Viral Hepatitis

Types of Viral Hepatitis

Hepatitis A virus (HAV):

HAV is transmitted through the consumption of contaminated water or food that is commonly found in the faeces of infected persons. It also gets spread through certain sex practices. In many cases, HAV infections are mild and a majority of patients are able to make full recovery. During the HAV health condition, patients become immune to further HAV infections that can lead to severe and life-threatening conditions. Poor sanitation is one of the most common causes of the global spread of HAV.

Hepatitis B virus (HBV):

HBV is transmitted when a person has infected body fluids such as blood, semen, etc. It can also be transmitted from infected mothers to babies at birth or from family members to babies in early childhood. In addition, transfusion of HBV-contaminated blood and blood products, use of contaminated injections during medical procedures, and injectable drugs can transmit the infection. Healthcare workers who accidentally sustain needle stick injuries while caring for HBV-infected patients are more likely to contract the HBV virus. HBV can be prevented with safe practices and effective vaccines.

Hepatitis C virus (HCV):

HCV is commonly spread during medical procedures or during drug injection by drug users, often exposing healthcare professionals and drug users to infected blood through transfusions of HCV-contaminated blood and blood products. The infection could be sexually transmitted but is much less common. There is no vaccine against HCV.

Hepatitis D virus (HDV):

HDV contamination can only affect HBV patients. Due to dual HDV and HBV infection, more severe disease and poorer outcomes are more likely to occur.HDV infection can be prevented by hepatitis B vaccines.

Hepatitis E virus (HEV):

HEV disease is transmitted through consumption of contaminated food or water. HEV is a common cause of hepatitis outbreaks in most developing countries of the world and is increasingly recognized as a major cause of disease in developed countries. Vaccines have been developed to treat HEV infection, but finding one can sometimes be difficult.

Symptoms of Hepatitis:
Hepatitis B and C are chronic forms of hepatitis that may show symptoms only when the damage affects liver function. However, acute hepatitis may show some symptoms shortly after contracting a hepatitis virus.
Common symptoms of Hepatitis include:

• Fatigue
• Fever
• Flu-like symptoms
• Dark urine
• Pale stool
• Abdominal pain
• Loss of appetite
• Unexplained weight loss
• Yellow skin and eyes, normal indications of jaundice
• Muscle or joint aches
• Nausea and vomiting
• Itchy skin

Causes of Hepatitis:

• Hepatitis A: Exposure to HAV in food or water and body fluids
• Hepatitis B: Contact with HCV in body liquids, like blood, vaginal emissions, or semen
• Hepatitis C: Contact with blood and blood products of HCV infected person
• Hepatitis D: Contact with HCV in body liquids, like blood, vaginal emissions, or semen
• Hepatitis E: Exposure to HEV in food or water

Treatments for Hepatitis:

Hepatitis A:

The symptoms of this short-term (acute) infection disappear within three months. There is no specific treatment for hepatitis A other than using a medication, such as a painkiller, to relieve symptoms. Through vaccination, hepatitis A can be prevented.

Hepatitis B:

In most cases, patients infected with the hepatitis B virus are able to repel the virus and have a full recovery from the infection within a couple of months. The infection doesn't cause enduring harm, however, it may make the patient feel a little uncomfortable. This is known as chronic hepatitis B. Patients with drug abuse problems are recommended to take hepatitis B vaccination.

Hepatitis C:

Similar to Hepatitis B, many patients fight off the infection and will be free of the virus. In some cases, the virus tends to stay in the patient’s body for many years. This is known as chronic hepatitis C. Antiviral medications are often prescribed for chronic hepatitis C treatment, however, it may lead to unpleasant side effects. Vaccination for hepatitis C is not yet available.

Hepatitis D:

 Acute or chronic hepatitis D has no known treatments yet. Although the antiviral medications are found effective in other forms of hepatitis, it doesn’t work on HDV. Usually, patients infected with hepatitis D are given large doses of protein based medication for up to 12 months which may stop the virus from transmitting. Patients infected with hepatitis D can still test positive for the virus post treatment. To prevent the infection from spreading, it is imperative to take precautionary measures. Caution should always be exercised if symptoms recur.

