• Hepatitis: Know More and Act Right

    On the occasion of World Hepatitis Day! This 28th July 2016, Hiimpact is making an initiative to bring into notice to policy makers, healthcare professionals, and the common public to know more about Hepatitis and take immediate steps in its prevention to combat Hepatitis and eradicate it completely. Irony is common mass of people have little or no information about this dreadful disease. Making an effort and bringing forth to you all the details one should know about hepatitis.

    Introduction:

    Hepatitis is the contracted viral infection followed by inflammation of the liver, which are caused by strong viruses named A, B, C, D or E. These viruses are usually spread through contaminated water, blood, semen other body fluids or stool. The consequences of severe Hepatitis leads to liver cirrhosis, liver failure and liver cancer. Hepatitis B and C are the deadliest of its type, damaging the liver completely. Most of the patients with complete liver failure often have to undergo liver transplant. It has been observed that the destruction and damage of liver cells starts due to Hepatitis viruses replicating (multiplying) primarily in the liver cells (hepatocytes) which obstruct livers normal working leading to malfunction.

    Prevalence of Hepatitis:

    • Viral Hepatitis affects 400 million people globally.
    • According to WHO it is estimated that around 12 million people are affected by the disease in India.
    • WHO claims an estimated 95% of people with Hepatitis do not know that they are infected.
    • Over 90% of people with Hepatitis C can be completely cured within 3–6 months of timely diagnosis and proper treatment.
    • Only 1 out of 20 people with hepatitis are properly diagnosed and can avail the right treatment, rests are left undiagnosed due to which the hepatitis when found is in advanced stage.
    • Only 1 out of 100 people with this disease take full treatment and get completely cured.

    Types of Hepatitis:

    • Hepatitis A: The incubation period of HAV is 15-45 days. This virus is excreted in stool during the first few weeks of infection before the onset of symptoms.
    • Hepatitis B: Immune system mediated cytotoxicity damages liver, so considered as life threatening. The incubation period of HBV is 40-150 days.
    • Hepatitis C: Hepatitis C virus leads to both acute and chronic infection which is usually asymptomatic, and is not life-threatening disease. Only 15–45% of infected persons spontaneously clear the virus within 6 months of infection without any treatment. Scientists have found that a direct-acting antiviral treatment may cure acute hepatitis C over a short duration of six weeks. Hepatitis-C (HCV) is 10 times more infectious than HIV. Recently US Food and Drug Administration (FDA) have approved a drug called Epclusa which is developed to treat all genotypes of the Hepatitis C virus by Gilead Sciences.
    • Hepatitis D: Hepatitis D or delta hepatitis is usually caused by the hepatitis delta virus (HDV), which is a defective RNA virus. HDV requires the help of a hepadna-virus like hepatitis B virus (HBV) for its own replication, which increases the risk of cirrhosis of the liver is between 15–30% within 20 years.
    • Hepatitis E: The hepatitis E virus is transmitted mainly through the fecal-oral route due to fecal contamination of drinking water. The incubation period following exposure to the hepatitis E virus ranges from 2-10 weeks, with an average of 5–6 weeks. The infected persons are believed to excrete the virus beginning a few days before to around 3–4 weeks after the onset of disease.

    Assessment of Hepatitis risk:

    • Detection and evaluation of different stages and extent of liver damage.
    • Planning of antiviral therapy which can delay or reverse the progression of the existing liver disease.
    • Ultrasound surveillance to detect HCC (hepatocellular carcinoma) at a potentially treatable stage
    • Psychological counseling of people for avoiding excessive alcohol use
    • Avoidance of unnecessary vaccination, as vaccination is not beneficial for persons already chronically infected and is unnecessary for persons already immune (either through prior vaccination or a previous resolved acute infection
    • Vaccination of unprotected individuals

    Clinical Spectrum of Hepatitis

    Virus Transmission Route Incubation Period Mortality Likelihood of
    Carrier State
    Likelihood of Chronic Disease Associated with HCC
    HAV Fecal-oral 2-6 wk 1% None None No
    HBV Parenteral, perinatal, sexual 4-26 wk 1%-2% (3,000/y) 5% (adults) 90% (infants) 1%-10% Yes
    HCV Parenteral, perinatal, sexual 2-23 wk 1%-5% (12,000/y) 50%-80% 80%-90% Yes
    HDV Parenteral, sexual, perinatal 6-26 wk 2%-20% Variable 80% in super infection Yes
    HEV Fecal-oral 2-9 wk 1% Rare Rare No

     

    Prevention of Hepatitis:

    • Data analyst need to generate more and more data on the extent of the burden of Viral Hepatitis in India
    • Identification of risk factors of hepatitis affecting the rural and urban population
    • Improvement in birth dose vaccination and dose coverage of Hepatitis B Virus vaccine
    • Imparting knowledge about safe use of injection among health care workers
    • Improving the access to treatment and availability as well as affordability of the drugs for Hepatitis B virus and Hepatitis C Virus
    • Improve sanitation and safe drinking water for prevention of Hepatitis A Virus and Hepatitis E Virus

    Current Medications available for Hepatitis:

    • Interferon Alpha (Intron A): It is given by injection used by adults and children several times a week for six months to a year, or sometimes longer. The drug can cause side effects such as flu-like symptoms, depression, and headaches.
    • Pegylated Interferon (Pegasys): It is given by injection once a week usually for six months to a year. The drug can cause side effects such as flu-like symptoms and depression. Approved May 2005 and available only for adults.
    • Lamivudine (Epivir-HBV, Zeffix, or Heptodin): This is a pill that is taken once a day, with few side effects, for at least one year or longer. Approved 1998 and available for both children and adults.
    • Adefovir Dipivoxil (Hepsera): It is a pill taken once a day, with few side effects, for at least one year or longer. Approved September 2002 for adults. Pediatric clinical trials are in progress.
    • Entecavir (Baraclude): It is a pill taken once a day, with few side effects, for at least one year or longer. Approved April 2005 for adults. Pediatric clinical trials are in progress.
    • Telbivudine (Tyzeka, Sebivo): It is a pill taken once a day, with few side effects, for at least one year or longer. Approved October 2006 for adults.
    • Tenofovir (Viread): It is a pill taken once a day, with few side effects, for at least one year or longer. Approved August 2008 for adults.

    Note: All the above pills are to be taken only on prescription from a practitioner only.

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