By Dr Manoj Sahu*
Hepatitis is an inflammation of the liver, most commonly caused by a viral infection, referred to as types A, B, C, D and E. These five types of infection pose a threat to India and are of the greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread.
Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of contact with blood and infected body fluids – in the same way as the human immunodeficiency virus (HIV). However, Hepatitis-B is 100 times more infectious than HIV.
The common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment, sharing needles for injections and blades for shaving, infected mother to baby at birth, from family member to child and also through sexual contact.
The Hepatitis-B and C viruses can survive outside the body for at least seven days. During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine. They do not spread by sharing of utensils, sharing of food or drinks, breast-feeding, hugging, holding hands, coughing, sneezing or by recreational use of public pools. So persons infected with it should not be discriminated at the workplace or in the society.
Approximately 500 million people worldwide are living with either Hepatitis-B or Hepatitis-C, 46 million of them in India alone. While many people worry more about contracting AIDS than Hepatitis, the reality is that every year, 1.5 million people worldwide die because of either Hepatitis-B or C and faster than they would from HIV/AIDS. Most people who were infected with HBV or HCV remain unaware of their chronic infection. They are at high risk of developing severe chronic liver disease and can unknowingly transmit the infection to other people.
Hepatitis-A and E cause acute infection, which subsides within six months, whereas Hepatitis-B and C, in addition to acute infection, cause chronic infection which persists beyond six months. Acute infection occurs with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. Most persons fully recover, but a small proportion of persons can die from acute hepatitis.
Hepatitis-E is the commonest and Hepatitis-B the second common etiology for acute hepatitis in India. Pregnant women are at risk of death if they acquire Hepatitis-E infection during pregnancy. If left untreated and unmanaged, Hepatitis-B or C can lead to advanced liver scarring (cirrhosis) and other complications, including liver cancer or liver failure.
.Hepatitis-B is the major cause of chronic hepatitis, cirrhosis and primary liver cancer in India. Hepatitis-D infections occur only in those who are infected with Hepatitis-B. The dual infection of HDV and HBV can result in a more serious disease and worse outcome.
Viral hepatitis can be prevented. Prevention and control of Hepatitis-A and E transmission can be achieved by improvement in sanitation and sewage disposal, measures for water and food safety, and health education on hygienic practices.
Safe and effective vaccines are widely available for the prevention of Hepatitis-A and HEV vaccine has recently been licensed in China.
For Hepatitis-B ,a vaccine is available since 1982 which has an outstanding record of safety and effectiveness. It can be administered at any age and even pregnancy is not a contraindication to vaccination. Protection lasts for at least 20 years and possibly lifelong, no booster injection is recommended. So for protection against the deadly disease, all that we have to do is to receive vaccination only once in our lifetime.
There is no vaccine for Hepatitis-C though research is on. Prevention of HCV infection depends on prevention of transmission into our body. For those who are already infected and diagnosed early, very effective treatments are available which can control and cure the infection. For vey advanced disease, liver transplant is the option, where the diseased liver is changed with another healthy liver.
Early diagnosis provides the best opportunity for effective medical support and prevention of further spread. Early diagnosis of those with chronic infection also allows people to take precautions to protect the liver from additional harm, specifically by abstaining from alcohol and tobacco consumption and avoiding certain drugs that are known to be toxic to the liver.
World Health Organization (WHO) celebrates World Hepatitis Day on July 28 every year to spread awareness and understanding of viral hepatitis. It provides an opportunity to focus on strengthening prevention, screening and control of viral hepatitis. The date was chosen for World Hepatitis Day in honour of the birthday of Nobel Laureate Professor Baruch Samuel Blumberg, discoverer of the Hepatitis-B virus.
In recent decades, viral hepatitis has not received the attention it deserves from the global community. Although the burden of the disease is very high, the problem has not been addressed in a serious way. We need to come forward, focus attention on the global health threat of hepatitis, think again about this silent killer, promote actions to confront it and create a hepatitis free environment for the future generation.
*The author is Associate Professor, Department of Gastroenterology and Hepatology at IMS and Sum Hospital, Bhubaneswar