Hepatitis refers to an inflammation of the liver. Our liver is the vital organ that processes nutrients, filters blood and fights infections. When the liver is inflamed or damaged, the way that it functions can be affected. Heavy alcohol use, toxins, certain medications and medical conditions can cause hepatitis. However, one common way that hepatitis is often caused is by a virus. Viral hepatitis is an infection that affects the liver and is one of the deadliest health threats in Pakistan, with over 400 people succumbing to the infection on a daily basis.

Pakistan has the second highest prevalence of Hepatitis C in the world. Approximately 15 million people in Pakistan are infected with Hepatitis B and C, which amounts to over 9% of our country’s population. It has been reported that every fifth death taking place in the Sindh province is attributed to either Hepatitis B or C. It is believed that about 20%to 25% of Sindh’s population is infected with this viral disease. And an estimated 150,000 new patients are added to this list each year due to lack of prevention, testing and treatment resources as well as inadequately screened blood transfusion, improperly sterilized invasive medical devices and unsafe injections.Major risk factors for the transmission of Hepatitis B and C infection in our country includes therapeutic injections, syringe reuse, surgery, improper sterilization of invasive medical devices, blood transfusion, hospitalization and sharing of razors while getting a shave at the barbers.

Certain groups in our population are highly affected by Hepatitis B and Hepatitis C, for instance, thalassemia patients and injecting drug users. For Hepatitis C specifically, a high prevalence of infection is reported in children especially those who were admitted in hospitals with acute hepatitis, while for HEV (Hepatitis E), most of the infections were due to fecal contamination of water. A vast majority of people catch this infection in healthcare settings without even being aware of it. This is why viral hepatitis is referred to as a silent killer as many patients remain undiagnosed and untreated for years before developing complications and dying. To curb this, Pakistan hosted World Hepatitis Day 2019, where our government announced the Prime Minister’s ambitious initiative to eliminate viral Hepatitis B and C infections in the country by 2030.

There are different types of viral hepatitis, but the most common are Hepatitis A, B and C. Here are some of the main things you need to know about the common forms of viral hepatitis, their symptoms and prevention.

What is Hepatitis A?

Hepatitis A is a highly contagious liver infection that can range from mild illness to a much more severe condition that could last for months. This form of hepatitis is usually transmitted through the ingestion of food or water contaminated by feces or stool from an infected person, or through contact with an infected person. Hepatitis A is easily preventable with a vaccine, which is recommended for all children at one years old and for adults who may be at risk.

• Transmission: spread through contaminated food or water and interpersonal contact
• Symptoms: fever, fatigue, dark urine and yellowing of the skin
• Seriousness: people can be sick for a few weeks to a few months but most recover with no lasting liver damage. Unlike Hepatitis B or C, it does not cause chronic liver disease

What is Hepatitis B?

Hepatitis B is a liver disease that is caused by infection from the Hepatitis B virus. For people who may have been infected as infants, the infection can lead to a lifelong illness. The Hepatitis B virus is spread mainly when blood, semen, or other body fluids from an infected person enters the body of someone who is not infected. The Hepatitis B virus can be spread through sexual transmission as well as through contact with blood, (i.e. sharing injections). This virus may also be passed from an infected woman to her baby at birth, if the baby does not receive a vaccine for Hepatitis B. This is why a vaccine for hepatitis B is recommended for all infants at birth and anyone else at increased risk.

• Transmission: spread through birth (from mother to child), exposure through bodily fluids or sexually transmitted
• Symptoms: abdominal pain, vomiting and yellowing of the skin
• Seriousness: 15%–25% of chronically infected people develop chronic liver disease, including cirrhosis, liver failure, or liver cancer. If not vaccinated, 9 out of 10 children infected with hepatitis B at birth will develop chronic infections

What is Hepatitis C?

Hepatitis C is also a liver disease that results from infection with the Hepatitis C virus. Similar to Hepatitis B,most people who are infected with the virus go on to develop a chronic infection that causes serious liver problems for the rest of their lives. The Hepatitis C virus is typically spread when blood from an infected person enters the body of someone who is not infected. Recently, the most common way people are becoming infected with Hepatitis C is by sharing needles, syringes, or any other equipment to inject drugs. Hepatitis C may be also transmitted sexually,as well as from an infected women to her baby. People born from 1945-1965, or baby boomers, are more likely to have Hepatitis C. The reason is not completely understood, however, anyone born during this time is at a higher risk and should get vaccinated.

• Transmission: spread through unsafe injections or sexual transmission. Peopleborn between 1945 and 1965 are more likely to be infected. 3 out of 4 people do not know they are infected
• Seriousness: over 50% of people who get infected with the hepatitis C virus develop a chronic infection, and 5%-25% of people with chronic hepatitis C develop cirrhosis over 10–20 years.

Signs and symptoms of viral hepatitis?

Many people with hepatitis do not have symptoms and do not know they are infected. If symptoms do occur with an acute infection, they may appear anywhere from 2 weeks to 6 months after exposure. Symptoms of hepatitis can include: fever, fatigue, loss of appetite,nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain,and jaundice. If you think your child or anyone else in your house has these symptoms, see your doctor as soon as possible. If you’re having trouble leaving the house, please visit www.shifaam.com and consult with your doctor virtually.

Steps toward prevention?

Vaccination is the most effective way that you can protect yourself and your loved ones against viral hepatitis. An estimated four million people in our country have been exposed to the Hepatitis B virus. Timely vaccinations can prevent you and your loved ones from the virus. Three doses of the Hepatitis B vaccine are given to children in Pakistan in the first year for free, at 6 weeks, 10 weeks and 14 weeks of age. As withal most all other vaccines, if the dose(s) is missed, it can be given later as well. It is absolutely necessary for all parents to ensure that their children are vaccinated as per schedule. If you are unsure about your child’s vaccination schedule, you can visit the Expanded Programme on Immunization (EPI) for more information.

Sources:

The News

World Health Organization

Northwestern Medicine

Centers for Disease & Prevention

Expanded Program on Immunization - GOP