Hepatitis A - Pakistan: (Azad Kashmir

A ProMED-mail post,http://www.promedmail.org, ProMED-mail is a program of the International Society for Infectious Diseaseshttp://www.isid.org

Date: Mon 6 Dec 2010
Source: The Express Tribune
http://tribune.com.pk/story/86427/hepatitis-a-spreading-because-of-lack-of-awareness/

As a result of poor hygiene standards and the lack of awareness campaigns, hepatitis A is fast spreading in Azad Jammu and Kashmir (AJK), doctors of the area have said. Hepatitis A is an acute illness associated with fever, malaise, jaundice, anorexia and nausea. The disease is spreading at an alarming rate, especially in the earthquake affected areas of the region, where hygiene conditions have still not improved despite all the money that was spent on these areas to rehabilitate the health structure.

The Health Department has still not launched any awareness campaigns to educate the masses about this fast spreading disease. The Khalifa Sheikh Zaid Al-Nayan hospital in Muzaffarabad has been receiving patients from the earthquake affected areas of the Neelum and Jhelum valley, Bagh and Rawalakot districts infected with hepatitis A.

A recent survey conducted by Dr Tahir Raheem Mughal, a general practitioner (GP) at the hospital in Muzaffarabad, observed that at least 150 patients were diagnosed with hepatitis A in last 2 months.
"Acute viral hepatitis (AVH) is one of the most common diseases in the patients who visited hospital," Mughal said. Doctors have observed that the reason for the spread of AVH in AJK is through the fecal-oral route, which means that the infection travels from one person to another when a person comes into contact with something that is directly or indirectly contaminated by feces of another infected person.

"Though the hygiene conditions in the region have improved, the lack of proper sewerage lines adds to the increasing number of AVH patients," Mughalsaid. The sewerage system in AJK was functional, but after the October 2005 earthquake, it was destroyed and has still not been repaired 5 years on. Another big reason for the spread of this disease is the consumption of contaminated water.

Health experts say that increasing the awareness amongst the general population regarding preventive measures and improving hygienic conditions are essential. Hepatitis A vaccine can prevent the spread of the infection, but patients predominately come to the hospital late. Two doses are needed 6-18 months apart to ensure long-term protection.

[Azad Jammu and Kashmir (AJK) [current ISO nomenclature: Azad Kashmir (JK) - CopyEd.MSP], is the southernmost political entity within the Pakistani-administered part of the former princely state of Jammu and Kashmir. It borders the present-day Indian-controlled state of Jammu and Kashmir to the east (separated from it by the Line of Control), Khyber-Pakhtunkhwa to the west, Gilgit-Baltistan to the north, and the Punjab Province of Pakistan to the south. With its capital at Muzaffarabad, Azad Kashmir covers an area of 13 297 square km (5134 sq mi) and has an estimated population of about 4 million.

Hepatitis A is a viral liver disease that can cause mild to severe illness. It is spread by faecal-oral transmission when a person ingests food or drink contaminated by an infected person's stool. The disease is closely associated with poor sanitation and a lack of personal hygiene habits, such as hand-washing. Epidemics can be explosive in growth, and improved sanitation and hepatitis A vaccine are the most effective ways to combat the disease.

The symptoms of hepatitis A range from mild to severe, and can include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-colored urine and jaundice (a yellowing of the skin and whites of the eyes). Not everyone who is infected will have all of the symptoms. Adults have signs and symptoms of illness more often than children, and the severity of disease and mortality increases in older age groups. Infected children under 6 years of age do not usually experience noticeable symptoms, and only 10 percent develop jaundice. Among older children and adults, infection usually causes more severe symptoms, with jaundice occurring in more than 70 percent of cases. Most people recover in several weeks -- or sometimes months -- without complications. (More detailed information can be accessed at:http://www.who.int/mediacentre/factsheets/fs328/en/index.html

A map and further information about Azad Jammu and Kashmir can be found athttp://www.ajk.gov.pk/index.php?option=com_content&view=article&id=62&Itemid=96.

see also:

2009
Hepatitis, viral - Pakistan (04): (SD) prisoners 20091125.4045 Hepatitis, viral - Pakistan (03), syringe re-use 20090920.3304 Hepatitis, viral - Pakistan (02): prevalence 20090610.2141 Hepatitis, viral - Pakistan: (SD) fatal 20090609.2125

2007
Hepatitis, viral - Pakistan 20070306.0796