Hepatitis – “The silent assassin”

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By: Dr. P. Narendra, MD (Medicine)

Hepatitis B and C affects one in every twelve people and kill one million people every year. World Hepatitis, Day, observed on July 28, aims to raise global awareness of hepatitis B and hepatitis C and encourage prevention, diagnosis and treatment. It was launched by the World Hepatitis Alliance in 2008. In May 2010, the World Health Assembly passed a resolution on virai hepatitis which, together with viral commitments on prevention, treatment and patient care, made World Hepatitis Day an official WHO awareness day. The 2011 theme for World

Hepatitis Day is “This is hepatitis …… Know it. Confront it. Hepatitis affects
everyone, everywhere.” This is an opportunity to raise awareness and improve disease prevention and improve access to diagnostic testing and treatment.

Hepatitis is an inflammatory disease with a variety of causes. Among the most important causes are the hepatitis viruses; hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), the HBV associated delta agent or hepatitis D virus (HDV) and hepatitis E virus (HEV). All of these five viruses can cause acute hepatitis. Blood borne types (HBV, HCV and HDV) can cause asymptomatic and unapparent to fulminant and fatal acute infections common to all types, on the one hand, and from subclinical persistent infections to rapidly progressive liver disease with cirrhosis and even hepatocellular carcinoma. Among the important non viral causes are alcohol, autoimmune diseases and drugs.

Hapatitis B and C can be transmitted by transfusion of blood products, other percutaneous routes such as injection drug use. In addition, these viruses can be transmitted by occupational exposure to blood and inadequately sterilized medical instruments, unhygienic tattooing practices. Hepatitis B can also be transmitted via body fluids – most notably semen and saliva and can also be transmitted from mother to child at birth.

Persons at risk for hepatitis B and C are those with multiple sexual partners, intravenous drug users, healthcare professionals, those patients on hemodialysis and haemophiliacs receiving blood products.

Acute viral hepatitis usually cause constitutional symptoms of anorexia, nausea and vomiting, fatigue, malaise, arthralgias, myalgias, fever and headache among others and may precede the onset of jaundice by 1 – 2 weeks. Dark urine and clay colored stools may be noticed by the patients from 1-5 days before the onset of clinical jaundice i.e. the yellowish discoloration of skin and conjunctiva.

Chronic hepatitis B develops in approximately 10% of those affected with this virus, while 50 to 70% of those affected with hepatitis C develop chronic hepatitis. These patients with chronic jnfection are at risk of developing progressive liver injury, cirrhosis of the liver and hepatocellular carcinoma (cancer). Chronic hepatitis may be asymptomatic or have minimal symptoms until features of liver failure develop.

These viral infections can be detected by various blood tests, many of which are rapid and cost effective. Those who are at risk or have been inadvertently exposed should avail to these tests. An effective vaccine exists for hepatitis B and India has a policy of universal vaccination for hepatitis B virus. No vaccine exists at present for hepatitis C virus. Both these infections can be prevented to a large extent by avoiding high risk behavior, such as using condoms, voluntary exclusion from donation of blood by those with high risk behavior, avoiding professional blood donors at blood banks and following universal precautions by health care professionals.

Treatment of acute hepatitis is usually supportive and in certain groups of patients, treatment with Interferon alpha and antivirals can be considered. Chronic hepatitis B can be treated effectively with antivirals. Chronic hepatitis C is treated with a combination of pegylated Interferon alpha and ribavirin with acceptable responses.

In conclusion, hepatitis B and C are “silent assassins” which require detection and appropriate management. Thus detection with recommended tests is the most important first step in tackling this global menace of hepatitis.

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