International symposium meets in Paris to share findings PARIS: For over a decade, the world's medical experts on hepatitis have come together to discuss, share and present the causes, effects and treatment for this global disease at the International Symposium in Viral Hepatitis and Liver Disease. Together, these world-renowned doctors are joining forces to bring hepatitis to an end. This year's symposium, which marks the 12th anniversary of the event, kicked off in Paris on July 1. For five days, controversies in treatment, new studies, known co-viruses and possible new viruses that come by way of hepatitis will be considered at the basic and clinical levels. Hepatitis A, E, B and C are being discussed at length, with various doctors presenting breakthrough and controversial treatments and vaccinations for the four forms of hepatitis. Joining these global experts is a number of Egypt's top doctors in the field of hepatitis. On the sidelines of the ongoing conference, The Daily Star Egypt sat down with Dr. Gamal Esmat, professor of hepatology at Cairo University and president-elect of the International Association for the Study of Liver Disease, to discuss how this virus is attacking the Egyptian public. "Each form of hepatitis comes with different means of contraction, side effects, treatments and statistics, and should be treated as a separate entity, explains Esmat. According to Esmat, hepatitis A (HAV) is the most common form of hepatitis in the country, infecting 90 percent of the general population. The good news, according to Esmat, is that this form of the virus does not leave any side effects and doesn't cause any damage to the liver - the most common and serious result of hepatitis. "The good thing about HAV is that it treats itself without vaccine; just like a mild case of the flu that can come and go without using antibiotics, says Esmat. "You could have contracted it then gotten rid of it without knowing. According to a presentation at the conference entitled "Hepatitis A: Molecular Virology and Pathogenesis, by Dr. Martin at the Institut Pasteur in Paris, HAV, which was first identified almost 35 years ago, lacks a proven association with chronic liver disease, a feature that distinguishes it from other hepatitis viruses. Martin also had good news to share. In recent years, a growing number of identifications of features and attributes of the virus have been made, which is likely to be of relevance to the pathobiology of the virus. "This is a very significant step in the HAV virus. By being more informed, we begin to understand the virus better, thus beginning the process of eradicating HAV globally. Furthermore, the mounting data will aid in providing hints as to why HAV, unlike hepatitis C (HCV), does not stay within the bodies of those infected, even after vaccination, states Martin. Yet HAV has not been completely exonerated, according to Esmat. The problem with HAV, he states, is that because most people do not check to see if they have contracted it; those who haven't do not get vaccinated. "Most Egyptians who have never had HAV are those who lived abroad. Therefore, they should get vaccinated. As with most forms of hepatitis, the older you are when you contract it, the bigger the health problems become, he says. Similar to HAV is hepatitis E (HEV), according to Esmat. Both share the same oral mode of transmission and both lack an association with chronic liver disease. But this is where the similarities end. "Like hepatitis A, HEV is contracted from the mouth, specifically through food, and the body can rid itself of this virus without vaccination. However, people who contract it after the age of 20 may be susceptible to lots of problems, such as fulminant hepatic failure, which is the failure of the liver, says Esmat. In Egypt, 70 to 90 percent of the general population has contracted HEV, and the bad news is the mortality rate for HEV infected persons is over 50 percent, states Esmat. According to a presentation entitled, "Hepatitis E: Light at the End of the Tunnel? by Dr. R. Purcell, of Bethesda, Maryland, United States, HEV has been an enigma since it was first recognized as a unique disease in 1980. While it was the last form of hepatitis to be discovered, it was probably the first to be recognized as a disease in ancient times, says Purcell. Furthermore, a presentation by a number of doctors, entitled "Protection against Hepatitis E by a Recombinant Vaccine, states that HEV is a major public health problem in many developing countries, as it is the leading cause of viral hepatitis for which there is no vaccine. This leads to considerable economic consequences: a high mortality rate in pregnant women (particularly those in their second and third trimesters, where the mortality rates reaches 20 percent) and disruption to tourists and expatriates, state the doctors in their presentation. According to Purcell, the problem with HEV is that it is hard to study and track, as the disease cannot grow in cell culture or be transmitted to laboratory animals. As a result, clinical studies of the disease have been carried out based on surveys of human volunteers. Patients involved in outbreaks of HEV and experimental models of infection in animals, which involve reproducing the disease in test animals, have been used as a means of research. However, it would seem that there is light at the end of the tunnel for HEV sufferers. According to Purcell, a growing understanding of the questions perplexing scientists in regards to HEV, which is the most common form of hepatitis among adults in most of Asia, is finally taking place. "HEV is becoming better understood as the pathogenesis and host response to HEV infection become more revealed, says Purcell. "This is leading to the development of control measures, including a highly effective vaccine, resulting in the potential to control four of the five recognized human hepatitis viruses - a remarkable achievement, considering the many difficulties associated with studying this group of viruses. A protein vaccine, known as rHEV, was developed and tested in Nepal and the United States. The findings of the study, state the doctors, indicate that in a high-risk population, rHEV vaccine is well tolerated, safe and effective in preventing hepatitis E.
