POP quiz: What do many of our fellow Filipinos have in common with Pamela Anderson?

Is it (a) Breasts that can be seen from outer space; b) A sex video starring your ex-husband that has been distributed all over the Internet, or c) A potentially deadly disease.

If you answered (a), you most likely work for a plastic surgeon specializing in breast implants. If you chose (b), kindly provide the URL to said video so that, uhm, we may verify that you’re telling the truth. And if you said (c), you are, unfortunately, correct.

Ms. Anderson is just one of the millions of people worldwide who suffer from one of the variants of the potentially deadly disease, hepatitis. Other famous folk with this viral infection include rock star Steven Tyler, famed Chinese television host Cheng Lei and country singer Naomi Judd.

For those unfamiliar with this ailment, the American Center for Disease Control (CDC) defines it as an “inflammation of the liver and… a group of viral infections that affect the liver.” According to the CDC (www.cdc.gov/hepatitis/ index.html), the most common types are Hepatitis A, Hepatitis B, and Hepatitis C, although in recent years new strains called Hepatitis D and Hepatitis E have also been identified.

So what has all this got to do with us Pinoys? Well, it just so happens that according to the Asian Liver Center at Stanford University (www.jaderibboncampaign.com), in some Pacific Rim countries – the Philippines included – up to 20 percent of the population are chronically infected with Hepatitis, specifically Hepatitis B. Though Hepatitis A is also quite common, and in fact more easily transmissible than Hepatitis B, most people especially in developing countries like the Philippines, are exposed to it quite early in life, thus developing a lifelong immunity to it and lowering the risk of chronic infection.

Hep B, in contrast, while harder to contract, is also more likely to develop into a chronic condition. Studies have shown that chronic Hep B infection increases one’s risk of dying from cirrhosis of the liver and/or liver cancer by up to 25 percent! In other words, one out of every four of those chronically infected will die of liver failure-related causes. This is particularly true of those who aren’t even aware that they carry the virus and therefore don’t regularly monitor the progression of the illness.

Research indicates that over 350 million people worldwide may be infected with the Hepatitis B virus, and of that group, a staggering 78 percent, or around 275 million, reside in Asian or Pacific Island nations, a grouping that, regrettably, includes the Philippines. Reasons for this include poor access to health care, lack of awareness of the need to screen for the virus, as well as a genetic susceptibility to Hepatitis infections. Over two-thirds of those infected don’t display any signs of the disease, so many who catch it don’t realize they have it until severe damage has happened to their liver. Making it even more difficult to identify infection is the fact that many symptoms of Hepatitis mimic those of a bad cold or flu – a fever, fatigue and aching muscles, loss of appetite, nausea and vomiting.

You might now be thinking, “Great. I thought the only thing dangerous about Pam Anderson was the possibility of being smacked unconscious by her breasts. Now I have to worry that I might have a disease like hers, too!”
No need to get unnecessarily alarmed. First, let’s start by listing how Hepatitis B is not transmitted. It’s not food- or water-borne, does not spread by casual contact like handshakes or hugging, cannot be caught through sneezing or coughing and, contrary to some assumptions, can’t be conveyed through breastfeeding.

Among the ways you can get infected are through blood transfusion, unprotected sex, getting tattooed with non-sanitized needles, reusing intravenous medical supplies, as well as during childbirth if the mother is unaware that she has the virus. Other avenues for the virus come from sharing of implements like razors and toothbrushes, because the organism can survive for up to seven days outside the human body, and then enter a new host when the razor blade or toothbrush bristles break the surface of the skin or gums. Furthermore, young children are considered especially vulnerable to infection. Common methods of transmission among kids are via skin-to-skin contact with wounds or open sores, and through contact of blood-containing secretions, including saliva, with breaks in the skin or through mucous membranes,

Now that you know the different conduits down which the Hepatitis B virus can go, how best to shore up your defenses against it? A fact sheet from the World Health Organization, or WHO (www.who.int/ media centre/factsheets/ fs204/en/index.html), gives some guidance. Primarily, make sure that you are vaccinated against Hep B. In ideal circumstances, vaccination should be universal for infants. When administered this way, it can be doled out in either a three- or four-dose program within the child’s regular immunization schedule. If there is a risk of mother-to-child infection, the initial dosage should be provided within 24 hours of birth.
If you weren’t immunized during infancy, you can get the vaccine at any age. The inoculation has been extensively documented for safety and efficacy. Since it was first dispensed in 1982, over a billion doses have been given out the world over, with the vaccination credited for reducing rates of chronic Hep B infection to under one percent in countries where its adoption is widespread.

If for some reason you cannot immediately get the Hepatitis B vaccine, or have some sort of gene mutation that prevents vaccination from being effective, then it’s imperative that you avoid Hep B-risky behavior. So if you’re in some backward location where blood supplies aren’t regularly screened for infection, avoid the use of anonymously donated blood. Don’t have unprotected sex, otherwise defined as sexual contact where bodily fluids (such as blood, semen, and other genital secretions) may be exchanged. Resist the temptation to get tattoos from dodgy, unregulated establishments whose instruments are unlikely to be properly sanitized. In other words, that cool-looking skeleton that you got from that quaint little roadside stand in the provincial Third World outpost you vacationed at may literally mean the death of you. Make sure any IV equipment you use is brand-new and sealed for your protection. And as ickily obvious as this might seem to be, do not share your toothbrush or razor with anyone.

Should you discover that you are a carrier of Hepatitis B, hold off from undergoing a complete meltdown. Despite the rather dire nature of this disease, it is considered in the medical field to be a long-term, chronic condition that’s generally manageable with regular testing and treatment. You’ll want to get your blood tested every three to six months, to monitor viral load and liver enzyme levels.

Also recommended is a CT scan of your liver every six months and a liver MRI yearly, to assess liver inflammation and possible cirrhosis. You should reduce intake of salty and fatty food, as well as consumption of red meat, which is processed mainly by the liver. When taking medication, first verify that it affects the liver minimally; for example, aspirin in even moderate doses can be highly toxic to the liver. And naturally, any intake of alcohol and other recreational substances should be immediately curtailed.

Depending on the severity of your infection, your doctor may prescribe several medications currently accepted for the treatment of Hepatitis B infection. In the United States, there are seven drugs approved by the FDA to counter Hep B – the antivirals adefovir (Hepsera), entecavir (Baraclude), lamivudine (Epivir), telbivudine (Tyzeka), and tenofovir (Viread), along with two immune system modulators, interferon alpha-2a and PEGylated interferon alpha-2a (Pegasys). In the Philippines, though, not all these are available (and the ones that are tend to be quite costly), so it’s best to consult with a liver specialist to see what options can be had locally. It’s important to note that all meds currently approved for treating Hep B do not rid you of the infection; they instead inhibit the virus from replicating and causing damage to the liver.

To sum things up, with regard to Hepatitis B, your best bet is to get vaccinated. Failing that, refrain from behavior that can get you infected. If these measures fall short and you do find yourself host to chronic Hep B, get regularly tested, and if necessary, treated. As dreadful as this disease may be, even its most virulent manifestations can be mitigated. Should you be able to keep the infection under control and keep yourself as healthy as possible, there is a bit of a bright side—at least you’ll be able to comfortably tell people you truly have something in common with Pamela Anderson! •