Hepatitis C in Kokernag

Let us think of the most common possibilities of spread of infection in a rural society

EPIDEMIC

DR. MIRZA ASHRAF BEG

Kokernag is one of the most visited tourist destinations in south Kashmir. Like Cheshmashahi in Srinagar, it is well known for its sparkling waters that gush out of the hills surrounding this world famous hamlet. Some even say Kokernag waters have medicinal effect and improve your digestion. Recently Kokernag has been in the news not for its scenic beauty or trout fish but Hepatitis C - something very nasty and unfortunate. It is encouraging that our prominent gastroenterologists have visited the place and health department has sought help from New Delhi too but before we score points let us try to know from a common man’s point of view as to what is hepatitis C, its mode of infection, diagnosis and possible treatment.
First of all from the disaster management point of view: -
1: Let us not panic.
2: No rumors please.
3: Consult the experts.
4: Coordination of experts is a must and no overlaps please.
5: Involve the civil society for educating the community.
6: Kokernag area has highly qualified doctors, dentists, panchayat members and social activists; please involve them for public awakening
From a research point of view Hepatitis C virus is encapsulated much smaller than HIV virus measuring 50nm. If untreated it leads to a chronic infection resulting fibrosis, cirrhosis and sometimes malignancy of liver. Most of the patients have no symptoms and get diagnosed on a routine blood screening only.
The infection is mostly spread through blood-to-blood contact such as blood transfusions of contaminated blood or its products. HCV was first time discovered in 1989 and facilities for screening of blood came in to vogue in 1992. This technology is available in all the blood banks registered by government of India. Mirza Afzal Beg Memorial Hospital, the only available blood bank supplying blood for the patients from Kokernag area too is equipped with these facilities besides expert technologists in the field of blood transfusions etc.
So first things first.  Let us think of the most common possibilities of spread of infection in a rural society where heterosexuality out of wedlock, or homosexuality, are condemnable acts and drug abuse through syringe sharing is not the trend as yet, although all possibilities need to be kept open.  At the same time,  all of us know in the rural setup a barber is an important component of the society so with a single blade for all the scalps in the village plus facial shave and sterilization unknown to him he could have been an unwilling source for spread of infection in Kokernag. No doubt books make references but one needs to think twice before suggesting the laborers or drivers traveling outside could have been the primary source to barter the infection and create a social stigma for the people of Kokernag.
Being mostly a disease without symptoms during its acute phase Hepatitis C is diagnosed in the laboratory generally on routine blood tests for blood screening. Anti HCV antibodies can be detected in 80% patients exposed to the infection in fifteen days time in 90% within 5 months and in 97% after six months of exposure to the infection. Over all detection of anti HCV antibodies in the blood is a strong basis to believe an exposure to the infection.  We need to remember that rarely people with HCV never develop antibodies. Anti-HCV antibodies indicate exposure to the virus, but cannot determine if ongoing infection is present. All persons with positive HCV antibody test must undergo additional testing for the presence of Hepatitis C itself to determine whether virus infection is present. The HCV viral load is an important factor in determining the probability of response to interferon based therapy but does not indicate disease severity or the likelihood of disease progress.
In people with confirmed HCV infection, genotype testing is generally recommended. HCV genotype testing is used to determine the required length and potential response to interferon based therapy.
Let us talk about possible preventive measures currently at hand. As Hepatitis C is spread through exposure to large quantities of blood either through the skin or by injection so disposable syringes and thorough screening of blood and blood donors are recommended strongly. Hospitals should arrange for proper disposal of the waste material through incinerators etc. Dental clinics should be extra judicious in terms of sterilization etc. Similarly beauty salons and barbershops need to use fresh blades for every individual besides sterilized gloves and other equipment. Health care workers need to be extra cautious regarding accidental needle stick injuries on job. Babies born to HCV positive mothers need to be screened properly. As HCV can also be spread through HCV infected person so need to emphasize against extramarital sex besides sharing personal items like razor or toothbrush. Last but not the least government agencies should keep an eye on rag pickers coming from outside the state that collect used syringes and other biomedical wastes to recycle and make a little money.
The treatment part of this disease is quite expensive hence central government must step in for financial assistance and leave it to the experts from SKIMS or Medical College in Srinagar besides our other pioneers in the field that are readily available to the community.
The author is a clinical pathologist.

Lastupdate on : Tue, 5 Feb 2013 21:30:00 Makkah time
Lastupdate on : Tue, 5 Feb 2013 18:30:00 GMT
Lastupdate on : Wed, 6 Feb 2013 00:00:00 IST




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