Awareness-Raising - my passion
This week I was very fortunate. I was chosen by 
Now I would like to take advantage of this extra exposure to raise awareness about a topic that is very close to my heart: Liver health and chronic hepatitis B (called hep B from here on). And yes, that includes YOUR liver too!
Not many people know what hep B is, how common it is, how damaging it can be (yes, it can literally kill you before you know it), and who should really get a hep B test. Further down, I will give an overview of hep B without overloading everyone with too much information (because it is a tricky beast, and if there is interest, I will gladly provide more detail in further posts).
But first things first:
Do you even know how magnificent your liver is?
I suspect most people, even amongst the smartest of steemians, don't often think about that specific organ. It's just quietly doing its job and it's very easy to ignore because it doesn't have any pain receptors. So it rarely complains, doesn't cause much discomfort, and is generally not very noticeable. A very agreeable organ indeed. But do you even know how amazing your liver is and how many essential jobs it does on a daily basis, every minute of your life? Well, check this out (it may just make you appreciate your lovely liver a little bit more):
Oh wait, there's more... here's a little 3.5 min video that explains it very well Liver factory video.
I hope this makes it clear that if the liver shuts down, life will extinct! I have to put it bluntly because it is the truth. Nobody wants that to happen!
So, what can you do?
There are a few things everyone can easily do to make life a little less tough for our poor livers such as drink a little less alcohol, eat a little less fatty foods (the bad fats, as in fast food), and generally avoid toxin overload from household and other chemicals, sprays etc. All these things can cause hepatitis which just means inflammation of the liver. Then there is viral hepatitis, three kinds, A, B, and C (there are others but I won't confuse you more at this point). Note: clinical information about hep B is sourced from http://www.hepbhelp.org.au/
Hep A is transmitted through food contaminated by faeces (i.e. you eat something prepared by someone who has hep A and didn't wash their hands after going for a number two). This can be avoided by getting the hep A vaccine, no problem.
Hep C is transmitted through blood, as in sharing needles, needle stick injuries, getting a tattoo from a shady place; and some older folks got it through a blood transfusion before blood donations were tested. Today, hep C can mostly be avoided by being blood-aware, using universal precautions in health care settings, using reputable tattoo parlours, etc.
And what about hep B?
Hep B is the trickiest of the three viruses, and of course, it's the one I had to get (meh...)
Fortunately, for those who don't have it, it is easy to avoid. Just get vaccinated. Here in Australia, we have an universal infant immunisation program and there was also a high school catch-up program. So most of the younger population is protected. Here I'd like to mention that, while everyone's opinion is welcome and appreciated in the comments, I will probably not respond to negative views about hep B vaccination, or vaccination in general. Hep B immunisation is a public health issue and the benefit for humanity in general is much, much greater than the rare negative effects on a few. I totally understand that for those who experience a negative effect, it is very unfortunate. Of course, they wish they hadn't taken the vaccine, just like I wish there had been one when I was a child. In the greater scheme of things, I believe hep B vaccination is a good thing.
Hep B is different from hep C in that most adults who have chronic hep B today were infected either at birth or during early childhood. If someone catches hep B as an adult, the chance of it turning into a chronic (usually life-long) infection is very small at about 5-10%. However, if infected at birth, the chance is about 95%, and in early childhood about 70%. This is why all pregnant women are (or should be) tested for hep B as transmission to the baby can be prevented with a couple of needles soon after the birth.
Apart from mother-to-child transmission, hep B can be passed on in all the same ways as hep C (see above), but also through unprotected sex. Soooo, another easy way to prevent catching hep B is, of course, using condoms. I'd say vaccination is the safer option though because - as I know from working with a public sexual health service - it is somehow still difficult to get people to use condoms, at least not all the time. But as I said, new infections of adults is not our main concern because most will clear the infection without treatment, and often even without them noticing. Once someone has been exposed and the immune system has reacted and cleared it, the person is immune for life. So if you're unsure about getting vaccinated, have a test first to see if you might already be immune (or if unlucky, already have chronic hep B).
Who should get tested for hep B?
