PREVENTION OF HEPATITIS
THE TRIPURA MODEL
Tripura is small but beautiful. A healthy population is the index of state’s developmet & economy. Infective & communicable diseases disrupts the health of society. Hepatitis - or more specially Viral hepatitis is the cause of common disorder ''Jaundice'' - which causes loss of many man days.
Among various Viral Hepatitis - Hepatitis 'B' & 'C' may go into chronicity causing long - term sickness of liver. An unwell man unable to perform his activities - causing loss to him, his family, his society & state.
Chronic Hepatitis 'B' & 'C' remaining in persons body gradually destroys the liver and at the same time may cause liver cancer or liver cirrhosis.
Fortunately 'B' & 'C' - the two dangerous Hepatotrophic Virus can be Prevented by observing simple universal protective measure, like HIV/AIDS. Vaccine against Hepatitis 'C' is still in research laboratory but Hepatitis 'B' can easily be prevented by immunisation - a very effective and protective recombinant vaccine is in use through out the wold.
Hepatitis Foundation of Tripura spontaneously took the holy task of making Tripura Hepatitis free. It is a dream, a vision, a mission. But the scientific approach can convert the dream into reality.
Today our purview of discussion is hepatitis - 'B' and only this disease will be discussed subsequently. The outline of a model approach - ''The Tripura Model '' - is being presented in brief.
The Problem :
We do not have the exact figure of existing patients of hepatitis 'B' in Tripura but national figure is some where between 3 to 5% of population. If we consider the population of Tripura is about 35 lacs the burden is around 1.5 lacs (average) and this number will increase in a geometric proportion leading to many mortality, morbidity, loss of man days and destablizing state’s economy, which will be further jeopardized by highly expensive investigation and treatment of the patient.
The Target :
We are harbouring about 1.5 lacs of HepatitisB patients but we can not afford further increment of the number. So our target is; Not to allow anybody to get the virus of Hepatitis B de novo.
Is it possible ? Yes it is .
Hepatitis Foundation of Tripura is determined to achieve this goal.
The Project : The chronological approach :
Our approach to the problem starts from the mothers womb and let us draw the sketch of a man's life and the problem can be solved systemetically and chronologically.
1. Mothers womb :
It has been estimated that perinatal transmission or infection during childbirth is the commonest (40%) cause of transmission of Hepatitis B. All mother should routinely be tested for Hepatitis 'B' during ante - natal check up by simple & cost effective method of testing ''HBsAg''. All positive mother will be followed till confinement or child birth.
2. At Birth (Neonate) :
(a) Baby born to Hepatitis B positive mother will be given
i) Hepatitis B immunoglobulin injection at brith.
ii) Hepatitis B vaccine at brith and subsequently as per schedule. (0 - 1- 6 months)
b) Baby born to healthy mother will be given Hepatitis B vaccine at brith and
subsequently as per schedule.
3. 0 - 10 year of Age :
All children of 0 - 10 year should be immunised against Hepatitis B irrespective of caste, creed & sex, if not immunised earlier. This group is targeted as because - (1) Dose and cost of vaccine for this age group is less, (2) children are already following other immunisation schedule, (3) parents are more concerned about their children, (4) children are not aware of their problem.
4. 10 - 50 year of age :
Should ideally be immunised & vaccine is equally effective. This group of people are exposed to education, awareness programme through various media and can easily be convinced.
5. Above 50 years :
Effectivity of vaccine gradually decline with age but protection is always advocated.
6. Family Member of Hepatitis B positive patients :
Should by screened for HBsAG. Positive persons should undergo treatment and negative persons should immediately be vaccinated.
7. High Risk Group :
Health Care Providers : Doctors, Nurses, Paramedical workers, Laboratory technicians and other health workers should be immunised at the joining of their service and if not, later on at the first instance. Frequent blood receivers - Thallasemia and hemophilia patients, patient on hemodialysis, candidates for kidneys transplantation, candidates for major surgery, and cancer patients should receive immunisation at the earliest.
8. Don't give the disease to others :
If some one is harbouring the disease, please express - do no infect others.
9. health Care Providers please do not gift ''Hepatitis B'' virus to your patients :
Screen all patients for Hepatitis B (and C) before any surgical or invasive procedure.
10. Protect yourself :
Whenever receiving any injection please ensure sterility.Health care provider please do not get discase while treating patients.
Take only screened blood.
Is it so easy ? No, Never.
Education and awareness is the only key to success. Today even if an illiterate person receive any injury he immediately rushes for ''TOXOID'' injection. This has not happened in a day.
Today most of the parents are concerned about the routine immunisation of their children. This took decades to teach through global approach.
- Small pox is eradicated from the world.
- Polio is at the verge of eradication.
Through many years of teaching and awareness by WHO, World community, International NGOs, National & State Governments, Local NGOs, Text book teaching in educational institutions and medical fraternity.
What About Hepatitis B ?
v WHOs approach is hesitant.
v International NGOs are silent.
v National Government is indifferent.
v State Government is undone due to cost burden.
v No free vaccination against Hepatitis B, though all vaccine in Expanded
Programme of Immunisation (EPI) is free of cost.
v No commuity approach.
v Medical Fraternity is unaware of gravity of illness.
v Health Care Providers are also not immunised.
A Ray of Hope :
Many countries (about 116) has already included ''Hepatitis B'' in their national health programme. (not India). It stimulates others to take positive initiative.
A tough Task :
Definitely fighting all there odds is a very tough task but Hepatitis Foundation of Tripura's target is 35 lacs people of ''Beautiful Tripura'' - and with the help of ''You''this task is easy and the dream of'' Hepatitis Free Tripura'' will become reality.
Few - Suggestions :
1. Screen all pregnant mothers for Hepatitis B (and C)
2. Immunise all new born at brith. If missed, immunise today.
3. Inclusion of Hepatitis B in National Health Programme.
4. All Children upto 10 year of age should be immunised.
5. Family member of Hepatitis B patients should be screened for HBsAg and be immunised (if negative)
6. Pre-operative screening for HBsAg & compulsory immunisation against Hepatitis B before major surgery.
7. Use only screened Blood & Use only sterilized syringe.
8. Compulsory immunisation of Health care provider before joining service.
9. High Risk group - protect yourself.
10. Compulsory immunisation against Hepatitis B before admission in schools.
Hepatitis Foundation of Tripura's Programme :
1. Awareness generation throughout the State.
2. Counselling of patients and their family members.
3. Advice regarding treatment.
4. Immunisation at highly subsidised rate.
5. Expansion of programme to every corner of Tripura.
6. Scientific study in Tripura regarding prevalence and incidence of disease.
We know ..........
The task is tough.......... and miles to go before I sleep and miles to go before I sleep..