World Hepatitis Day has been led by the World Hepatitis Alliance since 2007 and on May 2010, it got global endorsement from the World Health Organization. In an exclusive interview with Salome Phelamei of Zee News.com, Dr. Jai Babu talked on Hepatitis and its threat to public health, symptoms and treatment, and prevention methods.
Dr. Babu did his MBBS from Bangalore Medical College, and MD in General Medicine from PGIMER, Chandigarh. He had also completed his Senior Residency from JIPMER, Pondicherry.
What is Hepatitis?
The word Hepatitis comes from the ancient Greek word ‘hepar’ meaning 'liver', and the Latin ‘it is’ meaning inflammation. Hepatitis means inflammation of the liver, an irritation or swelling of the liver cells. There are many causes of Hepatitis which include viral infections A, B and C, auto-immune Hepatitis, Hepatitis secondary to fatty liver, alcoholic Hepatitis and toxin induced Hepatitis.
Types of Hepatitis - Causes, Symptoms and Treatment
Hepatitis can be caused by:
- Immune cells in the body attacking the liver and causing autoimmune hepatitis. - Infections from viruses (such as Hepatitis A, B, or C), bacteria, or parasites. - Liver damage from alcohol, poisonous mushrooms, or other poisons. - Medications, such as an overdose of acetaminophen, which can be deadly.
Of these, viral infections are the most common. There are five main types of Hepatitis that are caused by a virus, A, B, C, D, and E - plus types X and G.
Hepatitis A - this is caused by consuming food or water contaminated by Hepatitis A virus. Nearly everyone who develops Hepatitis A makes a full recovery - it does not lead to chronic disease.
Hepatitis B - this is an STD (sexually transmitted disease). It is caused by Hepatitis B virus and is spread by contact with infected blood, semen, and some other body fluids. One gets Hepatitis B by unprotected sexual intercourse with an infected person, using a syringe that was previously used by an infected person, using unsterilized needles,(as might be the case when getting a tattoo), being accidentally pricked, sharing personal items such as a toothbrush or razor, with an infected person. The liver of a person infected with Hepatitis B swells. The patient can suffer serious liver damage due to infection, resulting in cancer. For some patients the Hepatitis becomes chronic (very long-term or lifelong).
Hepatitis C - Hepatitis C is usually spread through direct contact with the blood of a person who has the disease. It is caused by Hepatitis C virus. The liver can swell and become damaged leading to cirrhosis and cancer in some.
Hepatitis D - only a person who is already infected with Hepatitis B can become infected with Hepatitis D. It is caused by Hepatitis D virus. Infection is through contact with infected blood, unprotected sex, and perforation of the skin with infected needles. The liver of a person with Hepatitis D swells.
Hepatitis E - a person can become infected by drinking water that contains Hepatitis E Virus. The liver swells, but there is no long-term consequence.
Hepatitis may occur with limited or no symptoms, but often leads to jaundice, poor appetite and malaise. Hepatitis is acute when it lasts less than six months and chronic when it persists longer.
How severe Hepatitis depends on many factors, including the cause of the liver damage and any other illnesses present.
The symptoms of Hepatitis include:
Loss of appetite Nausea and vomiting Weight loss Fever, usually low-grade Abdominal pain or distension Dark urine Jaundice (yellowing of the skin or eyes) Fatigue General itching
Many people with Hepatitis B or C do not have symptoms when they are first infected. They can still develop liver failure later.
A small proportion of people with acute Hepatitis progress to acute liver failure leading to confusion, coma and spontaneous bleeding. This may become life-threatening.
Extensive damage and scarring of liver (i.e. cirrhosis) leads to weight loss, easy bruising and bleeding tendencies, swelling of the legs and accumulation of fluid in the abdominal. Eventually, cirrhosis may lead to various complications like esophageal varices (enlarged veins in the wall of the esophagus that can cause life-threatening bleeding) hepatic encephalopathy (confusion and coma) and hepatorenal syndrome (kidney dysfunction).
Hepatitis A: Fortunately, 99% of those infected will recover without treatment.
Hepatitis B: While there is no treatment for acute Hepatitis B, there are approved treatments for chronic Hepatitis B – interferon alfa-2b and lamivudine.
Hepatitis C: Interferon and ribavirin are used to treat Hepatitis C.
Hepatitis D: Interferon alfa-2b treatments may be beneficial to a small proportion of patients. Vaccination against HBV will prevent HDV.
Hepatitis E: No treatment is necessary for HEV. It is typically self-limiting.
Which is the most serious form of Hepatitis?
