Overview
Hepatitis is derived from the ancient greek word hepar meaning ‘liver’, and the Latin itis meaning ‘inflammation’. In other words, it means injury to the liver with inflammation of the liver cells.It is a condition that can be self-limiting or can progress to fibrosis, cirrhosis or hepatocellular carcinoma (cancer of the liver).
The common causes of hepatitis in the world are viruses (mainly Hepatitis A, B, C, D & E viruses), infections, toxic substances (e.g. alcohol, certain drugs like paracetamol, isoniazid,) and some diseases. The prevalence of Hepatitis is mostly attributed to the viruses; with types A, B, C, D & E being of great concern due to the burden of illness and death they cause globally.Viral hepatitis affects 400 million people globally. Annually, 6–10 million people are newly infected with a consequent death of 1.4 million. It is also on record that hepatitis affects more than ten times the number of people affected by HIV. However it is unfortunate to state statistically that just one in 20 people with viral hepatitis know they are infected, and only one in 100 with the disease is being treated. These data and facts are heart breaking and what is more troubling is that little attention has been drawn to viral hepatitis globally in the same context as enjoyed by other diseases and infections. Dr. Margaret Chan, World Health Organization director-general aligned herself to this when she said: “The world has ignored hepatitis at its peril, it is time to mobilize a global response to hepatitis on the scale similar to that generated to fight other communicable diseases like HIV/AIDS and tuberculosis.” Persons with hepatitis live with the virus in ignorance until very serious harm has been caused to the liver thus late detection has remained the greatest threat in the fight against viral hepatitis.
Symptoms of Viral Hepatitis
Generally, the symptoms of hepatitis are not viral specific in the sense that it is hard to say which of the 5 main types of hepatitis viruses one is infected with except when tested. The most common are flu like symptoms including loss of appetite, nausea, vomiting, fever, weakness, tiredness. Less common symptoms include dark urine and jaundice. However most people acutely infected with Hepatitis A, B, C or E viruses have little or no symptoms at all.
Routes of Transmission
Hepatitis A Virus (HAV): This is mainly through contaminated food and water. However, certain sex practices can also spread HAV.
Hepatitis B Virus (HBV): Infection is through unprotected sex , Mother-to-Child transmission (MTCT), transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. HBV shares similar routes of transmission with HIV.
Hepatitis C Virus (HCV): The transmission of HCV is similar to HBV. Sexual transmission is however less common.
Hepatitis D virus (HDV): This is an incomplete virus which requires the presence of HBV to thrive thus HDV occurs only in people with HBV. Transmission could be through mucosal contact with infectious blood.
Hepatitis E Virus (HEV): Transmission is via contaminated food or water. It is usually the common cause of outbreaks in developing countries.
Treatment
HAV: There is no specific treatment for HAV. Treatment is mostly supportive and includes, bed rest, hydration and improved nutrition pending when the body clears the virus which may be slow and may take several weeks or months. Immunity for life is usually developed after HAV infection.
HBV:Acute HBV –Treatment is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids lost from vomiting and diarrhea.
Chronic HBV – Treatment is achieved with drugs including viral agents. Treatment is aimed at slowing the replication of the virus, slowing the progression to cirrhosis, reducing the incidence of liver cancer and improving long term survival. There is no drug that cures HBV or prevent its progression to the chronic form. Some people could however naturally clear the virus from their system.
HCV:Treatment is not always required in the case of HCV because the immune system of usually clears the infection in some people. The goal of HCV treatment is usually to end in a cure. The use of antiviral agents like interferon and ribavirin also plays a dominant role in the treatment of HCV.
HDV:There is no specific treatment for acute or chronic HDV infection. Persistent HDV replication is the most important predictor of mortality and the need for antiviral therapy.
HEV: This is usually a self-limiting infection thus there is no specific treatment capable of altering the course of acute hepatitis. In most cases, hospitalization is generally not required.
Prevention
The 5 types of viruses possess different prevention strategies even though some intertwine with each other. The various prevention measures for them are dissected in the following lines.
HAV:Following the routes of transmission, HAV can be prevented via the provision of adequate supplies of safe drinking water, proper disposal of sewage within communities; and personal hygiene practices such as regular hand-washing with safe water. HAV vaccine is also available internationallyhowever;no vaccine is licensed for children younger than 1 year of age.
HBV: The surest way of HBV prevention is the HBV vaccine. Unlike HAV, HBV vaccine is also available for infants and children. Also, screening of blood products before transfusion, safe sex practices, proper mentoring and awareness to pregnant mothers are other safe strategies to employ in preventing HBV.
HCV: Unlike HAV and HBV, HCV has no vaccine thus the prevention is premised around reducing every risk of exposure to the virus. Some popular ways of preventing HCV include hand hygiene: including surgical hand preparation, hand washing and use of gloves, safe handling and disposal of sharps and waste, provision of comprehensive harm-reduction services to people who inject drugs including sterile injecting equipment, testing of donated blood for hepatitis B and C (as well as HIV and syphilis), training of health personnel, and promotion of correct and consistent use of condoms.
HDV: Due to the fact that HDV does not exist in isolation but leverages on the presence of HBV to survive, it is therefore logical to prevent HDV by preventing HBV, thus all the means of transmission of HDV applies to HDV. For emphasis, some of these ways include hepatitis B immunization, blood safety, injection safety, and harm reduction services. However, it is worthy to note that Hepatitis B immunization does not provide protection against HDV for those already HBV infected.
HEV: With the background already established on the routes of transmission of HEV, the prevention of HEV is all hinged on hygienic practices either at individual or community levels. Some ways include maintaining quality standards for public water supplies and establishing proper disposal systems for human feces. These will to a very large extent also prevent an epidemic at the community level.
Conclusion
This article is not in its entirety an all-inclusive one but has attempted to address viral hepatitis as it affects us. Viral Hepatitis is within us; yet going unnoticed as it tactically affects people and cause harm to the human population. It is an evil that needs to be faced with all resources to crush it out of our world. The fight against viral hepatitis is a global one and we are all expected to leave our comfort zones and curb this menace.
Pharm. Ezinne Anizoba
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