All about Hepatitis

Dr Shoket Choudhary
Hepatitis is defined by the inflammation or swelling of the liver that occurs when cells/tissues of the liver become injured or infected.
Hepatitis is caused due to viral infections that affect the liver, commonly being hepatitis A, hepatitis B, and hepatitis C.
World Hepatitis Day Celebrated
Following the adoption of a resolution during the 63rd World Health Assembly in May 2010, World Hepatitis Day was given global endorsement as the primary focus for national and international awareness-raising efforts and the date was changed to July 28 (in honor of Nobel Laureate Baruch Samuel Blumberg discoverer of the hepatitis B virus, who celebrates his birthday on that date). The resolution resolves that “28 July shall be designated as World Hepatitis Day in order to provide an opportunity for education and greater understanding of viral hepatitis as a global public health problem, and to stimulate the strengthening of preventive and control measures of this disease in Member States.”
* World Hepatitis Day is now recognized in over 100 countries each year through events such as free screenings, poster campaigns, demonstrations, concerts, talk shows, flash mobs and vaccination drives, amongst many others.[5] Each year a report is published by the WHO and the World Hepatitis Alliance detailing all the events across the world.
Objective of Themes:
* 2014: Hepatitis: Think Again
* 2013: More must be done to stop this silent killer.
* 2012: It’s closer than you think.
* 2011: Hepatitis affects everyone, everywhere. Know it. Confront it.
Theme For 2015:   Prevent Hepatitis It’s Up To You
Burden Of Disease Globally : The global burden of disease due to acute hepatitis B and C and to  cirrhosis  and cancer of the liver is high (about 2.7% of all deaths) and is forecast to become a higher ranked cause of death over the next two decades. An estimated 57% of cases of liver cirrhosis and 78% of cases of primary liver cancer result from hepatitis B or C virus infection.
Burden of Disease in INDIA:  India has more than 37 million HBV carriers and contributes a large proportion of this HBV burden. While horizontal transmission in childhood appears to be a major route of transmission, the role of vertical transmission ( mother to baby ) is probably underestimated. Blood transfusion and unsafe therapeutic injections continue to be important modes of transmission of HBV.
Transmission
Hepatitis B is transmitted through blood and infected bodily fluids. This can occur through:
* direct blood-to-blood contact
* unprotected sex
* unsterile needles
* from an infected woman to her newborn during the delivery process.
Other possible routes of infection include sharing sharp instruments such as razors, toothbrushes or earrings.  Body piercing, tattooing and acupuncture are also possible routes of infection unless sterile needles are used
Hepatitis B is NOT transmitted casually. It cannot be spread through sneezing, coughing, hugging or eating food prepared by someone who is infected with hepatitis B. Everyone is at some risk for a hepatitis B infection, but some groups are at higher risk because of their occupation or life choices.
High Risk Groups
* Health care workers and emergency personnel
* Infants born to mothers who are infected at the time of delivery
* Partners or individuals living in close household contact with an infected person
* Individuals with multiple sex partners, past or present
* Individuals who have been diagnosed with a sexually transmitted disease
* Illicit drug users (injecting, inhaling, snorting, popping pills)
* Men who have sex with men
* Individuals who received a blood transfusion prior to 1992 ( when universal screening was not available )
* Individuals who get tattoos or body piercing
* Individuals who travel to countries where hepatitis B is common (Asia, Africa, South America, the Pacific Islands, Eastern Europe, and the Middle East)
* Individuals emigrating from countries where hepatitis B is common, or born to parents who emigrated from these countries (see above)
* Families adopting children from countries where hepatitis B is common (see above)
* Individuals with early kidney disease or undergoing kidney dialysis
* Individuals who use blood products for medical conditions (i.e.hemophilia)
Blood-borne Viral Hepatitis
Hepatitis viruses B (HBV), D (HDV) and C (HCV), which predominantly transmit through the parenteral route, pose a serious “silent epidemic” challenge to India. Infected persons are unaware of their chronic carrier status, and continue to infect others for decades and eventually burden the society with loss of productive workforce, and the health care system with expenses of treating liver failures, chronic liver diseases, and cancers.
Disease burden and sero-prevalence.
HBV and HCV together are estimated to have led to 500 million chronically infected persons and one million deaths. In the South-East Asia region, the estimated burden of chronic HBV infection is 100 million and the estimated burden of chronic HCV infections in South Asia is 50 million. HBV is the second most common cause of acute viral hepatitis after HEV in India. With a 3.7% point prevalence,  over 40 million HBV carriers, India is considered to have an intermediate level of HBV endemicity. Every year, one million Indians are at risk for HBV and about 100,000 die from HBV infection. The population prevalence of HCV infection in India is 1%. HDV infection is not very common in India and is observed in 10% to 20% of HBV positive patients..
Laboratory diagnosis.
Presence of HBsAg determines infectivity of the HBV infected case. Presence of HBeAg suggests increased viral replication in the infected case. Appearance of anti-HBs implies immunity to HBV infection either by natural infection or vaccination. Acute infection is identified by the presence of IgM hepatitis B core antigen (anti-HBc). Presence of anti-HBc in the absence of IgM anti-HBc and persistence of HBsAg indicates chronic infection. Presence of anti-HCV and anti-HDV suggest exposure to HCV and HDV, respectively. HCV-RNA detection is necessary for verification of current HCV infection. Liver disease activity is evaluated on clinical imaging, blood biochemistry, liver enzymes, and histo-pathological findings along with viral load studies Prevention and control.
Prevention and control
can be achieved through safe and effective HBV vaccines. WHO recommends routine infant vaccination along with catch-up immunization for adolescents and high risk populations. India introduced universal immunization against hepatitis B in 10 states in the year 2002, and in 2011, scaled up this operation countrywide. Recently a pentavalent vaccine, which also protects against HBV, has been introduced in some states. The HBV vaccine also protects from HDV infection. There is no vaccine against HCV. Screening and immunization of high-risk groups, such as those with history of exposure, risky practices, and occupational risk; specific measures for prevention of mother-to-child transmission and promoting safe blood supply, safe injections and safe sex are other recommended preventive measures.Residents and staff of correctional facilities and group homes.
(The author is HOD Gastroenterology Superspeciality Hospital Jammu)

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