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Flirting with Hepatitis

Unsafe sex and faeces-contaminated food and water are the main ways of spreading Hepatitis which is caused by a group of viruses that affects the liver.

ABOUT 30 Jamaicans die every year from the type of the Hepatitis virus which is spread through unprotected sexual contact. Health experts indicate that this particular Hepatitis virus ­ identified as the Hepatitis B virus ­ is also spread in contaminated blood or other body fluids when people engage in unsafe sex; by using contaminated needles; by patronising establishments that practise unhygienic tattooing or acupuncture procedures and when blood is donated in countries with substandard blood transfusion services.

The Hepatitis B virus (known as serum Hepatitis) is listed among the sexually transmitted infections (STIs) but does not attract high-profile attention in health when compared to similar infections such as the human immunodeficiency virus (HIV). Both viruses are transmitted in the same way but the World Health Organisation (WHO) indicates that the Hepatitis B virus is in fact 50 to 100 times more infectious than HIV and in some developing countries almost all children become infected with the virus either from their mothers during delivery or from the reuse of unsterilised needles and syringes.

Ideas about the prevalence in the Jamaican population of this virus is extrapolated from the occurrence of the virus in blood samples collected by local blood transfusion units. When the blood samples are screened for Hepatitis infection, Dr. Yitades Gebre, senior medical officer, HIV/AIDS Control Programme, indicates that about a 0.5 per cent (or 5 per 1,000) of donated blood is contaminated with Hepatitis B. He does not consider this prevalence rate to be abnormally high.

"This prevalence is just about similar to what we see in North America. In fact, in endemic areas (of the world), the rate is between five and eight per cent, that is 10 to 15 times what we see in Jamaica," he said.

Between one and five per cent of those infected with the Hepatitis B virus become chronic carriers of the virus ­ meaning that the virus will remain in their system even when they appear to be in good health. Dr. Gebre said that these chronic carriers will pass on the virus for life when they have sex.

However, the Hepatitis B virus is only of a number of Hepatitis viruses that affect the liver. There is also Hepatitis A, C, D, E, non-A and non-B viruses.

The Hepatitis A virus, also called infectious Hepatitis, is the mild form of the disease, which is spread not through sexual contact but in environments where the sanitation is poor.

Dr. Gebre said that this virus does not pose a major risk in Jamaica where waste disposal and treatment systems are at fairly acceptable standards but is more common in developing countries where food (including fruits and vegetables) and water are contaminated with poorly-disposed, infected faeces. Infected food handlers who do not wash their hands regularly and carefully can also pass on the virus.

"The Caribbean, including Jamaica, has a relatively good environmental sanitation. The vaccine against Hepatitis A is recommended especially for people who are travelling to developing countries in Africa, the Middle East, India and Mexico. Travellers have to be careful about eating seafood, (oysters, shellfish, clams) especially eating them raw," he said.

The Hepatitis A virus, Dr. Gebre said, can be completely healed within three to four weeks though sometimes these patients may continue to shed the virus for up to six months.

Before international and local blood transfusion services started screening for Hepatitis C in the 1990s, this form of Hepatitis was spread primarily through blood transfusion and so it was mainly a condition of those persons who had to received blood transfusion. Its prevalence rate among blood donors is between one and two per cent ­ higher than the 0.5 per cent rate found in Hepatitis B screening.

Dr. Gebre indicates that Hepatitis C can also be spread through sexual contact but is less efficiently transmitted in this way than other viruses such as HIV or Hepatitis B.

Signs and symptoms

  • Fatigue
  • Fever
  • Loss of appetite
  • Nausea and vomiting
  • Abdominal pain, tenderness/discomfort on right side of abdomen
  • Discolouration of eyes or skin (jaundice)
  • Dark urine due to increased bilirubin (the compound associated with liver function)
  • Pale or clay-coloured stool
  • Generalised itching

TREATMENT/PREVENTION OPTIONS

Unfortunately the Hepatitis A and B vaccines are not yet a part of this country's routine immunisation programme because, health officials indicate that they are too expensive. Ideas of cost ­ the Hepatitis B vaccine costs between $800 and $1,000 per shot in private practices; about three shots are recommended to build immunity.

Safe sex practices ­ use condoms, limit sex partners to one faithful partner.

Dr. Yitades Gebre indicates that there is no specific treatment for Hepatitis outside of proper bed rest. There is no cure for Hepatitis B, however, there are treatments approved for this virus ­ the antiretroviral drugs such as Lamivudine (Epivir) or interferon. These treatments help fewer than 40 per cent of patients. These treatments are expensive.

Patients who develop end-stage liver disease may incur high costs for liver transplants. The failed liver is unable to produce blood clotting factors, cannot store sugar, will not digest food and is unable to remove waste from the body.

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