CAIRO: Although flu-like symptoms, nausea, stomachache, skin rash and yellow eyes and skin are all signs of a hepatitis B infection, experiencing them can actually be good news. These symptoms usually indicate that a patient has a short-term liver infection and within about six months the immune system will clear the body of the virus. The other kind of hepatitis B infection, the chronic type, on the other hand, is much more dangerous, as the majority of patients don t show symptoms and this type of liver virus is often left undetected. Dr. Yehia El Shazly, professor of endoscopy and hepato-gastroenterology at Ain Shams University, says the virus has mutated in Egypt, making it even more difficult to detect through simple tests. According to a study carried out by Kasr Al-Aini hospital in 2000, 40 million Egyptians show signs of exposure to the virus. More than 2.5 million suffer from chronic hepatitis B, known as chronic HBV. Experts believe this number could be doubled if surveying and testing procedures were expanded. The World Health Organization (WHO) describes hepatitis B, a form of liver inflammation, as the most serious type of viral hepatitis and the only type causing chronic hepatitis. In this lifelong infection, the patient never gets rid of the virus. Chronic HBV is the second cause of cancer worldwide; smoking is the first. According to data released during a seminar recently held by the Egyptian Society of Endoscopy and Hepato-Gastroenterology, the virus causes liver failure, fibrosis, cirrhosis, liver cancer and ultimately, death. Hepatitis B is one of the major diseases of mankind and is a serious global public health problem, reads the WHO Web site. Liver cancer, described as almost always fatal, and cirrhosis of the liver combined kill about one million persons each year, continues the Web site. In developing countries, most people with liver cancer die within months of diagnosis. In industrialized countries, surgery and chemotherapy can prolong life up to a few years, states the Web site. The problem with making a chronic HBV diagnosis is the lack of symptoms. As the virus attacks the liver cells, patients are usually unaware of the battle taking place between their immune system and the virus. El Shazly says that even after the destruction of 50-60 percent of liver cells, the organ still carries out its functions. It is not until the later stages that the patient experiences symptoms and consequently seeks medical help. Medical tests can detect infection in the early stages, but some of the viruses mutations can only be detected by special PCR tests that cost about LE 600. Due to the high costs, some blood banks stop at the preliminary tests; consequently, blood bags presumed free of hepatitis B could in fact be infected by the mutant type of the virus. Other barriers to diagnosis include fear and social stigma, which may prevent people from seeking a diagnosis, according to El Shazly, adding, In some countries, discrimination may occur and limit job opportunities. He also notes the lack of access to healthcare in some areas. Unfortunately, there isn t much awareness of the virus, especially when compared to hepatitis A and C, which are not as widely spread as chronic HBV. Two billion people around the world have been exposed to the virus and though 350 million suffer from chronic HBV, only 170 million are infected with hepatitis C. The virus is 100 times more infectious than HIV. Evident in blood and body fluids, the virus is transmitted through sexual contact, childbirth, needles and blood transfusions. In some parts of the world, sexual contact and intravenous drug use are the main causes of infection, while in Egypt, unhygienic habits run high. Habits such as sharing combs can be a source of infection since the virus survives up to seven days in dried blood, notes El Shazly. Household exposure is one of the most common sources of infection. While hepatitis C, for example, can only be transmitted through major surgical operations, hepatitis B requires no more than a contaminated needle, he adds. The infection, he continues, could even result from a warm greeting between two freshly shaved men. As the cheeks touch, the meeting of two tiny wounds could lead to an infection. This is why, adds El Shazly, awareness of the virus can only be built through one-on-one campaigns. Since what is required is the change of small and deep-rooted habits, general campaigning won't be effective in propelling a national change towards pro-hygienic behavior. Parallel to this campaigning, he stresses, a budget is needed, but not a large one. He explains that if a person advises a neighbor against families sharing blades, the neighbor will only listen if a free blade is offered. Getting blades for all Egyptians would cost less than two liver transplants, notes El Shazly. Vaccination against hepatitis B is now mandatory for newborns. Figures indicate that since the local introduction of the vaccination in 1992, infection percentages have dropped. In 1985 studies showed that 80 percent of the population was infected, with 10 percent suffering from chronic HBV. The latter number dropped to 4.5 percent in 1996. El Shazly, however, disagrees. Vaccination is a reason but is not the only one, he says. The WHO Web site explains that the vaccine is 95 percent effective in preventing chronic infections from developing, but it doesn t cure chronic hepatitis. Due to their immature immune systems, children are more prone to develop chronic HBV if infected. What is now needed in Egypt is more emphasis on testing, says El Shazly. Increased testing will enable the medical community to better indicate citizens at risk, and eventually help to lower the overall rate of infection in Egypt. We are confident that the rate of HBV infection can be lowered in Egypt, we just need to raise awareness amongst citizens.
