevention of transmission
• Axis 4 – Screening, care, and treatment

Hepatitis, a general term referring to inflammation of the liver, may result from various causes, both infectious (ie, viral, bacterial, fungal, and parasitic organisms) and noninfectious (alcohol, drugs, autoimmune diseases, and metabolic diseases). Viral Hepatitis refers to liver inflammation due to a viral infection.

The World Hepatitis Alliance is the leading patient-led, patient-driven organization that works on viral hepatitis advocacy. It was instrumental in the passage of the WHO resolution on viral hepatitis and the declaration of July 28 as World Hepatitis Day. Its main office is in Geneva, Switzerland.

The Coalition to Eradicate Viral Hepatitis in Asia-Pacific (CEVHAP) is a not-for-profit organization that advocates for the for public policy reforms that aim to reduce the burden of viral hepatitis in the Asia-Pacific region. They aim to reduce the burden of viral hepatitis in the Asia-Pacific region. Their headquarters is located in Singapore.

References:
Prevention and Control of Viral Hepatitis Infection: Framework for Global Action
World Health Organization
World Hepatitis Alliance
Coalition to Eradicate Viral Hepatitis in Asia-Pacific

National Response

In the Philippines, the Hepatology Society of the Philippines (HSP), together with the Philippine Society of Gastroenterology, has been the prime movers in Viral Hepatitis advocacy. The HSP was instrumental in the passage of the Department of Labor and Employment (DOLE) Department Advisory No. 05 – Guidelines on the Implementation of a Workplace Policy and Program on Hepatitis B. This Advisory aims to eliminate discrimination in the workplace on the basis of Hepatitis B infection status.

In 2013, the HSP convened a multisectoral coalition of stakeholders with a shared interest in viral hepatitis prevention and control – the National Viral Hepatitis Task Force (NVHTF). This is composed of the following organizations:

• Hepatology Society of the Philippines as Convenor
• Department of Health (DOH)
• Department of Labor and Employment (DOLE)
• Philippine Health Insurance Corporation (Philhealth)
• Philippine College of Physicians (PCP)
• Philippine Pediatric Society (PPS)
• Philippine Society of Gastroenterology (PSG)
• Philippine Society of Microbiology and Infectious Diseases (PSMID)
• World Health Organization (WHO)
• Yellow Warriors Society of the Philippines (YWSP)

The NVHTF aims to develop and maintain a national strategy to eliminate or significantly decrease the prevalence of hepatitis B and hepatitis C in the Philippines.It has created a road map for viral hepatitis prevention and control entitled “Prevention and Control of Viral Hepatitis in the Philippines: A Call to Action”. This document follows the framework of the Global Hepatitis Programme using the four axes to address viral hepatitis in a comprehensive manner.

The Yellow Warriors Society of the Philippines (YWSP) is the leading patient-led organization involved in viral hepatitis advocacy. It is a member of the World Hepatitis Alliance and its former president sits on the Executive Board of the WHA. The YWSP conducts awareness programs including the celebration of the World Hepatitis Day as well as work towards increased government support for viral hepatitis services.

TMC Response

The Medical City Center for Liver Disease Management and Treatment (CLDMT) was established as the institution’s response to the burden of Viral Hepatitis in the Philippines. It is composed of a group of highly trained specialists from multiple disciplines who take care of patients with liver diseases and actively participate in efforts to promote liver health and prevent liver diseases.

The CLDMT offers a wide array of diagnostic modalities and therapeutic options in the management of liver disease in close collaboration with other specialty units such as the Cancer Center, the Wellness Center, diagnostic and therapeutic radiology, Nutrition Management Services and the various clinical departments, especially Medicine and Surgery.

The CLDMT adopts a comprehensive approach to the problem of Hepatitis B, from advocacy to screening and prevention to medical treatment to liver transplantation for Hepatitis B-related end-stage liver disease. It offers clinic consults, diagnostic testing (serology, virology, ultrasound, CT scan, MRI, transient elastography [Fibroscan], liver biopsy) for viral hepatitis, counseling, vaccination, multidisciplinary conferences for individual cases and treatment of viral hepatitis.

Treatment options for all stages (early, intermediate, advanced) of liver cancer are available at the CLDMT. There include the following:
Treatment options for liver cancer:

• Surgery
  Liver resection
  Liver transplantation

• Local ablation
  Radiofrequency ablation (RFA)
  Percutaneous ethanol injection (PEI)

• Locoregional treatment
  Transarterial Chemoembolization (TACE)
  Drug-eluting Bead Chemoembolization (DEB-TACE)
  Bland embolization
  Selective Internal Radiation Therapy (SIRT) with Yttrium90 beads

• Systemic therapy
  Chemotherapy
  Molecular targeted therapy
  Biologic agents

• Palliative care

The CLDMT is likewise actively involved in research in viral hepatitis and liver cancer. Soon, a Liver Cancer Surveillance Program will also be available at The Medical City.

For more information, call:

Center for Liver Disease Management and Treatment (CLDMT)
2nd Floor , Poduim Bldg., The Medical City
Telephone No. 635.6789 ext. 6506 / 6507