The Tribune, Chandigarh, India

Curbing hepatitis outbreak
The hepatitis B virus, 50 to 100 times more infectious than HIV, kills over 6 lakh people every year worldwide. The incidence among the Indian population may be about 2-5 per cent, according to WHO. Creating awareness against the deadly virus is the only solution
Dr Ashish Bhanot
Liver diseases do not get as much media space as cancer and heart ailments, but they are equally menacing and deadly. The most important of these is hepatitis, an inflammation of the liver, which is caused by a viral infection. Hepatitis is of five types: A, B, C, D and E. While hepatitis A and E are caused by the consumption of contaminated food and water, hepatitis B, C and D most commonly occur due to contact with infected body fluids like blood and semen, and contaminated injections.

Apps that help people get fit
There's no shortage of health and fitness apps monitoring everything from sleep patterns to calories and caffeine consumption. Free apps such as MyFitnessPal track diet and weight and can connect with apps like RunKeeper, which monitors fitness, to adjust calorie intake based on the speed and duration of a run. Sleep 101, for the iPhone, and Sleep Bot, for Android devices, monitor sleep patterns and quality.

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Liver diseases do not get as much media space as cancer and heart ailments, but they are equally menacing and deadly. The most important of these is hepatitis, an inflammation of the liver, which is caused by a viral infection. Hepatitis is of five types: A, B, C, D and E. While hepatitis A and E are caused by the consumption of contaminated food and water, hepatitis B, C and D most commonly occur due to contact with infected body fluids like blood and semen, and contaminated injections.

Hepatitis B and C can lead to chronic (long-term) diseases such as liver cancer and liver cirrhosis. Liver cancer is almost always fatal, with most patients in developing countries dying within a few months of diagnosis. Liver cirrhosis patients are sometimes given liver transplants, with mixed success.

The deadly killer

Hepatitis B is the most dangerous type of viral hepatitis. According to WHO, the hepatitis B virus – which is 50 to 100 times more infectious than HIV – kills over 6 lakh people every year worldwide. About 2 billion people are estimated to be infected with it. The incidence among the Indian population may be about 2-5 per cent, according to WHO.

When infected with hepatitis B virus, about 80 per cent of the people do not show any symptoms during the short-term (acute) phase. Since they remain unaware of the ailment, it is easy for them to transmit the virus to others. The symptoms, if these occur, include jaundice, dark urine, vomiting and stomach pain. There is no specific treatment for acute hepatitis B and most patients recover after a few weeks without any medication.

Sometimes, the hepatitis B virus may reside in a patient’s body for years (chronic phase) and damage the liver by causing serious life-threatening diseases. Blood tests can diagnose people with hepatitis B and distinguish between acute and chronic infections.

Age is an important factor in determining if hepatitis B will remain acute (run for a few weeks) or turn chronic (life-long). The lower the age of a person getting infected with hepatitis B, the higher are the chances of the infection turning chronic. Young children infected with hepatitis B are the most likely to develop chronic infection. About one-fourth of adults, who get chronically infected during childhood, succumb to liver cancer or cirrhosis later. That is why it is extremely important to protect children from hepatitis B infection. This can be done through vaccination.

About 15 crore people in the world are infected with Hepatitis C, around 3.5 lakh of whom die every year to complications related to the virus, according to WHO. Unfortunately, there is no preventive vaccine for hepatitis C currently available. It is curable using anti-viral drugs but the treatment is very expensive, much beyond the capacity of most patients in developing countries.

Modes of infection

Hepatitis B and C spread through unsafe injection practices, unprotected sex with an infected person and transfusion of infected blood. The infection may also spread from mother to baby at birth. Sharing a razor or toothbrush with a hepatitis-infected person, getting body piercing or tattoo done with infected tools, and using needles that have already been used by a hepatitis-positive individual (such as for therapeutic injections or taking drugs)spread the infection. But one cannot contract hepatitis B and C through sharing food or drinks with an infected person or through casual contact such as hugging, kissing, sneezing or coughing.

Unsafe injections

In India, where unsafe injection practices are rampant, hepatitis outbreaks are hardly unusual. In February 2012, Ratia in Fatehabad, Haryana, bore the brunt of such an epidemic, with over 1,600 persons testing positive for Hepatitis C. The culprit: the reuse of syringes and needles by doctors. Just three years earlier, in 2009, Modasa town in Sabarkantha, Gujarat, was also hit by a hepatitis B epidemic that lasted six months. The virus infected 126 persons, killing 50. The outbreak was again traced back to a few private medical practitioners in the town reusing syringes and needles.

According to a 2004 study by the International Clinical Epidemiology Network (INCLEN), about 6 billion injections are given in India annually, 62 per cent of which are unsafe. Non-sterile needles and injection reuse are among the top causes of blood-borne diseases. Every year in the world, 21 million hepatitis B infections, two million hepatitis C infections, and 260,000 cases of HIV/AIDS infections are caused by unsafe injections, according to WHO figures.

Since April 2005, the Indian government has introduced auto-disable syringes under the universal immunisation program (UIP) in all states. This is a landmark decision but clearly not enough because 95 per cent of injections given in India are therapeutic. Since April 2009, all Central Government hospitals under CGHS have been mandated to switch to auto-disable syringes for therapeutic care too. However, there is no such provision for private medical practitioners.

