The ABCs of viral hepatitis

Viral hepatitis is one of the biggest global health threats of our time, with 1.34 million deaths a year caused by the viral liver disease. Hepatitis B and C kill more people annually than HIV/AIDS, malaria and TB. However, according to the World Health Organisation, there are approximately 290 million people in the world that are unaware that they are living with viral hepatitis.

Every year on the 28th of July, World Hepatitis Day (WHD) takes place to raise awareness and to encourage real change in how we tackle hepatitis. Unless there is a massive scale-up in screening, diagnosing and access to care, people the world over will continue to be infected and many more lives will be lost. 

What is hepatitis? 

Hepatitis refers to inflammation of the cells in the liver that can lead to liver damage. Our liver removes toxins from our blood, stores vitamins and produces hormones. Hepatitis can affect all of these functions, so the damage done by hepatitis can be fatal. It can be autoimmune or caused as a secondary result to drugs, toxins and alcohol, but it is mostly caused by viruses.

There are at least five types of hepatitis that are caused by a virus; hepatitis A, B, C, D, and E. We’ll focus on the most common types; hepatitis A, B and C. These three types are each caused by a different virus that can lead to acute hepatitis, lasting for up to six months or chronic (long-lasting) hepatitis (in the cases of hepatitis B and C).

Hepatitis A

Hepatitis A is caused by infection with the hepatitis A virus (HAV). This is commonly transmitted by consuming food or water contaminated with faeces of a person infected with the virus. A lot of people contract it while travelling abroad. It can also be transmitted through direct contact with an infectious person. 

Most people make a full recovery after hepatitis A, with symptoms resolving within two months, after which they are immune to the condition. If the virus continues to progress, however, it can be life-threatening.

There are vaccines to protect against hepatitis A.

Hepatitis B

Hepatitis B can be transmitted in a number of ways, through contact with infected blood, semen and other bodily fluids that are infected with the hepatitis B virus (HBV). More specifically, these include:

  • Unprotected sex with an infected person
  • Sharing infected needles 
  • Getting a tattoo done with unclean, unsterilized needles
  • Accidentally pricking oneself with an infected object if you’re a nurse or care worker 
  • Sharing an infected razor or toothbrush 

A newborn baby can also catch the virus from breast milk if the mother is infected with HBV.

Most adults can overcome HBV after three months of the infection and be immune to the infection for the rest of their lives. Unfortunately, 90% of infants and 20% of children will develop chronic HBV, which means they are at a high risk of developing liver cancer or scarring of the liver. In 2015, 887,000 deaths worldwide were linked to HBV. 

There is currently no cure for hepatitis B, but a vaccine is available to protect against it. 

Sharing toothbrushes can put you at risk of hepatitis B

Hepatitis C 

Hepatitis C comes from the hepatitis C virus (HCV). HCV becomes an infection that lasts for life in 70-85% of people. It can lead to liver swelling and damage, with approximately one in four people developing cirrhosis which can lead to liver cancer. HCV is passed through direct contact with infected bodily fluids, typically through injected drug use.

Others at risk of HCV include:

  • Anyone who has received infected blood donations (now blood is tested for HCV)
  • Healthcare workers exposed to sharp infected objects
  • Children born to infected mothers 

HCV is not picked up from contact with faeces and it is less likely to be transmitted through sexual intercourse. 

No vaccine is available to prevent HCV; however it can be successfully treated if caught in time. 

How would I know if I had hepatitis? 

Many people with hepatitis have few to no symptoms. Sometimes, symptoms might not appear until 15-180 days after being infected. At first, hepatitis symptoms are similar to a mild cold or flu and can include:

  • Diarrhoea 
  • Nausea and vomiting
  • Fatigue
  • Fever
  • Muscle or joint aches 
  • Abdominal cramping 
  • Weight loss 
  • Jaundice
  • Pale stools 

Acute hepatitis is not usually fatal, but if it progresses into chronic hepatitis, it can result in liver failure. 

