Hepatitis – A Global Health Concern
Hepatitis is a term used to describe the inflammation of the liver as a result of viral infection or exposure to harmful or toxic substances such as drugs or alcohol. While some types of hepatitis will pass without causing permanent damage to the liver, chronic cases can cause cirrhosis, liver failure or cancer. There are five main hepatitis viruses, referred to as types A, B, C, D and E, which pose the greatest risk. Hepatitis B (HBV) and C (HCV) are viral infections which can cause chronic hepatitis and are the leading causes for hepatic cirrhosis and cancer, thus creating a significant burden to healthcare systems due to the high morbidity / mortality and costs of treatment. Around 70-80% of people with Hepatitis B or C do not even have any symptoms. The symptoms often go unnoticed, the reason why this disease is also known as the ‘silent killer.’
Approximately 1 in 12 persons worldwide, or some 500 million people, are living with chronic viral hepatitis. About 15 million Indians are anti-HCV positive and 5 million of them may be viraemic. Of these, nearly 25%, i.e. over 1 million, may develop chronic liver disease within 2 decades and 1%–4% of them may develop liver cancer. Annually, in India about 250,000 people die of viral hepatitis or its sequelae. About 130–170 million people worldwide are chronically infected with hepatitis C virus, and more than 250,000 people die from hepatitis C-related liver diseases each year.
There are an estimated 2-4 million people in the United States, 5 to 10 million people in Europe and about 15 million people in India who are chronically infected with HCV. HCV has six major genotypes, referred to as genotypes 1 through 6. It is important for the treating physician to determine which HCV genotype a patient has, as this information can impact decisions regarding the type and duration of treatment.
The major risk factor for HCV infection is parenteral exposure, primarily through blood products and needle sharing among injection drug users. Recipients of previously unscreened blood, blood products and organs, patients and employees in haemodialysis centers (nosocomial infections). hemophiliacs, injection drug users sharing contaminated needles and/or injection materials , people exposed to unsterile medical or dental equipment. Occupational exposure to blood – people administering or receiving acupuncture and/or tattooing with unsterile devices. Health care workers ,through sexual route and perinatal transmission (infants born to infected mothers )
Screening for HCV among blood donors has reduced the risk of acquiring HCV from blood products by half to two thirds. Some people acquire the infection through non-parenteral means that have not been fully defined, but include sexual transmission in persons with high risk behaviors, although transmission of HCV is generally less common than that of HBV and HIV.
Approximately 70%–80% of people with acute Hepatitis C do not have any symptoms. If present they can include : Flu-like symptoms • Fatigue • Nausea • Aching muscles and joints • Anxiety and depression • Poor concentration • Stomach ache • Loss of appetite • Dark urine/bright stools. Transfusion and use of unsterile syringes are the dominant mode of transmission of HCV in India. 15%–20% of all chronic liver disease and hepatocellular cancer HCC in India are caused by HCV .
Currently, there is no approved vaccine for HCV. All children should get the Hepatitis B vaccine. Babies should get a first dose of the hepatitis B vaccine at birth. They should have all three shots in the series by age 6 to 18 months. Infants born to mothers who have acute hepatitis B or have had the infection in the past should get a special hepatitis B vaccine within 12 hours of birth. Children younger than age 19 who have not had the vaccine should get “catch-up” doses.
Adults at high risk for Hepatitis B should also be vaccinated, including: Health care workers and those who live with someone who has hepatitis B, people with end-stage kidney disease, chronic liver disease, or HIV infection, people with multiple sex partners and men who have sex with other men and those who use recreational injectable drugs. There is no vaccine for hepatitis C.
Hepatitis B and C viruses are spread through contact with blood or bodily fluids of a person infected with the virus. The viruses are NOT spread through casual contact, such as holding hands, sharing eating utensils or drinking glasses, breastfeeding, kissing, hugging, coughing, or sneezing. Avoid coming in contact with blood or bodily fluids of others, avoid sharing personal items, such as razors or toothbrushes
DO NOT share drug needles or other drug equipment. Clean blood spills with a solution containing 1 part household bleach to 9 parts water. Be careful when getting tattoos and body piercings.
Safe sex means taking steps before and during sex that can prevent you from getting an infection, or from giving an infection to your partner.
After realizing the gravity of these infections, and in recognition of the birthday of Professor Baruch Blumberg, who won the Nobel Prize for discovering the Hepatitis B virus, World Health Organization has decided to observe 28th July as the “World Hepatitis Day” to create awareness among the people about the infection, its consequences and ways and means to prevent the spread of this dreadful and fatal disease. World Hepatitis Day was launched in 2008 in response to the concern that chronic viral hepatitis did not have the level of awareness, nor the political momentum, seen with other communicable diseases such as HIV/AIDS, tuberculosis (TB) and malaria. This is despite the fact that the number of people chronically infected with, and the number of deaths caused by, hepatitis B and C is on the same scale as these conditions. World Hepatitis Day has generated massive public and media interest, as well as support from governments and Non-Governmental Organisations.
For public awareness
Zion Hospital and Research Centre