Doris Obinna
As the world marks the World Hepatitis day on July 28, people and governments are expected to continue raising awareness on the disease, which claims the lives of about 1.34 million people yearly. Efforts are geared towards attaining total elimination of the disease by 2013.
Surveys have revealed that viral Hepatitis B and C affect 325 million people worldwide . It is the second major killer infectious disease after tuberculosis, and nine times more people are infected with it than HIV. The good news is that Hepatitis is preventable, treatable, and in the case of Hepatitis C, curable.
This year, the World Health Organisation (WHO) is urging all countries and partners to promote the theme: “Invest in eliminating hepatitis.” The world body would be releasing new estimates for additional investments needed to achieve globally agreed hepatitis elimination goals by 2030, in the context of the universal health coverage.
The World Hepatitis Day is currently recognised in over 100 WHO-member countries with millions of people across the world taking part.
According to Publicity Secretary, Dr. Uchenna Ijemo of Society for Gastroenterology and Hepatology in Nigeria (SOGHIN), hepatitis is an inflammation of the liver due to the presence of toxic substances or infections caused by a protozoan parasite or viruses.
He said “people affected by viral hepatitis usually recover, but some continue to carry the virus for many years and can spread the infection to others. These are chronic carriers.”
According to him, chronic hepatitis may persist for years and lead eventually to cirrhosis (destruction and replacement of liver cells by fibrous tissue), saying a substantial number of cirrhotics end up with liver cancer.
He said: “Chronic carriers serve as an important source of new infections; most have no signs or symptoms and an estimated two-thirds are unaware of their status. Hepatitis B virus (HBV) is 50-100 times more infectious than human immunodeficiency virus (HIV) and it is estimated that over two billion people are infected worldwide and approximately one million deaths occur annually from HBV related illnesses.” 
There are 300-400 million carriers of HBV in the world. Several studies have demonstrated that HBV is endemic in Nigeria and have also shown the sero-prevalence among various groups. About 170 million people are infected with hepatitis C virus.
Ijemo said Nigeria has put the burden of Hepatitis B in most cities to an average of 13 per cent, translating to an estimated 20 million people infected. This means that at least one of every 10 Nigerian is a chronic carrier of Hepatitis B and not only at risk of liver diseases and death but also at risk of transmitting it to others. It is estimated that hundreds of people die annually due to the consequences of this disease.
He said viral hepatitis is described as a ‘silent killer’ because most persons do not realise that they are infected and usually are without any clinical symptoms.
An expert, Dr. Paul John, said about 23 million Nigerians are infected with Hepatitis B, making Nigeria one of the countries with the highest Hepatitis infection in the world. It is believed that about 400 million people in the world are living with either Hepatitis B or C.
Hepatitis viruses
Scientists have identified five unique hepatitis viruses, identified by the letters A, B, C, D, and E. While all cause liver disease, they vary in important ways.
Hepatitis A virus (HAV): This is present in the faeces of infected persons and is most often transmitted through consumption of contaminated water or food. Certain sex practices can also spread HAV. Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections. However, HAV infections can also be severe and life-threatening. Most people in areas of the world with poor sanitation have been infected with this virus. Safe and effective vaccines are available to prevent HAV.
Hepatitis B virus (HBV): This virus is transmitted through exposure to infective blood, semen, and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant in early childhood. Transmission may also occur through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. HBV also poses a risk to healthcare workers who sustain accidental needle stick injuries while caring for infected-HBV patients. Safe and effective vaccines are available to prevent HBV.
Hepatitis C virus (HCV): This is mostly transmitted through exposure to infective blood. This may happen through transfusions of HCV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. Sexual transmission is also possible, but is much less common. There is no vaccine for HCV.
Hepatitis D virus (HDV): Infections occur only in those who are infected with HBV. The dual infection of HDV and HBV can result in a more serious disease and worse outcome. Hepatitis B vaccines provide protection from HDV infection.
Hepatitis E virus (HEV): This is mostly transmitted through consumption of contaminated water or food. HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognised as an important cause of disease in developed countries. Safe and effective vaccines to prevent HEV infection have been developed but are not widely available.
Causes
Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Hepatitis A is caused by a virus that infects liver cells and causes inflammation.
