Pregnant Shakuntala in her routine blood investigations found that she is HBsAg positive (Hepatitis B). Shakuntala is scared, worried about how she got infected with Hepatitis and how can she disclose it to her husband? She had many other questions like will she pass it on to her unborn baby?
Krishna is a cricketer who decided to donate blood on his birthday. He discovered that he is hepatitis C positive. He too is shocked. How did he get it?
Prashanti has a 16-year-old daughter who frequently visits roadside eateries. Her doctor says she has contracted Hepatitis A virus infection. How did she get the infection? These are few examples where innocents knowingly or unknowingly are becoming the victims of viral infections of the liver. Fortunately, advancements in modern medicine offer viable treatment for Hepatitis.
WHAT IS HEPATITIS?
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.
World Hepatitis Day is observed every year on July 28 to raise awareness of viral hepatitis - an infection of the liver that can cause severe liver disease and hepatocellular cancer. This year the theme is “HEPATITIS CAN’T WAIT”.
The five strains of the hepatitis virus are; A, B, C, D and E. About 2 billion people are infected with one or more of these viruses with 1.4 million dying each year. 90% of deaths are caused by hepatitis B and C viruses. In India, 40 million people are infected with hepatitis B and 10 million with Hepatitis C. More than 2 lakh people die each year due to hepatitis B and C more than HIV and malaria put together.
TYPES OF HEPATITIS
Hepatitis A and E virus are spread by feco-oral route mainly through faecal contamination of drinking water. Usually, these viruses cause fever, body ache, jaundice lasting for a few weeks. These viruses are also responsible for outbreaks of epidemics of jaundice. In the majority, it is a self-limiting illness and many recover with supportive treatment. Few of them may land up with a severe form of liver disease. Personal hygiene and vaccination can protect from Hepatitis A.
The hepatitis B, C, D viruses usually cause lifelong and serious infections. These viruses are blood-borne infections and spread when blood, semen or other infected body fluids enter the body of an uninfected person- through sexual contact, sharing needles and syringes in drug addicts, unsterilized surgical equipment’s, non-intact skin or mucous membrane contact and from mother to child at birth. Once these viruses enter the body, they usually cause lifelong infection. They cause the entire spectrum of liver disease from acute hepatitis, chronic hepatitis, cirrhosis, liver failure and liver cancer. In the initial few years of infection, many remain asymptomatic and unknowingly transfer the virus to others — very alarming for society. Once symptomatic these patients suffer from jaundice, swelling of the feet and abdomen, vomiting of blood, liver coma and may cause death. Treatment for hepatitis B and C infection is difficult, long-term, frequent hospitalization and economic burden to the family.
To prevent Hepatitis B infection, safe and effective vaccination is available with more than 95% protection after three doses of the vaccine. Unfortunately, medical science is yet to produce a vaccine for Hepatitis C. It is a herculean task to identify asymptomatic people in society and vaccinate their contacts before they infect others. Screening and vaccination would help in containing the spread of hepatitis B and prevent mortality and morbidity.
WHO IS AT RISK?
The risks are different for the different types of hepatitis. For example, with most of the viral types, your risk is higher if you have unprotected sex. People who consume alcohol over long periods are at risk for alcoholic hepatitis.
To treat the Hepatitis C virus, oral drugs are administered for 3 to 6 months with high cure rates. For hepatitis B virus oral drugs have to be long term sometimes lifelong with supportive liver treatment. These drugs help in controlling the virus and prevent the worsening of liver disease. For patients who are diagnosed with advanced stage of infection may develop liver failure, such patients require liver transplantation. Liver transplantation is not very easily available and it is an expensive treatment modality.
The Department of Gastroenterology & Liver Clinic of KLEs Dr Prabhakar Kore Hospital, Belgaum in the last 5 years has screened more than 50,000 citizens in various places and vaccinated at subsidised cost to an equal number of people.
(The author is a Senior Gastroenterologist & Liver Specialist at KLES Dr Prabhakar Kore Hospital & MRC Belgaum)