World Hepatitis day is observed on 28^th July every year. WHO estimates that approximately 1.5 million people are infected with HAV each year. Following hygienic practices is the key to keeping hepatitis at bay.

World health organization (WHO) recognizes 28^th July every year as world hepatitis day. Hepatitis is inflammation of the liver due to various causes, prominent ones being – various types of viruses, alcohol, and fatty liver. WHO estimates that approximately 1.5 million people are infected with HAV each year. Hepatitis is caused by several viruses, virus like Hepatitis A, B, C, D, and E, can harm the liver. While Hepatitis A and E generally cause acute hepatitis, Hepatitis B and C cause chronic liver infection. Hepatitis D virus infection commonly occurs with Hepatitis B virus infection.

Hepatitis B infection is widespread in India. In India, chronic hepatitis B affects between 1.4 percent and 2.7 percent of the population overall. The prevalence of HCV infection in India is estimated at between 0.5% and 1.5%. The majority of new cases are brought on by vertical Hepatitis B transmission. In addition, it was disseminated through unsafe sexual behaviours, body piercing, and tattooing. Once infected, Hepatitis B and C can lead to chronic liver infection. The virus can be indolent in the infected person for many years without any symptoms. However, it can create an ongoing liver injury. Patients may exhibit jaundice, water in the abdomen, disorientation, or liver cancer when the liver is no longer able to make up for continuous damage.

Acute infection by viruses A and E are caused by unhygienic practices like consuming contaminated water, under cooked food, etc. After an incubation period ranging from 2 weeks to 6 weeks, patients may manifest with jaundice, abdomen discomfort or fever. In most of the cases, the symptoms are self-limiting, and there is recovery of liver function. Rarely, a patient may develop a liver illness that progresses and necessitates liver transplantation or critical care management. Early detection of the infection is crucial to preventing liver decompensation throughout the course of the disease.

Some of the preventive measures: 

While there have been significant improvements in the treatment of hepatitis B and C in recent years, prevention is the key. Some of the preventive measures that can help in keep the condition at bay are

1. By maintaining proper personal cleanliness and avoiding consumption of raw or undercooked shrimp and oysters, hepatitis A and E can be prevented. Hepatitis B, C, and D which are contracted through contaminated blood, can be prevented by not sharing drug needles, razors or toothbrush and avoiding touching spilled blood. 

2. Hepatitis B and C can also be contracted through sexual intercourse and intimate sexual contact. Practicing safe sex by using condoms  can aid in reducing the risk of infection.

3. Vaccination against hepatitis B and hepatitis A help to prevent infection. Medications with good efficacy are available for treatment of hepatitis B and hepatitis C. These medicines help to prevent progressive liver damage caused by hepatitis virus.

4. People with immediate family members with hepatitis B should be tested for presence of infection and vaccinated if the tests turnout to be negative.

On this world hepatitis day, let us pledge to keep our liver healthy and get tested for hepatitis virus and get treatment whenever needed.

Also Read: Protect yourself from hepatitis 

Do you Know?

World Hepatitis Day is observed on July 28 on the birth anniversary of Dr. Blumberg (28 July 1925, USA). He and his team of researchers discovered the virus in 1967 and invented the World’s first hepatitis B vaccine in 1969.

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With Covid-19 outbreak, we are living through a tough time like no other. The deadly virus has not just infected our body but also our mind and has disrupted the normal course of life. Nothing is the same as before, including hospital visits or reaching out to the doctor to treat conditions other than the Coronavirus. It has been observed that the SARS-CoV-2 virus does affect liver inflammation and liver enzymes and can also result in liver dysfunction. This makes it essential for individuals with liver cirrhosis or Hepatitis B and C to take special precautions like enhanced monitoring of liver enzymes as one goes through the pandemic times.

 Why Hepatitis patients must be more careful?

