Text by Henrylito D. Tacio
Photo: Getty Images and WHO
“Many young men in their 20s and early 30s have very severe liver cancer and die within 12 to 18 months,” lamented Dr. Janus Ong, adding that most of these liver cancers are caused by hepatitis B, a viral infection that attacks the liver.
Dr. Ong is a transplant hepatologist who used to work in the United States. At one time, he returned to the Philippines, stayed for good, and now works in The Medical City. The reason: he was surprised to know that hepatitis B is such a huge health problem in the country. “(Hepatitis B) affects so many people,” he deplored. “Something has to be done.”
With 16.7% of adult Filipinos (7.3 million) described as “chronically infected with the hepatitis B virus (HBV), the Philippines has been touted as a “country hyperendemic for hepatitis B.”
“This rate is extremely high in comparison to other countries and is more than double the 8% prevalence of HBV infection in the Western-Pacific region,” the Hepatology Society of the Philippines (HSP) warns.
What is even more alarming is that the prevalence of hepatitis B is highest among the 20-49 years old group, according to a study conducted in 2003. The age bracket, if you care to know, comprises the country’s workforce.
“HBV is the most common cause of liver cancer around the world,” says Professor Mei-Hwei Chang, chairman of the Department of Pediatrics at the National Taiwan University Hospital in Taipei. “Although hepatitis C virus is the most prevalent cause of liver cancer in some countries where HBV infection is not prevalent, HBV is still the most prevalent cause worldwide.”
If you’re wondering how the virus attacks the liver, here’s a brief explanation from Prof. Nancy Leung, consultant and honorary associate professor and chief of hepatology at the Prince of Wales Hospital in the Chinese University of Hong Kong: “When a person becomes infected by the hepatitis B, the virus travels to the liver where it enters individual liver cells. Here, it replicates and may reenter the blood stream or reinfect other liver cells.”
Liver cancer spares no one – whether you’re rich or poor. Recent statistics showed liver cancer is the third leading cause of cancer deaths in the country. It is second among Filipino men and fifth among women.
To have liver cancer is unfortunate. What is even more unfortunate is if the said disease decimates an entire family.
“I have a 31-year-old patient with liver cancer caused by hepatitis B,” Dr. Ong recalled. “After he was diagnosed, an immediate surgery was done. Unfortunately, the cancer came back shortly after. At this time, he urgently needs a liver transplant or his disease will progress. And – his wife is pregnant with their second child.”
But the sad story doesn’t end there. “This man’s youngest brother died of liver failure,” Dr. Ong said. “A few months later, another of his brother died of liver cancer. Then, another brother died of liver cancer. How can I not try to help him? His mother, who is herself infected with chronic hepatitis B, had four sons. Now, she only has one. If there is a way to potentially cure her remaining son, I have to do it.”
Treatment may be the main concern of the young man. But like other Filipinos infected with HBV, there is another battle that he has to fight: stigma and discrimination. “Many assume that people who have hepatitis B infection acquire the virus through immoral acts, and that they can transmit the disease through casual contact,” Dr. Ong explained.
“They do not know that hepatitis B can be unknowingly transmitted through contaminated blood products including during blood transfusions, contaminated medical devices and from infected mothers to infants during childbirth,” he added.
A recent survey conducted in various countries in Asia, including the Philippines, showed that ignorance is fueling the spread of hepatitis B in the region. “Ignorance helps the transmission of the disease and the survey finds this ignorance results in people giving up on the chance of proper treatment,” Prof. Leung said. “They don’t think it’s important to be treated because they don’t have symptoms.”
Estimates from the Bureau of Food and Drug showed that 10%-15% of Filipinos are chronic carriers of the virus, which is said to be 100 times more infectious than the human immunodeficiency virus (HIV). “On a silent rampage in the Philippines” was how one journalist described HBV.
