Both diseases if not addressed will have a huge health and socio-economic impact on Bhutan
Though HIV, Malaria, Dengue, Cholera etc. may have grabbed the national headlines for decades there is increasing concern over the rise in the number of Hepatitis B and also C cases.
High prevalence of Hepatitis B and C
A study done in 1986-87 in Bhutan showed that 3 to 4 % of the Bhutanese population has Hepatitis B.
According to leading scientific journals and international research the rate of Hepatitis C (HCV) infection is 2 to 3% of the global population with the numbers being higher in least developed and developing countries.
Hepatitis essentially is a viral infection of the liver leading to liver inflammation and liver disease in most cases and to liver cirrhosis and liver cancer in some cases.
Annual Health Bulletin 2012 shows about 744 cases of Viral Hepatitis infection in 2011 alone as per the statistics collected by Health Management Information System (HMIS) under Ministry of Health (MoH).
“These are all Hepatitis B cases though Bhutan has other types like Hepatitis A and Hepatitis C cases,” said a medical specialist at the Jigme Dorji Wangchuk National Referral Hospital in Thimphu. He spoke on the condition of anonymity.
The higher rate of detection of Hepatitis B has been mainly due to the fact that along with HIV many voluntary blood testing centers in Bhutan now have provisions for testing for Hepatitis B.
There, however, is limited emphasis on testing for what many consider the more serious form of Hepatitis C (HCV) also known as the ‘silent killer’.
The disease was discovered by scientists only in 1987 explaining the low awareness about Hepatitis C.
“Hepatitis B which is found to be more common in Bhutan is spread through blood transfusion, un-protected sex, and sharing of needles contaminated by the H-B virus,” said the medical specialist.
He said that around 5% of the H-B cases went on to become chronic cases which could turn into liver cirrhosis or liver cancer leading to death in some cases.
“The 95%, with treatment will continue to mainly lead a normal life but will still be carriers and never clear the virus,” said the doctor.
According to the specialist all the Hepatitis-C cases he has come across are some Bhutanese that have gone out of the country for organ transplant or major surgeries where blood transfusion is involved.
According to the Center for Diseases Control in America and other medical journals Hepatitis-C is mainly transmitted through infected blood transfusion, organ donation from a Hepatitis-C patient and infected needles. Other potential modes of transmission are sharing razor blades and tooth brush items.
The majority of international scientific evidence suggests that HCV unlike H-B is not transmitted through sexual intercourse. CDC in American does not recommend condoms between lifelong monogamous partners if one of them has HCV. However, HCV may spread in case of sex involving bleeding.
The medical specialist, however, recommended using condoms to be on the safe side.
Medical studies indicate that a significant chunk of HCV patients are due to the transfusion of contaminated blood, contaminated needles and organ donation. In Egypt where improperly sterilized needles are used 22% of the population suffers from HCV cases. In China its number is 3.2%. Some researchers say that HCV cases can also be blamed internationally on hospitals for not being aware of or taking enough precautions to check for HCV in blood transfusions and needle sharing. HCV cases have grown in the 20th century due to improper sterilization of needles and unsafe needle use.
“In HCV cases around 70% of the patients become chronic while up to 30% can fight off the virus naturally,” said the medical specialist.
According to international research of the 70% chronic patients the risk of cirrhosis after 20 years varies between studies but has been estimated at 10%-15% for men and 1-5% for women. Once cirrhosis is established, the rate of developing hepatocellular carcinoma or liver cancer is 1%-4% per year.
However, the specialist said that unlike H-B, HCV patients can completely get rid of the virus.
HCV has six genotypes of HCV from 1 to 6 with each with different level of response to treatment. The treatment in responsive genotypes is up to 80% after prolonged treatment of 24 months to 48 weeks.
Hepatitis C is also known as the ‘silent killer’ as most people with the diseases do not know they have it since the symptoms are apparent only 20 to 25 years later.
The medical specialist said that Hepatitis A, B and C is not spread through casual contact, such as hugging, kissing, or sharing eating or cooking utensils
“The symptoms for both H-B and HCV include yellow eyes, dark yellow urine, extreme fatigue, nausea, vomiting and abdominal pain.
The medical specialist said that Hepatitis A is usually a less serious self containing disease that the body fights off naturally. It spreads through fecal matter and only in very rare cases leads to liver damage.
The Health Ministry’s Chief Program officer (CPO) Tandin agrees that the prevalence of Hepatitis B has been high.
For the health promotion, the chief Program officer says, there is no awareness campaign as such but when we cover HIV advocacy and awareness, we also cover sexually transmitted illnesses adding that “if the issues of sexually transmitted diseases are prevented, hepatitis B should also be prevented.”
However, the MoH has no program so far on HCV awareness or HCV detection.
Prevention and Cure
Hepatitis A, B, C is diagnosed through a normal blood test. However, in Bhutan voluntary testing centers test only for HIV and H-B and not HCV.
Bhutan has started with Hepatitis B vaccine in 1997 after the study conducted showed high prevalence of Hepatitis which provides 3-step vaccination.
Currently there is no cure for Hepatitis B but it is preventable.
The medical specialist said that if possible all Bhutanese should take blood tests and insist to be tested for H-B and HCV. Early detection and medication makes a significant difference.
The specialist urged that Hepatitis patients should stay away from alcohol.
He said that in both H-B and HCV cases Bhutan provides for full and free medical treatment.