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 Fever & Infection

March 2010
Viral Hepatitis - FAQs on the Disease
Dr Shravan Bohra
 
What are the various types of viruses causing hepatitis?
There are five major types called A,B,C,D & E.

How do they differ?
Hepatitis (swelling of liver) A or E is an acute illness lasting from one to 10 weeks. Contaminated water is the source of infection, and there are epidemics during monsoon. Hepatitis A is common in children and hepatitis E is common in adults. Once a person recovers from hepatitis A or E, recovery is complete.

Hepatitis B and C are transmitted from the infected mother to the newborn, through transfusion of blood and blood products, hemodialysis, sexual route, intravenous drug abuse, repeated surgeries / dental procedures / instrumentation without proper sterilisation. Occasionally, hepatitis B can spread to close family members through blood/salivary contact, sharing of razors, toothbrushes, combs, nail clippers etc. Hepatitis B is three times more common than hepatitis C and is the commonest cause of chronic liver disease.

What are the consequences of hepatitis B and C ?
Hepatitis B causes an acute illness, which completely resolves in 90 percent of adults and 50 to 70 percent of children, while remaining patients will develop chronic hepatitis and cirrhosis of liver (permanent liver damage). Newborns can acquire hepatitis-B infection from their infected mothers, and when they do, they have 90 percent risk of developing chronic liver disease over several years to a decade. Hepatitis C recovers fully only in half of the sufferers. In a quarter, it causes chronic hepatitis and another quarter, it leads to permanent liver damage unless treated on time. Simultaneous alcohol consumption accelerates liver damage.

What treatment options are available?
For hepatitis A and E, treatment is generally supportive. A fraction of patients who have severe vomiting or become drowsy require hospitalisation, few require treatment in the ICU, and mortality is around one percent only. Chronic hepatitis B can be treated effectively with drugs like Interferon, Adefovir, Tenafovir, Talbivudine, Entecavir etc. although sustained response is variable between 10 - 40 percent only. It is not yet known how long the treatment should continue but a minimum of two years treatment is advised. A combination of Interferon and Ribavirin is highly effective for the treatment of chronic hepatitis C with 50 to 90 percent success rate. Interferon is a very costly medication with several side effects. Liver transplantation is an option for end stage liver disease.

What preventive measures can be taken?
Good hygiene, hand washing, proper disposal of faeces, safer sex and strict sterilisation of hospital equipment are good preventive measures. Blood and blood products must be screened very carefully for the presence of hepatitis B and C viruses, and the products should be used only when absolutely necessary. Screening of blood and blood products by PCR based methods is advisable, although cost may be a constraint. No protective vaccine is available against hepatitis C and E. Universal vaccination has been advocated against hepatitis B but vaccination against hepatitis A is still debated.

What is so serious about hepatitis B and C?
Since fatigue is the only symptom in most of the chronic sufferers, the majority of them are not aware of the disease till the liver is irreversibly damaged. They are also the source of infection to others. They require frequent hospital visits/hospitalisation and suffer a lot till they eventually die within one to 10 years unless their liver is transplanted. Some may develop liver cancer. Patients can pass on the disease to the health care workers and vice versa. Unfortunately, all health care workers are not yet vaccinated against hepatitis B, which poses a serious threat to them and also to the patients whom they are attending to. Each visit to the hospital with the transfusion of blood and blood products, dialysis, surgeries and instrumentation, adds to the risk of hepatitis B and C.
Dr. Shravan Bohra - Liver Diseases specialist at Apollo Hospitals, Ahmedabad

    
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