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17,500.000 Millions of Peoples in Indonesia Suffers from Chronic Hepatitis

Prof.Dr. H.Ali Sulaiman, Ph.D, SpPD, KGEH

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23-Sept-2009   (Red. Klinik Hati)

   

How is hepatitis B transmitted among Asians and Pacific Islanders?

Reusing needles for injection or tattoos, and unprotected sex, many APIs become infected when they are infants or young children. Frequently, transmission of the hepatitis B virus occurs during the birthing process when the virus is passed on from the mother (who is often unaware that she is a carrier and has chronic hepatitis B) to her child. It can also be transmitted during early childhood through direct contact with blood of infected individuals, occurring from contact between open wounds, sharing contaminated toothbrushes or razors, or through contaminated medical/dental tools.

Why is hepatitis B often not diagnosed?

The danger of hepatitis B lies in its silent transmission and progression. Many chronic hepatitis B carriers have no symptoms and feel healthy. Carriers may exhibit normal blood tests for liver function and be granted a clean bill of health. The diagnosis of cannot be made unless the doctor orders a specific blood test that tests for the presence of the hepatitis B surface antigen (HBsAg), a marker for chronic infection. Since the detection of hepatitis B is so easily missed, even by doctors, it is up to the patient to specifically request the HBsAg test. Early detection not only benefits the carrier, but will also prevent the infection from being passed silently from one child to another, and from one generation to another.

How is hepatitis B life-threatening?

Without appropriate management and screening, one in four hepatitis B carriers (25%) dies from liver cancer or cirrhosis (liver damage leading to scarring and eventually death from liver failure). Some develop cancer as early as 30 years of age. Every year, approximately one million people worldwide die from the disease
because they are diagnosed past the point where current treatment can be effective. Because so many carriers feel perfectly healthy even with early liver cancer, the disease can progress without the carrier even knowing. When symptoms do appear, it is often only at the late stages of their disease. All chronic hepatitis B carriers, whether they feel healthy or sick, are at risk for developing liver cancer or cirrhosis. Finding the cancer when it is small by regular screening remains the best chance of surviving liver cancer.

 

Hepatitis B is one of the largest health threats for Asians. Thus it is important for all APIs to be checked for hepatitis B and vaccinated if not previously exposed. Because hepatitis B is the major cause of liver cancer, the hepatitis B vaccine, which prevents hepatitis B infection, is also regarded as "the first anti-cancer vaccine."

In addition to this big health problem another dangerous virus hepatitis C has made the touble worse.The prevalence of anti HCV as a marker of hepatitis C virus infection (HCV) is also high and is not to much far behind HBV which is about 2.0%-3.5%.Unlike HBsAg, the prevalence of anti HCV is almost similar in any area in Indonesia. It is estimated that there are about 5 to 7.5 million people are suffering from HCV infection at present. It is very unfortunate that effort to make vaccine for hepatitis C is still not successful, so that attemt to reduced the transmission still laid on health education.to the public.

Most people who are infected with the hep C virus go on to develop chronic hep C. The infection becomes chronic (long-lasting) because the body’s immune system is unable to fight it off. You might think that such a condition would make you feel sicker and sicker over time. However, for many people, hep C is an asymptomatic condition—which means they may not experience symptoms for many years after they are infected. No one can tell you now whether or not you will have symptoms in the future.

 

 

 

Here’s the tricky part: a lack of symptoms does not mean that hep C stops attacking liver.

The virus can stay active in the body without producing recognizable symptoms. In fact, some people experience no symptoms that they are aware of until significant liver damage has occurred.

The hep C virus attacks liver cells and uses them as a host to reproduce itself. When the body attempts to fight the virus, it sends
lymphocytes (a type of white blood cell) to the liver, which results in inflammation (swelling). This inflammation is a normal response to infection, but over time this process, and certain chemicals released by the lymphocytes, can damage liver cells.
When the liver cells are damaged, they cannot function well and may die. Some of these cells may grow back, but severe injury may lead to fibrosis (a buildup of scar tissue on the liver). Fibrosis slows down the liver's ability to circulate blood and remove toxins.
Treatment may help prevent further damage or reduce progression of the condition. However, the longer treatment is delayed, the more likely significant and permanent liver damage will occur.
Over time, hardened scar tissue can replace large amounts of normal liver tissue. This condition, called cirrhosis, seriously impairs the liver's ability to function. As a result, blood that cannot pass freely through the liver may back up into the spleen, and this may lead to the destruction of healthy blood cells. In addition, the liver may not be able to produce enough bile to aid in the handling of nutrients, such as vitamins A, D, E, and K, and most fats. If the liver is damaged, there are some important steps that canbe taken to keep the undamaged cells as healthy as possible.

Clinical Care:
To carry out an outstanding clinical care of patients with liver disease.

  1. To improve the quality of health and medical care of patients with liver diseases and it’s related diseases.

  2. To treat and to cure patients suffering from viral hepatitis, especially those infected with hepatitis B and hepatitis C virus.

  3. To prevent those chronic hepatitis to become liver cirrhosis.

  4. To prevent those liver cirrhosis to become liver cancer.

  5. To prevent and treat complications from liver cirrhosis

Prevent from being infected:
To prevent individual or public from being  infected by the virus and eventually suffering from liver diseases.

  1. To prevent individual and community from being infected by HBV and HCV infection

  2. To carry on clinical researchs in acute and chronic liver diseases.

  3. To perform basic researschs related to the existing evidence based problems.

  4. To produce Hepatitis A, B vaccine.

Clinical research interests:

  1. The diagnosis and management of chronic hepatitis, especially that resulting from infection with the hepatitis B and C viruses.

  2. Diagnosis and treatment of hepatic fibrosis.

  3. Acute liver failure, alcoholic liver disease.

  4. Drug-induced toxicity including TPN-related liver disease.

  5. Fatty liver disease, Wilson’s and other genetic liver diseases.

  6. Complications of chronic liver disease including ascites and hepatorenal syndrom.

  7. Development of hepatocellular carcinoma.

Conduct health education of liver diseases:
To conduct health education on many aspects of liver diseases for patients and communities.

  1. To socialize knowledge on liver disease to population and community.

  2. To make public aware of  the danger of HBV and HCV.

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