The inflammation caused by hepatitis can affect how the liver works and cause other signs and symptoms of Hepatitis A. The virus most commonly spreads when you eat or drink something contaminated with faecal matter, even just tiny amounts. It does not spread through sneezing or coughing.
Here are some of the specific ways the Hepatitis A virus can spread by eating food handled by someone with the virus who doesn’t thoroughly wash his or her hands after using the toilet. They include:
• Drinking contaminated water
• Eating raw shellfish from water polluted with sewage
• Being in close contact with a person who’s infected, even if that person has no signs or symptoms
• Having sex with someone who has the virus.
Signs and symptoms
If you have infectious forms of chronic hepatitis, like Hepatitis B and C, you may not have symptoms in the beginning. Symptoms may not occur until the damage affects liver function.
Signs and symptoms of acute hepatitis appear quickly. They include: fatigue, flu-like symptoms, dark urine, pale stool, abdominal pain, fatigue, loss of appetite, unexplained weight loss and yellow skin and eyes, which may be signs of jaundice.
Chronic hepatitis develops slowly, so these signs and symptoms may be too subtle to notice.
Diagnoses
History and physical exam: To diagnose hepatitis, first your doctor will take your history to determine any risk factors you may have for infectious or noninfectious hepatitis.
During a physical examination, your doctor may press down gently on your abdomen to see if there’s pain or tenderness. Your doctor may also feel to see if your liver is enlarged. If your skin or eyes are yellow, your doctor will note this during the exam.
Liver function tests: Liver function tests use blood samples to determine how efficiently your liver works. Abnormal results of these tests may be the first indication that there is a problem, especially if you don’t show any signs on a physical exam of liver disease. High liver enzyme levels may indicate that your liver is stressed, damaged, or not functioning properly.
Other blood tests
According to an expert, if your liver function tests are abnormal, your doctor will likely order other blood tests to detect the source of the problem. These tests can check for the viruses that cause hepatitis. They can also be used to check for antibodies that are common in conditions, like autoimmune hepatitis.
Ultrasound: An abdominal ultrasound uses ultrasound waves to create an image of the organs within your abdomen. This test allows your doctor to take a close look at your liver and nearby organs. It can reveal, fluid in your abdomen, liver damage or enlargement, liver tumours and abnormalities of your gallbladder.
Sometimes the pancreas shows up on ultrasound images as well. This can be a useful test in determining the cause of your abnormal liver function.
Liver biopsy: A liver biopsy is an invasive procedure that involves your doctor taking a sample of tissue from your liver. It can be done through your skin with a needle and doesn’t require surgery. Typically, an ultrasound is used to guide your doctor when taking the biopsy sample.
This test allows your doctor to determine how infection or inflammation has affected your liver. It can also be used to sample any areas in your liver that appear abnormal.
Treatment
Treatment options are determined by which type of hepatitis you have and whether the infection is acute or chronic.
Hepatitis A: Hepatitis A usually doesn’t require treatment because it’s a short-term illness. Bed rest may be recommended if symptoms cause a great deal of discomfort. If you experience vomiting or diarrhea, follow your doctor’s orders for hydration and nutrition.
The hepatitis A vaccine is available to prevent this infection. Most children begin vaccination between ages 12 and 18 months. It’s a series of two vaccines. Vaccination for Hepatitis A is also available for adults and can be combined with the Hepatitis B vaccine.
Hepatitis B: Acute Hepatitis B doesn’t require specific treatment.
Chronic Hepatitis B is treated with antiviral medications. This form of treatment can be costly because it must be continued for several months or years. Treatment for chronic Hepatitis B also requires regular medical evaluations and monitoring to determine if the virus is responding to treatment.
Hepatitis B can be prevented with vaccination. The Centre for Disease Control recommends Hepatitis B vaccinations for all newborns. The series of three vaccines is typically completed over the first six months of childhood. The vaccine is also recommended for all healthcare and medical personnel.
Hepatitis C: Antiviral medications are used to treat both acute and chronic forms of Hepatitis C. People who develop chronic Hepatitis C are typically treated with a combination of antiviral drug therapies. They may also need further testing to determine the best form of treatment.
People who develop cirrhosis (scarring of the liver) or liver disease as a result of chronic Hepatitis C may be candidates for a liver transplant. Currently, there is no vaccination for Hepatitis C.
Hepatitis D can be prevented by getting the vaccination for Hepatitis B, as infection with Hepatitis B is necessary for Hepatitis D to develop.
