Hepatitis Screening: Need of the Hour

23/07/2020

"Globally, over 300 million people suffer from Hepatitis and yet are unaware that they have Hepatitis. In fact, viral Hepatitis B and C are the second major killer infectious diseases, following closely after tuberculosis. 95% of people are living with Hepatitis, unaware of their condition. This silent killer can not only be fatal to the host but also poses a risk of spreading to others."

Hence, regular screening for a wide range of population, availability of tests, as well as awareness about the disease is of utmost importance. As per current recommendations by WHO, universal screening for B & C has been made mandatory for everybody followed by universal immunization for Hepatitis B.

Every year to commemorate the birth anniversary of Prof Bloomberg who discovered the dreaded yet treatable Hepatitis B virus, World Hepatitis Day is celebrated on 28th July around the world. It is important for everyone to be screened for this infection and take appropriate treatment if necessary to have a secure future.

What is Hepatitis?

The term hepatitis is used in conditions when there is inflammation in the liver. Most often, Hepatitis is caused by viruses, and the common viral Hepatitis infections are Hepatitis B and C.

Both, Hepatitis B and Hepatitis C infections begin as short-term infections (acute) but in some people, the virus remains in the body that leads to a lifelong (chronic) infection

  • Chronic Hepatitis B and C infections are more serious and can lead to considerable liver damage and scarring (cirrhosis) or liver cancer
  • Risk for chronic infection is related to age at infection
  • About 90% of infected infants with Hepatitis B will become chronically infected, while only 2%–6% of adults will have the chronic form
  • About 75%–85% of people who become infected with Hepatitis C virus will develop a chronic infection

Why is Hepatitis B so dreaded infection?

Hepatitis B is the most important cause of liver cancer across the world. Hence, it is important to identify and treat in early stages to prevent complications of liver cirrhosis and liver cancer in later life. Hepatitis B can also cause liver cancer in early adulthood as well if virus has been acquired in childhood and there is positive family history. Secondly, Hepatitis B integrates into the human DNA in the liver cells and hence can never be completed eliminated once infected.

Hence, it is of paramount importance to identify the presence of infection and start treatment in early stages before damage to the liver is irreversible. Moreover, it is absolutely essential that everyone gets vaccinated so that chance of transmission and acquiring this dreaded infection is minimised.

It is a wake-up call for us to be more proactive and bridge the gap between the undiagnosed and diagnosed cases of Hepatitis. This may help decrease fatalities associated with it and improve the quality of life of infected individuals.

Risk factors

  • Having mucosal contact with infectious blood, semen, and other body fluids
  • Sexual transmission
  • Sharing contaminated needles to inject drugs
  • Getting a tattoo in unregulated settings
  • Sharing shaving blades
  • From an infected mother to her newborn during delivery
  • Patients on hemodialysis

Treatment:

Hepatitis B
  • Acute infection
    • Since 85-90% patients clear the virus in acute stage, no medicine is required
    • Rest, proper nutrition, and fluids are recommended
    • Some people may need to be hospitalized if there is persistent nausea and vomiting
    • Jaundice is self-limiting and will settle in next 4 – 6 weeks
    • Complementary or alternative medicines not recommended
  • Chronic infection
    • Should seek the care or consultation of a doctor, especially a liver specialist
    • Regular monitoring for signs of liver disease and evaluation may be necessary
    • Several medications have been approved for Hepatitis B treatment; new drugs are in development
    • Not all persons need treatment, but once a person starts treatment, he or she will need to take medication for life
    • Hepatitis B is one of the most important causes of development of liver cancer. Hence if detected, it is important to stage the infection and initiate treatment to prevent further liver damage, halt any progression to cirrhosis and most importantly,reduce the risk of liver cancer
    • All family members of the patient should be screened for Hepatitis B mandatorily and vaccinated immediately if negative
  • Prevention of Hepatitis B by taking vaccination should be mandatory as prevention is always better than cure

Hepatitis C

  • Acute infection
    • Since 75-85% patients clear the virus in acute stage, no medicine is required
    • Rest, proper nutrition, and fluids are recommended
    • Some people may need to be hospitalized if there is persistent nausea and vomiting
    • Jaundice is self-limiting and will settle in next 4 – 6 weeks
    • Complementary or alternative medicines not recommended
  • Chronic infection
    • Present treatment of chronic Hepatitis C is safe and extremely effective with 90 – 95% cure rate
    • Depending on the clinical setting, the duration of treatment maybe 3 – 6 months
    • Early detection and treatment prevents further liver damage and progression to cirrhosis and liver cancer
    • All family members of the patient should be screened for Hepatitis C mandatorily and start treatment if detected infection
    • At present, no vaccination is available to prevent Hepatitis C
    • Patient with Hepatitis C and liver cirrhosis should be screened for liver cancer at periodic intervals as there is a continued risk of liver cancer even after Hepatitis C virus infection is cured
    • Patients should be vaccinated against Hepatitis A and Hepatitis B
    • Persons with chronic Hepatitis C should avoid alcohol because it can cause additional liver damage
Dr Chandan Kumar M.D (Gen Med), D.M (Hepatology)
Senior Consultant – Hepatologist &
Lead Transplant Physician

Disclaimer:The views and opinions expressed in this article belong solely to the author. They do not reflect the opinions or views of the organization.

 

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