(On occasion of World Hepatitis Day, 28th July 2017)
Zion Hospital and Research Centre
Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. There are five main Hepatitis viruses, referred to as types A, B, C, D and E. These five types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread.
Viral hepatitis is a leading cause of death globally, accounting for 1.34 million deaths per year — comparable to HIV/AIDS, Tuberculosis or Malaria. Together, Hepatitis-B and Hepatitis C virus cause 80% of most liver cancer cases in the world.
Viral Hepatitis is not found in one location nor amongst one set of people; it can affect millions of people without them even being aware. Currently, only 11% of people living with Viral Hepatitis are aware of their status. This can result in the real possibility of developing fatal liver disease at some point in their lives and in some cases, unknowingly transmitting the infection to others.
With the availability of effective vaccines and treatments for Hepatitis B and a cure for Hepatitis C, the elimination of Viral Hepatitis is achievable, but greater awareness of the disease and the risks is a must, as is access to cheaper diagnostics and treatment.
As mentioned earlier, there are five different Hepatitis viruses: Hepatitis A, B, C, D and E. In a nutshell, the route of transmission, prevention and treatment of each of such viruses are given below:-
HEPATITIS A: Transmission: Hepatitis A is mainly spread through eating contaminated food or drinking contaminated water. The disease is often endemic in countries which lack safe drinking water facilities and sanitation. Transmission is through oro-faecal route.
Prevention: A vaccine exists to prevent Hepatitis A. Treatment within a few weeks of exposure to the virus can also bring short term immunity. The risk of exposure can be greatly reduced by practicing good hygiene and sanitation and avoiding drinking water that has come from a potentially unsafe source.
Treatment: There is no specific treatment for Hepatitis A. Hepatitis A only causes acute hepatitis so the body is often able to clear the infection itself within a few weeks. However, Hepatitis A infection can sometimes cause further complications. It needs supportive and symptomatic treatment.
HEPATITIS B: Transmission: Hepatitis B is transmitted through contact with the blood or other body fluids of an infected person. For example, it can be spread from mother to child during childbirth, through sharing razors or toothbrushes, having unprotected sex, and sharing needles and syringes to inject drugs.
Prevention: Hepatitis B vaccination is very effective in preventing infection. If you have not been vaccinated, it is best to use condoms, and to avoid sharing needles or items such as toothbrushes, razors or nail scissors with an infected person to reduce chances of exposure. You should also avoid getting tattoos or body piercings from unlicensed facilities. If you think you are likely to be exposed in future, vaccination is highly recommended. Children born to mothers with Hepatitis-B should be vaccinated within 12 hours of birth, as this can prevent an infection that is likely to progress to chronic Hepatitis-B.
Treatment: Although there is currently no real cure for Hepatitis B, drugs such as alpha interferon and Peginterferon and a variety of antiviral drugs are available. These drugs slow the replication of the virus and occasionally result in its clearance. Most importantly, they greatly reduce the risk of the complications that Hepatitis B can cause such as liver cirrhosis and liver cancer.
HEPATITIS C: Transmission: Hepatitis C is spread through blood-to-blood contact. The most common modes of infection include unsafe injection practices, inadequate sterilization of medical equipment and use of unscreened blood and blood products. It can also be transmitted through certain sexual practices where blood is involved. However, whether it can be transmitted sexually without the presence of blood remains unclear. If it does happen it appears to be extremely rare although the risk may be increased by the presence of other sexually transmitted infections.
Prevention: Currently there is no vaccination for Hepatitis C. To reduce risk of exposure, it is therefore necessary to avoid sharing needles and other items such as toothbrushes, razors or nail scissors with an infected person. You should also avoid getting tattoos or body piercings from unlicensed facilities.
Treatment: Treatment can cure Hepatitis C infection. Until recently the treatment involved a combination of interferon, generally pegylated (long-lasting interferon) and Ribavirin but there is increasing use of potent direct acting antiviral drugs. People with different Hepatitis C genotypes respond differently to treatment, some more successfully than others but the differences between the genotypes is disappearing as cure rates with the new drugs approach almost 100%.
HEPATITIS D: Transmission: Hepatitis D is passed on through contact with infected blood.
Prevention: Hepatitis D only occurs in people who are already infected with the Hepatitis B virus. People who are not already infected with Hepatitis B can therefore prevent Hepatitis D infection by getting vaccinated against Hepatitis B. Avoid sharing needles and other items such as toothbrushes, razors or nail scissors with an infected person. You should also avoid getting tattoos or body piercings from unlicensed facilities.
Treatment: Treatment for Hepatitis D consists of interferon but it is not very effective.
HEPATITIS E: Transmission: Like hepatitis A, Hepatitis E is mainly transmitted through eating contaminated food or drinking contaminated water. Outbreaks generally occur where there is a lack of safe water and poor sanitation. Prevention: Currently there is a vaccine to prevent Hepatitis E, but it is not widely available. Reduce the risk of exposure to Hepatitis E by practicing good hygiene and sanitation, and avoiding drinking water that has come from a potentially unsafe source.
Treatment: There is no treatment for Hepatitis E but people usually recover with supportive treatment alone. It can, however, be fatal in some cases, especially in pregnant mothers.
Yes, elimination of Viral Hepatitis is an ideal goal towards which we are all moving. By improving sanitation, supply of clean water and food, vaccination, use of properly sterilized medical equipments and use of screened blood and blood products we can achieve this goal.