Hepatitis E:

Acute hepatitis E has no specific treatment available. The disease is usually self-limiting, so hospitalisation is generally not required. By avoiding unnecessary medications, one could be cautious and take preventive measures.

Autoimmune Hepatitis

In rare cases, chronic or long term hepatitis causes autoimmune hepatitis. Chronic inflammation and damage occur when the white blood cells attack the liver. Some of the common symptoms are tiredness, pains in the abdomen, joint aches, jaundice (yellow tinge to your skin and whites of eyes), and cirrhosis. Autoimmune hepatitis is treated with medicines that are meant to suppress the immune system and reduce inflammation. To gradually reduce the swelling and control the symptoms, steroid medication is often preferred.

Prevention measures for Hepatitis 

For infectious diseases, preventive measures are aimed primarily at the reduction or elimination of transmission of the agent. The preventive measure not only results in the reduction of new cases, thereby reducing the overall disease burden, morbidity, mortality, and healthcare expenditure Preventive measures for an infectious disease depend on its modes of spread. Various hepatitis viruses differ in their modes of transmission. One could avoid getting viral hepatitis by following the below measures.

Water & Food Hygiene and Sanitation

HAV and HEV are typically transferred through the faecal-oral route. This often occurs through the consumption of contaminated food or water. Access to safe drinking water, consumption of hygienically cooked fresh food, proper disposal of excreta particularly from the people suffering with viral hepatitis are the best methods to inhibit the spread of these viruses.

Safe injection practices

Majority of HBV or HCV infections are seized through unsafe percutaneous injection exposure. Such exposure can occur when injection equipment such as needles and syringes are reused without proper sterilisation. This situation can occur in healthcare settings or among injection drug users who are more likely to share syringes and needles. The prevention of HBV and HCV infection can be easily done by avoiding unnecessary percutaneous injections, promoting the use of disposable single-use (auto-disable), and safe disposal of used needles and other sharps.

Safe blood transfusion 

The most common route of HCV transmission is through transfusion of contaminated blood or blood products. This can also be a common cause of HBV and HDV cases. With the use of the following steps, such transmission can be reduced. Avoid using unpaid volunteer blood donors in place of substitute or commercial donors. Testing blood for infectious diseases. Avoid unacceptable blood transfusions. In addition, these measures are useful in preventing other transfusion-transmissible diseases such as syphilis.

Safe sex practices 

Unprotected sex is a common method to get HBV infection among young adults, and for some cases of HCV infection. Such transmission is particularly efficient among men who have sex with men. Sexual transmission of these hepatitis viruses can be prevented by promoting monogamous relationships; use of barrier methods (condoms) during the sexual act; avoiding sex with a person who has an ulcerative genital tract infection (e.g., a sexually transmitted infection of the genital tract) and screening commercial sex workers for HBV or HCV infection.

Prevention of Mother-to-Child Transmission

HBV can be transmitted efficiently from pregnant mothers to their new-borns, particularly if the mother has a high viral load. This transmission may occur either in utero (during the third trimester of gestation), during birth, or in the period after delivery. Since childhood HBV infection is much more likely to become chronic and lead to liver cirrhosis or liver cancer, prevention of HBV infection is particularly focused on such transmission. Mother-to-child transmission of HBV can be prevented by administering hepatitis B vaccine to new-borns. The baby should be given the first dose within 24 hours of birth. If the likelihood of HBV infection in a pregnant woman is high in addition to a positive HBeAg test or high viral load, administration of hepatitis B-specific immunoglobulin (HBIG) to the baby at birth and/or antiviral drugs oral administration to the mother The third trimester of pregnancy may provide some additional protection.

Vaccines and immunoglobulins 

Active and passive immune prophylaxis (with specific vaccines or immunoglobulins) are available to prevent HAV and HBV infections. A vaccine has been developed to cure hepatitis E but is not approved or available in India. Vaccines are not yet available for HCV infection.