Chronic hepatitis can also present with symptoms such as:

  • Swelling of the lower body
  • Blood in faeces 
  • Dark urine
  • Hives or itchy skin

Unfortunately a lot of people don’t know they have chronic hepatitis until liver failure occurs. This is why early diagnosis is so important.

Fatigue can be one of many silent signs of hepatitis

Diagnosing hepatitis 

As the symptoms of the different types of hepatitis can be similar, diagnosis will depend on a number of tests.

A physical exam will be carried out by your doctor, where they may press down on your abdomen to see if there is pain, tenderness or enlargement of the liver.

They will take a look at your medical history and whether you have been exposed to a possible cause of hepatitis, such as dirty needles. The following tests can confirm a diagnosis if hepatitis is thought to be present:

  • Blood tests: test for the presence of antibodies in the blood, which indicates that your body is fighting an infection. Liver function can also be tested. If there are high liver enzyme levels in the blood, this can indicate that the liver is stressed or damaged. 
  • Nucleic acid tests: can be done for hepatitis B and C. A HBV DNA or HCV RNA test can confirm the rate at which the virus is reproducing in the liver.
  • A liver biopsy: can measure the extent of damage to the liver. This is an invasive procedure that requires a sample of tissue to be taken from the liver.
  • An ultrasound: allows the doctor to take a close look at the liver, to see if it is damaged or enlarged and to check for any fluid in the abdomen. 

Prevention 

As hepatitis A is mostly spread through contaminated food and water, the best means of prevention is to take precautions while travelling such as making sure that food is cooked through, drinking only bottled water, washing your hands thoroughly after using the toilet and getting vaccinated against the virus before your trip. 

To lower the risk of contracting hepatitis B and C, always practice safe sex, only use clean needles and do not share toothbrushes or razors.

There are vaccinations available to prevent hepatitis A and B, so if you plan to travel to countries where sanitation is not the best or if you’re a healthcare worker, it’s a good idea to be vaccinated against hepatitis. There is currently no vaccine against hepatitis C, so precautionary measures, as mentioned above, are vital to avoid infection.

Treating Hepatitis 

There’s no specific treatment for HAV and it’s usually just a short-term illness, but the patient will be advised not to drink alcohol or take drugs while they’re recovering. Vaccinations are available in the UK against hepatitis A, however, they aren’t routinely given unless a person is at high risk of developing the virus. Someone who is travelling to a part of the world where the virus is rampant or someone with long-term liver disease would be in the high-risk group.

Anyone diagnosed with HBV must abstain from alcohol and will be prescribed antiviral medication if the viral infection becomes chronic. This medication will have to be continued for months or even years, depending on the severity of the condition. The vaccine available against HBV is 95% effective. The HBV vaccine is routinely available as part of the NHS and is offered to all babies at eight, 12 and 16 weeks. It is also recommended that medical personnel and anyone at risk of contracting the virus be given the vaccine.

There is no preventative vaccine against HCV at present, however it can be treated successfully with antiviral medication, effective in 90% of cases. 

Eliminating viral hepatitis 

Low coverage of testing and treatment is the most important thing to be addressed to achieve global elimination of hepatitis by 2030. Birth dose vaccines cost as little as 20 cents. However they are still unavailable in 48% of countries around the world. In 2015, viral hepatitis was included in the Sustainable Development Goals (SDGs) and in 2016 the world’s first global hepatitis strategy to eliminate the disease was ratified. Eliminating hepatitis B and C would prevent 36 million infections and save 10 million lives. Better awareness and understanding, as well as greater access to treatment needs to be achieved.

This year, you too can do something to raise awareness for hepatitis and to encourage anyone at risk to be vaccinated or to take precautionary measures to lower their risk of becoming infected. Even if it’s just posting to social media with the hashtag #WorldHepatitisDay, every small contribution made will make a huge impact when pooled together. Together we can find the missing millions who are unaware that they have hepatitis, in the hope that they will seek the treatment that they need.


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