Hepatitis B is a potentially life-threatening liver infection caused by the Hepatitis B virus. It is a major global health problem and the most serious type of viral hepatitis. It can cause chronic liver disease and puts people at high risk of death from cirrhosis of the liver and liver cancer. About 2 billion people worldwide have been infected with the virus and about 350 million live with chronic infection. An estimated 600, 000 people die each year due to the acute or chronic consequences of Hepatitis B. About 25% of adults who become chronically infected during childhood later die from liver cancer or cirrhosis (scarring of the liver) caused by the chronic infection. HBV is transmitted through blood and other body fluids, including semen and saliva. The virus is 100 times more infectious than human immunodeficiency virus (HIV) and, unlike HIV, it can live outside the body in dried blood for longer than a week. Hepatitis B virus is an important occupational hazard for health workers.
Can Hepatitis B affect anyone? Else, which age group is most at risk?
The virus can affect any age group. The average estimated carrier rate of Hepatitis B virus (HBV) in India is 4%, with a total pool of approximately 36 million carriers. Most of India's carrier pool is established in early childhood, predominantly by horizontal spread due to crowded living conditions and poor hygiene. There are 15.94 million Hepatitis B positives in India. Hence the pool of highly infectious Hepatitis B positives would be 3.26 million. Because newborns have an immature immune system, 90% of infants infected prenatally progress to chronic infection. Progression to chronic infection occurs in 25 to 30 % of persons infected before five years of age, and in 3 to 5 percent of those infected later in childhood or as adults. Immunosuppressed patients are at greater risk of becoming chronically infected.
How do you know that you have Hepatitis B?
Infection with Hepatitis B is suspected when the medical history and the physical examination reveal risk factors for the infection or symptoms and signs that are suggestive of Hepatitis B. Abnormalities in liver tests (blood tests) can also raise suspicion. The diagnosis of Hepatitis B can be made only with specific Hepatitis B virus blood tests. These tests are known as Hepatitis 'markers' or 'serology.'
How long will a patient take to recover from it?
The course of chronic Hepatitis B is variable and depends on several factors. These factors are the patient's age at which the infection began, the extent of viral multiplication, and the immune system's ability to control the infection.
The infection can progress to an:
-Immune tolerant phase (in which the immune system ignores the virus) - Immune clearance phase (in which the immune system attempts to eliminate the virus) - Quiescent phase (in which the virus is less active)
Hepatitis B is feared because it can lead to chronic infection and hence chronic sequel. Children are less likely than adults to clear the infection. More than 95% of people who become infected as adults or older children will stage a full recovery and develop protective immunity to the virus. However, this drops to 30% for younger children, and only 5% of newborns that acquire the infection from their mother at birth will clear the infection. This population has a 40% lifetime risk of death from cirrhosis or hepatocellular carcinoma. Of those infected between the age of one to six, 70% will clear the infection. Rate of chronic infection after clinically apparent acute hepatitis-B is 1% in normal, immunocompetent young adults. Moreover even amongst these carriers, about 2% clear the virus every year. The adult carriers with chronic active Hepatitis have 9-20% risk of developing cirrhosis over a five year period. 2 to 7% of adult cirrhosis develop hepatocellular carcinoma every year.
What is the annual estimated total of casualties in India and world as a whole?
The majority of Hepatitis B carriers go through life unaware of their status and unaffected by it. A small minority develops fulminant hepatic failure. Some develop chronic active hepatitis, cirrhosis and hepatocellular carcinoma (HCC). In India, in the absence of a surveillance system to track chronic liver disease, the incidence of hepatocellular carcinoma due to Hepatitis B is a surrogate measure of the magnitude of the problem of chronic liver disease caused by the virus. The estimated annual deaths attributed to hepatocellular carcinoma due to Hepatitis B is approximately 5000. Worldwide, the virus causes more than 1 million deaths annually.
What would be the cost of disease on the country’s economy?
The economic burden of HBV infection is substantial because of the high morbidity and mortality associated with end-stage liver disease, cirrhosis, and HCC. Interferon therapy for Hepatitis B would cost approximately Rs 432 500 for each year of life gained, which is 20.5 times the per capita gross national income of India. The annual recurring cost of evaluation and treatment of decompensated cirrhosis is estimated to be Rs 10 000, while it may cost as much for just one day of hospitalization with hepatic encephalopathy.
Suggest some of the prevention methods of Hepatitis B:
Hepatitis B can be prevented by the following measures -
Practising safe sex by using condoms and not sharing needles when using drugs can reduce the risk of infection.
When having any body piercing, tattoo or acupuncture, make sure that the needles used are disposable and that an autoclave is used for any equipment that's sterilised.
Normal social contact carries no risk of infection. One cannot catch Hepatitis B from toilet seats or by touching an infected person.
There's an effective vaccination to protect people from Hepatitis B infection. Family and other household members of an infected person should be vaccinated against Hepatitis B. Healthcare workers, the police, the emergency services and anyone who is likely to come in contact with infected blood through their job should also be vaccinated. Ideally all newborns should be immunised against Hepatitis B.