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Published: August 6th 2017
It's been almost three weeks since I first arrived in Laos and already my perspective on the country has changed immensely. For the first two weeks, I stayed entirely within the confines of Vientiane, the capital city of Laos. While this area is full of cafes, coffee shops, and other places that the falang (i.e. foreigners) like to frequent, the landscape and quality of life change drastically once you enter the provinces outside Vientiane.
For my first "field" experience, I joined the communications team from the local World Health Organization (WHO) office and a crew from the Ministry of Health's media production unit (called the Center for Information Education for Health, or CIEH) in order to film a short educational documentary about viral hepatitis for World Hepatitis Day
, which takes place every year on July 28. In fact, World Hepatitis Day is one of only four disease-specific global awareness days officially endorsed by the World Health Organization, the other three being World Tuberculosis Day (March 24th), World Malaria Day (April 25th), and World AIDS Day (December 1st). I think this speaks to the incredible health burden caused by viral hepatitis, as the five hepatitis viruses combined are responsible for 1.34 million deaths
per year, which is comparable to HIV/AIDS, malaria, and tuberculosis. Due to this incredible health burden, combatting viral hepatitis was added to the Sustainable Development Goals in 2015, along with the adoption of the world's first global hepatitis strategy.
"Hepatitis" generally refers to inflammation of the liver, which can be caused by viruses, heavy alcohol use, autoimmune diseases, other infections (e.g. bacteria, liver flukes, etc.), medications, and non-alcoholic steatohepatitis (i.e. "fatty liver disease"). Symptoms of hepatitis include jaundice (or yellowing of the skin and eyes), abdominal pain, vomiting, and diarrhea. Among the various causes of hepatitis, viruses are the most common worldwide--in 2015, hepatitis A affected roughly 114 million people, hepatitis B roughly 343 million people, and hepatitis C roughly 142 million people. The worldwide prevalence of hepatitis D and hepatitis E is still not well-known.
Each of the five hepatitis viruses actually comes from a different family of viruses, which is determined by nucleic acid type and the presence or absence of a protective envelope. Really, their only common attribute is that they all have a predilection for liver tissue. Of these five viruses, hepatitis A and E are structurally similar (RNA and non-enveloped) and hepatitis B
and C are structurally similar (both are enveloped, though B is DNA and C is RNA). These structural differences are the primary reason why hepatitis A and E are often transmitted via the fecal-oral route (e.g. from contaminated water, poor hand hygiene, etc.), while hepatitis B and C are often transmitted through bodily fluids, particularly blood and saliva. Consequently, hepatitis B and C can be transmitted sexually, through the sharing of needles (particularly for hepatitis C), and by sharing food. Hepatitis D is sort of a defective virus that needs hepatitis B in order to replicate. As a result, it is not typically symptomatic by itself, but co-infection with hepatitis B and hepatitis D can cause a superinfection that has a 20% mortality rate.
In Southeast Asia, as in the rest of the world, hepatitis B and C are the most common hepatitis viruses and the most likely to lead to death (see diagram for more details). However, compared to the other regions of the world, Southeast Asia has the highest rate of hepatitis A, though the absolute numbers are still far less than for hepatitis B and C. With regard to prevention, the vaccine series for hepatitis B
Thoulakohm District Hospital
Hospital that saw most of the hepatitis A patients during the recent outbreak.
is currently available in Laos, but the vaccine for hepatitis A is not (there is no vaccine for hepatitis C).
For World Hepatitis Day, the WHO and Ministry of Health decided to make a 30-minute video about hepatitis A, focusing on signs/symptoms, routes of transmission, and effective preventative measures such as hand hygiene. In order to do this, we spent the past four days traveling to an area about 2 hours from Vientiane capital, where there was recently an outbreak of hepatitis A. While there, we interviewed the head of the provincial health center as well as some doctors and nurses at one of the regional hospitals (Thoulakhom). We also interviewed some of the current hepatitis A patients in the hospital and some of the recovered patients in the community. What was perhaps most interesting was that most of the patients, including the first person in the region to exhibit symptoms ("patient zero"), were young men between the ages of 15 and 20. Thankfully, school is not currently in session due to summer recess--otherwise, the outbreak could have been much worse. Another interesting feature of the outbreak was that it occurred towards the beginning of the rainy season, and
that a similar outbreak occurred last year around the same time. Due to the fact that hepatitis A is often spread by contaminated water sources, this is maybe not so surprising.
In addition to filming those involved in the recent hepatitis A outbreak, the WHO also organized an event for World Hepatitis Day in a park right by the Mekong River, which forms the border between Laos and Thailand. The event included games, posters, a guitar player, and an entertainer who would probably best be described as a stand-up comedian. Hopefully, this event along with the 30-minute documentary will play an effective role in curbing the spread of viral hepatitis both in Vientiane and Laos as a whole.
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