World Hepatitis Day is observed on 28th July each year, endorsed by the World Health Organisation. It aims to raise awareness of hepatitis to encourage prevention, diagnosis and treatment. Hepatitis is currently considered to be a public health threat due to a mixture of factors due to subtle symptoms, inaccessible treatment, lack of education, and stigma around the condition.
“Worldwide, 290 million people are living with viral hepatitis unaware. Without finding the undiagnosed and linking them to care, millions will continue to suffer, and lives will be lost. On World Hepatitis Day, 28 July, we call on people from across the world to take action and raise awareness to find the “missing millions.” - World Hepatitis Alliance
What is Hepatitis?
Hepatitis is inflammation of the liver that can be caused a number of different ways. There are several types of hepatitis, each of which have different characteristics and ways in which they are transmitted.
Viral hepatitis, caused by viral infections, is the most common type of hepatitis. However there is also autoimmune hepatitis which is much less common, as well as hepatitis caused by heavy alcohol consumption, medications, medical conditions and toxins.
Viral hepatitis, the most common type, is caused by viruses infecting the liver. The most common types are known as hepatitis A, B, C, D and E. In many cases, viral hepatitis shows no symptoms. This is why there are so many people that are unaware that they have the condition, therefore preventing them from getting timely treatment, and increasing the risk of accidental transmission to others.
AutoImmune Hepatitis (AIH)
Autoimmune hepatitis is a chronic autoimmune disease. This means that it is a condition, for at least 6 months, whereby your immune system attacks your body’s cells. AIH is fairly uncommon, compared to viral hepatitis, and it’s not entirely clear what causes it but there are some theories. This includes autoimmunity, genetic predisposition and environmental factors.
Alcoholic hepatitis is caused by drinking excessive amounts of alcohol over a number of years. While this technically is the cause, it’s not necessarily that straightforward. This is because the relationship between hepatitis and alcoholic hepatitis isn’t yet entirely clear.
Types of Hepatitis & Their Causes
As mentioned above, viral hepatitis is the most common, most complicated to catch, and more likely to go undetected. These are split into 5 most common types. For each, we will go into more detail about their causes and how they are transmitted.
Cause: Infection with the hepatitis A virus (HAV)
Common Transmission: Consumption of food or water containing faeces of a person with hepatitis A.
Common Length: Acute, short term
Cause: Infection with the hepatitis B virus (HBV)
Common Transmission: Contact with body fluids containing HBV, including blood, semen or vaginal secretions. It is also commonly spread from infected pregnant women to their babies.
Common Length: Ongoing, chronic
Cause: Infection with the hepatitis C virus (HCV)
Common Transmission: Direct contact with body fluids infected with HCV, commonly through sexual contact and drug use.
Common Length: Ongoing, chronic
Cause: Infection with the hepatitis D virus (HDV)
Common Transmission: Direct contact with blood infected with HDV. Can only occur where an HBV infection is already present.
Common Length: Ongoing, chronic
Cause: Infection with the hepatitis E virus (HEV)
Common Transmission: Ingestion of water contaminated with HEV
Common Length: Acute, short term
For chronic hepatitis, it is unlikely that you will have any symptoms, or noticeable symptoms, in the beginning due to its slow development. Unfortunately in most circumstances, there won’t be any indication that you have been infected until it has caused enough liver damage to affect its function.
With acute hepatitis, it is common to not experience any noticeable symptoms at all if any. However, there are some common symptoms that can appear soon (2 weeks to 6 months) after you are infected. These include:
- Muscle pains
- Stomach pain
- Unexplained weight loss
- Loss of appetite
- Pale or grey stool
- Dark urine
- Yellow skin
- Yellow eyes
Because of the subtle symptoms or absence of symptoms, many don’t go to the doctor to be tested. This is a significant reason why there is a push to encourage governments to organise regular screenings, especially for those in high risk categories like pregnant women, and make treatments and vaccines more accessible.
For those that do go to their doctor, there are a number of methods that can be used to diagnose suspected hepatitis.
Your doctor is likely to start off by asking you about your medical and family history to assess how at risk you are for any form of hepatitis.
In a physical examination, your doctor will look for signs of hepatitis or liver damage. They can do this by looking for signs of jaundice, like yellow skins or eyes. They may also gently press down on your stomach to see if your liver is enlarged, or if there is any pain or tenderness.
