Hepatitis C
One of blood born disease is Hepatitis C, its causative agent is Hepatitis C virus which is small single-stranded enveloped and positive sense RNA. Hepatitis C virus has six major genotypes and hepatitis C virus belong to hepatic virus in the family Flaviviridea.
There is still no vaccine available for hepatitis C virus and the HCV can spread via blood to blood contact easily. Furthermore, some patient can be totally cured by getting anti-viral medicine while the associated symptoms will be managing medically. Patient with HCV commonly getting mild symptoms so they do not go for the proper treatment but early detection and treatment is more helpful.
The virus can be detected in blood with minimum 1 week and maximum 3 weeks of period. While the antibodies can be detected after 3 weeks to 12 weeks. About 15 to 40 patient completely wash virus from their bodies, identified by liver function test (LFTs) and AST will be normal as the clear of plasma HCV-RNA, furthermore, a lots of patients can be lead to chronic HCV infection.
The patient which have chronic hepatitis C is more chances for developing of liver cirrhosis which is risk factor hepatic carcinoma. For various decades’ symptom of HCV can be mild, 3 out of 20% have chance to develop cirrhosis or liver cancer and interferon is only significant treatment.
In chronic hepatitis C patients, the viriological response remain 20 to 56% sometime combination ribavirin and Alpha interferon (IFN). Approximately 160 million of population in developing country like Pakistan, unrestrained outburst of hepatitis C virus part of the country. while the
In Pakistan approximately 88 lac people are infected by HCV infection stated by Pakistan medical research council in previous study which the conducted in sero prevalence. According to their study burden of HCV 60% between liver cancer patients and beta thalassemia major patients was 51%.
Other studies have also recorded high prevalence of anti-HCV antibodies among various risk groups from various parts of the country. Numerous of the above research based on the antibody-based investigation to identified burden of HCV. Therefore, the research outcomes to identifies both the burden of anti-HCV antibodies and active HCV infection in people of KPK. This research will mix the modern molecular detection method (PCR) and antibody-based test this will analyze the burden of active HCV infection.
Hepatitis B
Hepatitis B virus is more infectious and much more resilient than hepatitis C or human immune deficiency virus. It is present in large amounts in the body fluids and Blood of those who are infected. Human blood plasma is the main virus reservoir and sera from certain HBV carrier-even in dilution of 1: 4 100,000,000 are still able to infect chimpanzees when administered intravenously. The hepatitis B virus can live outside the body for seven days and still be capable of causing infection; this combined with its high seroconversion has made it of a particular concern for occupational transmission.
The high concentration of hepatitis B virus in blood of infected people makes its transmission in works setting very easy. It can be transmitted by personal care procedure and be equipment used such as blades, razors and hair clippers, tattooing and body piercing needle, cuticle scissors, nail filers and emery boards, orange sticks, hair removal tools such as tweezers and electrolysis equipment and even-hair cutting scissors and combs. The virus can cause infection even when minutes amount of blood, invisible to the naked eye stays on the equipment and comes into contact with broken skin, mucous membrane and rash.
The common risk factor contributing to the rapid spread of hepatitis B in developed countries include unsafe use of injections, tattooing, blood transfusion, unsafe sexual practice, mother to the child transmission and shave from barbers. The beauty therapy industry has been identified as a potential risk factor for the spread of Hepatitis B virus and Hepatitis C virus in various parts of the world such as Pakistan, Italy and Japan. The transmission of HBV infection through razor sharing, beauty treatment, tattooing piercing, and manicure/chiropody might be considered important risk factors in developed and undeveloped areas.
Route of transmission and prevention of hepatitis B and C
In a study done in Pakistan to assess the risk factors in the transmission of hepatitis B and C it was analyzed that the major risk factor for males was circumcision and barber shop shaving whereas or females it was blood transfusion and nose/ear piercing. Very few studies have been done to assess the knowledge and attitude of the people working in the beauty industry regarding hepatitis B. In a study done in Egypt it was found that the level of knowledge regarding the transmission of hepatitis B among barber was high.
