More than half of Singaporeans are unaware of the link between hepatitis B and liver failure.

The hepatitis B (hep B) virus can be spread through unprotected sex.

Yet, many Singaporeans, particularly younger people, mistakenly believe that hep B is transmitted by eating contaminated raw seafood. Among the various hepatitis viruses, hep B causes the majority of liver cancers. Hepatitis A (hep A) is spread through contaminated food, and is usually passed out of the body after some months without long-lasting health problems.

“This is an alarming observation, especially as viral hepatitis symptoms tend to be silent and remain undiagnosed until the disease progresses to liver cirrhosis, failure or cancer,” said Professor Tan Chee Kiat, Senior Consultant, Department of Gasteroenterology and Hepatology, Singapore General Hospital.

“While the prevalence of viral hepatitis is low in Singapore, we cannot be complacent. Hep B-related liver cancer is still a substantial problem, and complications arising from chronic hepatitis C (hep C) infection are common indications for liver transplants in Singapore.”

Like hep B, the hep C virus is transmitted through blood and other bodily fluids.

Prof Tan is the author and Principal Investigator of the February 2020 Singapore Liver Index Study, which aimed to understand Singaporeans’ awareness, knowledge and attitude towards liver health. It was published in the Journal of Gastroenterology and Hepatology in March 2021.

The study involved 500 respondents aged 18 years and above who responded to an email invitation to participate in the survey. Participants were tested on their knowledge of liver health and care, liver diseases, risks, screening and diagnosis. More than half (64 per cent) were aged 35 years and older, and 54 per cent were male.

Among its findings, the study learnt that just seven in 10 respondents (70 per cent) underwent health screening in the two years before the study, even though a majority (91 per cent) agreed on the importance of regular screening for maintaining liver health. For respondents who attended health screenings, only 36 per cent were aware that tests for liver diseases were included.

Of the 61 respondents reported to have been diagnosed with liver disease, 70 per cent were not on treatment. They cited cost and a preference for traditional Chinese medicine over Western medicine as reasons.

“Misperception and inaction can have devastating consequences, not only on mortality rates in Singapore, but also on eventual healthcare and economic burden. There needs to be multi-sectoral collaboration to enhance education and public awareness through the most effective communication channels to treat and eliminate viral hepatitis in Singapore,” Prof Tan said.

Liver cancer is the third-deadliest cancer among men and fourth-deadliest among women in Singapore. Hep B, the most common serious liver infection that causes about two-thirds of the total number of liver cancer cases in Singapore, is passed to others through direct contact with blood, unprotected sex, the use of unsterilised or contaminated needles and from an infected woman to her newborn. However, over half of those surveyed (52 per cent) are unaware that sex is a major risk factor.

Read more: 10 Tips to keep your liver functioning well. Find out what they are here.  

When the liver fails

The organ does not work well enough to perform functions such as manufacturing bile and ridding the body of harmful substances. Symptoms of liver failure include nausea, loss of appetite, and blood in the stool. Patients are advised to avoid alcohol and certain foods, and cut down on salt intake. If it is an acute or sudden liver failure, treatment includes intravenous fluids to maintain blood pressure, medications to flush out toxins, and blood transfusion (should there be an excessive loss of blood).


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