The Tragedy of Hepatitis B among the South Sudanese people
By Adol Akuei, Eldoret, Kenya
August 5, 2017 (SSB) — “The secret of good health for both mind and body is not to mourn for the past, not to worry about the future, or not to anticipate troubles, but to live the present moment wisely and earnestly.”
It is with deep sympathy and empathy that I am writing this article address to the public based on; the ongoing sufferings of our people back home. This is especially in the health sector, not political sector or rather arena as you may think of it.
Besides, it is mainly to create awareness unto the victims and those that are in the status of being “victims” of this disease that I called “the second HIV/AIDS”, that is HEPATITIS. It has been reported that the disease is quite rampant in our country and it needs direct address and awareness since most of our people are melting away with their hope buried in the stigma of the disease and would rather think that all is done and that they can easily die.
That is where the name “second HIV/AIDS” came in. People, beware of these facts highlighted below in this article concerning the disease and after all said and done, you will appreciate the essence of having good health which is necessary for your own life as you continue living on this planet.
I hope beyond doubt that you will help me preach this good news about hepatitis and the slogan, “prevention is better than cure,” will be fulfilled; and as the awareness progresses, we too in totality are going to save many South Sudanese lives.
To begin with, hepatitis is the inflammatory condition of the liver. The name hepatitis originated from Greek words– hepar meaning liver and –itis meaning inflammation. So when you combine the two, you get the name hepatitis with that full meaning I mentioned.
You should not think of any other part of your body where the disease might get hold of you apart from your liver; located at the right upper hypochondriac region. Sometimes it might get to gall bladder, bile duct, spleen or pancreas. All in all, it majorly found in the liver period!
In the history of hepatitis, the initial accounts of the syndrome that we now think are likely to be hepatitis begin to occur around 3000 BC. Damn it. You can see how long the disease had started. Clay tablets that served as medical handbooks for the ancient Sumerians described the first observations of jaundice.
The Sumerians by then believed that the liver was the home of the soul and attributed to the findings of jaundice to the attack of one’s liver by a devil named Ahhazu. Then at around 4000 BC, Hippocrates came in and recorded the first documentation of an epidemic jaundice in a particular noting the uniquely fulminant course of the cohort of patients who all died within two weeks.
He wrote,” the bile contained in the liver is full of phlegm and blood, and erupts….after such an eruption, the patient soon raves, become angry, and talks nonsense and bark like a dog”. His recommended treatment was a mixture of honey and water called melikraton.
From that history, the disease that was observed as jaundice then epidemiologically spread with the poor given sanitary conditions of the war. Infectious jaundice played a large role as a major cause of mortality among troops in the Napoleonic war, the American Revolutionary War and both world wars.
During world war two, estimates of soldiers affected by the hepatitis were up to ten million. Soldiers received vaccines against diseases such as yellow fever but these vaccines were stabilized with human serum and the often created epidemic of hepatitis.
Besides that, researchers from England, Findlay, and McCollum suspected these epidemics to be due to a separate infectious agent and not due to the yellow fever virus itself after noting eighty-nine cases of jaundice in the months after vaccination out of a total 3100 patients that they vaccinated.
After changing the seed virus strain, they observed no cases of jaundice in the subsequent 8000 vaccinations. That lot is to aware you on how the disease, hepatitis with its first sign and symptom, described as “jaundice” came to existence and also its treatment and prevention which involves vaccination.
However, this disease has its causative agents. The main worldwide cause is virus. Other causes are; heavy alcohol use, prolonged use of certain medications like paracetamol, toxins, non-alcoholic steatohepatitis (NASH), other infections like liver cirrhosis and the autoimmune diseases.
The main types of viruses that cause hepatitis are five; A, B, C, D, and E; standing for hepatitis A, hepatitis B, hepatitis C, hepatitis D and hepatitis E respectively. Each of this hepatitis has its own causative agents as follows:
Hepatitis A
It is usually acute and a short term disease. It is caused by an infection with A virus (HAV).This type of hepatitis is most commonly transmitted by consumption of contaminated food or water contaminated by feces from a person infected with A virus, the causative agent for hepatitis A. Moreover, it’s also caused by poor sanitation, taking raw fruits and vegetables without being washed and eating undercooked shellfish, which is a common scenario in developing countries like the case of South Sudan.