If your doctor suspects you have hepatitis, they may perform an ultrasound. An ultrasound will allow the doctor to take a closer look at your liver to identify if there is any enlargement or tumours. They will also be able to see the areas surrounding your liver to look for signs of fluid in your abdomen or changes to your gallbladder.
Liver Function Tests
Your doctor may choose to take blood samples to test the functionality of your liver. One of the main things they will be looking for is high liver enzyme levels. This is because it is a sign of your liver being stressed or damaged.
If your tests results come back normal, your doctor may take more blood samples to look for hepatitis viruses and antibodies that develop as a result of autoimmune hepatitis.
As this is an invasive procedure, it is likely that your doctor will have chosen any or all of the above examinations/tests before deciding to take a biopsy sample. A liver biopsy entails taking a sample of tissue from your liver to be further tested. This sample will be checked for signs of how hepatitis or an infection has affected your liver.
The ways to prevent the transmission of hepatitis depends on the type. However there are general things that can be done to minimise the risk of transmission of any viral hepatitis.
Practicing good hygiene is the most significant way to decrease the risk of contracting hepatitis A and E due to them commonly being transmitted through contaminated food or water. This involves:
- Washing your after using the bathroom
- Washing your hands before you eat
- Ensure your food is stored safely
- Ensure your food is cooked thoroughly
- Avoiding local water while travelling
- Avoiding raw fruits and vegetables while travelling
- Avoiding uncooked shellfish while travelling
Hepatitis B, C and D however would require more caution where blood could be involved. This means:
- Not sharing toothbrushes
- Not sharing razors
- Not sharing needles (especially used for drugs)
- Ensure that all equipment is sterilised before having a tattoo or acupuncture
- Not touching spilled blood
As hepatitis B and C can also be transmitted to sexual contact, safe sex is the most effective method of prevention. Generally speaking this involves:
- Using a condom
- Using a dental dam
- Having honest communication with sexual partners
Vaccinations are the most effective form of prevention for hepatitis, but are not yet available for all. Currently in the UK, vaccines are only available for hepatitis A and B. The hepatitis B vaccination is now available in the UK as part of the routine immunization program to help protect children, as well as those at risk of contracting hepatitis B. The hepatitis A vaccine is recommended for those that will be travelling to countries where HAV is common, or if infection of the virus will cause you to have severe consequences.
If you are diagnosed with hepatitis, the treatment you receive, or whether or not there is a hepatitis cure available, will be determined based on the type you have contracted, and whether or not your condition is acute or chronic.
Hepatitis A: There isn’t usually a recommended treatment as your body should be able to recover on its own. However, you may be advised to rest and make sure you are hydrated should you experience symptoms such as vomiting or diarrhea.
Hepatitis B: This will generally be treated through the use of antiviral medications and regular monitoring of your body’s response to the treatment.
Hepatitis C: Antiviral medications are used to treat both acute and chronic hepatitis C. However, in chronic cases, it is likely that you will be prescribed a combination of medications, as well as regular testing to assess your body’s progress.
Hepatitis D: At the moment, there is no effective treatment for hepatitis D, as antiviral medication doesn’t seem to have much of an effect. There are however medications that can be prescribed that may be able to stop the spread of the virus, or reduce the risk of liver damage. However you would still be advised to practice methods to prevent the spread of the virus and to look out for symptoms.
Hepatitis E: Similar to A, as this is generally acute and will go away on its own, you will be advised to rest and stay hydrated. However, if you are pregnant, it will also be recommended that you have regular monitoring to check the health of yourself and your baby.
The outlook of acute hepatitis is generally quite positive. Your body’s immune system should be able to fight the virus and help you recover on your own. However, with chronic hepatitis, the problem is that most don’t know that they have it until they’re already experiencing liver failure. Chronic hepatitis is therefore more likely than acute hepatitis to lead to the following complications:
- Ascites (build up of fluid in your abdomen)
- Kidney failure
- Hepatocellular carcinoma (a type of liver cancer)
- Bleeding disorders
- Portal hypertension (high blood pressure in veins leading to your liver
You are also at a higher risk of developing the following:
- Chronic liver disease
- Liver cancer
- Cirrhosis (late stage of scarring of the liver)
To summarise, whether or not you think you have hepatitis, decrease the risk of transmission by practicing good hygiene and safe sex, have your vaccines when they are recommended, and speak to your doctor should you have any concern that you have been infected.
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