Less than 10% people infected with hepatitis are aware of the condition

Health Care, Heart Care Foundation of India, Medicine Comments Off

Urgent awareness initiatives and prevention need of the hour

New Delhi, 28 July 2018: Recent estimates by the World Health Organization (WHO) have indicated that less than 10% of those infected with viral hepatitis are aware of this potentially life-threatening condition. Such lack of awareness and treatment can cause progressive liver damage and life-threatening conditions such as fibrosis and liver cancer. This can further result in about 4.1 lakh deaths in the country every year.

Viral hepatitis remains a major public health challenge in India with intermediate to high endemicity of hepatitis B. The hepatitis B virus infection is a big cause of viral hepatitis and about 3% to 5% of the Indian population is a carrier of the infection. The most common route of transmission in India is from mother to child.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “The HB virus is highly contagious via infected blood or other body fluids, and is mainly transmitted from mothers to their infants, or between children. There is no cure, but antiviral drugs have proven effective in coping with symptoms. The virus gets transmitted by percutaneous and mucosal exposures and HUMAN BITES. It can survive on counter tops for up to seven days and remain capable of causing infection. 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.”

Early symptoms of hepatitis B may be non-specific and include fever, a flu-like illness, and joint pains. Symptoms of acute hepatitis may include fatigue, appetite loss, nausea, jaundice, and pain in the upper right abdomen.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “Acute hepatitis due to any virus is usually self-limiting and requires a good diet, bed rest and only symptomatic treatment. Urgent hospitalization may be required only in cases of acute liver failure in acute viral hepatitis. One may also need intensive treatment and liver transplant. Chronic hepatitis B and C can be treated with antiviral drugs both oral and injectable. Hepatitis C virus (HCV) is curable now and HBV can be controlled with medication. The vaccine is available for hepatitis A virus and HBV only.”

Some tips from HCFI

  • Maintain quality standards for public water supplies
  • Establish proper disposal systems for human feces
  • Maintain hygienic practices such as handwashing with safe water, particularly before handling food
  • Avoid consumption of water and/or ice of unknown purity
  • Get immunized at regular intervals as advised
  • Safe blood transfusion
  • Safe injection
  • Test any donated blood for hepatitis B and C
  • Indulge in safe sex and promote correct and consistent use of condoms

Prevention is the only bet for avoiding the onset of Lassa fever

Health Care, Heart Care Foundation of India, Medicine Comments Off

Be careful of rodents and avoid direct contact with infectious body fluids

New Delhi, 19 July 2018: Earlier this year, Nigeria fell under the grip of a viral infection called the Lassa fever. Many people succumbed to the symptoms and died. This fever comes under the list of priority diseases enlisted by the World Health Organization (WHO). Apart from Nigeria, the Lassa virus is endemic in Benin, Ghana, Guinea, Liberia, Mali, Sierra Leone, and other countries in West Africa.

Lassa fever is an acute viral hemorrhagic illness caused by Lassa virus, a member of the Arenavirus family of viruses. It is a zoonotic disease. Rodents (multimammate rats) are the animal reservoirs and shed the virus in their urine and feces.

Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, HCFI, said, “Humans acquire the infection from contact with infected rodents through rodent urine or feces, inhalation of aerosolized rodent excretions, or consumption of infected rodents as a food source. Person-to-person transmission can occur through direct contact with infectious body fluids (e. g., blood, urine, pharyngeal secretions, vomitus, or other body secretions), unprotected contact with potentially infectious material (e.g., touching vomitus) and mucosal exposure from splashes of body fluids. People with Lassa infection are not believed to be contagious prior to symptom onset. The incubation period of this fever is about 10 days (range 6-21 days).”

Initially, the symptoms are mild and include low-grade fever, general weakness, and malaise. This is followed by headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhea, cough, and abdominal pain. In severe disease, facial swelling, fluid in the lung cavity, bleeding from the mouth, nose, vagina or gastrointestinal tract and low blood pressure are present. Later stage may be characterized by shock, seizures, tremor, disorientation and coma.

Adding further, Dr Aggarwal, who is also the Group Editor of IJCP, said, “The overall case-fatality rate is 1%, while in hospitalized patients, the case-fatality rate is 15%. The diagnosis of this condition is usually supported by a relevant history of exposure along with suggestive signs and symptoms. It is possible to improve survival rates through early supportive care with rehydration and symptomatic treatment. However, there is currently no vaccine for this condition.”

Indian doctors need to update their knowledge in view of a large number of Nigerian patients coming to India for treatment.

Some tips from HCFI

  • Avoiding rodents (multimammate rats).
  • Consider all patients as infectious even if signs and symptoms are mild.
  • All standard, contact, and droplet precautions as well as correct use of appropriate personal protective equipment should be strictly adhered to.
  • Blood and body fluid specimens from patients with suspected Lassa fever infection should be considered highly infectious. Caution should be exercised when handling such material.
  • Postexposure prophylaxis with oral ribavirin for contacts with known or suspected Lassa fever infection with risk factors for transmission such as penetrating needle stick injury, exposure of mucous membranes or broken skin to blood or body fluids, and participation in procedures involving exposure to bodily fluids or respiratory secretions without use of personal protective equipment.

WHO Priority Diseases: Disease X

Health Care Comments Off

WHO has added a new, yet unknown disease, calling it ‘Disease X’, in its list of eight priority diseases, which pose a public health risk due to their epidemic potential and for which there are no drugs or vaccine to treat them or prevent them. And there is an urgent need for research into these diseases for better diagnostic methods, improved vaccines and treatment.

“Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease, and so the R&D Blueprint explicitly seeks to enable cross-cutting R&D preparedness that is also relevant for an unknown “Disease X” as far as possible,” says the WHO.

It is believed that the next big global epidemic could be even deadlier than the presently known diseases such as Ebola. Just as the pathogen is unknown, so is its probable source. But, it is presumed that it will most likely be a zoonotic disease, with animals as the source of infection. And, modern travel and transportation will only facilitate rapid spread of the infection so that it becomes a global threat. Mutations can change the existing viruses into genetically new virus types. Then lab-mutated viruses or creation of new viruses in labs can also be a likely source. We don’t know. These are only speculations.

Urbanization is a public health risk. Newer townships are coming up rapidly or cities are being expanded. The cost of urbanization is deforestation. This means that we are encroaching further into an ecosystem that was previously undisturbed by humans. The resulting closer contact of wild animals and humans allows unknown pathogens to be introduced into the urban areas increasing the risk of potential zoonoses and other diseases. Infectious diseases that were previously unknown or even rare are emerging and re-emerging now.

The need of the hour is to strengthen surveillance, public health care systems and research and development. A robust surveillance system to notice early, something that is unusual, not normal, is the basis of preparedness for an epidemic. Increasing public access to good health care will help in early detection of an epidemic and initiate measures to control it before it spreads further. Communication is crucial for sharing information.

The WHO has sounded a note of caution. Its up to us to be better prepared… “Forewarned is forearmed”.

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

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