World Hepatitis day – Test.Treat.Hepatitis

Today is world Hepatitis Day . The theme is Test.Treat.Hepatitis.

325 million people are affected with Hepatitis B and C which is root cause for liver cancer leading to 1.3 million deaths every year. Hepatitis B can be prevented and C is treatable.

As with my blogs, I want to share a true story and this time the story is about myself.

I have been operating patients with Liver cancer and Hepatitis B for the past 3 decades. Like many others, I was under the false notion that I was immunized for Hepatitis B. Hepatitis B immunization is done on Day 1, Day 30 and after 6 months. I vaguely remembered that I was immunized on Day 1 and Day 30 but was not sure on the 6 months booster which unfortunately is the case with many of us.

One of my doctor colleagues was looking for a job in another Institution and fortunately that Institution insisted on Hepatitis B and C testing. To his utter shock and disbelief he was tested positive for Hepatitis C, which must have been contracted from a patient. Fortunately there are drugs for treating Hepatitis C and also new drugs that reduces the treatment to just 3 months. He was cured completely from Hepatitis C and could join the job.

Then I thought, why not get tested for Hepatitis B & C and to my utter disbelief found that I had NO antibodies for Hepatitis B. In other words, I was at high risk for contracting the disease. This was because of inadequate immunization. So I was operating patient with Hepatitis B taking due precautions but I could have contracted Hepatitis B and C. There is effective immunization for Hepatitis B. I immediately took immunization again and now have adequate antibody titre.

This certainly is relevant and I urge my medical colleagues and friends to get tested for B and C. We do not know when get exposed. Hepatitis is a silent disease which goes on for a long time and can lead to cirrhosis or fibrosis of liver and then later  liver cancer.. This can be easily prevented.

In the US, the CDC has given directive that those born in the 50s and 60s are not immunized for Hepatitis B, as the vaccines were not part of the universal immunization programme as per today’s guidelines.  This is also  true for us.

Yes, we have risk of getting exposed. Hepatitis B spreads with body fluids, could be in hospitals, dentists, tattooing or unsafe use of injections. All this can be prevented. India has only constituted committees ( WHO infographic). This is the time for action and not just forming committees. Apart from the guidelines, WHO makes it amply clear that we can eliminate Hepatitis by 2030 . My own example is more than enough for anyone to be tested immediately.

If you do not remember that you are immunized, you can get immunized for Hepatitis B. This is partly true of those families who have patients diagnosed with Hepatitis B. Hepatitis C has no vaccine at this point of time but has good treatment.

Elimination of hepatitis reduces risk of liver cancer and cirrhosis. Saves lives.

Here’s an appeal by Dr. Tredos Adhanom Chebreyesus, Director General of WHO that calls for immediate action.

“World Hepatitis Day is an opportunity to highlight one of the world’s most pressing public health issues. Globally, viral Hepatits B and C affect 325 million but only 1in 10 of those people have been tested and only one in 5 have received appropriate treatment. Viral Hepatitis slowly and silently degrades a person’s health leading to liver cancer and cirrhosis which results in 1.3 million deaths every year. The good news is that we have new medicines that can cure Hepatitis C in 3 months or less. WHO’s new recommendations call for treating everybody with Hepatitis C aged 12 years or older with these new drugs. That’s about 70 million people. While testing and treatment are key to eliminating Hepatitis, we also need strong focus on prevention. We have a clear vision for elimination and we have the tools to do but we must accelerate our goal of eliminating Hepatitis by 2030.”

 

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/