Management of Hepatitis in the United Arab Emirates

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Table of Contents

Historic background
Etiology
Prevalence and incidence in the world
Prevalence and incidence in the U.A.E
Identified risk factors
Possible risk factors still under study
General treatment and management strategies
Treatment and management strategies in UAE
Conclusion
References

Historic background

This research paper explores hepatitis in the United Arab Emirates, UAE, with a focus on several elements like historic background, etiology, prevalence, risk factors and management strategies among others.

Hepatitis is a major health problem in the United Arab Emirates. While type B and C are commonly known to occur in Asia, UAE has always been threatened by hepatitis D. This has seen the country erect some measures to deal with the problem, including the listing of hepatitis C among deportable diseases in the year 2008. From July 1, 2008, hepatitis C joined other diseases like hepatitis B, HIV and tuberculosis, which gained the status after becoming a major health problem in the region (Travel Doctor, 2012). Based on this condition, the government further endorsed the testing of visitors while applying for labor and residency visas to curb cases of new infections. This directive was to affect the Ministry of Health of Dubai and Abu Dhabi and was to affect every new person with the intention of visiting the country. Furthermore, it was noted that those found positive were to be deported. This decision caused a lot of panic among patients with thalassemia, a blood disorder that requires constant blood transfusion for survival. It had also been found that several patients in UAE had contracted hepatitis C through contaminated blood needles (Abro, Al-Dabal & Younis, 2010).

It is however important to note that the United Arab Emirates initiated blood screening in the year 1993 in response to WHO requirements. Following the 2008 decision, some people argued that thalassemiapatients deserved screening exemption due to their dependence on blood from other individuals. This was based on the fact that thalassemia patients were likely to get infected without their knowledge, through contaminated blood, donated by infected citizens. Moreover, minimum research has been done concerning the distribution of hepatitis in most Middle East countries like the UAE (Abro, Al-Dabal & Younis, 2010). Nevertheless, type D has been found to be common in the region. Female patients in UAE are highly affected by this virus since most of them originate from Egypt, where it is predominant.

Etiology

As mentioned before, hepatitis is commonly caused by contaminated food and water. This does not exclude the United Arab Emirates, where type D has been found to be rampant. Importantly, hepatitis A mainly occurs when a person is infected with the hepatitis A virus. This results from the consumption of substances with a minute and contaminated particle of fecal matter. As a result, patients experience inflammation of liver cells, which may lead to improper functioning of the liver and other related health complications. On this basis, the virus can be transmitted through a number of ways, including but not limited to the handling of food with contaminated hands, especially after using the toilet and consumption of impure water. Additionally, type A virus can be contracted from feeding on raw shellfish, which have been obtained from water that may have been contaminated with sewage. It is also important to note that infected patients can pass the virus to healthy individuals through close contact, even in the absence of physical manifestation of the disease (CDC, 2012). Lastly, the hepatitis A virus can be passed to another person through sexual intercourse.

Similarly, hepatitis B virus is caused by getting in contact with body fluids like blood, vaginal fluid and semen, from a person who has been tested positive, even when there are no signs and symptoms of infection. HBV shares transmission modes with HIV even though the former is approximately 50 to 100 more communicable. Additionally, the hepatitis B virus has the capability of surviving outside the human body for almost seven days, distinguishing it from HIV, which cannot survive outside. It is essential to note that the virus remains active during the seven days and can cause equal harm when it enters the body of a healthy person (CDC, 2012). Although contact with infected blood is the commonest cause, there are several modes of transmission, especially in developing countries. These include but are not limited to sexual contact, risky injection practices, perinatal and blood transfusion. On the contrary, transmission modes in developed countries are slightly different, with sexual activity among young adults being a risky causal factor. Due to its mode of transmission, HBV is a major occupational hazard for most medical practitioners.

In the same manner, type C causes swelling of the liver, which in turn affects the normal functioning of the organ. HCV is responsible for hepatitis C infection and may be transmitted through an array of channels. For instance, one can contract the virus through contact with contaminated blood, unprotected sexual intercourse, risky injection behaviors, close contact with an infected person and receiving donations from hepatitis C patients, including blood, organs or blood products (CDC, 2012).

