What's With Hepatitis B?

There is no other way to explain all the hype Hepatitis B has been generating from all over the globe. The figures attached to it are too overwhelming to not be given much notice. Hepatitis B's prominence in the world's health care concerns is too big to miss. With about 350 million people worldwide infected and about one third of world's population being exposed to the virus, Hepatitis B boasts of an unwanted and unwelcome super stardom. To make this claim more founded, let figures in America speak for themselves. The Centers for Disease Control (CDC) places the number at 140,000 to 320,000 cases of acute (short duration) hepatitis B occurring each year. At the other side of the globe, the figures reflect 15 to 20 percent infection rate among adults in southeast Asia and sub-Saharan Africa.

Hepatitis B ranks as one of the many possible infectious diseases of the liver. Other types are Hepatitis A, C, D, and E. Hepatitis is basically the inflammation of liver. The hepatitis virus attacks and destroys the parts of liver cells. As common knowledge has it, the liver is one of the most important organs of the body. The liver is responsible for the production and secretion of the bile, an important element of digestion and metabolism. The liver is also responsible for glycogen storage, plasma protein synthesis, and drug detoxification. It is also responsible for regulating the many high-volume biochemical reactions of the body. You can just imagine then how detrimental it is to have a malfunctioning liver.

Hepatitis B, originally serum hepatitis, is the infection of Hepatitis B virus (HBV). A member of the Hepadnavirus family, HBV is but one of the very few known non-retroviral viruses. Non-retroviral viruses are the kind that replicates through reverse transcription. Once the virus enters the body, its double-stranded DNA genome transfers to the nucleus of liver cells. Actually, the body is equipped with antibodies to combat the virus, but these antibodies are not enough to eliminate the infection already present in the infected liver cells. The continuous replication of the virus and the continuous production of the antibodies are believed to be the reasons for the development of complex immune diseases.

The primary mode through which the Hepatitis B virus can be transmitted is exposure to contaminated bodily fluids. Specific types of this mode are unprotected sexual intercourse, blood transfusion, use of contaminated syringe and needles, mother-to-child transfer, and others. Bodily fluids like breast milk, saliva, and urine (low concentration) are also known agents of transmission. Other modes of transmission are tattooing, body piercing, acupuncture, and bites from infected insects like tropic mosquitoes and bed bugs.

Infection from HBV comes in two stages: acute (self-limited) or chronic (long-standing). Acute Hepatitis B manifests through symptoms like loss of appetite, nausea and abdominal pain, jaundice, skin rash, pain and swelling of the joints, and low-grade fever. Chronic Hepatitis B, on the other hand, is either asymptomatic or chronic hepatitis associative.

The older the person at the onset of infection, the higher the chances are of clearing the infection. Full recovery and the development of protective immunity is seen among 95 percent of patients who got infected as either adults or older children. For patients at the age of one to six, the chance is at 75 percent. The chance of recovery is only 5 percent for newborns.

Anti-viral treatments are not given to Hepatitis B of acute stage since the infection is very likely to resolve on its own. For chronic Hepatitis B, the available antivirals are lamivudine, adefovir, and interferon alpha. Lamivudine is a nucleaoside drug which functions as an impostor. It closely resembles the biochemical units of the virus' DNA and tricks the HBV to hasten replication. Lamivudine is safe to use by patients with advanced cirrhosis. It can also improve liver biopsies and patients get less liver scarring and inflammation. Interferon alpha, on the other hand, enhances the production of white blood cells for higher fighting power against infection. Interferon alpha also works by further stimulating the immune system to get rid of the virus.

Prevention from HBV contamination lies mainly in avoiding the modes through which it can be transmitted. Practicing protected sexual contact, using safe and sterilized needles, and keeping a healthy lifestyle are the most basic preventive measures. There are also vaccines that make use of immunological methods to prevent Hepatitis B.

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Bird Flu: Human Infection

Bird flu is a disease caused by a specific type of avian (bird) influenza virus, the so-called H5N1 virus. This virus was first discovered in birds in China in 1997, and since then has infected 125 people in Vietnam, Cambodia, Thailand, and Indonesia, killing 64 of them. It is spread by infected migratory birds (including wild ducks and geese) to domestic poultry (primarily chickens, ducks, and turkeys), and then to humans.