However, only 40% were aware of the presence of hepatitis B vaccine. 94.5% of the barbers changed their blades and 76.9% disinfected the used instrument. Overall the hygiene condition of the barber’s shops and their practice were really good which can be attributed to the knowledge about the of transmission of hepatitis B and the positive attitude towards infection control and protection of their clients. The study not only assessed the knowledge and practice of these barbers but hepatitis B diagnosis was only performed and it was found that there was not much difference in the prevalence of hepatitis B I barbers and their customers. HBsAg was detected in twenty-five individual (barbers and clients) an overall prevalence of 4.1%.
The beauty industry may potentially expose it customers to various infections. The people involved in the business need to be aware of the various infections that can be transmitted through this industry. In a cross sectional survey Italy the knowledge, attitude and practices of hairdressers towards blood borne viruses was evaluated. Most of the hairdressers were aware of the risk of transmission of these blood borne viruses in their profession yet some still indulged in unsafe practice, which shows that there is a need to educate the general public about the risk associated with personal care service, which can be done effectively through media campaigns. Similarly, refresher course should be made compulsory for all involved in the beauty industry.
A survey of barbers in Pakistan revealed that most of the barbers reused and should razors. Although sixty-four percent of barbers claimed use of new blades for each customer only 18% declared sterilization of their instruments. It found that 46% of barbers in Pakistan reused blades without sterilization. Although the frequency of exposure was low in general, for individuals who received daily shaves from barbers the frequency of exposure was very high.
In Pakistan a survey show that a lots of hairdresser reused the razors. Although 64% of hairdresser told that the use new blades and razor for every client only 18% confirmed that they did disinfection of equipment’s. survey showed 46% hairdresser in Pakistan reused blades and equipment without disinfection. Although the incidence of exposure was decrease in general, for person who getting daily shaves from hairdresser the incidence of risk is very extensive.
The study included that the probability of transmission increase with the frequency of reuse, however contrary to the above stated study done in Rawalpindi, it was found that the practice was very good as almost all barbers used disposable blades for very customer and almost all barbers disposed of the used blades properly. The researchers observed the practices of the barbers, whereas in the latter study. The researcher based the findings on answers given by the respondent.
In Khyber Pakhtunkhwa a province of Pakistan, 0.7852 million of burden of hepatitis B and 1.1778 million of burden of the hepatitis C virus was estimated.
Percutaneous injury, non-intact skin and eyes splash can spread the blood born viruses. One of the possible risk for spreading the blood born viruses is the reused of the unsterilized equipment for different clients or patients. However, beautician have limit access to new and current knowledge on occupational health and safety. So the risk of infection will increase because of the lack of awareness regarding the occupational health and safety.
Despite the alarmingly increasing prevalence of hepatitis B infection there is not much been done in Pakistan to mitigate this spread. Diseases and accidents in the work place are dreadful tragedy. In Pakistan the burden of occupational injuries and disease is very high because in Pakistan there is no available data about occupational health and safety (OHS) because there is proper for reporting system for accidents and diseases.
Steps take international to prevent Hepatitis B and C
To reduce the burden of hepatitis in common people the national hepatitis control program was launched in 2005.One of the objective of the program is to vaccinate high risk group i.e. health worker, prisoners, thalamic, hemophilic, hemodialysis patient and intravenous drugs user. Beauty therapist/barbers also constitute the high risk group but are not the focus of this program; rather it is the spread of HBV through improper sterilization and re-use of medical equipment, including needle, syringes, IV tubes and other medical equipment that is the prime focus of the national hepatitis control program. HBV control and prevention program currently focusing on the importance of proper sterilization technique, sharing of contaminated equipment, should be the also target barbers.
Currently much awareness is being created by the public health authorities about hepatitis through print and electronic media but much more needs to be done to increase awareness of the public and the high risk population (beauty therapy industry) about the various risk factors in the transmission of hepatitis B virus infection. What is lacking in the developing world is implementation of international standard which is why blood transfusions, unsafe use of therapeutic injections, nose and ear piercing, tattooing, injection drugs user, dental and surgical procedures are the major sources of spread of viral hepatitis.
