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[Special] Hepatitis B overlooked by TB issues in N. KoreaHealthcare on Korean Peninsula ② N. Korea’s hepatitis B prevalence hits 15%
  • By Lee Min-ju
  • Published 2018.07.13 16:17
  • Updated 2018.07.13 16:17
  • comments 0

The once-frozen inter-Korean relations are thawing after the inter-Korean summit, and the summit between North Korea and the U.S. The two Koreas are seeing progress in discussions for economic cooperation and reunion of families separated by the Korean War. On July 4, the South and the North met in Pyongyang for a friendly basketball game. Exchanges and cooperation in the healthcare sector are likely to begin soon. However, experts note that inter-Korean collaboration in healthcare could become a burden for both sides, without thorough preparations. They say the two Koreas need to check the North’s healthcare status and issues before starting inter-Korean exchanges. Korea Biomedical Review reports what kind of effort the two Koreas should make to seek the right balance between the two countries’ healthcare services. – Ed.

A beginning of inter-Korean exchanges opens a possibility of germs freely traveling with people coming and going. When South Korea suffered a massive outbreak of the MERS (Middle East Respiratory Syndrome) in 2015, North Korea could stay out of the trouble because of the air-tightly closed borders.

What is the current status of the North concerning infectious diseases? Infections with high incidence in the North include tuberculosis, malaria, parasites, water-borne diseases, and measles. While the South has almost eradicated malaria, the North is still in the pre-eradication stage. According to the World Health Organization, the number of malaria patients in the North hit the peak at 23,537 in 2012. Then, the number has been going down every year, with the international organizations’ efforts to fight the disease.

Experts assume that the North’s parasite infestation rate is at the level of that of the South in the 1970s or 1980s. Such assumption came from a glimpse into the North Korean soldier, who survived gunshots to cross the Joint Security Area and defected to the South in November last year. At that time, a South Korean trauma specialist in charge of the soldier, found hundreds of parasites in the soldier’s ruptured small intestine.

According to the Korea Centers for Disease Control and Prevention (KCDC), 35.5 percent of teenage North Korean defectors and 24.6 percent of adult defectors had parasite infections.

Experts note that chronic infections, not acute ones, cause more severe problems. Chronic infectious diseases can lower immunity even after treatment and recur at any time, triggered by aging or diabetes.

Chronic infectious diseases such as TB and hepatitis B are lifelong infections.

According to the Korean Association for the Study of the Liver, South Korea’s prevalence of hepatitis B is about 3-4 percent. About 400,000 patients in the South are estimated to have chronic hepatitis.

South Korea used to have more than 10 percent in hepatitis B prevalence in the 1980s. The authorities started to give hepatitis B vaccines to pregnant women to prevent vertical transmissions from mothers to newborns. From the mid-1990s, the government aggressively carried out a national vaccination project to encourage vaccinations from birth.

With such effort, the prevalence of hepatitis B fell to 0.7 per 100,000 people in 2016, according to data by the Organization for Economic Cooperation and Development.

The prevalence of hepatitis B in the North is 4-5 percent, officially. The WHO’s 2003 estimate was 4.5 percent, and that of the North’s authorities was 4.7 percent in 2009.

However, an NGO’s unofficial data marked at 15 percent. It is impossible to conduct an accurate estimation in the North, allowing wide gaps in official and unofficial data. Experts have to merely rely on the official announcement of the North Korean authorities.

Experts speculate that the North is poorly dealing with hepatitis B because the North had requested that the South give them “vascular ligation tools” during the previous inter-Korean exchanges.

A patient with bleeding from an expanded blood vessel leading to the esophagus will die if the blood vessel is not immediately tied through the endoscope. Surgeons use a vascular ligation tool to do so. As the North requested the tools first, there could be many chronic hepatitis B patients in the North, and many might have reached a serious stage, experts said.

Hepatitis B prevalent due to vertical transmission, reuse of supplies
Why does the North have such a high prevalence of hepatitis B?

National Cancer Center professor Ki Mo-ran attributed it to several reasons; increased infections in newborns due to vertical transmissions from mothers, prevalent reuse of disposable consumables such as syringes, a broader spread of infections due to insufficient treatment and lack of management, and the poor screening system for blood products.

“To prevent vertical transmission, we should give vaccination to the newborn immediately after the birth. If the mother is a carrier, we should use not only vaccination but immunoglobulin, a ready-made antibody,” Ki said. “To do so, we need to check if the mother is a hepatitis B carrier. However, the North is poorly equipped with the healthcare system, so it is almost impossible to do so there.”

Ki went on to say that as hepatitis B spreads through blood, physicians must adequately examine blood used for transfusion. However, the North’s screening system is weak, often failing to prevent infections through blood transfusions, she said.

“There is no disposable product such as a syringe in the North, so they use supplies again and again. Due to the lack of sterilizers, infections due to insufficient sterilization are common,” she added.

She noted that it was hard to say that the North had a national serological study on viral hepatitis.

Fact-finding research needed to curb infant infections
Ki emphasized that the first thing to do in the North was to conduct a fact-finding study on hepatitis B infections. Based on the study, the South should support vaccines and immunoglobins to prevent vertical transmissions, she said.

“It is not easy even for South Korea to pull down the number of adult patients with hepatitis B. Globally, it is unprecedented. We need to help the North reduce vertical transmissions to control the number of carriers in the long term,” Kim said.

Kwon Hyeok-choon, head of health promotion center at the National Medical Center, said the first thing to do is to identify the current status.

“Just like South Korea that manages chronic diseases through national health check-up programs, the North should grasp the prevalence of infectious diseases by conducting screening tests on all the North Korean people,” she said.

For example, major hospitals and public health centers can do the tests and manage the infections, which will allow the authorities to gather data, Kwon said.

“Based on this, the South should come up with plans to support what’s needed such as medical techniques and infrastructure,” she added.

minju9minju@docdocdoc.co.kr

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