Hepatitis E: Currently, no specific medical therapies are available to treat Hepatitis E. Because the infection is often acute, it typically resolves on its own. People with this type of infection are often advised to get adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol. However, pregnant women who develop this infection require close monitoring and care.
Experiences
Tolulope Dele (not real name) said, she didn’t believe she could be a victim of hepatitis because, according to her, “I thought it could only be contracted from living recklessly because I quite knew a little about it. Little did I know that a slight contact with the disease could change my life permanently.
“This is to enlighten you about the fact that hepatitis could be contracted in several ways than you can imagine. I started feeling pains around the upper area of my stomach, not consistently though but I felt it was just a slight ache from work.
“At 39 and working with a television station (name withheld), I had reasons to always sit for long hours so I assumed it was just a random pain. My greatest regret was not going for immediate checkup. About two months later or thereabout, the stomach pains became severe, it started taking me up to 40 minutes to get up from the bed because of the pains around my stomach area.
“I could not carry out simple activities, like cleaning the house or even bathing myself. For about a week of the reoccurring pain, it suddenly went away. This was the first stage of hepatitis, which I didn’t know about.
“Other symptoms were pains around my joints and loss of appetite. I could not eat solid nor take liquid. I started becoming very lean and I threw up every little thing I managed to eat or drink. Thinking it was malaria, I was taking treatments for Malaria and typhoid. I know the discomfort that comes with having to bear the pain of urinating. This made me even avoids drinking water.
“After the early stages of severe pain and loss of appetite, I started vomiting and feeling fatigued even after long hours of rest. I immediately went to the physician around my neighborhood because my doctor wasn’t accessible at that point in time. This was another mistake I wish I didn’t make because I was slowly killing myself.
“The physician told me it was probably food poisoning and gave me some remedies to use. These meds included pain relievers, which I took morning, afternoon and night. I was also given gastric juice, which I took morning and night. Even after this, I didn’t see any improvements. I still continued using them. Later, I started visiting hospitals.”
Narrating further, she said, about a month after, she woke up one morning and knew all was not well. “I looked into the mirror and saw that my eyes were yellow and my face was covered with rashes. I was able to drag myself to hospital for immediate check up.
“The doctor broke the news of Hepatitis B and recommends an immediate operation on my liver because a large portion of it had injuries. This meant I was close to having liver cancer.
“My case of hepatitis must have been caused by contaminated water. The tricky thing about Hepatitis B is you’d only start experiencing full symptoms about 21 days after the virus must have fully developed from hepatitis A.”
Prevention
Speaking on prevention tips, Ijemo, urges Nigerians to pay attention to the following key preventive messages:
Knowing the risks: Unsafe blood, unsafe injections, sharing of sharps including drug injection equipment can all result in hepatitis
Demand safe injections: About two million people contract hepatitis from unsafe injections. Using sterile single use disposable syringes can prevent these infections. Approximately eight billion injections are given unnecessarily globally and unnecessary injections increase the risks.
Vaccinate children as well as adults: A safe and effective vaccine can be given and this protects from hepatitis B for life.
Get tested, seek treatment: Effective treatment options exist for Hepatitis B and cure for Hepatitis C.
It is important to: Talk to your doctor about testing you for hepatitis virus infection, irrespective of your health status and about receiving a vaccine to prevent Hepatitis B if you test negative for the virus. All pregnant women should be screened for hepatitis with a view to protecting the yet-unborn baby.
An expert said: “Also, practicing good hygiene is one key way to avoid contracting hepatitis A and E. If you’re traveling to a developing country, you should avoid: local water, ice, raw or undercooked shellfish and oysters, raw fruit and vegetables.
“The use of vaccines is an important key to preventing hepatitis. Vaccinations are available to prevent the development of Hepatitis A and B. Experts are currently developing vaccines against \Hepatitis C And A. Vaccination for Hepatitis E exists in China, but it isn’t available in the United States.”
Complications
Unlike other types of viral hepatitis, Hepatitis A does not cause long-term liver damage, and it doesn’t become chronic. In rare cases, Hepatitis A can cause a sudden loss of liver function, especially in older adults or people with chronic liver diseases.
Acute liver failure requires a stay in the hospital for monitoring and treatment. Some people with acute liver failure may need a liver transplant.