Hepatitis – From A to E

Hepatitis – From A to E

Worldwide, around 300 million people are living with viral Hepatitis without even knowing that they are infected with the Hepatitis virus. Without finding the undiagnosed and linking them to care, millions will continue to suffer, and lives will be lost.

On World Hepatitis Day, 28 July, the World Health Organization calls on people from across the world to take action and raise awareness to find the “missing millions”.

“Hepatitis” means inflammation of the liver. The liver is a vital organ that processes nutrients, filters the blood, and fights infections. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can cause Hepatitis. However, Hepatitis is most often caused by a virus.

There are 5 main Hepatitis viruses, referred to as types A, B, C, D and E. These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of Liver cirrhosis and cancer.

Hepatitis A and E are typically caused by ingestion of contaminated food or water. Acute infection may occur with no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

Hepatitis A and E viruses are responsible for several outbreaks of sporadic viral Hepatitis in India, usually secondary to contamination of drinking water. It is the most common cause of acute viral Hepatitis in children. However, in the recent times there has been an epidemiological shift in Hepatitis A infection in India, with increasing incidence of infection being noted in the adult and adolescent population compared with children.

Most people who get Hepatitis A and E infection feel sick for several weeks, but they usually recover completely and do not have lasting liver damage. In rare cases, Hepatitis A can cause liver failure and death; this is more common in people older than 50 and in people with other underlying liver diseases.

Hepatitis A and E infection is treated with rest, adequate nutrition, and fluids. Some people will need medical care in a hospital. The best way to prevent Hepatitis A is through vaccination with the Hepatitis A vaccine. Two doses of Hepatitis A vaccine are recommended at 6 months interval. Safe and effective vaccines to prevent Hepatitis E infection have been developed but are not widely available.

Hepatitis B, C and D usually occur as a result of receipt of contaminated blood or blood products, through sexual contact, sharing needles, syringes, or other drug-injection equipment; or from mother to baby at birth.

Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease. World Health Organization estimates that in the year 2015, 257 million people were living with chronic hepatitis B infection. The average estimated carrier rate of Hepatitis B virus (HBV) in India is 4%, with a total pool of approximately 50 million hepatitis B infected patients (second only to China) and constitutes about 15 per cent of the entire pool of Hepatitis B in the world.”

India falls in the intermediate endemicity zone (prevalence of 2–7%, with an average of 4%), with a disease burden of about 50 million. Pockets of higher endemicity are found in tribal areas where the high burden is maintained through inter-caste marriages, tribal customs, illiteracy and poor exposure to health care resources. Every year, nearly 600,000 patients die from HBV infection in the Indian continent.

For some people, Hepatitis B is an acute, or short-term, illness but for others, it can become a long-term, chronic infection. Risk for chronic infection is related to age at infection: approximately 90% of infected infants become chronically infected, compared with 2–6% of adults. Chronic Hepatitis B can lead to serious health issues, like liver failure or liver cancer. Hepatitis B can be prevented by vaccines that are safe, available and effective.

Most individuals with chronic Hepatitis B do not have any symptoms, do not fall ill, and can remain symptom free for decades. When and if symptoms do appear, they are similar to the symptoms of acute infection, but can be a sign of advanced liver disease. About 1 in 4 people who become chronically infected during childhood and about 15% of those who become chronically infected after childhood will eventually die from serious liver conditions, such as cirrhosis (scarring of the liver) or liver cancer. Even as the liver becomes diseased, some people still do not have symptoms, although certain blood tests for liver function might begin to show some abnormalities.

For acute infection with HBV, no medication is available; treatment is mainly supportive. There are several antiviral medications for people with chronic infection. People with chronic HBV infection require regular monitoring to prevent liver damage and/or liver cancer.

According to World Health Organization, globally, an estimated 71 million people have chronic Hepatitis C virus infection. A significant number of those who are chronically infected will develop cirrhosis or liver cancer. WHO estimated that in 2016, approximately 399,000 people died from Hepatitis C, mostly from cirrhosis and hepatocellular carcinoma.

Due to the absence of a chronic Hepatitis C virus surveillance system in India, there is a complete lack of knowledge about the actual number of people living with HCV-related liver diseases and the people who died of it. Global studies estimate that there are 8.7 million people living with chronic HCV in India.

For some people, Hepatitis C is a short-term illness but for 70–85% of people who become infected with Hepatitis C, it becomes a long-term, chronic infection. Chronic Hepatitis C is a serious disease than can result in long-term health problems, even death. The majority of infected people might not even be aware of their infection because they are not clinically ill. Currently there is no effective vaccine against Hepatitis C; however, research in this area is ongoing. The best way to prevent Hepatitis C is by avoiding behavior that can spread the disease, especially injecting drugs.

There isn’t a recommended treatment for acute Hepatitis C. People with acute Hepatitis C virus infection should be followed by a doctor and only considered for treatment if their infection remains and becomes a chronic infection. There are several medications available to treat chronic Hepatitis C. Hepatitis C treatments have gotten much better in recent years. Current treatments usually involve just 8-12 weeks of oral therapy (pills) and cure over 90% of people with few side effects.

How would you know if you have Hepatitis?

The only way to know if you have Hepatitis is to get tested. Blood tests can determine if a person has been infected and cleared the virus, is currently infected, or has never been infected.

Who should get tested for Hepatitis B and why?

  1. All pregnant women are routinely tested for Hepatitis B: If a woman has Hepatitis B, timely vaccination can help prevent the spread of the virus to her baby.
  2. Household and sexual contact of people with Hepatitis B are at risk of getting Hepatitis B: Those who have never had Hepatitis B can benefit from vaccination.
  3. People with certain medical conditions should be tested, and get vaccinated if needed. This includes people with HIV infection, people who receive chemotherapy and people on hemodialysis.
  4. People who inject drugs are at increased risk for Hepatitis B: but testing can tell if someone is infected or could benefit from vaccination to prevent getting infected with the virus.
  5. Men who have sex with men have higher rates of Hepatitis B: Testing can identify unknown infections or let a person know that they can benefit from vaccination.

Who should get tested for Hepatitis C?

The only way to know if you have Hepatitis C is to get tested. Early detection can save lives.

  1. Anyone who has injected drugs, even just once or many years ago
  2. Anyone with certain medical conditions, such as chronic liver disease and HIV or AIDS
  3. Anyone who has received or donated blood/ organs before 1992
  4. Anyone born between 1945 – 1965
  5. Anyone with abnormal liver tests or liver disease
  6. Health and safety workers who have been exposed to blood on the job through a needle stick or injury with a sharp object
  7. Anyone on hemodialysis
  8. Anyone born to a mother with Hepatitis C

Why is it important to get tested for Hepatitis C?

  1. Millions of Americans have Hepatitis C, but most don’t know it.
  2. About 8 in 10 people who get infected with Hepatitis C develop a chronic, or lifelong, infection.
  3. People with Hepatitis C often have no symptoms. Most of the people can live with an infection for decades without feeling sick.
  4. Hepatitis C is a leading cause of liver cancer and the leading cause of liver transplants.
  5. New treatments are available for Hepatitis C that can get rid of the virus.

A balanced and healthy lifestyle with controlled consumption of alcohol and tobacco is necessary to fight the disease that is an alarming public health concern in India. In addition, maintaining hygiene, avoiding roadside food and beverage, being careful in salons and tattoo parlors for avoiding infections and washing hands can help protect us from Hepatitis. 

Dr. Somashekara HR | Consultant Paediatric Hepatologist & Gastroenterologist | Narayana Health City, Bangalore

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