Some infected people have developed abnormal clotting profiles resulting in excessive bleeding?which was a frequent clinical symptom in the deadly so-called Spanish influenza of 1918-19, which killed more than 100 million people worldwide. Indeed, bird flu shares a number of disturbing characteristics with the 1918-19 influenza virus. These two viruses have, in fact, recently been shown to be similar genetically. And in a recent laboratory experiment with mice, the 1918-19 virus was found to produce 39,000 times more viruses four days after infection than the regular seasonal human flu strain. The 1918-19 virus killed 100 percent of the mice that were infected with it, compared to none of the mice infected with the regular flu strain. With a current ?case fatality rate,? or death rate of approximately 50 percent in humans, bird flu is obviously also a very deadly disease.

There are only a few reports in the medical literature describing the clinical features of bird flu in humans. The clinical spectrum of H5N1 infection ranges from asymptomatic infection?where the person doesn?t even know he or she is infected?to fatal pneumonia and multiple organ failure. Some infected individuals develop liver or kidney dysfunction, and there were two children who died from the virus that came to medical attention because of diarrhea and seizures related to encephalitis (infection of the brain). However, the most common presentation is one of fever, cough, and trouble breathing. Approximately 70 percent of patients also have diarrhea, and a few patients have had only gastrointestinal symptoms (such as stomach ache, vomiting, and diarrhea) and no breathing problems.

Deaths have generally been in normally healthy people. The first report in the medical literature of deaths from bird flu was on 12 patients living in Hong Kong. Their median age was nine years, with a range of one to 60 years. All presented with fever, and eight had symptoms or signs of upper-respiratory infections (five had clinical and X-ray evidence of pneumonia when first diagnosed). Gastrointestinal (GI) symptoms, including stomach pain, vomiting, and diarrhea, were present in eight patients. There were a total of five deaths (one died with Reye?s syndrome, which is associated with taking aspirin in children).

In a study of 10 patients in Vietnam with laboratory-confirmed avian influenza (H5N1), the mean age of the patients was 13.7 years. For eight of the patients, there was a clear history of either direct handling of poultry (chickens or ducks) or exposure to sick poultry in the week before the onset of illness. All presented in January 2004 with cough, shortness of breath, and fever, and seven had diarrhea; none had myalgia (muscle aches)?which is often found in the regular seasonal flu. Notably, oseltamivir (Tamiflu) was administered to five patients, four of whom died (treatment was probably started too late for the medication to be effective?it must be given within 48 hours after onset of symptoms to be effective). In total, eight of the patients died, for an 80 percent case fatality rate or death rate.

As is apparent from the descriptions above, the presenting symptoms of individuals with bird flu are very similar to the symptoms of the normal seasonal flu. Infections caused by either the bird-flu virus (H5N1) or the seasonal influenza virus can be completely asymptomatic?that is, cause no symptoms at all. Fever, cough, malaise (feeling ill), and gastrointestinal symptoms are common to both infections. Excessive bleeding occurs only with bird flu, but currently this symptom doesn?t appear to be common. Difficulty breathing is more common with severe cases of bird flu, not seasonal flu. Runny nose and sneezing are found only with colds (or allergies).

The cough in either type of infection is what is referred to in medicine as ?nonproductive??meaning there is no sputum brought up when coughing, or if any sputum is brought up, it is white in color. This type of cough is characteristic of upper respiratory viral infections. As either type of infection progresses or worsens, tissues may be damaged, disrupting the normal structure and function of the infected cells. This in turn may allow bacteria to grow and also cause damage. When this happens following a viral infection, it is referred to as a ?secondary? bacterial infection. When this occurs, the color of the sputum characteristically turns yellow or green. If this happens, antibiotics are indicated to treat the bacterial infection. (Antibiotics are not indicated in the treatment of viral infections, because they don?t work.)

