BRIEF HISTORY

Initially, World Hepatitis Day was celebrated on May 19th of each year but in 2010 the World Health Assembly changed the date to July 28th in honour of the birthday of the noble laureate Professor Baruch Samuel Blumberg, who discovered Hepatitis B.

World Hepatitis DayWorld Hepatitis Day

INTRODUCTION:

About 23 million Nigerians are infected with Hepatitis B, making Nigeria one of the countries with the highest Hepatitis infection in the world since about 500 million people in the world are living with either Hepatitis B or C. It is pathetic that many people worry more about contracting AIDS than Hepatitis, even when in reality in each year about 1.4 million people worldwide die FASTER with viral hepatitis than they would with AIDS. Remember that globally, HIV-AIDS currently SLOWLY kills close to 1.6 million people yearly. And more unfortunate, is the fact that just only Hepatitis B virus is about 50 to 100 times more infectious than HIV. Despite this mind-boggling data,the disease has attracted very little attention from both the government and the people of Nigeria.

THE THEME FOR THIS YEAR:
The WHO and partners urge policy-makers, health workers, and the public to THINK AGAIN about this silent killer.

DEFINITION AND CLASSIFICATION:
Hepatitis is a medical condition characterized by the presence of inflammatory cells in the tissues of the liver.It can be self-limiting(healing on its own) or can simply progress to fibrosis(scarring),Cirrhosis,liver failure or liver cancer. Hepatitis can be acute when it lasts for less than six months or chronic when it lasts for more than six months.

Viral hepatitis is mainly classified into five groups: Hepatitis A, B, C, D and E. There are other classifications of hepatitis such as autoimmune, alcoholic hepatitis etc., but the main aim of the World Hepatitis Day is to sensitize and encourage people on how to prevent, diagnose and treat these five VIRAL hepatitis infections mentioned above.

Hepatitis A:
Caused by Hepatitis A virus and it occurs when an uninfected person ingests food or water contaminated with the faeces of an infected person. It can also be contracted through close physical contact with an infectious person,although casual contact among people does not spread the virus. There are about 1.4 million cases each year worldwide. Unlike Hepatitis B & C, it does not run a chronic course but can lead to debilitating symptoms and fulminant hepatitis(acute liver failure), which has a very high mortality rate.
Hepatitis B:
It is a potentially life threatening disease of the liver caused by Hepatitis B virus and it is contracted by contact  with the blood or body fluids of an infected person. It is commonly spread from mother to child at birth,or from person to person in early childhood. In the rural settings, it can be contracted by sexual transmission (when no barrier protective measure is used) and the use of contaminated sharp objects like needles, razor blades etc., and inadequately sterilized hospital equipment. It runs both acute and chronic courses and about 240 million individuals globally have chronic Hepatitis B infection whereas in each year, about 780,000 people die globally  from acute and chronic Hepatitis B infections. It is an important occupational hazards for health care professionals, members of the Federal Road Safety Corps,commercial sex workers,long distance drivers etc
Hepatitis C:
Caused by Hepatitis C virus and it is contracted the same way Hepatitis B infection is contracted through unsafe injection practices;inadequate sterilization of medical equipment in healthcare settings;and unscreened blood and blood products. Like Hepatitis B,it runs both acute and chronic courses but it has more propensity of running chronic course than Hepatitis B.A significant number of the chronic carriers of the disease will come down with Cirrhosis or Liver cancer. It is estimated globally that about 130-150 million people are chronic carriers of the infection while about 350,000-500,000 people die annually from Hepatitis C related infections.
Hepatitis D:
Caused by Hepatitis D virus, which is called an incomplete virus or subviral satellite because it can propagate only in the presence of Hepatitis B virus,hence the transmission of Hepatitis D can only occur either via simultaneous infection with hepatitis B virus(co-infection) or superimposed on chronic Hepatitis B carrier state (superinfection). Regrettably, in combination with Hepatitis B virus, Hepatitis D infection has the highest mortality rate of all the Hepatitis infections.
Hepatitis E:
Caused by Hepatitis E virus and mainly transmitted through contaminated drinking water. Less commonly,it can also be transmitted by transfusion of infected blood products and vertical transmission from a pregnant woman to her fetus. It is self-limiting,resolving within  four to six weeks,though it may at times run a fulminant course(acute liver failure) leading to death. Globally, there are approximately 20 million incidents of Hepatitis E infections every year; three million acute cases; 56,600 hepatitis E-related deaths. Hepatitis E can also induce a mortality of about 20% among pregnant women in their third trimester.

CLINICAL FEATURES:
The viral hepatitis infections have almost common features which can be asymptomatic (no symptoms) but often lead to jaundice, loss of appetite, and malaise. As noted earlier on, some of them can run either acute or chronic courses.

The acute features:

In children, the features are usually asymptomatic while in older individuals, there may be nonspecific flu-like symptoms,common to almost all acute viral infections which include: malaise; muscle and joint aches; fever; nausea or vomiting; diarrhoea; headache. The more specific acute features include: loss of appetite; aversion to smoking (among smokers); dark urine; yellowing of the eyes and the skin; enlargement of the liver; enlarged lymph nodes in about 5%; enlargement of the spleen.

Meanwhile, a small proportion of the people with acute infections can develop liver failure with associated hepatic encephalopathy (confusion and coma due to inability of the liver to perform its functions); peripheral edema and bleeding.

The chronic features: Although they may present with malaise; tiredness; weakness; jaundice, individuals with chronic infections usually run asymptomatic courses until complicated with cirrhosis, liver cancer, and liver failure.

PREVENTION:
Hepatitis A can be prevented by adequate supplies of safe drinking water; proper disposal of sewage within the communities; personal hygiene such as regular hand washing with safe water and soap; getting immunized with Hepatitis A vaccine.

Hepatitis B can be prevented by quality-assured screening of all donated blood and blood components used for transfusion;safe injection practices; safe sex practices,including minimizing the number of partners and using barrier protective measures (condom). Moreover, Hepatitis B vaccine is the mainstay of prevention, no wonder it is part of  our National Programme On Immunization. However, adults who were not immunized at childhood and who are among the high risk groups should meet their doctors to ascertain if they are eligible for the vaccination.

Hepatitis C and D infections have almost the same preventive measures as Hepatitis B except that Hepatitis C vaccine is currently unavailable globally though research is still ongoing.

Hepatitis E can be prevented by maintaining quality standards for public water suppliers;establishing proper disposal systems to eliminate sanitary wastes; maintaining hygienic practices such as hand washing with safe water, particularly before handling food; avoiding water/or ice of unknown purity; adhering to WHO safe food practices. Hepatitis E vaccine is still not available in the global market, though it has been produced and licensed in China.

DIAGNOSES AND TREATMENTS:
Consult your doctor who is trained to request and interpret the relevant laboratory tests you will run based on the information he/she gets from history taking and physical examination.  The doctor will go on to draw other management plans suitable for you.

In view of the above, our government should map out comprehensive national plans to tackle this silent killer called (viral) hepatitis.

REFERENCES:
(1) Kumar and Clark's Clinical Medicine,8th edition
(2) Davidson's Principles And Practice Of  Medicine,21st edition
(3) Oxford Handbook Of Clinical Medicine,9th edition
(4) www.who.int/en/
(5) http://en.m.wikipedia.org/wiki/Hepatitis

DR. PAUL JOHN
Port Harcourt-based medical practitioner
Phone: 08083658038
Email: mazipauljohn@gmail.com

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