Many people mistakenly think that hepatitis means viral hepatitis, and that all forms of hepatitis are contagious. Actually, the word hepatitis is a catch – a term that refers to any inflammation of the liver – the irritation or swelling of the live cells from any cause. Hepatitis can be acute (inflammation of the liver that lasts less that 6 months ) or chronic (inflammation of the liver that lasts more than six months ) and has many different causes.
It is usually caused by a group of viruses known as the hepatitis viruses, including A, B, C, D and E. Other viruses may also cause it, such as those that cause mononucleosis (the Epstein-Barr virus) or chicken pox (the varicella virus). Hepatitis also refers to inflammation of the liver caused by drugs and alcohol abuse or toxins in the environment. In addition, people can develop hepatitis from other causes such as fat buildup in the liver called fatty liver hepatitis or NASH (Nonalcoholic steatohepatitis) or an autoimmune process in which a person’s body makes antibodies that attack the liver (autoimmune hepatitis).
Viral hepatitis is common. Most people with chronic hepatitis are not diagnosed. Many people mistake their symptoms as flu instead of hepatitis. The five hepatitis viruses can be transmitted in different ways, but they all have one thing in common: They infect the liver and make it swell up. Many people with acute hepatitis recover with a lifelong immunity to the disease, but some people with hepatitis die in the acute phase (Fulminant liver failure). Hepatitis B and C may progress to chronic hepatitis, in which the liver remains inflamed for a decade or more. This can lead to cirrhosis, liver cancer, and sometimes death.
There are 5 main hepatitis viruses, referred to as types A,B,C,D and E. In particular, types B and C lead to chronic disease in millions of people world over and together, are the most common cause of liver cirrhosis and cancer. Hepatitis A and E are typically caused by ingestion of contaminated food and water. Hepatitis B,C and D usually occur through contact with infected blood and body fluids. Common modes of transmission for these viruses include receipt of contaminated blood and blood products, invasive medical procedures using contaminated equipment, transmission from mother to baby at birth and also by sexual contact. Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine,fevr,fatigue, nausea, vomiting and abdominal pain.
Hepatitis A virus (HAV) is present in the feces of infected persons and is most often transmitted through consumption of contaminated water or food. Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections lifelong. However, HAV infection can also be severe and life threatening. Most people in areas of the world with poor sanitation including rural India get infected with this virus. Safe and effective vaccines are available to prevent HAV.
Hepatitis B virus (HBV) is transmitted through exposure to infective blood, semen, and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth. Transmission may also occur through transfusion of HBV – contaminated blood and blood products, through injections during medical procedures and through injection drug use. HBV also poses a risk to health care workers (doctors , nurses) who sustain accidental needle stick injuries while caring for infected – HBV patients. Safe and effective vaccines are available to prevent HBV.
Hepatitis C virus (HCV) is mostly transmitted through exposure to infective blood . This may happen through transfusion of HCV – contaminated blood and products, contaminated injections during medical procedures, and through injection drug use. Sexual transfusion is also possible, but is much less common. Intravenous Drug Abuse (IVDU) is an evolving cause of HCV transmission in India. There is no vaccine for HCV.
Hepatitis D virus (HDV) infections occur only in those who are infected with HBV. The dual infection of HDV and HBV can result in a more serious disease and worse outcome. Hepatitis B vaccines provide protection from HDV infection.
Hepatitis E virus (HEV) is mostly transmitted through consumption of contaminated water or food. HEV is a common cause of hepatitis out breaks in developing parts of the world and is increasingly recognized as an important cause of disease in developed countries. In India, it is more common in north India especially Jammu and Kashmir.
