Threats to hepatitis B

An article by Dr  M. Athar Ansari

Department of  P.S.M. A.M.U.Aligarh

            Ramesh, travelling to Delhi was injured in a road accident. He was given blood in a Hospital. After some time he died due to liver cirrhosis, the condition in which irreversible changes occur in the liver.On investigation, it was revealed that he contracted the infection of Hepatitis B virus (HBV) when blood transfusion was done. The picture became more gloomy when it was found that his wife and two children also got infected. It is better to say that Ramesh was given "blood with tears" in the hospital on that fateful day.Time is to come a person will carry hs own set of instruments for hair cut and shaving if he visits a barber provided he is not vaccinated against HBV. A small cut from barber's razor can cause a infection of HBV which might be fatal.

            HBV, first discovered in 1963, replicates in liver cells and is endemic through out the world. There are 65 million expected liver deaths in the world due to HBV, larger than the total deaths in the the second world war. The magnitude of the problem in India is alarming as 1-7% of the total population is infected with HBV. The actual picture would be more dangerous as large number of cases are not reported.

It has been well recognised that HBV is more deadlier than AIDS virus. HBV requires only 0.00007 ml. of blood contact to tranmit the infection in the body of a person. Because of such a very small amount of blood contact, it can be spread through small pricks or cuts.

The virus can survive Aligarh's heat for seven days, minus 4C temperature of a refrigerator for two years and minus 80C temperature in deep freezer for more than fifteen years.

Once the virus enters the body, the person becomes a life time carrier. Most of the time the virus gets entrance in the body through blood transfusion and sexual contacts. The infection may be transmitted from carrier mother to foetus. The high risk groups include individuals who need frequent blood and blood products transfusion, homosexuals, drug addicts sharing the needles, health care workers specially surgeons and laboratory staff, sex workers and house hold contacts of HBV carriers.

According to hepatologists, nearly 10% of the carriers are having the chances of developing acute hepatic failure. Super infection with the Delta virus can be very dangerous. Delta Virus is an incomplete virus and needs surface antigens of HBV to replicate. The super infection with Delta virus results in fulminant Hepatic failure which is nearlyy 100% fatal.

Since there is no specific treatment, the only option left is to protect the people from being infected with HBV. The spread of the virus has to be checked immediately through effective and complete screening of blood which is to be transfused. All those positive for Australia Antigen should be rejected for blood donation.

As per the supreme court's directive, the land mark judgement on January, 4th, 1996, the system of collection of blood professional donors is to be banned. However, judgement still remains unimplemented by most of the states.

If you are some one in the authority, regulate use of blood to ensure that these are sold only to licensed blood banks and promote blood donation support voluntary organizations. If you are a doctor, ensure appropriate and rational use, promote autologous transfusion and motivate patient's relatives and friends to donate blood voluntarily.

Health personnel should be well aware of the importance of sterilization of instrument. A study conducted in Calcutta in 1997 revealed that a staggering 56% of the disposable syringes and needles being sold in the market, were contaminated. In major cities these oversights still jeopardise lives and in small towns, reckets are unchecked.

The immunization campaign against HBV should be carried out vigorously through IEC (information, education, communication) activities and potent vaccine available in the market. The people should be told about safe blood transfusion, safe sex and hazards of sharing contaminated needles and blades. Immunization against HBV should be given to all irrespective of their financial status specially to those who constitute high risk groups. Three doses of Hepatitis B Vaccine are given at the interval of one month and six months of the initial first dose.