Pakistan

Hepatitis A spreading because of lack of awareness

Hepatitis A spreading at alarming rate in earthquake affected areas.

Roshan Mughal December 06, 2010

MUZAFFARABAD: As a result of poor hygiene standards and the lack of awareness campaigns, hepatitis A is fast spreading in Azad Jammu and Kashmir (AJK), doctors of the area have said. Hepatitis A is an acute illness associated with fever, malaise, jaundice, anorexia and nausea.

The disease is spreading at an alarming rate, especially in the earthquake affected areas of the region, where hygiene conditions have still not improved despite all the money that was spent on these areas to rehabilitation the health structure.

The Health Department has still not launched any awareness campaigns to educate the masses about this fast spreading disease.

The Khalifa Sheikh Zaid Al-Nayan hospital in Muzaffarabad has been receiving patients from the earthquake affected areas of the Neelum and Jhelum valley, Bagh and Rawalakot districts infected with hepatitis A.

A recent survey conducted by Dr Tahir Raheem Mughal, A General Practitioner (GP) at the hospital in Muzaffarabad, observed that at least 150 patients were diagnosed with hepatitis A in last two months.

“Acute Viral Hepatitis (AVH) is one of the most common diseases in the patients who visited hospital,” Mughal said.

Doctors have observed that the reason for the spread of AVH in AJK is through the fecal-oral route, which means that the infection travels from one person to another when a person comes into contact with something that is directly or indirectly contaminated by feces of another infected person.

“Though the hygiene conditions in the region have improved, the lack of proper sewerage lines adds to the increasing number of AVH patients,” Mughal said.

The sewerage system in AJK was functional, but after the October 2005 earthquake it was destroyed and has still not been repaired five years on. Another big reason for the spread of this disease is the consumption of contaminated water.

Health experts say that the need to increase the awareness amongst the general population regarding preventive measures and improving hygienic conditions is essential. Hepatitis A vaccine can prevent the spread of the infection but patients predominately come to the hospital late.

Two doses are needed six to 18 months apart to ensure long-term protection.

Published in The Express Tribune, December 6^th, 2010.

COMMENTS (2)

Tahir Rahim | 13 years ago | Reply thanx Express TRIBUNE Our Public health Department need to exert more efforts to educate the people about the hygiene and basic preventive measures of Most common diseases. ........................... @Dr.Alain i agree with ye

Dr. Alain B. Labrique | 13 years ago | Reply Thanks to the Express Tribune for highlighting this outbreak of acute viral hepatitis in the Kashmir region. However, unless hepatitis A has been confirmed by serologic testing, it is more likely that the agent responsible for these outbreaks is hepatitis E. The hepatitis E virus (HEV) is presently the leading cause of acute viral hepatitis in the world, with large outbreaks mostly associated with flooding and contamination of drinking water occurring across most of riverine South Asia. Most infants in these endemic areas acquire lifelong immunity to hepatitis A in their first years of life, but for reasons that are still unclear, hepatitis E seems to infect and cause illness in the second and third decades of life. This is the main reason why we strongly suspect this outbreak may be caused by HEV, and not HAV. Like hepatitis A, hepatitis E is rarely life-threatening (although extremely debilitaing) in these settings, except in pregnancy. There is a growing body of evidence that demonstrates an increase risk of death to both the mother and the infant, when HEV infections occur during pregnancy. This has been shown in large outbreaks in India, Bangladesh and even Sudan and Uganda. There is little available standardized treatment for HEV infection. Prevention of HEV infection is rooted in basic water and sanitation hygiene precautions. However, at least three highly efficacious vaccines have been developed within the past 10 years, which would offer a promising strategy of preventing large outbreaks like this from taking place. We urge the authorities to test a sample of affected patients serologically for acute-phase antibodies to HEV, and to establish access to clean water. Close attention should be paid to monitoring pregnant women and attempting to assess excess maternal mortality during the outbreak period. http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/hepatitis-e.aspx http://scholar.google.com/scholar?hl=en&q=Labrique+HEV&assdt=20000000&asylo=&as_vis=1 Sincerely, Dr. Alain Labrique, PhD, MHS, MACE Office: E5543, 615 N. Wolfe St., JHBSPH, Baltimore, MD 21205 Work: +1 (443) 287-4744 Cell: +1 (443) 857-7332 Fax: +1 (410) 510-1055 Skype/Yahoo/Twitter: alabriqu Department of International Health & Department of Epidemiology (jt.) Program in Global Disease Epidemiology and Control Bloomberg School of Public Health Johns Hopkins University (Baltimore, MD (USA))

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