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Image Credits: CDC
Hepatitis occurs when there is inflammation of the liver. Hepatitis can resolve without treatment or progress to fibrosis (scarring of the liver), cirrhosis (end-stage liver disease) or liver cancer. Viral hepatitis B and C are major health challenges, affecting 325 million people globally. They are the root causes of liver cancer, leading to 1.34 million deaths every year.
Most hepatitis sufferers may not exhibit any symptoms and are unaware of their infection. If an acute infection develops. symptoms may show up anywhere between 2 weeks and 6 months following exposure. It may take decades for persistent viral hepatitis symptoms to develop. Symptoms might include fever, exhaustion, appetite loss, nausea, vomiting, abdominal discomfort, light-colored feces, dark urine, joint pain, and jaundice. Signs of hepatitis confirmed by your doctor include increased alanine aminotransferase (ALT) or aspartate aminotransferase (AST) concentrations.
Risk factors of chronic hepatitis (infection of 6 months or more) may be due to:
Viral causes including hepatitis viruses B,C,D, cytomegalovirus (CMV), Epstein-Barr virus (EBV), Rubella virus
Drug induced hepatitis due to methyldopa, nitrofurantoin, isoniazid, sulfonamide, propylthiouracil
Metabolic disorders such as autoimmune hepatitis, Wilson disease (a metabolic liver disease), α1-Antitrypsin deficiency
Image Credits: Onhealth
Different viral hepatitis are transmitted differently.
Hepatitis A and E are spread by ingestion of contaminated food or water. Even in small amounts, the virus can be spread through contact with objects, food or beverages that have been contaminated by an infected person’s feces or stool.
Whereas, hepatitis B is primarily spread by blood, semen and other body fluids. Hepatitis B can also be passed from mother to her baby shortly after delivery. If someone had sex with an infected person, shared equipment or personal items such as toothbrushes contaminated with blood from infected person, they are at high risk of getting hepatitis.
Hepatitis C and D are spread by infected blood. Sexual transmission of hepatitis C can occur in person who has multiple unprotected sex. All people diagnosed with chronic hepatitis B should be tested for hepatitis D, as hepatitis D virus requires hepatitis B virus for replication.
Treatment of hepatitis is dependent on the type and stage of viral hepatitis, patient’s comorbidities, whether pregnancy or breastfeeding, other medical conditions including HIV, kidney impairment, cancer chemotherapy or immunosuppression. Adequate care of your hepatitis is usually provided by your primary care doctor. However, if your hepatitis is severe, you may need to visit a hepatologist or gastroenterologist- who specializes in liver diseases to treat you. Hospitalization is typically not essential unless you are vomiting or unable to eat or drink.No specific treatment is available for hepatitis A and E. Usually, your body will naturally clear itself from the virus without treatment. Hence, the liver will heal within 6 months in most cases without any long-term damage. Supportive care includes resting if you feel tired, sick and have less energy, staying hydrated and well-nourished.
There are antiviral treatments available for chronic hepatitis B and C. Your doctor may recommend antiviral therapy including entecavir, tenofovir, peginterferon for hepatitis B. Treatment for hepatitis B helps to control the disease, prevent progression to cirrhosis but it is not a cure. Not all patients with hepatitis B will require treatment. On the contrary, hepatitis C is curable and a combination of antiviral therapy such as glecaprevir + pibrentasvir or sofosbuvir + velpatasvir is usually given. To verify hepatitis C cure, test for hepatitis C viral RNA at least 12 weeks following the end of treatment.
For hepatitis D, pegylated interferon alpha is the generally recommended treatment. Regardless of how the patient responds, the course of treatment should extend at least 48 weeks. Although the virus has a low response rate to the treatment, the treatment is linked to a decreased risk of illness development.
Vaccination: Long-lasting protection is provided by the hepatitis vaccine or prior infection to the virus. Vaccination is only given for hepatitis A and B. Depending on the hepatitis B surface antigen (HBsAb), high risk workers or high risk patients who are not infected with hepatitis will require a booster for hepatitis B. There is no available vaccine for hepatitis C, D and E. Moreover, Influenza vaccine is also recommended once per year usually in the fall. Standard immunization including diphtheria and tetanus booster should also be given for patients with liver diseases.
Liver cancer screening: Routine liver cancer screening is recommended, especially for older people, people with cirrhosis, people with a family history of liver cancer, and high risk workers including healthcare workers, sex workers etc.
Lifestyle: Avoid alcohol as it can worsen liver damage and can cause liver complications. Some studies also show that smoking can increase risk of liver cancer with hepatitis. Eating a healthy balanced diet and exercise does not improve outcome in people with hepatitis, but generally for overall health.
Prescription, over the counter and herbal medications: Many medications are metabolized in the liver. Thus, it is advisable to inform your healthcare provider or pharmacists if you are starting a new medication. Unless the liver has already developed scarring, most medications are generally safe for hepatitis B patients.
Prevention: Do not share personal items such as razors, toothbrushes or injections such as needles, syringes with others if you are infected. Remember to cover open sores and cuts with a bandage.
Vaccinations given at government health facilities
Image Credit: Myhealth KKM
Vaccinations available in private hospitals or clinics
Pneumococcal (conjugate vaccine)
Medically reviewed by Nur Ariffin, MBBS UniSZA
CDC. What is Viral Hepatitis? Accessed on 17 July 2022. https://www.cdc.gov/hepatitis/abc/index.htm#:~:text=Hepatitis%20means%20inflammation%20of%20the,medical%20conditions%20can%20cause%20hepatitis.
eTG. Liver Disorder. Accessed on 17 July 2022. https://tgldcdp-tg-org-au.ezproxy.lib.monash.edu.au/viewTopic?etgAccess=true&guidelinePage=Liver%20Disorders&topicfile=viral-hepatitis-overview&guidelinename=Liver%20Disorders§ionId=toc_d1e47#toc_d1e47
Mayo Clinic. Hepatitis A. Accessed on 17 July 2022. https://www.mayoclinic.org/diseases-conditions/hepatitis-a/diagnosis-treatment/drc-20367055
MyHealth Kementerian Kesihatan Malaysia. Accessed on 17 July 2022. http://www.myhealth.gov.my/en/immunisation-schedule/
WHO. Hepatitis D. Accessed on 17 July 2022. https://www.who.int/news-room/fact-sheets/detail/hepatitis-d
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