The problem of unsafe injections is chronic in nature, with no easy solutions. The only way out is increased awareness among the people and legislative action to make auto-disable and reuse prevention syringes mandatory for all Injections. WHO has urged all member countries to consider adopting Reuse Prevention Technology for preventive and therapeutic injections in a country, where the incidence of reuse is high. While state health machinery in Odisha and Puducherry are already using this technology, many other states and the National health authorities need to take holistic steps to curb this menace. Professional organisations like Indian Academy of Paediatrics have also developed safe injection guidelines for dissemination among practitioners. This will go a long way in protecting people from the transmission of blood-borne pathogens that cause diseases like hepatitis, AIDS, malaria and hemorrhagic fevers.

— The writer is a Delhi based gastro-surgeon

Tips for preventing infection

For patients

To avoid contracting or spreading the Hepatitis virus:

Never share needles

Do not share toothbrushes or razors

Never get a tattoo or piercing done with tools that are not sterlised

Be vigilant about the use of fresh syringe and needles by the health care providers in all settings

Always use a condom during sex

For medical practitioners

Always wear latex or plastic gloves to avoid direct contact with blood

Never use the same syringe to medicate more than one patient, even if the needle was changed

Never recap needles

Never access the bag with a syringe that has already been used to flush a patient’s IV or catheter

Never use a shared medication vial with a used syringe to medicate another patient

Ensure that you and your staff are immunized against Hepatitis B

In case of accidental needle stick injury follow NACO guidelines on post exposure prophylaxis within 72 hours

Apps that help people get fit

There's no shortage of health and fitness apps monitoring everything from sleep patterns to calories and caffeine consumption.

Free apps such as MyFitnessPal track diet and weight and can connect with apps like RunKeeper, which monitors fitness, to adjust calorie intake based on the speed and duration of a run. Sleep 101, for the iPhone, and Sleep Bot, for Android devices, monitor sleep patterns and quality.

Now there's Argus, a free app for iPhones released last week. It combines multiple factors to take detailed snapshots of sleep, diet, activity and vital signs such as heart rate. It also shows how each factor relates to the others.

"People are getting more health conscious and lifestyle diseases are an increasingly large problem, especially in the last two decades," said Peter Kuhar the chief technology officer of Palo Alto-based Azumio, the company that developed the app. "This is where mobile technologies can help to guide you to a healthier lifestyle and with that help reduce the risk," he said.

Using built-in sensors, Argus can determine whether a person is walking or running. It also pairs with the company's Sleep Time app to track sleep patterns. Heart rate is measured when a finger is placed on the device's camera. "The importance of tracking the data is that we can increase users' awareness of their health-affecting habits and help steer them on the right path," said Kuhar, adding that the app is also useful for observing trends over time. By correlating the data the app can show, for example, how water consumption affects sleep and how caffeine impacts heart rate.

Other apps connect with wristbands to track activity, sleep and diet. They include the Jawbone UP, for iPhone and Android, and Fitbit and Larklife, both for iPhone. The wristbands cost between $60 and $150.

Kuhar said apps that connect to devices such as wristbands may be more accurate because they are worn on the body. MyFitnessPal also integrates with Withings, a WiFi-enabled scale; Runtastic, a fitness tracking app; and Fitbit, a wearable wristband that tracks sleep and activity for automatic logging of weight, sleep and activities. Last month the company MyFitnessPal teamed up with RunKeeper, the iPhone and Android app that tracks running speed and duration. "When we started MyFitnessPal we tackled nutrition first, and as we've grown, we've set our sights on other pillars that are crucial to health and wellness," said Mike Lee, co-founder of San Francisco-based MyFitnessPal.

"Diet is one piece of the puzzle but by tracking diet and exercise alongside each other, we're able to give a more complete view of a person's health," he added. — Reuters

HEALTH NOTES

DNA abnormalities may up cancer risk in diabetics

Washington: Researchers have found that a type of genetic abnormality that has been associated to cancer is more common in people suffering from type 2 diabetes. People with type 2 diabetes are already known to have a higher risk of cancers, especially blood cancers like lymphoma and leukaemia. The new study, led by scientists at Imperial College London and CNRS in France, suggests that mutations called clonal mosaic events (CMEs) may partly explain why this is. CMEs are defects that result in some cells having extra copies or missing copies of large chunks of DNA. They are very rare in young people but more common as we get older. Among those aged over 70, around one in 50 people have some of these mutations. Research published last year found that people with CMEs have a 10-fold higher risk of blood cancers. In the new study, researchers looked for CMEs in blood samples from 7,437 participants in genetic studies in Europe, including 2,208 people with type 2 diabetes. They found that CMEs were four times more common in people with type 2 diabetes. Professor Philippe Froguel, who led the study, said type 2 diabetes patients could be followed up closely to watch for early signs of leukaemia The new study has been published in Nature Genetics.

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Washington: Human-caused outdoor air pollution is directly responsible for over two million deaths globally — many of them in South and East Asia - each year, a new study has claimed. The study estimates that around 470,000 people die each year because of human — caused increases in ozone. — Agencies