The HBV may be found in blood, semen, vaginal fluids, tears, and saliva. It is transmitted the same way as HIV. That is, through sexual intercourse (vaginal, oral, or anal), use of contaminated needles, unsafe blood transfusion, and from mother to child.
Most people who get HBV fight off the infection by themselves, but the HBV antibodies “will be present in their blood for the rest of their lives,” writes Dr. Alan Berkman, author of Hepatitis A to G: The Facts You Need to Know About All the Forms of This Dangerous Disease.
Actually, there are two forms of hepatitis B: acute (short-lived) and chronic (long-lasting). “The acute disease is very unpleasant,” says Dr. Berkman, “but if you recover from it you are likely to be immune from then on. Unfortunately, sometimes the acute disease progresses to the chronic form.”
Not everyone exposed to HBV develop symptoms. “Although majority of adults develop symptoms from acute hepatitis B infection, many young children do not,” HSP says. “Adults and children over the age of 5 years are more likely to have symptoms. Seventy percent of adults will have symptoms from an acute hepatitis B infection.”
Symptoms of acute hepatitis B include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored stool, joint pains, and jaundice (yellow color in the skin or the eyes). “Symptoms can appear 90 days after exposure, but they can also manifest between 6 weeks and 6 months after exposure,” HSP informs.
Generally, people with acute hepatitis B have symptoms for a few weeks, although some may fell ill for as long as six months. But there are people who may be infected with HBV, and yet they look healthy and have no symptoms; still, they can spread the virus.
Most people with chronic hepatitis B may not experience symptoms and may feel healthy for many years. “About 15% to 25% of people with chronic hepatitis B develop complications in the liver, such as cirrhosis or liver cancer,” HSP points out. “In the early stages of liver cirrhosis and live cancer, patients may remain to have no symptoms. However, tests for liver function or liver ultrasound might begin to show some abnormalities.”
Chronic hepatitis B shouldn’t be ignored as it can result in liver damage, liver failure, liver cancer, or even death. “Liver cancer carries a poor prognosis, making it the second leading cause of cancer death locally,” HSP claims.
But the good thing is: both types of hepatitis B can be treated. In acute hepatitis B, the main treatment is mostly supportive, that is, in the form of rest, adequate nutrition, and adequate hydration.
For chronic hepatitis B, there are now several drugs available. “The choice of antiviral drug may depend on the patient,” HSP says. “However, not all patients which chronic hepatitis B need antiviral drugs. Patients should be evaluated by health professionals experienced in the management of hepatitis B.”
Another good news: hepatitis B can be prevented through a vaccine. “The vaccine is given as a series of 3-4 shots over a period of 6 months,” HSP says. “It stimulates the body’s immune system to produce the antibody that protects against hepatitis B.”
Studies have shown that once the person has been given the vaccination series, he or she is “greater than 90% protected” compared to those immunized before being exposed to hepatitis B.
The safety of the hepatitis B vaccine has been evaluated by many leading health authorities, including the United Nations health agency and the United States Institute of Medicine. “The hepatitis B vaccine is safe,” HSP assures. “Pain at the injection site is the most common side effect reported.”
According to HSP, hepatitis B vaccination is recommended for the following: all infants, starting with the first dose of the vaccine within 24 hours of birth; all children and adolescents younger than 19 years of age who have not been vaccinated; people whose sexual partners have HBV; sexually active persons who have multiple partners; persons undergoing management for sexually transmitted infections; men who have sexual contact with other men; people who share needles, syringes, or other drug equipment; and people who have close household contact with someone infected with the HBV.
Hepatitis B vaccination is also recommended for health care and public safety workers at risk for exposure to blood or blood-contaminated body fluids on the job; people with end-stage renal disease, including predialysis, hemodialysis, peritoneal dialysis, and home dialysis patients; residents and staff of facilities for developmentally disabled persons; people with chronic liver disease (not from hepatitis B); people with HIV infection; and anyone who wishes to be protected from HBV infection.