Viral Hepatitis - I Can't wait to get tested

Today July 28th is recognised as World Hepatitis day bringing the world together under a single theme to raise awareness of the global burden of viral hepatitis. Theme this year is 'I Can't wait to get tested '.

Stats say it's cruel: 

Yes this is the illness that we cannot wait to act on it. Most of the people dying with this are unaware of this illness until they are in their last stages of disease. Hepatitis affects hundreds of millions of people worldwide, causing acute and chronic disease and killing close to 1.34 million people every year. Hepatitis can cause inflammation of the liver both acutely and chronically, and can kill a person. In some countries hepatitis B is the most common cause of cirrhosis and may also cause liver cancer.

What is Viral Hepatitis? : 

It is the damage of liver tissue due to the invasion of Hepatitis virus. Hepatitis virus are of different types including Hepatitis A, B, C, D and E. 

• Hepatitis A and E are mainly spread by contaminated food and water. 
• Hepatitis B is mainly sexually transmitted, but may also be passed from mother to baby during pregnancy or childbirth and spread through infected blood. 
• Hepatitis C is commonly spread through infected blood such as may occur during needle sharing by intravenous drug users. 
• Hepatitis D can only infect people already infected with hepatitis B.

Infection due to all other types of Hepatitis can be curable if effected and detected early except Hepatitis B virus. Once infected with Hepatitis B is a life long bond with that virus to the liver tissue.  

What are the symptoms? : 

Many people have no symptoms during an initial infection. 95% of the people stay asymptomatic in the initial phase until the liver damage is 75% done. 

Some people stay asymptomatic lifelong and may go unrecognised. If recognised accidentally, they are termed to be carriers with out any active infection. Still they can transmit disease if their blood is transfused accidentally without testing. 

• But some people in an acute phase of infection develop illness that begins with general ill-health, loss of appetite, nausea, vomiting, body aches, mild fever, and dark urine, and then progresses to development of jaundice.
• Some people develop severe form of liver disease known as fulminant hepatic failure and may die as a result.
• In chronic phase of the disease inflammation of the liver progress to cirrhosis and may also develop hepatocellular carcinoma. Chronic carriers are encouraged to avoid consuming alcohol as it increases their risk for cirrhosis and liver cancer.

Although rare, reactivation is seen most often following alcohol or drug use, or in people with impaired immunity. Approximately 50% of overt carriers experience acute reactivation.

How to diagnose? :

For detection of hepatitis B virus infection serum or blood tests that detect either viral antigens (proteins produced by the virus) or antibodies are required. 

Antigens tested - HBsAg (surface antigen), HBcAg (core antigen), HBeAg. These antigens are detected with the help of detection of antibodies produced against them. Antibiodies against HbsAg is most commonly tested using a rapid test kit that tests for both IgG and IgM. This test may be negative in the early days of infection. 

Liver enzymes : Alanine transaminase is elevated in the chronic cases due to inflammation of the liver tissue. Other liver function tests may also be seen elevated in severe symptomatic cases. 

PCR tests have been developed to detect and measure the amount of HBV DNA, called the viral load, in clinical specimens. These tests are used to assess a person's infection status and to monitor treatment.

A number of different tests are available to determine the degree of cirrhosis present. Transient elastography (Fibro-Scan) is the test of choice, but it is expensive.

Treatment : 

As majority are asymptomatic and undetected, treatment is not included early in many cases which progess to severe form of the disease. Acute hepatitis B infection does not usually require treatment and most adults clear the infection spontaneously. 

Although none of the available medications can clear the infection, they can stop the virus from replicating, thus minimizing liver damage. 

World Health Organization recommended Tenofovir or Entecavir as first-line agents. Two immune system modulators interferon alpha-2a and PEGylated interferon alpha-2a are also used in the treatment. Those with current cirrhosis are in most need of treatment. 

Tenofovir given in the second or third trimester can reduce the risk of mother to child transmission by 77% when combined with hepatitis B immunoglobulin and the hepatitis B vaccine, especially for pregnant women with high hepatitis B virus DNA levels. 

Liver transplantation is the last step in the management of liver failure due to viral Hepatitis. 

Prevention : 

Prevention is better than cure is must followed in case of viral Hepatitis. As once infected cannot be cured at any cost. 

So screening for the Hepatitis virus is a must before performing blood transfusions, surgical procedures, Dialysis, invasive procedures, dental procedures. As it is a blood born infection screening is compulsory before every blood transfusion. Even the BIG B Amitabh Bachchan is infected with Hepatitis B due to the unscreened blood transfusion. 

Apart from the screening the major tool in prevention is the Vaccination. Every newborn is recommended to be vaccinated with the HBV vaccine before 24hrs after birth. Later two booster doses are given. All the people who are in a risk of getting HBV especially Health care workers, Blood bank technicians, immunocompromised patients, patients on chemotherapy, alcoholics and people with multiple sex partners. According to the data vaccination not only decreased the incidence of the disease but also decreased the incidence of liver cancer.

HBV vaccine is available in the market with different names Recombivax HB, Engerix-B, Heplisav-B. It is given as intramuscular injection. 

Viral Hepatitis is not a simple issue that should be ignored. Everyone should be educated about this and awareness should be created among people in undergoing screening at an early stage and get vaccinated at an early time.

Screen early, get yourself vaccinated, stay hydrated, Maintain your health and save your liver.

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