Lastly, hepatitis D, also known as delta agent, only occurs among patients with hepatitis B. As a result, it has been found that HDV may worsen the observed signs manifested by patients diagnosed with HBV. Additionally, the virus may be seen through symptoms, even though one may not have shown the symptoms while suffering from hepatitis B (CDC, 2012). The virus affects up to fifteen million people globally and can be passed to healthy individuals through blood transfusion, unprotected sexual intercourse and abusive injection of drugs. These factors expose people to contracting the disease, even though the presence of HBV is a major predisposing factor.

Prevalence and incidence in the world

In the understanding of the occurrence of hepatitis across the world, it is paramount to note that different regions of the world register different statistics, due to a number of factors like the economic status of a country among others. Additionally, the four types of hepatitis occur variably due to their predisposing factors. Research indicates that the prevalence of hepatitis is currently high and the situation is likely to worsen in the next two decades. Importantly, more than 75% of cases are caused by hepatitis B and C. According to World Health Organization, over 4.3 million people are infected with hepatitis B in the Eastern Mediterranean region while over 800,000 with type C every year (World Health Organization, 2009). Moreover, most of these cases are acquired in medical set-ups, with over 17 million having been diagnosed with chronic HCV. As a result, treatment of type B and C has become more challenging compared to the cost of establishing prevention programs in the region. Globally, approximately 361 million people in the world live with chronic hepatitis B, which increases the risk of developing liver complications. WHO further estimates that up to 0.6 million people die annually as a result of HBV or related diseases.

Prevalence and incidence in the U.A.E

The distribution of hepatitis in the United Arab Emirates has not been well captured by most researchers. However, the region equally faces the challenges posed by different types of hepatitis. For instance, Abro, Al-Dabal and Younis found out that hepatitis occurs among UAE nationals and expatriates. According to the 2010 survey, HAV was found to have the highest prevalence percentage of 40.3% among patients, followed by type C with 34.9% of patients. Type A and C were also found to be common among drug abusers, with 42.1% and 58% respectively (Alfaresi et al., 2010). On the other hand, patients with a record of blood transfusion registered a high prevalence of type A and C, while type 1 (42.5%) and 4 (40.2%) occurred among adults 40 years and above. Additionally, it was found that 42.6% of hepatitis cases are caused by risky IV drug abuse while sexual activity contributed 32.7% of recorded cases (Alfaresi et al., 2010). Other factors included tattoo marks at 21.5% while surgery and blood transfusion registered 19.2%. It is also important to note that most patients in the UAE contract hepatitis disease because of their exposure to different risk factors. Nevertheless, it was found that all the risk factors contribute to the high levels of type D occurrence. As noted above, type D was common among UAE females since most of the patients who were tested were of Egyptian origin, where the virus is common.

Identified risk factors

There are several factors, which have been identified as predisposing factors for the four types of hepatitis. For instance, people who work or travel in regions with a high prevalence of type A are likely to contract the disease. Additionally, research indicates that gay men are more prone than their counterparts that are non-gay. The presence of HIV has also been identified as a risk factor for type A. This is to say that the likelihood of an HIV-positive person contracting HAV is much higher compared to that observed among HIV-negative people (Alfaresi et al., 2010). The use of IV drugs by people further exposes patients and individuals to a higher probability of getting infected with HAV. In essence, such injection activities are risky as they may lead to contact with contaminated body fluids like blood.

With regard to HBV, people who have multiple sexual partners are at a higher risk of developing the disease than those who have one partner or practice safe sex. The risk of getting infected is significantly higher especially in cases where one of the partners is infected with the virus. Additionally, the presence of sexually transmitted infections predisposes the disease, with gonorrhea and chlamydia being considered as major contributors. Job opportunities equally expose people to being infected, i.e. working in areas that are prone to HBV or getting exposed to contaminated blood (World Health Organization, 2009).

