KOCHI: The liver is a vital organ that processes nutrients, filters blood and fights infections.
‘Hepatitis’ means inflammation of the liver. When the liver is inflamed, in due course it ends up in scarring and its function gets deranged. Heavy alcohol use, toxins, some medications, herbal remedies and rarely certain genetic conditions can cause hepatitis. However, hepatitis is most often caused by a virus. In India, the most common types of viral hepatitis are Hepatitis A, Hepatitis B, Hepatitis C and Hepatitis E.
Significant health problem in Asia
Deaths due to viral hepatitis are much more than due to AIDS and tuberculosis according to a publication by WHO. East Asia and South Asia have greatest number of hepatitis deaths (52% of total deaths happening globally due to hepatitis), followed by Africa. This does not form a major health hazard in the developed western world, particularly so in the case of food and waterborne viral hepatitis. It is difficult to accurately assess the death rate and morbidity due to viral hepatitis due to the fact that hepatitis deaths are caused by five distinct viruses (Hepatitis A-E) with different routes of transmission and death occurs after several decades following infection (silent slow scarring to the liver).
Two hepatitis virusespersist in human body for decades together and ultimately result in liver cancer and liver cirrhosis.Mode of transmissionViral hepatitis is either transmitted through contaminated food or water (A, E) or via blood and body fluids (B, C). The viruses which get transmitted through water and food are mostly self-limited resulting in acute illness with full resolution. The blood-borne viruses (B, C) are villainous and notorious to persist in the body for long, induce scarring, liver cancer and liver cirrhosis.
The waterborne viruses spread when unsanitary conditions allow water or food to become contaminated by human waste containing the viruses (fecal-oral mode of transmission). Hepatitis A is typically spread among household members and close contacts through oral secretions or stool (poor hand washing). It is common to have waterborne viral hepatitis spreading to customers in restaurants and among children and workers in day care centres if hand washing and sanitary precautions are not observed.
Bloodborne hepatitis viruses (B, C) spread when transfer of blood or body fluid occur from an infected person. HBV can spread by sexual contact, sharing needles among drug abusers, accidental needle stick injury, blood transfusions, hemodialysis and by infected mothers to their newborns.
What are the symptoms and signs of viral hepatitis?
The period of time between exposure to hepatitis and the onset of the illness is called the ‘incubation period’. It varies between virus to virus. Hepatitis A and E viruses have an incubation period of about 2 to 6 weeks while Hepatitis B and C roughly have an incubation period of 2 to 6 months.
Symptoms of acute hepatitis
Symptoms of acute viral hepatitis include flu-like symptoms, fatigue, dark urine, light-colored urine, fever, vomiting and jaundice (yellow discolouration of skin and white of the eye). However, infection with these viruses may occur with minimal symptoms and may go unnoticed. Rarely, acute viral hepatitis can end up in fulminant liver failure (drastic decline of liver function in a short span of hours to days). Treatment of acute fulminant hepatitis should be done in centres that can perform liver transplantation since fulminant hepatitis has high death rate to the tune of 80% without liver transplantation.
What is chronic hepatitis?
In contrast, the viruses transmitted through blood and body fluids although can have an acute presentation as mentioned above, more commonly it silently stealthily remains in body for a decade or two and cause chronic hepatitis, silent scarring damage. The Immune system is unable to eradicate B and C viruses and hence these viruses cause unrelenting long drawn inflammation in liver lasting for many years. This ultimately results in cirrhosis and liver cancer. The symptoms of chronic hepatitis due to B and C are often mild and non-specific and diagnosis are delayed until permanent damage is inflicted on to liver. Screening and early detection at a curable stage rarely happens.
Lifestyle measures and precautions to prevent liver damage from viral hepatitis
1. Ensure hygienic drinking water. It is desirable to install water purifiers with UV and or RO methods in addition to mechanical filtration using candle type filters. While travelling bottled mineral water from standard brands and reliable retailer to be used.
2. Avoid roadside food vending especially fruit juices, milkshakes.
3. Barber shops, beauty salons – sharing of razor blades, metal scrapper used to remove blackheads and white heads from facial skin can act as source of infection if not disposable or if not properly sterilised.
4. Sexual transmission is common in Hepatitis B and less so in HCV. Safe sexual practices to be observed.
5. Intravenous Drug use (IVDU)- is a growing epidemic in Kerala campuses. Sharing of needle happen especially since the user won’t be in his full senses. Warn your kids on the risk.
6. Hepatitis A and B are vaccine preventable.
7.Early detection of silent long standing persistence by Screening of HBV and HCV. Effective treatment is available for both these viruses.
Dr Harikumar R Nair,
Sr. Consultant Hepatologist,
VPS Lakeshore Hospital
(The views expressed by the author are his own)