While no official claims have been made that having Hepatitis B and C may put one at a greater risk of contracting Covid-19 as of now, it is certain that the virus can increase liver disease progression and decompensation of the organ. Clinical expertise and available information suggests that those with chronic conditions like Hepatitis may be at a higher risk for severe illness from Covid-19 virus, specifically if Hepatitis is not adequately controlled.

Staying safe during Covid -19 crisis with Hepatitis:

1. It is important that an individual with Hepatitis effectively practices social distancing like anyone else but with more restrictions. Self-isolate with or without an official order. Maintaining hand hygiene, i.e washing hands with soap and water or sanitiser, sanitising frequently touched surfaces along with the supplies from outdoor must be used after proper wash/care.

2. If one is on medications for chronic hepatitis during this time,  they must ensure that they have adequate stock for an extended period of time. The stocking up is important during uncertain times of lockdown as skipping a day’s medicine can flare up the virus and increase liver damage risk.

3. It is suggested to opt for a virtual meeting with the doctor if need be and use the telemedicine facility offered by most hospitals at this time to make sure the condition is under constant check. Hepatitis related tests like ultrasounds or blood tests could be kept on hold under the supervision of the doctor, if and only if, the delay does not affect one’s condition.

4. In case of visiting the hospital for any test, make sure one takes adequate protective measures to avoid contracting Covid-19 and makes a prior appointment with the doctor before visiting him or her.

Tips to keep your liver healthy during pandemic:

As we live through the pandemic, it is essential for those suffering from Hepatitis to be cautious about keeping up the health of their liver.

1. Keep an eye on the nutrition labels and make informed food decisions that are particularly favourable for liver health.

2. If possible, get fresh fruits and vegetables and freeze them for the upcoming weeks.

3. Do not give up on physical activities, both indoor and outdoor. Do indoor exercises and go out for a pinch of fresh air in a private garden or rooftop. Maintain social distancing for outdoor activities and get creative for indoor workouts.

4. Please beware of Over the counter/Unauthorized Herbs for any conditions during pandemic as most of these are toxic to liver.

5. Prefer home cooked foods as acute Hepatitis A and E are food borne.

Covid-19 and treatment for Hepatitis B or C

Those living with Hepatitis B or C should not stop or change their treatment unless they are advised by their doctors to do so. They must be prepared to pile up their medicines for a month, for now, to make sure they do not skip a dosage.

Although access to doctors may vary, continuous monitoring of health should not suffer. Make use of telemedicine consultancy as much as possible and in case the liver check-up has already got delayed, it is wise to schedule one on priority and go for it with adequate supervision by the treating doctor.

Also Reead: PROTECT YOURSELF FROM HEPATITIS

Dr Dinesh Kini K
Director – Gastroenterology & Hepatology
Sakra World Hospital, Bengaluru –  560103

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Viral Hepatitis is a global disease, a major public health challenge and large numbers of studies are available about the prevalence of various types of Hepatitis. Approximately 1.40 million fatalities worldwide occur every year due to Hepatitis and it is the second most leading cause of infection-related deaths after tuberculosis.

The liver is a vital organ that processes nutrients, filters the blood, and fights infections. When the liver is inflamed or damaged, its function get affected. Hepatitis means inflammation of the liver mostly caused by viruses but other infections, toxins, alcohol, drugs, and autoimmune diseases can also cause this disease. The viruses of different kinds, and therefore, different type of Hepatitis has been detected named as A, B, C, D and E based on the sequence of their discovery.

What is Hepatitis?

Hepatitis can manifest as acute or chronic illness. Generally speaking, Hepatitis is acute (early stage) if it resolves within 6 months and chronic (long-term type) if it lasts longer than 6 months. Hepatitis B, C and D are long time illnesses and are referred to as chronic hepatitis. Acute hepatitis has the ability to resolve on its own but chronic hepatitis may remain unrecognized and silent till a large proportion of liver cells are destroyed resulting in liver cirrhosis, liver cancer and/or liver failure.

