A Comparison between Hepatitis Prevention in Egypt and Australia - Essay Example

? A comparison between Hepatitis prevention in Egypt and Australia Overview The undisputed impact of the human viral hepatitis on the national economy and public health of both developed and developing nations is quite alarming. Globally, it has been estimated that at least 300 million persons are infected with Hepatitis B virus, and about 170 million are infected with hepatitis C (Hudson et al., 2012, p. 1196). Chronic hepatitis presented by either Hepatitis B or C eventually leads to hepatocellular carcinoma and liver cirrhosis. Additionally, exposure to some enterically transmittable hepatitis viruses such as Hepatitis A and Hepatitis E especially in developing nations accounts for most of the reported cases on a yearly basis (Paul et al, 2011, p. 580). Both HAV and HEV have been cited as the major causes of the epidemic hepatitis as well as acute sporadic and fulminant hepatitis in these nations. It has been estimated that close to 1000 000 people each year where approximately 2.7% of the deaths a related to the viral Hepatitis and mostly the liver disease and also including liver cancer. Notably, an estimated 57% of liver cirhossis and 78% of liver cancer directly result from HBV and BCV infections (Michael & Jacques, 2004, p. 1). Over the last 40 years increase in the knowledge concerning human viral hepatitis has been so explosive in nature. This began with the discovery of the Australian antigen in mid 1960 (Michael & Jacques, 2004, p. 1). Subsequently, sensitive, rapid, specific and precise immunological assay techniques for the detection of Hepatitis B surface antigens and antibodies to HAV were developed in the 1970s. Such progress led to the identification of a third Hepatitis Virus via exclusion which was tentatively named as a post transfusion non A, non B hepatitis virus. In the late 1970s, hepatitis delta virus was discovered, and later on the advent of molecular biology and the introduction of polymerase chain and viral genome was cloned molecularly and designated HCV (Polis & Barba, 2004, p. 1). The new cloning techniques led to the discovery of HEV and the GB viruses A B and C and even the TT virus. Notably, immunological and molecular probe assays were developed for detection and of these viruses. Egypt has been reported to have the highest Hepatitis prevalence in the world, this figure stands between 10-15% according to the latest statistics (Dalaglish, 2008, p. 6). This is a matter of concern since millions of people living with the viral hepatitis and other millions are at a greater risk. Indeed, most of the people living with the viral disease are unaware of their chronic infection and thus, they are at a high risk of developing severe liver disease which may be unknowingly transmitted to other people. This paper seeks to compare the existing prevention policies and practices between Egypt and Australia, with a view to elucidate on the types of Hepatitis, causes and prevention mechanisms. It is believed that the contents of this paper will encourage development of new and innovative approaches to the future research involving Hepatitis as well provide clear directions for a much better understanding of Hepatitis viruses. Viral hepatitis refers to the liver inflammation which is caused by any of the five hepatitis viruses, namely Hepatitis A, B, C, D and E (Mushahwar, 2004, p. 1). Though all of this viruses cause liver diseases, they vary significantly in terms of natural history, epidemiology, diagnosis, prevention and treatment. Hepatitis A (HAV) is mostly spread through water or food contaminated with the virus. Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are both transmitted via contact with contaminated blood and HBV can also be sexually transmitted (Polis & Barba, 2004, p. 1). As noted, both HBV and HCV can cause severe liver cancer, liver damage as well as an urgent need for liver transplants. In Australia close to 200, 000 people are living with Hepatitis C. After being infected with Hepatitis virus, some people have reported to experience symptoms such as fatigue and jaundice, however many people do not feel ill and often remain unaware of their infection. Overview of types, cause and symptoms of Hepatitis Virus Causes symptoms Hepatitis A contact with contaminated food or water by HAV virus Fecal matter and oral route Jaundice, uneasiness, loss of appetite, dark urine, fatigue, stomach pain, Hepatitis B Caused by the HBV virus and is spread by contact with contact with contaminated blood Jaundice, uneasiness, loss of appetite, stomach pain , dark urine, fatigue, Hepatitis C Caused by the HCV virus and it is spread through contact with contaminated blood Anesthesia contamination Dark urine , stomach pain, fatigue, jaundice Hepatitis D Caused by the HDV virus and infection is through unprotected sex, blood, perforation of the skin with infected needles A person infected with hepatitis B is the only one that can be infected by Hepatitis D Jaundice, uneasiness, loss of appetite, dark urine, pain in the stomach area, fatigue. Hepatitis E Caused by the HEV virus and spread through contaminated water, and anal –oral sex Jaundice, loss of appetite, dark urine, uneasiness, close to 90% of children infected with this virus show no symptoms Hepatitis G Caused by the Hepatitis G virus And may be spread through sharing of contaminated items, sexual activity, and mother to child. Usually has no symptoms (Polis & Barba, 