Liver diseases are increasing day by day. As its known most of the liver diseases are silent. Detection upon development of symptoms is often late for managing the liver diseases. Hepatitis B and hepatitis related disease, liver disease due to alcohol and obesity with fatty liver are the most common. Hepatitis B is the common liver infection by the viruses and is a major health problem for Asian countries, India and also for the state of Odisha. The 28th July was celebrated across the globe as World Hepatitis Day to create awareness on early detection, treatment, and prevention of spread as a respect to its inventor Dr. Barry Blumberg-the Nobel laureate.
What is Hepatitis?
It’s the swelling of liver as a response to injury by any infection. Most commonly it’s due to the common viruses like Hepatitis A & E (Due to contaminated water or food), Hepatitis B & C (Due to the blood related spread). Both of these hepatitis viruses can damage liver that can vary from mild jaundice to life threatening liver failure and death.
What is Jaundice?
Jaundice is the most common symptom of liver disease. It presents as yellow color of eye; yellow skin and sometimes-affected person also notice yellow vision too. Most commonly with jaundice there is a decrease in appetite, loss of interest for food, weakness and occasional fever and mild pain abdomen. Generalized itching, passage of whitish stool (instead of yellow stool) and severe abdominal pain warrants immediate medical attention. Jaundice is not a disease, it’s a symptom and indicates liver problem. So whenever you find yourself or anyone with jaundice, it needs immediate attention to find the cause and remedies. Never go for any treatment like traditional medicine or alternative medicine treatment without any diagnosis, it causes more damage to liver and further deterioration in jaundice instead of recovery.
What is Hepatitis A &E?
It’s the most common cause of jaundice outbreak in the community. Hepatitis A more common in children and hepatitis-E in adult. These infections are mainly due to contaminated water and unhygienic food. The summer and rainy season often showed a massive rise in the number of cases. Jaundice with fever and loss of appetite and weakness is the main symptoms. The patient need to visit a doctor and do test, to know the severity. But otherwise no restriction in food items to be kept, no medicine needed and strictly avoid any locally made drugs. Most of the cases recover well with diet and rest. The pregnant female develop more severe liver problem and death rate is 20times higher than the other person. So any pregnant female with jaundice needs close monitoring. As this hepatitis spread by contaminated water and poor hygiene, multiple members of the family, many families in a village or town affected at the same time.
Water borne hepatitis (A&E)-how to prevent?
As rightly said, hepatitis A &E spread by water. The infected person passes the viruses in their stool. The water contaminated by it, lack of adequate sterilization and unhygienic practices made it spread from one to other. The first of all the child can get vaccinated for hepatitis A vaccination, but this vaccine is not helpful for adults. Simple practice of boiling the water or use of bleaching powder is effective. Avoid vendor/street/road side foods that are not hygienic (ensure the food vendor is using gloves and properly handling them, not infected with Hepatitis A &E). Best possible to avoid uncooked food/ unpacked food or salad on roadside and unhygienic condition. At community level-ensure supply of safe drinking water, well maintained drainage system for sewerage, the water supply maintained periodical check up for leakage or contamination,
Hepatitis B-what is it and why its problematic?
Currently it affects 3% of population i.e. 40 millions Indians. About 15–25% of them suffer from cirrhosis and liver cancer and may die prematurely. Infections occurring during infancy and childhood have the greatest risk of becoming chronic. Of the 2.6 Crore (26 million) infants born every year in India, approximately 10 Lakhs (1 million) run the life-time risk of developing chronic
HBV infection. Problem is that 90% of public don’t aware of the infection and detected on routine evaluation. There is a need for awareness, detection and public health measures to prevent disease transmission and decrease the burden of the disease.
Hepatitis –C what is it and why it’s problematic?
It is a virus infection of liver and mostly blood borne i.e. by contaminated blood transfusion, surgery, needle prick, unsafe syringe and injecting drug abusers. It is most infectious virus i.e. 100 times more chance infection than the HIV. Once infected in 85% cases it becomes chronic liver disease may progress to cirrhosis and liver cancer in a period of 15-20 years. But often remain asymptomatic and early diagnosis and the recently available drugs make the treatment easy and effective. India is estimated at between 0.5% to 1.5% of population i.e. about 1 Crore Indians. With available effective drugs it can be cured. And patient can revert to complete normal life style if detected and treated early. This has been planned globally to eliminate hepatitis C by 2030.