Although each type of viral hepatitis is caused by a different virus and is spread in different ways, they all affect the liver and can cause serious health problems. Given below are the common root of transmission for Hepatitis B and C:

1. Blood transfusions

2. Mother to infant during childbirth (very common in hepatitis B; less common in hepatitis C)

3. Needle stick injury.

4. Sharing straws, razors, toothbrushes or other household items

5. Medical or dental interventions without adequate sterilisation of equipment

6. In the case of hepatitis B, infection can also occur through having unprotected sex with an infected person.

Sign and symptoms of  Hepatitis:

Chronic hepatitis may not have the symptoms in the beginning as it does not occur until the damage affects the liver function; however sign and symptoms of acute hepatitis appear quickly. They include:

1. Fatigue

2. Flu-like symptoms

3. Abdominal pain

4. Loss of appetite

5. Unexplained weight loss

6. Yellow skin and eyes, which may be signs of jaundice

If you think you could have been at risk or have above mentioned symptoms then it is recommended to contact with your doctor and follow the advice given by him/her. Specific tests are required to detect any illness. Do not assume that you would have been tested in a routine health check up.

Testing and diagnosis:

Testing and diagnosis is the gateway for access to both treatment and prevention services for Hepatitis. Viral Hepatitis can be quickly diagnosed with simple serological blood tests that are easily available, economical and easy to perform to diagnose and identify the type of hepatitis. If the results indicate the presence of hepatitis antibodies in the bloodstream, then blood sample is tested further to evaluate genotype of virus and the quantification of infection (viral load) by various molecular techniques like PCR. It also helps in monitoring the treatment and disease progression from acute to chronic disease. Blood test, Imaging studies and liver biopsy may be needed to determine the extent of liver cell damage. Correct diagnosis helps in timely management and prevention from developing chronic disease and risk of liver cancer.

Effective and safe vaccines that can prevent hepatitis A and B are available and it is recommended by the WHO that the hepatitis B vaccine should be given to all new-born as this can not only prevent infection from mother but also infection later in life. Hep B vaccination is the only vaccine that helps in prevention of liver cancer .More than one billion doses of the hepatitis B vaccine have been used since the early 1980s and it has been shown to be effective in approximately 95% of cases. Such vaccine provides very long term often lifelong immunity. Unfortunately, there is no vaccine available for hepatitis C, however effective medication has helped in curing the dreaded disease.

Covid-19 infection follow standard precautions:

Covid-19 infection does cause liver inflammation, increases liver enzymes and can also cause liver dysfunction, so in current scenario the patients with chronic hepatitis B or C without cirrhosis should follow standard precautions for coronavirus infection. Individuals, living with cirrhosis will be at higher risk of liver disease progression and decompensation. Additional precautions, such as frequent hand washes and regular monitoring of liver enzymes is required for such patients. Adoption of Universal precautions of avoiding unscreened blood transfusions, syringe/needle sharing /unprotected sexual contacts help in reducing the transmission of hepatitis B & C.

Protecting the health of your liver is most important. To avoid liver disease we should eat a balanced diet and avoid saturated fat, sugar and refined carbohydrates (such as white rice/bread and regular pasta). Physical activity indoor/outdoor should be encouraged during this time as well! Practice social distancing for outdoor activities, and get creative for indoor workouts. Last but not least, don’t share personal hygiene items like razors, toothbrushes and nail clippers etc. as they can carry microscopic levels of blood or other body fluids that may be contaminted with the viruses.

Also Read: VIRAL HEPATITIS IN PREGNANCY

HOW TO PREVENT HEPATITIS?

Dr Ahmad, Senior Consultant, Minimal Invasive Laparoscopic & Endoscopic Gastrosurgery
Dr. Nidhi Paliwal, Consultant Pathologist & Lab Incharge
Medeor Hospital Delhi NCR

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