2004, p. 2-11). Both Egypt and Australia have experienced a considerable growth in the number of viral hepatitis infected people. However, one striking difference is that infections in Egypt, Hepatitis infection has been related poor medical practices with most of transmissions occurring due to contact with infected blood (Dalaglish, 2008, p. 6). In Australia, improvements within the medical care system has led to a significant reduction of Hepatitis transmissions through poor medical system, however, most of the transmissions have been related to increased travels to HAV endemic regions, vaccine uptake and migration from endemic region to Australia (Heywood et al, 2012, p. 6024). Prevention policies and practices within Australia and Egypt Australia The main ways of prevention of HCV transmission in Australia are carried out through the Needle and the Syringe Program (NSP) and education, including peer education scheme (Australian Government Department of Health and Ageing, 2010, p. 10). Australian national strategy has three way approaches to illicit and licit drugs. This approach has enjoyed non partisan political influence since its inception. These ways include reduction of supply, reduction of demand and harm reduction. NSP is one of the major harm reduction strategies that are related to illicit Drug use. Though, there has been a low investment in NSP, still it has proved to be much more important within public health success especially in the benefits derived from preventing HCV and HIV transmissions among the Australian population. Additionally, all health care workers are vaccinated against Hepatitis B virus if they have no documented evidence of preexisting immunity (Australian Government Department of Health and Ageing, 2005, p. 3). And ensure that they are assessed for the post immunity vaccination. Health care workers are advised to undergo testing since the government provides support if they are found positive. All heath workers infected with BBV are given regular medical attention; additionally health care workers who have a history of HIV positive immunity are not allowed to carry out exposure prone procedure (EPPs) (Australian Government Department of Health and Ageing, 2005, p. 3). Health care workers are not required to perform EPPs when they are infected hepatitis C and may be permitted to return to EPPs after successful completion of treatment. The scope of restrictions on the practice of infected HCWs depends on the likelihood that EPPs will eventually form as part of the duties of the work undertaken. When a HCW is diagnosed with the disease, his rights are protected by the employer. In Australia compliance to the guidelines presented in the HIV/Hepatitis and other blood viruses in sport, minimizes blood exposure risks during sport or recreational activities. Additionally, Australian inmates are educated over the prevention and management practices of hepatitis including treatment as a fundamental and effective preventive intervention (Australian Government Department of Health and Ageing, 2008, p. 1). Compliance with the Australian infection control standards concerning body piercing reduces the risks of Hepatitis transmission within custodial environment. Drug treatment programs such as, free rehabilitation, drug substitution programs and detoxification helps to minimize transmission within custodial environments (Australian Government Department of Health and Ageing, 2008, p. 1). Routine testing for Hepatitis B surface antigen has been ongoing where it has been established that blood given to patients whom non a , non B hepatitis developed had antibodies against HBsAG and hepatitis B (Cossart, Ismay, & Kirsch, 1982, p. 208)Additionally, such practices are carried out in order to give a vaccination against the disease. More specifically, there is a voluntary National hepatitis testing policy which provides the guidelines for testing Hepatitis within custodial environments (Batey, 2006, p. 12). The impact of Hepatitis B has been reduced by implementing the national Hepatitis B immunization program, safe blood supply, and provision of treatment to all people having chronic Hepatitis B via the Pharmaceutical Benefits scheme (Australian Government Department of Health and Ageing, 2010, p. 4). In this regard, the national Hepatitis B strategy 2010-2013 widens this approach by promoting a more comprehensive strategy. In Australia there is an extensive vaccination program for the high risk individuals, in this regard, pre travel vaccinations as well as relocation from HAV endemic regions is ongoing. More particularly high risk groups including travelers into endemic areas, Torres Islander and Aboriginal children within high incidence states and territory as well as, those at risk of lifestyle or occupational diseases are the target for these vaccinations (Heywood et al., 2012, p. 6020) EGYPT Egypt has enacted the national control policy for viral Hepatitis, which includes infection control strategy designed through collaboration with WHO and indeed it has been considered as a reference point for Eastern Mediterranean region (Dalaglish, 2008, p. 14). However, full implementation of this policy has not been achieved. Studies have shown that only 16 percent of health workers were vaccinated against HBV and rates of hand washing were extremely low (Dalaglish, 2008, p. 14). Routine screening of blood has been inexistence since 1993. Organizations involved in blood supply include, MOD, MOHD, university hospitals