Induced seroconversion fetches US$65 or about PhP3,120. A liver-cancer patient, on the other hand, will have frequent admissions to the hospital that will chomp on a lot of money. Add liver transplantation to the equation, the costs pile up some more. Say, in Australia where citizens enjoy health-subsidy benefits, the government is only willing to support therapy if the budget is about Aus$45,000 for the entire treatment. If the amount goes beyond that, the government won't repay the cost, he pointed out.

    There has to be a better tack at managing the disease including its attendant skyrocketing costs: "Identify the patients at an early phase of the infection and attempt to treat vigorously."

    Sollano implies that identifying likely patients isn't that difficult. For one, survey done in the 1980s showed that as much as 20 percent of children below 10 years-one in every five-are already positive for the hepatitis-B antigen. Another survey identifies the most notorious carriers of the hepatitis-B virus-intravenous drug users, institutionalized people like prisoners, and commercial sex workers.

    "Some of us carry the virus as well. Nobody is safe from this infection," he warned.

    The disease runs in families. In a study of 500 patients at the University of Santo Tomas Hospital, one of every five HbsAg- positive patients has family members equally positive for the antigen or ailing from chronic hepatitis, cirrhosis, or liver cancer, he noted.

    An adult will kick off the virus once he gets acute infection. But the baby will carry the virus until they become adults. It will take about 30 to 50 years from the acute infection at birth to the development of cirrhosis and death. Among chronic-hepatitis-B patients, it takes five years for one of every five to be afflicted with cirrhosis while the illness of one in every four will worsen to decompensation-they can vomit blood, have ruptured varices, and die.

    The hepatitis-B virus spawns cancer. Feed your nightmare: from chronic infection, the hepatitis-B patient can skip cirrhosis and jump into liver cancer.

    Sollano said that the Philippine government isn't putting much of a fight or the monies to control the disease that in its full course touches off liver cancer. It is likely due to a prevailing notion that alcohol abuse leads to liver cancer rather than hepatitis-B infection.

    The virus mounts its attack on victims most probably in the mother's womb or at birth. Knowing that, an effective fight strategy entails vaccinating newborns and screening expectant mothers who might be possible carriers.

    While such a strategy can be workable, demographic figures point up weaknesses that allow the disease to remain rampant: health workers see to 54 percent of births, which implies that 46 percent aren't attended to. Also, 36 percent of births are in hospitals, which may mean that 64 percent are in other less clinical settings where immunization of the newborn or screening a mother for contagion isn't part of standard operating procedure.

    "We are actively campaigning for screening to be able to identify patients who need treatment. Treatment can prevent cirrhosis, its complications, and of course, prevent death. We gave also been successful in controlling complications of cirrhosis. We have also devised many ways of treating liver cancer today," he averred.

    For Sollano an ounce of prevention is worthier than a pound of cure: "We have emphasized vaccination; we want to prevent the acute infection."

    "Sadly, nobody goes to vaccination. The government is unable to launch an effective vaccination campaign. And those patients identified to be treated do not have the resources to be treated," he laments.

    Indeed, hepatitis B may be better than true love. It's latched on to its victim for life. Only in death do they part. M

Winning the war

The no let-up assault on hepatitis B now goes beyond just fighting the disease-winning against it is the new order of the day.

     Sounding such call to arms, Dr. Eric Tayag spelled out a winning strategy against disease that claims a yearly toll of two million lives worldwide.

    "While deaths from most vaccine preventable diseases occur at an early age, those from hepatitis B occur many years later. This is important because there is a sudden silence over its consequence for so many years," Tayag noted.

    The anti-HBV vaccine was developed 25 years back and as disease went on a deadly rampage, it took another 10 years for the World Health Organization to make sure that the world uses the vaccine.

     As early as 1992, agreements were hammered out to include the vaccine in the country's Expanded Program on Immunization. But it was only lately that vaccination at birth received much sattention.

    Changes in health-care attitudes are a must to combat and even eradicate infectious diseases. Whether or not vaccines are available and accessible, if the health-seeking behavior of mothers and those that will be affected is not taken care of, vaccine coverage will stay low. And targets are missed.

    "So what must happen? We need cost-effective vaccination strategies. We want to assess disease burden and cost because we really do not know the consequences of our high prevalence for hepatitis B. Of course, we have to scale up vaccination at birth," Tayag stressed.

    The fighting strategy against HBV rests on the assumption that everything occurs at birth, but there are also high-risk mothers and adults that must be tended to in risk reduction.

    "There is the other argument for developed countries that screening mothers is the best strategy in preventing hepatitis B in the newborn. [As] our assumption is that it is prevalent among the newborns, our strategy is focused on hepatitis B at birth. That is why monitoring, evaluation, and assessments are necessary so that we can find answers and verify our assumptions and make sure our strategies work," he explained.

    And while DOH is focused on vaccination, other sectors should look at other strategies of reducing the HBV risk that looms on the Philippine population, he concluded. M D. A. delos Reyes