Hepatitis B
It is transmitted through contact with infectious body fluids such as blood, vaginal secretions or semen containing the B virus which the causative agent of this disease- HBV. Moreover, injections, drug use, having sex with an infected partner or sharing razors with an infected person increase the risk of contracting the B virus.
You can see that the causes of B virus are almost similar to that of HIV/AIDS and that is why I called it somewhere back in my introduction that; hepatitis is a ‘second HIV/AIDS’. To be specific it’s the hepatitis B. Yea, almost similar though the signs and symptoms of hepatitis are different from that of HIV/AIDS.
Hepatitis attacks majorly the liver, unlike the HIV/AIDS. I only carry out my judgment on the causative agents in comparison to HIV/AIDS hence that name. However, research, as estimated by the CDC team, depicts that 1.2 million people in the United States and about 350 million worldwide live this chronic disease.
Hepatitis B may be passed from mother to the baby during pregnancy or childbirth and that makes it genetically inheritable, which involves genetic predisposition and tend to affect a characteristic population.
HEPATITIS C
It comes from the C virally hence (HCV). It is transmitted through direct contact with body fluids, typically through injections, drug use and sexual contact like the hepatitis B. Similarly to hepatitis B, viral infections are found in saliva and breast milk.
However, kissing, sharing utensils and breastfeeding do not lead to the transmission unless these viral fluids are introduced into the open sores or cuts of the infected person. HCV is the most common blood borne viral infection.
HEPATITIS D
This disease is also called delta hepatitis caused by the D virus- HDV. Hepatitis D is a serious liver disease. It’s transmitted through direct contact with the infected blood. Hepatitis D is a rare form of hepatitis that only occurs in conjunction with B infection. The hepatitis D virus can’t multiply without the presence of hepatitis B virus.
HEPATITIS E
It is a waterborne disease caused by the E virus- HEV. Hepatitis E is mainly found in the areas with poor sanitation and typically results from ingesting fecal matter that contaminates the water supply which humans might sometimes drink without treatment or chlorination.
In the Research conducted according to the CDC shows that the disease is common in the Middle East, Asia, Central America and mostly the underdeveloped countries of Africa. Hepatitis E is usually acute but can be particularly dangerous in the pregnant women.
NON-INFECTIOUS HEPATITIS
Alcohol and other toxins
Excessive alcohol consumption can cause liver damage and inflammation. This is sometimes called alcoholic hepatitis. The alcohol directly injures the cells of your liver.
Over time, it can cause permanent damage and leads to liver failure and cirrhosis, a thickening and scarring of the liver. Other toxic causes of hepatitis include overuse or overdose of medications like paracetamol and exposure to poisons which emanates majorly from the industries.
Autoimmune system response
In some cases, the immune system mistakes the liver as a harmful object and begins to attack it. It causes the ongoing inflammation that can range from mild to sense, often hindering liver function. It’s three times more common in women than in men.
The above disease –hepatitis, in general, has its own signs and symptoms that usually show up when you contracted the disease. If you have the infectious forms of hepatitis that are chronic like hepatitis B and hepatitis C, you may not have symptoms in the beginning. Symptoms may not occur until the damage affects the liver functions.
Signs and symptoms of acute hepatitis like hepatitis A and hepatitis E appear quickly which includes; fatigue, flu-like symptom, dark urine, pale stool, abdominal pain, loss of appetite, unexplained weight loss and yellow skin and eyes which may be the signs of jaundice. Chronic hepatitis then develops slowly after acute hepatitis.
Apart from that lot, it’s also good we look at how the disease can get complicated and gets to a level that is life threatening. Chronic hepatitis B and hepatitis C can often lead to more serious health problems because the virus affects the liver. People with chronic hepatitis B and hepatitis C are too at risk for chronic liver disease, cirrhosis, and liver cancer. When your liver stops functioning normally, liver failure can occur.
Complications of liver failure include; bleeding disorders, a buildup of fluids in your abdomen( ascites), increased blood pressure in portal veins that enter your liver which is called portal hypertension, kidney failure, hepatocellular carcinoma which is a form of liver cancer and death. People with hepatitis B and hepatitis C are encouraged to avoid alcohol because it can accelerate liver disease and failure.
Therefore, certain supplements and medications can also affect liver function and therefore should be avoided.