under MOHE, private groups and the Red Crescent. Through collaborations with the Swiss government, the National blood transfusion Center is currently restructuring the MOHP system into a centralized service connecting 24 centers (Dalaglish, 2008, p. 15). HBV vaccination was introduced in 1993 however coverage data of the vaccination are quite low. Egyptian Information education and communication, is handled by the communication for healthy living of which is majorly funded by USAID. Communication for healthy living has produced a strategy in collaboration with MOHP, USAID/Egypt and the ministry of information and state. This strategy was approved by all parties and USAID approved the funding for the initial process of the strategy (MMWR, 2012, p. 545). Though no scientific, medical epidemiological evidence exists for testing people prior to employment, or travel, the practice is carried out in Egypt by employers. In this regard, employers publicly disclose an individual medical status. This has promoted unfairness, stigma and untold suffering to persons diagnosed with the HCV. As such, the practice has been linked to the high unemployment rates in Egypt. In both countries the prevalence of Hepatitis is age dependent and irrespective of gender, for instance a new data on the Seroepidemology of HAV in Victoria Australia indicates that HAV increased considerably with age having no difference on gender (Heywood et al., 2012, p. 6020). However, Australia has been experiencing declining rates as opposed to Egypt. This could also be attributed to improvements in sanitation, more particularly amongst the young population of Australia. Additionally, improper sterilization techniques have been cited as a major cause for the spread of HCV in Egypt. As noted, both countries carry out a HAV vaccination amongst travelers (Ward, Borgen, Marzick, & Muehelen, 2006, p. 38). Passive immunization with immunoglobulin’s could be used for non immune travelers over their stay in endemic areas. Although, such vaccination has been going on, travelers continue to experience HAV cases, implying that most of them travel without adequate protection against HAV (Ward, Borgen Marzick and Muehelen, 2006, p. 39). Evaluation In Egypt, many of the HCV awareness programs have been misdirected and provide inaccurate information and they do not sufficiently address the stigma associated with HCV (Healio Education Research, 2012, p. 1). More particularly, the programs have been directed to the general public instead of directing them to the health care providers. It should be noted that, HCV is spread by blood; this is the case in Egypt since the likelihood of a person being infected is through dental or medical care (Dalaglish, 2008, p. 6). Primary prevention of Hepatitis requires that health care workers should be clean. It has been established that most of the doctors, nurses, pharmaceutical workers, and dental assistants have been reported of being very careless in most cases (Yahia, 2010, p. 1). In Egypt health care workers have insufficient training on handling of medical equipments, thus health care centers a serve as the most likely centers for the transmission of hepatitis virus. Additionally, available facilities do not march the overwhelming infected patients (Dalaglish, 2008, p. 33). In Australia, the health care centers serves as places for minimizing the spread of Hepatitis Virus since the medical practitioners’ are well equipped on the procedures to be undertaken while treating patients. In Egypt scant attention has been paid to effective interventions or preventive research. As such, it has been established that lack of awareness and knowledge concerning the viral hepatitis among the policy makers and public members posed a significant barrier to prevention mechanisms (Yahia, 2010, p. 2). Additionally, poor culture and literacy problems coupled with lack of insurance of the patients cause them to resort to primal medical substitutes and superstitions, which only worsens their medical conditions References Australian Government Department of Health and Ageing. (2005). “Guidelines for Managing blood borne virus infection in health workers”. Journal of Communicable disease networks, 1, 1-24. Australian Government Department of Health and Ageing. (2008). Hepatitis C prevention, Treatment and care: Guidelines for Australian Custodial Settings. Retrieved on 12th May 2013 from http://www.health.gov.au/internet/main/Publishing.nsf/Content/phd-hepc-guidelines-custodial-hs Australian Government Department of Health and Ageing. (2010). National Hepatitis B strategy 2010-2013, 6636, 1-36. Batey, R. (2006). Managing Hepatitis C in the community. Retrieved on 14th May 2013 from http://www.australianprescriber.com/magazine/29/2/36/9/#.UZGAQlFNBdE Hudson et al. (2012). “Hepatitis C virus Envelope Glycoprotein fitness defines virus population composition following transmission to a new host”. Journal of virology, 86(22), 11956-11966. Cossart, Y.E, Ismay, S. L, and Kirsch, S. (1982). Post Transfusion in Australia. The Lancet , 1, 208-213. Dalaglish, S. (2008). “Egyptian National Control Strategy for Viral Hepatitis from 2008 to 2012”.The Journal of the Ministry of health and population, 6(1), 1-62. Healio Education Research. (2012).Hepatitis programs in Egypt improved disease burden. Infectious disease news. 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(2010). “The burden of Egypt’s Hepatitis C epidemic”. Journal of Nature Middle East, 188, 1-4. Read More