Hepatitis B most commonly comes from mother-how to tackle it?
Hepatitis B transmitted by blood. The most common route being mother to bay transmission (most cases), surgery, blood product transfusion, tattoo are the other causes. The transmission of hepatitis B form mother to baby mainly occurs during pregnancy or immediately after pregnancy. When it infected the newborn, most of the kids develop chronic infection and early age liver cirrhosis and cancer. All pregnant mothers should be tested for hepatitis B during pregnancy (now this is done routinely and free of cost at all Gov. hospital) and free compulsory hepatitis B vaccine is being given to all newborn (Mission Indradhanush by Gov of India). Those mothers detected hepatitis B pregnancy should consult doctor and have to take medication which safe and effective in preventing the disease transmission. All delivery of hepatitis B positive mother should be institutional, so that the newborn will get special injection under supervision of a doctor. This will further minimize even any chance of infection transmission effectively.
Hepatitis and married life- no worries!!!
Hepatitis is not a disease that will hamper your daily life activities, physical activities or married life. A common problem is the nonrectifiable stigma for the marriage and physical relationship. With hepatitis C effective treatment in 3-6 moths cures the infection. Hepatitis C transmission by sexual contact is very minimal too. For hepatitis B the normal married life, sexual relationship and child bearing is possible. Never to be panic for it, be it male or female. Effective treatment, vaccination of the opposite partner is needed. The transmission by normal sexual route, oral secretion or body fluid is minimal.
What is family screening-what,whom and when to do?
As we discussed hepatitis B is mostly transmitted from mother to baby. So in family brothers and sisters, maternal side uncles or aunt or grandmother may also be infected. They are mostly asymptomatic or having an occult infection. So routine screening followed by vaccination for all the persons is the best policy. Else with detection of a hepatitis B infection in a patient, his/her immediate family members, should be immediately tested for possible infection, if detected then can be managed else need vaccination. Mother, siblings (brothers& sister), spouse (husband or wife) and maternal side first-degree relatives need to go for a family screening.
Strategies to reduce hepatitis burden in society
1.Using vaccines : For hepatitis-B; 3 doses of vaccine for nonvaccinated person, booster single dose for selected cases (low protective titer, more than 10 years from last vaccination, defaulters).
2.Improving blood safety:Ensuring the availability of safe blood and blood products.
3.Enhancing infection prevention and control in health care settings: safe injection practice, single use syringe, more use of disposable items and reducing unnecessary injection and educating employee regularly on these issues and effective sharps and waste management are important.
4.Preventing mother-to-child transmission of viral hepatitis: hepatitis B virus testing in young women, care of pregnant women with chronic hepatitis B virus infection, delivery of hepatitis B virus vaccine to the infant within 24 hours of birth, safe delivery practices, strengthened maternal and child health services, and interventions to prevent transmission based on antiviral treatment are crucial.
5.Birth: dose vaccination is a key intervention for prevention of hepatitis B virus infection in infants.
6.Promoting safer sex: Safer practices like minimizing the number of sexual partners, consistently and correctly using male and female condoms and to avoid male to male sex are few to be ensured or encouraged.
7.Expanding treatment: Effective antiviral agents against viral hepatitis B and C should be offered to the poorest of poor at the affordable price or free of cost and steps needed to address the compliance also needed.
8.Tailoring services for different populations and locations: high risk groups like people who inject drugs, migrants, haemodialysis patients, people who undergo skin-piercing procedures including tattooing, sex workers and men who have sex with men needs special attention towards early detection, treatment and vaccination and legal provision for the containment of infection. So that these groups will get maximum services for the highest impact.
- Linking and integrating hepatitis services with other health services: like that for sexually transmitted infections, HIV, reproductive health, drug dependence and blood safety etc. so that the message can reach maximum people in an effective manner.
- Strengthening community-based services: Involving NGOs, public figures, celebrities and people of social repute as brand ambassador. Periodic meetings, seminars, street plays, distribution of printed materials, television or multimedia advertisements will convey the message.
- Involving people living with viral hepatitis: Actively engaging affected populations, can act as a powerful force in addressing discrimination, and bring trust upon the services offered them via these people like brand ambassadors.
By Dr. Ashok Kumar Choudhury