Tuesday 28 July 2015

World Hepatitis Day

That would be today.  I have enough on my calendar with Darwinday (12nd Feb) when I have been known to give donuts and Christmas when I have been known to give small presents to children.  I am not about to starting giving people hepatitis at the end of July.  Although I must confess that our sheep routinely and involuntarily share needles when they are being dosed for worms and vaccinated for contractible lambhood diseases.  After a good bit of shifting about, Hepatitis Day has settled on 28th July because it is Baruch Blumberg's birthday. Baruch Whoberg? you may well say, but he was awarded the 1976 Nobel Prize in Physiology and Medicine for identifying the Hepatitis B virus in the blood of an Australian aborigine who was suffering from yellow jaundice.  Jaundice is due to the failure to clear yellow bile through the bile-duct which can happen from wide variety of causes and can sometimes be treated with an intervention of quite elegant simplicity which saved the life of Pat the Salt in the week of his 90th birthday at the beginning of June. The treatment is so easy that it is possible to treat the whole thing as a bit of a joke "Who's the Chinaman seating on your sofa, missus", "B'godde Pat but you're the colour of your Sou'wester" but hepatitis in general is no joke at all.

Blumberg not only did the nifty academic identification thing to explain why one of his global patients was looking crook and feeling crap, he also went on to a) develop a molecular screen to identify blood donations that were infected with Hep B AND b) to develop a successful vaccine against that strain of virus. When that therapy was loosed on children, it reduced the rate of HepB infection among Chinese children from  15% to 1% within a decade. You can hardly begrudge Blumberg his Nobel for thus improving the quality of life of millions (a billion wouldn't be an exaggeration) of people across the World. Saving life and improving its quality is different from encouraging the increase in the human population and I've had occasion to slag the enNobeling of Norman Borlaug and Fritz Haber for causing the latter.  On the slagging front, it is coincidental that Blumberg shared his 1976 Prize with Carlton Gadjusek, one of a handful of Nobelists whom I've met and who occasioned an ethical hand-shaking dilemma. On the small world front, it should be noted that Blumberg was educated in Far Rockaway High School seven years after Richard Feynman, another Nobel who has featured on The Blob. When Blumberg died in 2011 his boss stood up and said "I think it’s fair to say that Barry prevented more cancer deaths than any person who’s ever lived."  Which give a clue about the grosser causes of jaundice.  As an indication of liver failure, rather than a failure in the plumbing of the bile-duct, viral hepatitis can go on to cause complete liver failure, cirrhosis, liver cancer and death.  As opposed to, say, small cell carcinoma of the lung which can rip through you and kill within months, hepatitis can make you feel increasingly terrible over years and years. If you believe in Quality Adjusted Life Years [QALY], ye durty Utilitarian, you'd surely upvote a cure for hepatitis when you come to allocate the cash within your health service.

15% of Chinese children is a helluva a lot of Hepatitis and that's only HepB. There are five identified Hep viruses named HAV, HBV, HCV, HDV and HEV. In evolutionary terms they are as different from each other as viruses can possibly be - some use DNA to deliver their message and others use RNA, for starters - but all have in common a tendency to settle in the liver and replicate there.  Their replication, as with all viruses, involves infecting a cell, subverting the local nucleic acid replication machinery to make more virus, popping that cell to release dozen or hundreds of infective units to recursively repeat the process and propagate the virus. The viral propagation thus interferes with normal liver function which manifests initially as fatigue, nausea and other flu-like symptoms which get labelled as hepatitis when jaundice develops. The cirrhosis and liver cancer will develop in due course if you live long enough. Anita "BodyShop" Roddick, for example, died of a brain haemorrhage before HepC killed her.  Roddick got her dose from a blood-transfusion but many of the other celebs who have a HCV infection in common, got it from shared needles - don't do your own tattoos, kids.

We all take our liver for granted until it goes wonk and then we begin to appreciate how many and how varied are its beneficial functions. I could have had a lot to say about HCV, because its investigation formed a key thread in the Comparative Immunology lab in which I worked for the first part of this century.  But the Blob logs show that I have been unaccountably quiet on the matter.  Will rectify this in the future because there are some ripping yarns to be told.  But for today, take 5 minutes to reflect on the 180 million people across the World who suffer [sic!] from HCV infection.  Of these half a million die each year, which puts it at almost the same level as the big killers malaria, tuberculosis and infectious diarrhoea. Nobody has a developed a vaccine against that cause of hepatitis at least partly because, like HIV, it is a RNA virus which mutates so fast that it is hard for any vaccine strategy to keep up.  Lots of science done, more to do.

1 comment:

  1. Another reason we have no successful vaccines for many viruses is because they have such diverse and 'clever' ways of subverting the immune system.