What is Viral Hepatitis?
Hepatitis is a general term, which means inflammation of the liver due to any cause. Viral hepatitis is a systemic disease with primary inflammation of the liver by any one of a heterogeneous group of viruses. Common causes are the five unrelated viruses:
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Hepatitis D
- Hepatitis E
What is Acute and Chronic Viral Hepatitis?
When the viral infection lasts for less than 6 months, medically this state is called acute. Similarly, when the infection lasts for 6 months or more, we call it chronic. Hepatitis A and most cases of E cause only acute infections. Infection with Hepatitis B, C, D (and a small number of E, in certain predisposed persons) causes both acute and chronic infections. Acute Hepatitis state also denotes that when you recover from the infection – your liver will recover fully.
What are the complications of Viral Hepatitis?
The most feared complication of Acute Hepatitis is Acute Liver Failure leading to death. This term denotes that the liver is severely damaged and there is impairment of consciousness. Complications of Chronic Hepatitis are Cirrhosis (Permanent liver damage caused by the replacement of liver tissue with scar tissue) and its complications (bleeding, fluid in the abdomen, impairment of consciousness, etc.); and the development of Liver Cancer.
What is Hepatitis A?
Hepatitis A is an acute infectious disease caused by the Hepatitis A virus (HAV). The virus can withstand heating to 60o C for 1 hour and is not affected by chlorine in doses usually employed for chlorination of household water supply. The virus is inactivated by ultraviolet rays and by boiling for 5 minutes or autoclaving.
The only reservoir of infection are people infected with the virus. Most children are infected than adults. Immunity against the infection after an attack probably lasts for life. We are mostly infected due to the contamination of our food and water sources by human faeces. In India, the disease tends to be associated with periods of heavy rainfall. Although, cases may occur throughout the year.
The disease is heralded by non-specific symptoms such as fever, chills, headache, fatigue, generalized weakness and aches and pains, followed by anorexia, nausea, vomiting, dark urine, and jaundice. These symptoms are the same for all Acute Viral Hepatitis. The disease is benign with complete recovery in several weeks. Complications occur in less than 1% of cases.
We can prevent this disease from food hygiene and sanitation. Several types of effective vaccines are also available against this infection.
What is Hepatitis B?
The infection caused by the Hepatitis B virus is called Hepatitis B. It can cause first an acute infection and can persist in a minority of cases to chronicity. The symptoms of acute infection are similar to any other viral hepatitis. Acute infection causes death in less than 1% of cases. Acute infection in many individuals is also asymptomatic, i.e. without the appearance of Jaundice. In around 2-10% of the adults acutely infected the infection will persist to chronicity. If not treated early, the chronic infection will lead to cirrhosis and its complication leading to liver failure and death.
Hepatitis B is transmitted through body fluids – blood, semen, etc. It is present throughout the world, especially in tropical and developing countries. It spreads from person to person. People at high risk of getting this infection are –
- People from endemic regions
- Babies of mothers with chronic HBV
- Intravenous drug abusers
- People with multiple sex partners
- Patients requiring repeated blood and blood product treatment
- Health care personnel who have contact with blood
- Patients who are immunocompromised
Getting an unsterile tattoo, sharing razors, and even toothbrushes also increase your risk of infection.
For prevention, a highly effective vaccine is available and is generally recommended for everyone. Screening of blood donors and blood and body fluids is now mandatory by law and have reduced the chances of infection. Babies born to mothers with chronic Hepatitis B should receive HBV vaccine and immunoglobulin soon after birth.
What is Hepatitis C?
Hepatitis C is an infectious disease affecting primarily the liver, caused by the Hepatitis C virus (HCV). Mostly asymptomatic; chronic infection leads to scarring of the liver and ultimately to cirrhosis, apparent after many years. It is estimated that 150–200 million people, or ~3% of the world’s population, have Chronic Hepatitis C. HCV infection is prevalent in India too, with an estimated 12.5 million cases. About 50 to 80% of the patients progress to Chronic Hepatitis.
Hepatitis C is transmitted by:
- Intravenous Drug Use
- Healthcare Exposure like – a transfusion of Blood products, Organ Transplant without HCV screening carry a significant risk of infection
- Hemodialysis
- Accidental injuries with needles/sharpsSexual/household exposure to anti-HCV-positive contact
- Multiple sex partners
- Vertical Transmission: Vertical transmission of hepatitis C from an infected mother to her child
Hepatitis C can be prevented by only general prophylaxis, such as blood, tissue, organ screening. No specific vaccine or another immunizing agent is available.
What is Hepatitis E?
Hepatitis E is a liver inflammation caused by infection with a virus called Hepatitis E virus (HEV). Mostly Hepatitis E usually goes away by itself and the patient recovers; with low mortality rates. However, it occasionally develops into acute, severe liver disease, and is fatal in about 2% of all cases. Mortality in pregnant women the disease is more severe and the chance of liver failure and deaths are higher. It is spread mainly by the faecal-oral route due to faecal contamination of water supplies or food; person-to-person transmission is uncommon. Unhygienic street food is a major concern in urban areas of India. The disease symptoms are the same as Hepatitis A, though it is generally seen that Hepatitis E causes more severe disease than Hepatitis A. Currently, in Northeast India Hepatitis A is more common than Hepatitis E.
For prevention avoid drinking water of unknown purity, undercooked meat, and uncooked fruit/vegetables not peeled or prepared in a hygienic environment. Vaccines are undergoing research and are not yet available in our country.
What to do if you have symptoms of Acute Viral Hepatitis?
Firstly, visit the nearest health facility for consultation with a doctor as Jaundice can be due to many different causes. Some tests may be required to confirm the diagnoses in complicated cases. You may require hospitalization if you have severe symptoms, i.e. uncontrolled vomiting, dehydration, deep jaundice, etc. As stated most of the affected people will recover without complications and people having mild symptoms are usually treated at home with medical monitoring.
During the early part of illness when you have vomiting and low appetite you may be advised low fat and protein diet. As soon as your appetite and nausea improve you can have a normal diet. Scientific studies do not support stopping fat (oil) and protein (egg, fish, meat, etc.) even when you have deep jaundice when you don’t have nausea/vomiting. The liver needs more energy to recover during illness, so the more you eat the better. Medications will depend upon the cause of your illness and are mostly supportive.
And lastly
Recently, the medical fraternity is battling what is called ‘Herbal Drugs Induced Hepatitis’. It is commonly believed that herbal drugs are safe and devoid of all side effects, which is not true. Mostly, people having Jaundice have this mistaken belief that certain herbs help to reduce jaundice and they consume all sorts of plant products. Acute Viral Hepatitis recovers in the vast majority of patients, on its own. But, the liver damage caused by herbs converts this benign disease into a highly complicated one, with no known treatment at present. So, avoid all herbal products until more research clarifies which herbal products are safe to consume.
Dr. Hitesh Kalita | Consultant – Gastroenterology & Hepatology – Paediatric, Gastroenterology – Medical | Narayana Superspeciality Hospital, Guwahati