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Jul 12, 2014

On Viral Hepatitis

The World Hepatitis Day  is celebrated worldwide on 28th July, 2014. This day is organized by World Hepatitis Alliance.  I would like to take part and contribute in whatsoever capacity I can in order to make this day meaningful. For me, this day is personal because I know what does it mean to suffer from viral hepatitis. Like me, millions of people even today suffers or have suffered from this preventable disease due to various reasons.


First let me take you through my personal suffering as a result of viral hepatitis in early 1990s. At that time, I was studying in Kathmandu University, which was then located in Hadi Gaun in the valley. In the university, I was studying science (biology, chemistry and physics) aiming to be a doctor. It was in the second year, I caught jaundice and got confined to bed for almost 3 weeks. I was profusely vomiting and white of my both eyes became yellowish including skin. Commonly, people also call it as "Jaundice", where your white part of eye and even to some extent your skin turns yellow due to increase in "bilirubin" pigment in your body. I felt so weak and my appetite was so poor that I could not even tolerate the smell of food and walk few steps. During this illness, I took care of myself with pure restriction of those foods that were said  not to be eaten or avoided, instead had to rely on boiled vegetables and glucose reach sugarcane juice or papaya fruit. Slowly, day by day, I recovered from this illness and regained my strength and started to visit university class again. Looking back, now I realize, what it means to suffer from this preventable illness. I also came to know that I did suffer from viral hepatitis, which may have been be either type A or E [ Note - Here, I have  omitted anything about type B and C - this was not the type I contracted. However, I acknowledge that type B and C are even more notorious in its nature]. At that time, I was taken to local Vaidya (medicine man), who prescribed me herbal remedy. I took those remedy regularly with food supplementation. Now, I know that this viral illness is self limiting infection as a result of compromised water and sanitation. Somewhere in the chain of event, I must have got infected with this water borne illness. May be somewhere in the restaurant - where food hygiene must have been compromised. 

Structure of Hepatitis E virus

Now, let me walk you through  a public sphere and understand what happens when this same disease spreads in a community, where water and sanitation is compromised that is common in low income settings. In my last blog post May 2014, I wrote a briefly on "Increasing Reports of Enteric Diseases in Nepal". In that post, I stressed more on acute viral hepatitis outbreak that created news headline in national media. This outbreak was reported directly from Biratnagar, a city in Eastern part of Nepal. This outbreak created fear in the center of the city and caused huge toll of morbidity and some deaths. Some people said that whole town was frenzy due to this outbreak and everybody both rich and poor vulnerable to this illness. The sample tested were found to be hepatitis e virus. As per World Health Organization (WHO), this disease affects globally 20 millions of  people every year, around 3 millions get acute hepatitis and - 56,600 hepatitis e related deaths. Apart from its morbid nature, this virus can sometime lead to acute fulminant hepatic failure, which can even take someone's life. It is reported that hepatitis e infection during pregnancy is the gravest danger posing threat to the mother's life. This illness is, as I already mentioned, more prevalent in low income setting like in South Asia or Sub Saharan countries. I therefore say that this is public health problem that we can do away with clean water, proper sanitation and health education. However, I see such improvement in providing clean water and improved sanitation takes time, given the current socio - economic landscape.

A child with jaundice

Nonetheless, the best health policy is to impart people with health education on importance of hand washing, boiling water and visiting health professional if we get infected with this preventable illness. WHO also report that there is availability of vaccine against Hepatitis E & Hepatitis A. Vaccine against A is available. It is recommended to use in outbreak prevention in conjunction with improvement in water and sanitation. Regarding Hep E, China has produced and licensed the vaccine, but it is not widely available globally. There must be various reasons why this vaccine is not available in other countries. Finally, I feel, it is the common right of people living impoverished get safe, effective and affordable Hep E vaccine and this is what whole world is waiting for !! 

Anuj Bhattachan
12 July 2014

Jul 9, 2014

Random thought - Global Health and Diseases of impoverished

We are living in 21st century, the age of supercomputers. Or you may call it - the age of big data. So, for some of us, diseases related with poor water / food supply and sanitation may sound as a story of medieval period. You may also say, "I read only in a book !!" However, it is a fact that millions of people are still living with abject poverty and millions of children have to lose their life before fifth birthday. Even if we go through pages of our history, we have faced global pandemics that created havoc across Europe to Asia. Millions of people lost their invaluable life to cholera, flu pandemics, smallpox, tuberculosis, and thousands of children got handicapped & live crippled life due to paralytic poliomyelitis. On positive note, to be fair, we have also successfully controlled, eliminated or even eradicated many of these infectious diseases with the use of vaccine and public health measures since science took its foothold in the society from early 1900s. As an example, the greatest achievement in the human history is the eradication of small pox so far. The last case of this disease was detected in Ethiopia in 1980s. Now, we are almost nearing poliomyelitis eradication from the globe. In the backdrop of this success story, however, people in developing countries are still fighting death and illnesses caused by waterborne, airborne and vector borne diseases (in whatever capacity they can!!) through local and modern remedies available. But, the only challenge, this is further compounded by increasing population density, deforestation, climate changes, increasing numbers of multi – drug resistance bacteria, urbanization and poverty. It is reported that millions of children still miss regular vaccination either zero dose or incomplete dose. The reasons are simply related with a big gap in access and utilization of vaccines that are available through government health care delivery services. This means that all these missed children are "at increased risk" of vaccine preventable diseases and thus, outbreaks in the community. These unfortunate missed children are usually from poor family, especially tribal community or millions of so called "untouchables", who are pushed to the corner of social ladder always "under – privileged" and illiteracy rampant. So, we have a mission to reach these "High Risk" populations and provide them access to safe, effective and affordable vaccine against diseases of impoverished using science as its means. Our ultimate goal therefore should be to transcend vaccine science research from laboratory to the reach of community in high risk areas of developing countries.

Anuj Bhattachan
9th July, 2014

Anuj in Himalayas

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