Viral hepatitis is inflammation of the liver caused by a virus. There are five different hepatitis viruses, hepatitis A, B, C, D, and E. On this World Hepatitis Day, the theme for this year’s global campaign is ELIMINATION. In regards, with the campaign we asked our doctor a few questions and below are the replies:-
1) Have you received any patients suffering from Hepatitis during 2015 and 2016?
I have had a few cases of acute viral hepatitis in 2015-6. I cannot give exact data. I have seen 3 to 4 cases of chronic hepatitis C and treated one of them. I have also encountered a couple of cases of chronic hepatitis B and one of them is under investigations for possible antiviral therapy.
2) What is Hepatitis and how does one get affected?
Hepatitis is a term used to denote “inflammation” of the liver. Many agents- infectious as well as chemical- could potentially cause hepatitis. However, commonly when we talk about hepatitis, we generally intend to indicate infection by certain viruses that have a special affinity for the liver. These agents could be hepatitis A, B, C, D, or E viruses.
At this stage, it is important to get familiar with two main presentation of hepatitis- acute vs. chronic. While acute hepatitis is a short-term illness that comes with easily noticeable symptoms, chronic hepatitis does not produce dramatic symptoms, to begin with, but could last for years or even indefinitely if not treated. We label any hepatitis that lasts more than 6 months as being chronic in nature.
The A and E viruses are mostly transmitted through food or water or close personal contact. They could easily be transmitted by food handlers as well. These viruses generally cause acute hepatitis only and do not lead to long-term illness.
The B and C viruses are transmitted through contact with contaminated blood or bodily secretions. They could also be passed on from mother to child. While B virus could cause both acute as well as chronic hepatitis, the C-virus by and large causes chronic hepatitis only.
3) How can one prevent being affected by Hepatitis?
To prevent infection with hepatitis A and E, simple measures like maintaining hygiene at a personal and public level is extremely important. In fact, governmental effort in improving public hygiene like provision of clean drinking water has gone a long way in decreasing the incidence of infection with these viruses.
At a personal level, good hand washing before and after meals and avoiding eating at unclean eateries is important. Food handlers, especially in public arena must be properly trained. There is a vaccine available for prevention of hepatitis A, but so far no effective vaccine for clinical use is available for preventing hepatitis E.
Certain populations are at increased risk; for example, elderly people living in old age homes, mentally challenged patients who are unable to maintain personal hygiene by themselves, prisoners etc. Such potential patients should be considered for vaccination for hepatitis A. Infection with blood borne viruses like HBV and HCV can be prevented by following scrupulous blood banking practices. These are already in place internationally and modern blood-banking methods ensure that transmission of these viruses as a result of blood transfusion is now a rarity. It is advisable to be careful whenever there is potential for contact with blood or bodily secretions of another individual. Never share razors or injection needles. Always insist on disposable and sterilized equipment for tattoos, body piercing etc. Safe sexual practices need to be emphasized as well.
Since these viruses are transmitted through blood, there is a potential for transmission of infection from mother to baby. Mothers at risk need to be screened before childbirth and proper measures need to be taken at the time of delivery to minimize the risk of perinatal infection to the infant.
There is an effective vaccine available for hepatitis B but not against C. Hepatitis B vaccine is now offered as part of the standard immunization program for all infants in a large number of countries, and this has helped in decreasing the incidence of HBV infection significantly.
Finally, it is important for healthcare providers to observe standard safe practices when dealing with patients, blood samples, and secretions. This will help the health workers as well as their patients. All healthcare providers should ensure that they are vaccinated against hepatitis B and that they have protective antibody titers in the blood.
4) What are its symptoms?
Acute viral hepatitis generally presents with a low-grade fever and some discomfort in the upper abdomen. There is also some nausea/vomiting and distaste for food. A few days later jaundice appears and this takes several weeks to subside. Most acute hepatitis recovers spontaneously without permanent damage to the liver.
Rarely it is very severe and can cause danger to the patient’s life. Chronic hepatitis, unfortunately, cannot be identified with typical symptoms and that’s why it may not be diagnosed for several years in some cases. Most chronic hepatitis, particularly hepatitis C, would probably be associated with unexplained fatigue. When the liver damage becomes extensive then various symptoms of liver failure start appearing and this normally indicates a very late stage in the timeline of the illness.
5) What are the damage control measures to follow when found affected by Hepatitis?
As mentioned earlier, acute hepatitis rarely poses a threat to the life of the patient and generally recovers spontaneously. It is, however, important to trace close contacts of patients who could be at risk of contracting the same illness. This will depend on what kind of hepatitis the patient is diagnosed with. Patients should always consult their physicians for guidance.
If chronic hepatitis is diagnosed, then depending on the type of infection and its stage, treatment options are available. Patients should contact their physicians at soonest. It is not advisable to ignore the issue even if there are no symptoms because damage to the liver might continue/persist even when the patient feels no symptoms at all.
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Dr. Amal P Upadhyay,
Consultant Gastroenterology,
Aster Hospital, Mankhool
