A B C of Hepatitis

 

28th July is declared as ‘World Hepatitis Day’.  I thought I will share some information with you to help and prevent major illness affecting the liver causing nearly 1 million deaths annually world wide.

Hepatitis is a viral infection of the liver.   There are Hepatitis viruses A,B,C,D,E, but the most relevant are A, B & C.

Hepatitis A is relatively an innocuous viral infection, normally spreads by contamination of food and water and can be prevented by good hygiene. Nearly 1.4 million people across world get Hepatitis A.  Many of us including me, had mild jaundice in childhood and in a week’s time cleared off.  The infection occuring once, provides immunity for the rest of our life.  Hepatitis A vaccination is available and if one member of family has Hepatitis A, then others can take vaccine. Good hygiene and sanitation are most effective measures for  prevention.

Hepatitis B, on the other hand is a much more sinister virus.  More than 240 million people have chronic (long-term) liver infections. About 600 000 people die every year due to the acute or chronic consequences of hepatitis B.

This is actually a preventable disease.  Now an effective vaccine is available and  has been made mandatory as part of immunization program for neonates.  But in earlier days it was not mandatory.  You may not be sure whether you had Hepatitis B immunization in your childhood and it is worthwhile particularly if you are active and are likely to sustain some injury etc., to go in for a booster dose of Hepatitis B.

The biggest risk is that Hepatitis B spreads by body fluids through skin and mucosal injuries just like the AIDS virus but it is nearly 50 times more resistant than AIDS virus.  In fact, the AIDS virus is a very fragile virus which can just die on drying up.  But Hepatitis B, on the other hand, can stay on in moist surfaces for a period of atleast a week.  That is a big risk. There are so many places that can lead to spread- hospitals, clinics, unsafe sex, sex workers etc.

Hepatitis B virus does not enter through intact skin or mucus but if there is injury, there is all the more reason that you need to have protection.  Also when you go in for a procedure, you have to insist on the healthcare worker on wearing gloves while handling your wound or doing any examination.  Blood, body fluids, contaminated needles, unnatural sex are high risk factors for Hepatitis B.

So the best way to prevent is  vaccination or booster dose appropriately.

Please vaccinate the newborn and if you don’t know your immunization status, take a booster.

Hepatitis B, once it enters, can linger on in the liver and can be detected by a blood test called HBsAg.  So in case an adult gets jaundice and it clears off, it is definitely both Hepatitis B and C infections are to be tested for.

Sequelae of Hepatitis B: What happens to Hepatitis B or C when they infect the liver ? They produce cell necrosis.   When the liver cells die, there is always scarring, just like a scar forms after a wound on the skin.   The repeated internal scarring produces  ‘fibrosis or cirrhosis’ of the liver.  The liver becomes firm and fibrotic.  This takes a long time of may be even 10 years and can be detected. Nowadays cirrhosis can be easily picked up by Scans including CT, Ultrasound or Fibro Scan and one can limit the progress of the cirrhosis.

liver image

Liver Cancer The big risk of Hepatitis B & C viruses unfortunately is development of liver tumors.  Given enough time, at least a third of them develop liver cancer ,which are aggressive involving a large part of the liver.

Unlike kidneys, liver is a single large organ, a huge organ of the body to metabolize all the nutrients, drugs, etc.  So nearly 80% of the liver has to be damaged before there are any signs outside and that is a big reason why most liver diseases are silent and can only be detected much later when the damage is extensive.  So it is very very important for us to make sure that we undergo appropriate diagnostic measures to identify them in the early stage.

Hepatitis C also has a similar mode of transmission as Hepatitis B.  The most unfortunate thing however, is that Hepatitis C has no vaccine so far developed though there have been attempts on that.  But Hepatitis C has effective treatment.

Recently, a rich philanthropist who has been harboring Hepatitis C virus almost 30 years came to me with cirrhosis and liver cancer. Many told him that Hepatitis C has no treatment.  Fortunately it is not true.  Hepatitis C has effective treatment now  and should be treated.  This will prevent further progression into cirrhosis and liver  tumours and also chronic liver disease.

In brief, therefore, Hepatitis A is self-limiting, Hepatitis B is preventable and Hepatitis C is treatable.  So it is all good news for you – provided you take adequate care in your life.

WHO fact sheet on Hepatitis : http://www.who.int/mediacentre/factsheets/fs204/en/

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