All about hepatitis

The government of India has included vaccine of hepatitis B in its vaccination programme but has paid scant attention to hepatitis C

By Kundan Pandey
Published: Friday 26 July 2013

Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. There are five main viruses that cause the disease: Hepatitis A, B, C, D and E. According to the World Health Organisation (WHO), types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.

Hepatitis C facts
  • Hepatitis C virus is transmitted through contact with the blood of an infected person
  • About 150 million people are chronically infected with hepatitis C virus, and more than 350, 000 people die every year from hepatitis C-related liver diseases across the world
  • Hepatitis C can be treated using antiviral medicines
  • There is currently no vaccine for hepatitis C; research is on
Risk of infection can be reduced by avoiding:
  • Unnecessary and unsafe injections
  • Unsafe blood products
  • Unsafe waste collection and disposal
  • Use of illicit drugs and sharing of injection equipment
  • Unprotected sex with hepatitis C-infected people
  • Sharing of sharp-edged personal items like razors that may be contaminated with infected blood
  • Tattoos, piercing and acupuncture performed with contaminated equipment
The global health organisation says that hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids.

Common modes of transmission of these viruses include transfusion of contaminated blood or blood products, invasive medical procedures using contaminated equipment; in the case of hepatitis B, the virus gets transmitted from mother to baby at birth, from family member to child, and also by sexual contact. The government of India has included vaccine of hepatitis B in its vaccination programme.

However, hepatitis C has failed to receive the attention of the government so far. Hepatitis C is inflammation of the liver caused by hepatitis C virus (HCV). About eight out of 10 people infected with HCV develop permanent (chronic) infection.

It is estimated that anywhere between 1.5 to 3.5 per cent people in India are suffering from the disease. However, there is no mechanism in place to compile data to give a clear picture of its prevalence.

Hepatitis C is a blood borne-disease. As in the case of HIV/AIDS, it spreads through contact with infected blood and shared needles, particularly among drug users. The main sources of HCV are injected drugs and unsafe blood.

Those who are at risk include healthcare workers exposed to infected blood (though accidental needle prick, for example), children born to HCV-infected mothers, long-term dialysis patients, and people who have multiple sex partners.

HCV does not spread by sneezing, hugging, coughing, food or water, sharing eating utensils or drinking glasses, or casual contact.

The disease can range in severity from mild illness lasting a few weeks to a serious, lifelong condition that can lead to cirrhosis of the liver or liver cancer.

Hepatitis A: sanitation holds the key

Hepatitis A is a viral liver disease that can cause mild to severe illness. Globally, an estimated 1.4 million cases of hepatitis A are reported every year. Hepatitis A virus is transmitted through ingestion of contaminated food and water or through direct contact with an infectious person.

Hepatitis A is associated with non-availability of safe water and poor sanitation. Epidemics can grow explosively and cause significant economic losses. Improved sanitation and hepatitis A vaccine are the most effective ways to combat the disease.

In India vaccine against hepatitis A is made available to people who can afford it, but the government of India has not given it priority in the national immunisation programme.

Hepatitis B: cause for premature deaths

An article published in the Indian Journal of Public Health gives details of the impact of hepatitis B virus (HBV) infection and major steps taken to restrict it. The article, published in May, says that India has "intermediate to high endemicity" for hepatitis B surface antigen and an estimated 40 million chronic HBV carriers, constituting approximately 11 per cent of the estimated global burden.

The article says an estimated 1 million people annually become chronic HBV carriers and this lead to approximately 100,000-200,000 premature deaths from cirrhosis or hepato-cellular carcinoma in India. To tackle the problem, the government of India has included hepatitis B vaccine in its national immunisaton programme.

Hepatitis D: occurs as co-infection

Hepatitis D virus (HDV, also called delta virus) is a small circular RNA virus. About 300 million persons worldwide carry HBV. Of them, at least five per cent probably also have delta hepatitis. The rate of HDV infection varies widely in different parts of the world.

Chronic delta hepatitis is a more serious disease than either chronic hepatitis B alone or hepatitis C. A patient can acquire hepatitis D virus infection at the same time he/she gets infected with the hepatitis B virus.

This is called co-infection. A patient with hepatitis B can be infected with hepatitis D virus at any time after acute hepatitis B virus infection. This is called super-infection. Interferon-alpha is used to treat patients with chronic hepatitis B and hepatitis D infection.

Some studies have suggested that a dose higher than that usually used for hepatitis B infection may be beneficial, says the Liver Care Foundation.

Hepatitis E: spread by contaminated water, food

Hepatitis E was first identified in India, and has since been identified in West Asia, northern and western Africa, central Asian Republics of the former Soviet Union, in China and Hong Kong, says WHO.

Total 30,000 cases were reported in New Delhi in 1955-1956 after the flooding of the river Yamuna and contamination of the city's drinking water; 52 000 cases were reported in Kashmir in 1978, which shows the nature of its impact.

Just like HAV, HEV is transmitted from person-to-person via the faecal-oral route. Hepatitis E is a waterborne disease, and contaminated water or food supplies have been implicated in major outbreaks.

In India, the lifetime infection risk is more than 60 per cent, which translates into hundreds of thousands of cases annually.

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