On the other hand, people who are exposed to kidney dialysis for a long time have a higher likelihood of contracting hepatitis type C. Other risk factors include exposure to contaminated blood, unprotected sexual intercourse with infected people, receiving blood from patients with HCV and mother-to-child transmission. Lastly, patients who abuse IV injections are likely to contract type D with a lot of ease (Alfaresi et al., 2010). In addition, HDV can be passed to the developing fetus, when a pregnant mother gets the virus. It has also been found that the presence of HBV is a major risk factor for type 4. Like other types of hepatitis, numerous blood transfusions and sexual contact with infected people are recognized as predisposing factors.

Possible risk factors still under study

In order to combat this health threat, researchers have identified other risk factors, which are still under study. Their study is essential in order to establish their role in predisposing hepatitis viruses. One of the factors being studied is gender. For instance, in a survey carried out among UAE patients in 2010, it was found that females registered higher disease prevalence because of their originality. This was attributed to the fact that most of them were from Egypt, where type D, is common. In addition, research is underway to determine whether genetic factors and tattoo marks are responsible for the occurrence of the disease in some parts of the world (Muslim, 2008).

General treatment and management strategies

One important fact is that most types of hepatitis, which occur in the world, are preventable in a wide range of ways. For instance, vaccination against HAV and HBV is highly recommended. This guarantees an individual a long-term immunity. Additionally, type A can be managed through abstinence from substance abuse like alcohol drinking and proper medication. Good hygienic standards are also essential in preventing type A. Other ways include eating well-cooked foods and drinking safe water (CDC, 2012).

For type B, treatment is through enough rest and a balanced diet, rich in proteins and carbohydrates to allow faster repair and protection of the liver. Prevention strategies include safe sex, good use of IV injections, vaccination and use of sterilized equipment. On the other hand, type C is treated using interferon alfa-2b, while prevention strategies include covering of wounds, safe sex, use of sterilized equipment, proper use of IV needles and limited alcohol intake (CDC, 2012). Currently, there is no treatment for types D and E. However, D can be prevented by preventing type B, since the latter is a predisposing factor. Lastly, type E can be prevented through proper hygiene, eating well-cooked meals and consuming purified water.

Treatment and management strategies in UAE

There are several strategies, which have been adopted by the Abu Dhabi authorities to manage the issue of hepatitis. A good example is the Hepatitis awareness campaign, which was organized by the Al Jazira Sports and Health Foundation. The aim of the campaign was to eliminate social stigma against hepatitis patients (Absal, 2007). Additionally, it promoted physical fitness and a good lifestyle among school children. Moreover, there are vaccination programs, aimed at ensuring that UAE residents gain immunity against common types of hepatitis. Another important strategy is the screening of visas for Abu Dhabi residents (HAAD, 2012). This condition requires all expatriates who are above eighteen years to receive a fitness certificate from the authorities. This qualifies one to apply for the renewal or a new visa. Lastly, the deportation rule was adopted in Abu Dhabi in 2008 to lower infection cases of hepatitis B and C (Muslim, 2008).

Conclusion

From the above analysis, it is evident that hepatitis is a major health problem, affecting developed and developing countries. In UAE, the problem is equally evident, with several strategies having been put in place to deal with the scourge. It is also important to note that management of hepatitis solely depends on the change of lifestyle approaches.

References

Abro, A., Al-Dabal, L., & Younis, N. (2010). Distribution of Hepatitis C virus genotypes in Dubai, United Arab Emirates. Journal of the Pakistan Medical Association, 60 (12), 987-990.

Absal, R. (2007). Hepatitis Awareness Campaign in Abu Dhabi. National Aids Treatment Advocacy Project. Web.

Alfaresi et al. (2010). Hepatitis B virus genotypes and precore and core mutants in UAE patients. Virology Journal, 7 (160), 1-8.

CDC. (2012).Viral Hepatitis. Centers for Disease Control and Prevention. Web.

HAAD. (2012). Visa Screening for residence in Abu Dhabi. HAAD. Web.

Muslim, N. (2008). UAE adds Hepatitis C to list of deportable diseases. Gulf News. Web.

Travel Doctor. (2012). United Arab Emirates. Travel Doctor. Web.

World Health Organization. (2009). The growing threats of hepatitis B and C in the Eastern Mediterranean Region: a call for action. WHO. Web.

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