I always say, "if I got hep B, everyone can". The truth is that I have never found out when exactly and how I got infected. I got my diagnosis at age 18 after I wanted to give blood for the first time in the early 1980s (luckily they already tested for hep B then). I didn't have any of the risk factors so it's still a mystery to me. Anyway, I must have put my hand in the unlucky pot, the reality is that not everyone has a high risk of hepatitis B. It is most prevalent in Asian and African countries, and there is also increased prevalence in Southern Europe but much less so (I was born in Switzerland, so maybe there was a slightly increased risk). Many high-prevalence countries have now universal immunisation programs, so new infections of babies that could later become chronic should now be much reduced.
The people we are most worried about are adults (including migrants and refugees) from higher prevalence countries (see map below) who may have been infected early in life. I strongly encourage everyone who thinks they could have been exposed to go to a general practitioner and ask for a simple blood test to check for an infection, or to rule it out. In any case, it is better to know.
Why is it so difficult?
One of the biggest problems with chronic hep B is that in most cases, it has no symptoms. Hep B is not called a silent killer for nothing. It progresses in phases that are fairly unpredictable (that's some of the detail I will provide in another post). Suffice to say at this point that the hep B virus lives mainly inside a person's liver cells, and if the immune systems decides to do something about it, it will start killing off the infected liver cells (and remember, there are no pain receptors). This will cause scarring (fibrosis) of the liver tissue which then leads to cirrhosis and in many cases to liver cancer.
As unbelievable as it may seem, liver disease can progress to late-stage with no signs and Hep B kills over one million people a year!
By the time a person finally feels ill and sees a doctor, they often die within a month or two after the diagnosis. This saddens me to no end because it is completely preventable. And that is why I have to write this post in the hope that people use the knowledge and pass it on to family and friends, and to the whole world.
As it stands, staggering numbers of people living with a chronic hep B infection are unaware of the fact. Here in Australia it's about 40% (Source) but worldwide it could be up to 90% (Source, or read the journal article published this week in the Lancet Gastroenterology & Hepatology).
Ok, so how do you prevent disease progression?
Well, I am living proof that one can live a happy, healthy life WITH chronic hep B. We can NOT cure it (yet) but we can certainly control it. Once a person knows they have chronic hep B (preferably diagnosed as early as possible), they only have to keep monitoring it once or twice a year. Not everyone will need treatment but it's important to catch the moment when it's necessary. The regular monitoring usually involves a blood test (including a viral load test to see whether and how much virus there is), and some kind of test to determine if there is any scarring. If caught early, the liver should remain in tip-top shape, but even if there is advanced scarring, it can (yes it CAN, again I'm living proof of it) be reversed once on treatment. There are several methods to check the condition of your liver. Details in the next post.
What does the treatment involve?
Believe it or not, but all that suffering and heartache can be prevented with a single tablet a day (there are two or three different ones at the moment), and they have virtually no side effects, or in any case very rarely have any at all. I for one have been on treatment now for about 13 years and have had zero issues. It is an antiviral treatment which prevents the virus from replicating, so the immune system won't have anything to fight and will not damage any liver cells. It's best to keep monitoring though to make sure it keeps working.
Considering how low treatment rates are for hep B at the moment, I truly feel privileged to be receiving it. I was also very lucky that I decided to do something about my hep B when I did, and not a day later. I almost waited too long as I had my head buried deeply and firmly in the sand, and it was so comfortable down there that I was extremely reluctant to pull it out and confront this beast. You see, even people who know they have it, can have a hard time taking action. This is mostly because they are afraid. Afraid of the prognosis, afraid of how it might affect their family, afraid of not being able to work, afraid of it costing too much money. But life is more precious and more important than all that. For me, the fear of what might happen if I do nothing just got bigger than the other fears at some point, and I wish that had happened sooner.
I do have to mention that we are very fortunate here in Australia that the hep B treatments (like the new hep C cure for that matter but that is a different story) are listed on the government's Pharmaceutical Benefit Scheme. This means that everyone can afford them. I'm very aware that this is not the case in many other places, including the U.S. However, my hope is that the more research is coming out, the more awareness is being raised, and the more people demand government action, the more widely the treatments will become available on a larger scale. Also, I believe some pharmaceutical companies have compassionate access programs.
As with any infectious disease, the issue of stigma and discrimination raises its ugly head, and hep B is no exception. This is a very important topic that I will also cover in a future post.
My dream is that one day, hep B will cause no more loss of life, no more heartache and no more sorrow!
Take care everyone!