Besides, the disease can be treated. The treatment for hepatitis is determined by the type of hepatitis one has and whether the infection is acute or chronic. Below are the treatment methodologies for each of the hepatitis virus and the autoimmune system response;
HEPATITIS A
It does not require treatment because it is a short term illness. Bed rest may be recommended if the symptoms cause a great deal of discomfort. If you experience vomiting or diarrhea, follow up your doctor’s order for hydration and nutrition. A vaccine is available to prevent this infection in most children between the age of twelve and eighteen months.
It’s a series of two vaccines. Vaccination for adults is also available and can be combined with the hepatitis B vaccine. Visit your nearest hospital and get vaccinated to avoid future occurrences of hepatitis unto you.
HEPATITIS B
In the acute form, it does not require specific treatment. The chronic hepatitis B is treated with antiviral medications. This form of treatment can be costly because it must be continued for several four years. It requires medical evaluations and monitoring to determine if the virus is responding to the treatment or not.
Hepatitis B can be prevented with vaccination. CDC researchers recommend hepatitis B vaccination for all new born. The series of three vaccines is usually completed over the first six months of childhood.
HEPATITIS C
Antiviral medications are used to treat both the acute and chronic form of hepatitis C. People with this disease are treated with a combination of antiviral drug therapies. People who develop cirrhosis as a result of chronic hepatitis C may be candidates for liver transplant. There is no vaccination for hepatitis C.
HEPATITIS D
There are no antiviral medications exists for the treatment of hepatitis D. However, a drug called alpha interferon can be used to treat hepatitis D. Hepatitis D can be prevented by getting the vaccination for hepatitis B as injection with hepatitis B is necessary for hepatitis D to develop.
HEPATITIS E
There is no specific medical therapy available to treat hepatitis E. This is because the infection is often acute and it typically resolves on its own. People with this type of hepatitis are advice to get adequate rest, drink plenty of fluids, get enough nutrients and avoid alcohol. However, a pregnant woman who develops this requires close monitoring and care.
AUTOIMMUNE HEPATITIS
Corticosteroids like prednisone or budesonide are extremely important in the early treatment of autoimmune hepatitis. Azathioprine (Imuran) is a drug that suppresses the immune system which is then included in the treatment. It can be used with or without steroids.
Other immune suppressing drugs like mycophenolate (CellCept), tacrolimus (Prograf) and cyclosporine (neural) can also be used as alternatives to azathioprine for treatment.
Consequently, hepatitis can be diagnosed based on the patient’s sign and symptoms, medical history including sexual and substance use history, blood tests, imaging and liver biopsy. For viral hepatitis and other acute causes of hepatitis, the patient’s blood test and clinical picture are sufficient for diagnosis.
Liver biopsy is the gold standard for establishing the diagnosis as histopathology analysis is able to reveal the previous extent and pattern inflammation and fibrosis. However, ultrasound, CT scan, MRI, and screening are also used for the diagnostic mechanism for hepatitis.
It’s much better if we can adapt the culture of prevention since prevention is better than cure. Below are some of the preventive measures of hepatitis; patients should practice good hygiene to avoid contracting hepatitis A and hepatitis E.
If you are traveling to a developing country, you should avoid local water, ice, raw or undercooked shellfish and oysters and raw fruits and vegetables. Hepatitis B, hepatitis C and hepatitis D that are contracted through contaminated blood can be prevented by avoiding sharing of drugs needles, sharing razors, avoid using someone else’s toothbrush and not touching spilled blood.
Another way to prevent hepatitis is by use of vaccines. Vaccinations are made available to prevent the development of hepatitis A and hepatitis B.
In conclusion, health is the most important sector of human life and without it; people can easily go to their graves. Therefore, I would like to call upon each and every one of us to join hands together with me and create awareness of hepatitis and combat many of the rapidly increasing epidemics of many other diseases like cholera, et cetera.
Your health is our first priority. Cleanliness is next to Godliness, have proper sanitation and hepatitis will get shut away. In so doing, you will appreciate the nature of living. Fellow citizens, together we stand, divided we fall, let curb the rapid upcoming epidemic of hepatitis.
Adol Akuei, the author of this article, is a second-year student pursuing Bachelor of Science in nursing at Moi University, Eldoret, Kenya. He is the current secretary general of the Moi University South Sudanese Student Association (MUSSA). He was a former vice chairman of the Greater Bor South Sudanese Association based in Bungoma, Kenya. You can reach out unto him through the email; adolakuei@gmail.com
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