The period of time between viral entry into the body to hepatitis and the onset of illness is called the “incubation period”. It varies from virus to virus. Hepatitis A and E viruses have an incubation period of about 2 to 6 weeks while Hepatitis B and C roughly have an incubation period of 2 to 6 months.Symptoms of acute viral hepatitis include flu like symptoms, fatigue, dark urine, fever, vomiting and jaundice (yellow discoloration of skin and white of the eye). However, infection with these viruses may occur with minimal symptoms or even may go unnoticed. Rarely, acute viral hepatitis can end up in a very severe form called “fulminant liver failure”(drastic decline of liver function in a short span of hours to days resulting in death). Treatment of acute fulminant hepatitis should be done in centers that can perform liver transplantation, since fulminant hepatitis has high death rate to the tune of 80% without liver transplantation.
In contrast to waterborne viruses, the viruses transmitted through blood and body fluids (Hepatitis B, C) although can have an acute presentation as mentioned above, more commonly they remain silently in the body for a decade or two and cause chronic hepatitis. Immune system is unable to eradicate B and C viruses and hence these viruses cause unrelenting long drawn silent inflammation (Chronic Hepatitis) and scarring (Fibrosis) in liver lasting for many years. These ultimately results in cirrhosis and liver cancer.The patient is essentially without any symptoms when silent damage happens in chronic hepatitis. Early detection at the silent curable stage rarely happens. Biggest barrier to achieve successful treatment is the fact that curable stage of chronic viral hepatitis is the silent phase but disease mostly gets diagnosed when patients have symptoms which most of the time is advanced and incurable stage. Lucky are those in whom Incidental detection of chronic hepatitis due to C and B viruses happen when one attempts to donate blood or during medical checkup for visa processing for jobs abroad.
Major health consequences of chronic hepatitis due to HBV and HCV are development of cirrhosis and liver cancer. It takes a decade and more after entry of virus into body to evolve these lethal complications, which means a wide window of opportunity, is there to treat and clear the virus provided the infection is detected early. Since long standing hepatitis (chronic hepatitis) due to HBV and HCV induce damage silently, successful treatment depends on identifying the infection by doing screening tests. Since there is risk of liver cancer in HBV and HCV infection, regular follow up with a liver specialist to identify cancerous lesion at an early stage.
HAV and HEV are self limiting diseases and require no specific antiviral medications. Only supportive care and careful monitoring is all what is needed. There are effective medications available to treat HBV and HCV. Treatment can help to protect you from serious liver damage. Effective medications are available for both HCV and HBV in the injectable form as well as tablets.The conventional one year long injectible medicines for HCV has been replaced by oral medications and duration of treatment shortened to only 12 weeks . Early diagnosis is crucial because the sooner treatment is started, the better the chance that it may help to clear the virus. Treatment can also help to lessen damage to the liver and can prevent you from spreading the virus to others unknowingly.
In long standing viral hepatitis due to HBV and HCV, scar formation happens and ultimately may end up in liver cirrhosis. When liver cirrhosis leads on to failure of liver functions and increased pressure inside the liver, these might necessitate liver transplant intervention. Also, scarred liver forms a background for liver cancer formation. Select cancers can be dealt with by resecting the portion of liver affected by cancer.
Screening and early detection are key to successful eradication of these viruses before irreversible damage sets in. Worldwide, 300 million people are living with viral hepatitis unaware of their infection status. 1.3 million deaths occur annually due to viral hepatitis. Without finding out the undiagnosed patients in silent phase and link them to care, millions will continue to suffer and lives will be lost. In 2016, 194 governments across the globe adopted WHO’s global strategy which aims at eliminating viral hepatitis by 2030.Only few countries have put in concerted efforts to reach this time bound target. On july 28th world hepatitis day focuses on raising awareness and the quest to find missing millions through screening programs.
Some hepatitis viruses share common risk factors with other infectious diseases, like HIV, sexually – transmitted infections.
Depending on the type of viral hepatitis, you can reduce your risk of infection by :
There are vaccines available to prevent HAV and HBV, At this time, however, there is no licensed vaccine to protect you from HCV infection, so changing behaviors that increase risk is key to protecting yourself from infection and to preventing the spread of infection to others. If you have engaged in any activity that may have put you at risk of infection, whether recently or in the past, you should consult a liver specialist and carry out relevant blood investigations to confirm hepatitis and initiate treatment.