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Chandigarh 27th July:- 'Elimination of Viral Hepatitis by 2030 – is the new slogan for the World Hepatitis Day – 2016, which is celebrated every year on 28th July. World Hepatitis Day was launched by the World Hepatitis Alliance in 2008 in response to the concern that chronic viral hepatitis did not have the level of awareness, nor the political momentum, seen with other communicable diseases such as HIV/AIDS, tuberculosis (TB) and malaria. This is despite the fact that the number of people chronically infected with, and the number of deaths caused by, hepatitis B and C is on the same scale as these conditions. In May 2010, the World Health Assembly passed a resolution on viral hepatitis which, together with vital commitments on prevention, treatment and patient care, made World Hepatitis Day an official WHO awareness day. In recognition of the birthday of Professor Baruch Blumberg, who won the Nobel Prize for discovering the hepatitis B virus, WHO decided that World Hepatitis Day will take place on 28 July every year.
Hepatitis literally means inflammation in the liver and commonly occurs due to different viruses, alcohol, drugs, fat and auto-immunity. Viral hepatitis can be either acute which is usually a self limiting disease remaining for few weeks or chronic lasting for months to years. Of the different viruses which cause viral hepatitis, hepatitis A virus and hepatitis E virus (HAV, HEV) cause acute hepatitis whereas hepatitis B, C and D (HBV, HCV, HDV) are notorious in causing chronic hepatitis even if they have an acute presentation.
HAV and HEV which cause AVH usually spread by feco-oral route and the infection usually occurs by the consumption of contaminated water. Patients with acute hepatitis either come sporadically or in the form of epidemics when a large population is affected usually by a common contaminated source. HAV occurs more commonly in children and young adults whereas HEV infects adults more commonly than children. Patients with acute hepatitis usually present with fever, tiredness, loss of appetite, nausea/vomiting all together called the prodromal features followed later by abdominal discomfort, dark urine, and jaundice (yellow skin and eyes) with or without itching and clay colored stools. The diagnosis of acute viral hepatitis (AVH) is usually easy and is made with the help of typical clinical presentation and liver Function Tests (Blood test), Ultrasound of the abdomen and a blood test to confirm the type of virus (For hepatitis A: IgM anti HAV, For hepatitis E: IgM anti HEV). As mentioned earlier, AVH is usually a self-limiting disease in the majority with symptoms usually lasting for less than 2 months; though a few persons are ill for as long as 6 months. Uncommonly, AVH can be complicated with Acute Liver Failure, associated with altered consciousness, bleeding tendency, kidney and other organ failure. This has been reported to occur more often when HEV causes AVH in pregnancy. Further AVH can also be complicated in few patients with Hemolysis (breaking of red blood cells) and cholestasis (Itching). Treatment of patients with AVH is usually symptomatic accompanied with good nutrition. In contrast to usual myths in AVH, patients should be given normal diet without restriction of any food items. Patients with severe acute hepatitis should be monitored carefully in the hospital and those developing acute liver failure should be evaluated for liver transplantation. There is no vaccine for HEV; hence to prevent infection the importance of clean and hygienic food and water cannot be overemphasized. Children above two years should be given two doses of vaccine (6 months apart) for HAV which usually imparts a good immunity for 15-20 years in majority of individuals.
Both HBV and HCV which cause chronic viral hepatitis (CVH) spread by the parentral routes like blood transfusion, contaminated needles and instruments, razors and uncommonly by sexual route. In contrast to children, majority of adults after acute symptomatic infection with HBV will clear the virus and the disease becomes chronic only in around 10% of patients. In contrast to HBV, acute infection with HCV is usually asymptomatic and becomes chronic in the majority. World over there are around 50 crore individuals infected together with hepatitis B and Hepatitis C virus infection. Of these around 5-6 crores are present alone in India. With a total world population of around 740 crores, almost every 12th person seems to be infected with either hepatitis B or C virus infection. In PGI itself, almost 80-100 new patients of HBV or HCV are seen per month in the liver clinic run twice a week by the department of Hepatology of the Institute, said Dr. Duseja from the department of Hepatology, PGI. Unlike patients of acute viral hepatitis, patients with chronic viral hepatitis have non-specific symptoms in the form of fatigue, lethargy or right upper abdominal discomfort with enlargement of liver and spleen. Untreated, patients with CVH can progress on to cirrhosis liver which at a later stage can cause symptoms of jaundice, swelling of feet, fluid in the abdomen, bleeding from mouth and loss of consciousness. Patients with cirrhosis liver are also at risk of developing liver cancer. The diagnosis of CVH is made based on blood tests to check the liver functions and the activity of the virus (HBV or HCV) based on molecular tests. Ultrasound, CT scan, MRI and Endoscopy are useful in making the diagnosis of cirrhosis and liver cancer and liver biopsy is required in select patients with CVH. Over the years there has been significant advancement in the treatment of both HBV and HCV both with injections (Interferon) and oral drugs. Dr Duseja said that very potent oral drugs are now available for HCV and at PGI, the response rate in patients with chronic hepatitis C is close to 95% in patients with early stage of the disease. Patients who have advanced to cirrhosis liver and liver cancer are managed according to the stage of the disease and with oral drugs for HBV and HCV. A safe and effective vaccine is available against HBV which can be given at birth and requires three dosages for > 90% protection. Unfortunately there is no vaccine for HCV and all that is recommended is to take the universal precautions while handling patients infected with HCV.
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