MEDICINE CABINET

REINER W. GLOOR

EXPERTS and officials from the Department of Health (DoH), the National Institute of Health, and the World Health Organization (WHO) in the Philippines recently convened to review the current situation of hepatitis in the country. The meeting hoped to gather a consensus on the understanding of the disease burden and the program of actions needed to address the challenges posed by hepatitis in the Philippines. The participants agreed to develop a National Hepatitis Action Plan as one of the cornerstones in “understanding the true burden of chronic viral hepatitis in the Philippines.”

The DoH estimates that 10% to 16% of Filipino adults suffer from chronic hepatitis B infection. It is also approximated that around 1% of the estimated 100 million Filipinos has chronic hepatitis C.

The WHO estimates that almost 40% of global mortality due to viral hepatitis occurs in the Western Pacific Region.

Despite this high rate, the many effective drugs to combat viral Hepatitis B and C are only slightly more accessible now due to prohibitive cost in the Philippines and elsewhere.

In the case of hundreds of millions of people with hepatitis, including Filipinos, the WHO said that Hepatitis B and C infections lead to chronic liver disease, which is the most common causes of liver cirrhosis and liver cancer.

Viral hepatitis is defined as “an inflammation of the liver caused by one of the five hepatitis viruses: A, B, C, D and E.” Infections, toxic substances, such as alcohol and certain drugs, and auto-immune diseases can also cause hepatitis.

Viral hepatitis is considered a significant public health problem because of the sheer number of people affected, the number of deaths caused, and because of its potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people. Combined, hepatitis B and C are the most common cause of liver cirrhosis and cancer, globally.

The five kinds of hepatitis viruses are transmitted through different routes: hepatitis A and E through contaminated food and water; hepatitis B through unsafe blood and other bodily fluids; and hepatitis C and D mostly through infectious blood. Hepatitis C can actually be transmitted through sexual contact as well, though this is rare. Hepatitis D is only transmitted to individuals already chronically infected with the hepatitis B virus.

While hepatitis A and E are typically caused by ingestion of contaminated food or water, hepatitis B, C, and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission include transfusion of contaminated blood or blood products, invasive medical procedures using contaminated equipment, and, for Hepatitis B, transmission from mother to baby at birth, from family member to child, and also by sexual contact.

The five hepatitis viruses can cause an acute hepatitis which is characterized by fatigue, loss of appetite, fever, and jaundice. Most persons fully recover from acute hepatitis, but a small proportion can die from life-threatening complications.

Vaccination is still one of the most potent agents in the fight against hepatitis.

In the Philippines, about one in seven adults are infected with hepatitis B and more than half a million have hepatitis C, says a report in Medical Observer, a Philippine-based medical and health online publication. Hepatitis B accounts for more than two thirds of all cases of liver cancer, the second leading cause of cancer deaths in the country, said the article “Fight vs. Chronic Viral Hepatitis Rages in the Philippines,” in the Medical Observer.

The article estimated that the cost of hepatitis treatment and management in the Philippines can be prohibitive, given that the urban minimum daily wage is at P450.

“Hepatitis B profile costs P1,800; ultrasound, P450; hepatitis B viral load, P4,500; viral load for hepatitis C, P6,500; and genotyping, P14,350… Hepatitis B medication costs P135 a day or P49,000 a year that (may possibly run) for the rest of our lives. Hepatitis C treatment costs P732 per day for at least three months,” it said.

One notable aspect of the fight against the onslaught of hepatitis is the presence of two laws which give teeth and more power in the implementation of the vaccination program against hepatitis B.

From 1992, the nationwide immunization program started, to which the hepatitis B birth dose vaccination was included beginning 2006.

PhilHealth, the country’s version of a public or national health insurance program, also incorporated hepatitis vaccination in its newborn care package.

“Sadly, the program coverage for the entire 100 million Philippine population remains at its infancy; even the Department of Health has yet to turn up policies for viral hepatitis prevention and control,” the Medical Observer article said:

The article, meanwhile, noted that the “local government units are already integrating hepatitis B education in their information campaigns… that are usually integrated to their HIV programs and are implemented of varying degrees.”

Log on to www.phap.org.ph and www.phapcares.org.ph.  E-mail the author at reiner.gloor@gmail.com.