It is safe to assume that during a bird-flu pandemic, most individuals who become infected with the bird-flu virus will either be asymptomatic?having no symptoms?or their illness will not be severe enough to require hospitalization. The small percentage who do become seriously ill will have to be hospitalized, and treated with either of the two antiviral agents available, oseltamivir (Tamiflu) or zanamivir (Relenza). A smaller subset of that group will develop life-threatening complications such as acute respiratory distress syndrome (ARDS), which requires treatment with a mechanical ventilator, a respirator.

Some individuals may develop other serious complications such as liver failure, kidney failure, neurological problems?such as seizures, paralysis, psychiatric problems such as delirium or psychosis, or bleeding problems. However, it is reasonable to predict that most people infected with the virus will not die and will not have significant residual symptoms, although a small percentage will.

Bradford Frank, M.D., M.P.H., M.B.A.
The Frank Group
P.O. Box 138
Lakewood, NY 14750
http://www.AvoidBirdFlu.com

Bradford Frank, M.D., M.P.H., M.B.A. Dr. Frank graduated from the University of Colorado with a B.A. in chemistry and his M.D. degree. He completed two residencies, one in family practice and one in psychiatry. He is board certified in psychiatry as well as addiction medicine and geriatric medicine, and is a clinical assistant professor at the University of Buffalo School of Medicine and Biomedical Sciences, Buffalo, N.Y. He has a master?s in public health (M.P.H.) from Yale, where he specialized in infectious diseases, and an M.B.A. from Northwestern?s Kellogg School of Management.

Dr. Frank is president of The Frank Group, a diversified company that includes a business-contingency planning consulting firm. He has expertise in the areas of business-contingency planning, emerging infectious diseases, severe acute respiratory syndrome (SARS), avian influenza (?bird flu?), weapons of mass destruction, terrorism, epidemiology, and various public health issues.

Can Genital Herpes be Avoided?

Many kinds of diseases, especially sexually transmitted diseases (STDs) like genital herpes, can be avoided if a person is conscientious enough in practicing health habits. For genital herpes, the adage ?an ounce of prevention is better than a pound of cure? is appropriate. In fact, there is no vaccine against genital herpes.

Abstinence is definitely the most effective way of avoiding genital herpes and any other STDs. Having no sexual contact with anyone assures you that you will never be exposed to genital herpes.

However, abstinence can never be the choice of many people. And so, the next best thing is fidelity. It means that you must maintain a strictly monogamous relationship with a partner who has no genital herpes. This must be a two-way street. That is, you don?t have multiple sex partners, and your partner doesn?t maintain other sex partners. Having several sexual adventures may turn out to be nightmares in the end.

Unfortunately, finding one true love could be a trial and error process for some people. And so, to avoid genital herpes, the third best thing is being responsible. That is, you must practice safe sex.

Before starting a sexual relationship with a new partner, talk about STDs. It is probably not the most scintillating and romantic topic you could think of, but it is a vital one. Find out if your potential sex partner may have been exposed to the HSV virus. Having blisters and sores in the genital area and in the lips and mouth are hazardous signs. But you must also remember the fact that a person infected with HSV or any STD may never show any symptom. Thus, find out about your potential partner?s lifestyle, health history and sex history. If you are the 100th partner, think twice before consulting to a more intimate relationship. Prowess acquired due to experience may not always be a good thing.

Safe sex also means the use of condoms. Condoms, even if used properly, do not entirely prevent the transmission of genital herpes. But they do reduce the risk of acquiring STDs. Sometimes, the sores of genital herpes spread to the anus, the buttocks, and the thighs. These areas could not be covered by condoms. If your sex partner has genital herpes and the sores are limited to a small area, then either male or female condoms can be used. But let us reiterate that condoms do not offer 100% protection.

If pregnant, do everything in your power to avoid HSV infection, so that you do not endanger the health and life of your newborn.

If you are already infected with genital herpes, then have mercy and give others the chance to avoid your disease: avoid any sexual contact.

Chris Locker is writing articles about herpes for the genital herpes site and hemorrhoids articles for the hemorrhoids treatment site.