Hepatitis – It's Closer Than You Think!

World Hepatitis Day was launched in 2008 by the World Hepatitis Alliance and in 2010, the World Health Organization agreed World Hepatitis Day would be recognized annually on 28 July, to commemorate the birthday of Professor Baruch Blumberg, who discovered the hepatitis B virus. 

‘This is hepatitis…..it’s closer than you think’ is the theme for World Hepatitis Day 2012.  Hepatitis is everywhere and could affect those close to you or even yourself.  Over two billion people are infected globally and more than 240 million have chronic liver infections due to HBV.  About 170 million people are infected with HCV and more than 350 000 people die from liver disease related to the infection.  As a result, 1 in 12 people worldwide is living with the disease. This day serves to make people aware of hepatitis, inform about the risks and break down stigma, by recognizing that hepatitis is “closer to home”. 
What is hepatitis?
Hepatitis refers to the inflammation of the liver, which is primarily caused by either viruses or toxins. 

What viruses cause hepatitis?
Viral-induced hepatitis is mainly caused by viruses such as Hepatitis A, B, and C. These are contagious viruses i.e. they are can be spread from one individual to another.  These viruses are not related to each other and they differ in structure and how they are spread.  The different viruses may cause a similar disease presentation but how they are treated and how one can prevent infection is different.

How are these viruses transmitted?
Hepatitis B virus and Hepatitis C virus are transmitted through infected blood and blood products, sexual contact, inadequately sterilized surgical equipment sharing equipment for injecting drug use. In many case the route of transmission is not known.  Blood safety in South Africa has effectively reduced Hepatitis B and Hepatitis C transmission

What are the symptoms of hepatitis?
Symptoms of viral hepatitis infection are usually fever, tiredness, abdominal pain, nausea, vomiting and jaundice (yellow colouring of the skin and white of the eyes).  Over 80% of infected persons with hepatitis may be asymptomatic and show no sign of disease and especially in children.  Hepatitis B, and Hepatitis C cause an acute illness and in a proportion of cases where the virus is not cleared (15-25%), there is a chronic (long-term) infection that can be asymptomatic for several years.  Chronic infections can lead to fibrosis (scarring), cirrhosis (hardening), liver cancer and liver failure and death. 

What diagnostic tests are done for hepatitis?
Hepatitis B diagnosis: The diagnosis is based on the clinical picture and a blood is tested for the Hepatitis B antigens and antibodies. These markers are useful to decide whether the infection is acute or chronic. The laboratory marker can also inform whether an individual is protected against Hepatitis B or infectious (contagious) for hepatitis B.

Hepatitis C diagnosis: The diagnosis is based on the clinical picture and a blood sample that is tested for antibodies against the Hepatitis C virus. If the antibody test is positive, then a test for the virus itself is done to confirm the infection.

Can hepatitis be treated?

Hepatitis B: Treatment for HBV infection is available but the virus is not always eliminated from the body.  Chronic hepatitis B can be treated with medications such as pegylated-interferon and/or other drugs called nucleoside or nucleotide analogues can be used.

Hepatitis C: HCV is curable using antiviral drugs however HCV genotype and host genetic factors are clinically important in determining response to treatment.  The current standard therapy for hepatitis C is pegylated- interferon and ribavirin. Newer drugs (boceprevir and telaprevir) are added-on to treat HCV genotype 1 infections.

Are there vaccines available?
Hepatitis B is preventable with the currently available safe and effective vaccine.  The HBV vaccine is part of the Expanded Immunization Program (EPI) in South Africa and is given at 6, 10 and 14 weeks of age. It is imperative that vaccine schedules for babies are followed to prevent HBV transmission in childhood. 

Hepatitis C: there is no vaccine currently available for hepatitis C infection and research is continuing in this field. 

How can we prevent hepatitis infections?
Hepatitis B: Vaccination is the most effective tool for the prevention of Hepatitis B infection and in South Africa routine immunisation of children against Hepatitis B is part of the Expanded Programme for Immunisation (EPI).  Vaccination should also be considered under the following circumstances: People with multiple sex partners, anyone with a sexually transmitted disease, men who have sexual encounters with other men, people who inject drugs, people who live with someone with Hepatitis B, people with chronic liver disease, end stage renal disease, or HIV infection, healthcare and public safety workers exposed to blood, travellers to certain countries.
Hepatitis C: Currently there is no vaccine available and therefore prevention is important: Do not share needles or other equipment to inject cosmetic substances, drugs, or steroids, do not use personal items that may have come into contact with an infected person’s blood, such as razors, nail clippers, toothbrushes, or glucose monitors. Do not get tattoos or body piercings from an unlicensed facility or in an informal setting

What we can do to prevent being infected:
• Individuals at high risk should get tested
• Individuals at high risk should get vaccinated in the case of Hepatitis B. 
• Individuals at high risk should be educated to take healthy and safe measures, practice safe sex, safe drug use
• National education and awareness drives need to be implemented
• Reduce stigma by improving education
• Infected individuals should consider treatment options and manage their disease
• Influence policy for effective strategies to prevent high number of new cases
• Increasing hepatitis B vaccine coverage

Be Aware, Be Clean, Be Safe………..
 
HEPATITIS – IT’S CLOSER THAN YOU THINK!