Dr Santosh Kumar Enaganti
Every year is celebrated on 28th July under the WHO leadership aiming to spread the awareness of the hepatitis problem, promoting measures to reduce the disease burden and aiming to eliminate it by 2030. This year’s theme is “Invest in eliminating hepatitis”.
There are multiple types of hepatitis virus, most common ones are A, B, C and E virus infections.
325 million people are living with viral hepatitis B and C. 2850,000 people became newly infected in 2017 and 80% of people living with hepatitis lack prevention, testing and treatment according to WHO reports.
This is that time of the year with monsoon rains, broken drains and contaminated water supplies will result in waterborne diseases including hepatitis. Hepatitis A is transmitted by faeco-oral route and person will get the hepatitis by ingesting contaminated food or water with infected persons faeces. It generally results from poor sanitation and water contamination .It is common in middle income countries like India .Unlike Hepatitis B and C it results in Mild to moderate self-limiting illness but few can get fulminant liver failure with fatal outcome.
According to WHO, 7134 persons died due to hepatitis A in 2016 worldwide, however it results in significant morbidity ,can affect multiple members . It can take weeks or months for people recovering from the illness to return to work, school or daily life.
In low and middle income countries with poor sanitation and hygienic practices ,infections is common and most children -90% have been infected with the hepatitis A virus before the age of 10 years and are most often asymptomatic
Whereas middle income countries like India will have variable sanitary conditions and children escape early infection and adolescents and adults will get symptomatic illness with jaundice.
There is an additional issue in India where most people in the rural areas and those from the lower social economic status do not know which type of virus causing the infection and seek herbal remedies resulting in drug induced liver disease in otherwise straight forward cases of hepatitis A prolonging the recovery and sometimes causing undesired consequences of liver failure.
It is not uncommon to see people using eye drops for jaundice as a remedy due to misguidance and should be discouraged. Treatment involves supportive measures high carbohydrate and low fat diet.
Hepatitis A infection is preventable by drinking safe water, proper cooking of food , maintaining hand hygiene and practicing sanitary hygiene .It is reduced by the proper disposal of sewage in the communities. There is an effective vaccine available for high risk groups like students living in hostels. .
Hepatitis E is another virus which is transmitted similarly as hepatitis A and resembles in clinical course .Like Hepatitis A it will be self-limiting in many except in immune compromised patients and will have increased risk of liver failure in pregnant women . There is no approved vaccine at present for this.
Hepatitis B and C are the 2 most leading causes for chronic liver disease across the world and both are transmitted through blood contamination via sharing of needles, reusing medical equipment with improper sterilization, high risk sexual behaviour and blood transfusions.
Hepatitis B is preventable by proper vaccination and there is no vaccine available for hepatitis C.
There are significant number of adults with no immunity for hepatitis b, who can be protected by vaccination even if they are not working in the healthcare. Mainly patients with chronic illnesses like diabetes, inflammatory bowel disease,and chronic renal failure should have vaccination against hepatitis B to reduce the complications and mortality.Chronic renal failure patients cannot have dialysis with normal machine if they get infected with hepatitis b and c virus.
Hepatitis B can be controlled whereas Hepatitis C is curable in most with latest antiviral drugs called DAA`s .Effective treatment of chronic hepatitis will reduce the incidence of liver tumors in due course.
The Author is a Senior Consultant Medical Gastroenterologist & Hepatologist; MD (Int Med), MRCP, CCT-Gastroenterology (UK), FRCP (London); Continental Hospitals