It is more serious than you would imagine, ‘it's closer than you think’, says the World Health Organisation, about hepatitis (liver inflammation). “That’s because, there’s not much awareness about the disease, though it figures among the four major diseases declared by WHO as global health problems, along with HIV-AIDS,” says Dr. A. Olithselvan, senior consultant, hepatology and liver transplantation, Global Health City.
Considering an estimated 4 per cent of Indians carry the hepatitis B virus or HBV (it may be as high as 10 per cent in tribal populations and villages) and another 1 per cent of Indians carry the hepatitis C virus (HCV), there is reason to sit up and take notice. “Many chronic carriers of HBV and HCV get affected by varying degrees of liver disease — cirrhosis or even complete liver failure in the end stage,” warns Dr. Ubal Das, consultant hepatologist and gastroenterologist, Apollo Hospitals. There is another chilling reason to take the hepatitis virus seriously — it can lead to liver cancer.
The transmission route
“Both the B and C viruses get transmitted through transfusion of infected blood or blood products, through the intra-venous route, through sharing needles, and through sexual contact with an infected person,” says Dr. Naresh Agarwal. In India, childbirth is a major cause of hepatitis B transmission. Also, children living in close proximity to family members and others carrying the B virus may contract it.
Those contracting the virus in childhood tend to carry it for life, and it could result in chronic hepatitis. When adults contract it, the result is acute hepatitis, which is self-limiting. “If diagnosed early, medicines are available these days to treat chronic hepatitis effectively,” remarks Dr. Das. But what’s tricky is: how does one know if he or she is a chronic carrier of these viruses?
Unfortunately, chronic hepatitis does not show too many symptoms in the early stages. Dr. Olithselvan says, “We see people right from those in their late twenties to those in their eighties presenting with liver cancer induced by the hepatitis virus. They may have carried the virus for years without being aware of it.”
Some people report bleeding gums or have cuts and wounds that show abnormally prolonged bleeding. “The reason has been diagnosed — low platelet count, which happens because the liver (that controls the clotting capacity of blood) has got damaged by the virus,” says Dr. Olithselvan. There might be accumulation of fluid in the legs and the abdomen, appetite and weight loss, lethargy, weakness and tiredness during the later stages of chronic hepatitis. In adults with acute hepatitis by HBV, there may be symptoms such as fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, grey-coloured stools, dark urine, joint pain, and jaundice. Many people with Hepatitis C do not show symptoms. Symptoms of chronic Hepatitis B can take up to 30 years to develop, while liver damage occurs silently.
“Prevention of hepatitis is best achieved by vaccination. Other preventive measures include use of condoms, sterile needles during injections, not sharing needles while tattooing etc., medication of the infected mother during pregnancy and medication of the new-born baby of the infected mother,” suggests Dr. Das.
“Apart from those at high risk of carrying the virus, considering the high incidence of these viruses among Indians, it is advisable for everyone to get their blood tested, and the infection treated if the test results are positive. If the result is negative, vaccination to safeguard against hepatitis B virus is recommended. While the vaccination for hepatitis B is inexpensive, unfortunately, no vaccination is available for hepatitis C virus,” says Dr. Olithselvan. Not surprisingly, in the last few years, some states have made it mandatory for hepatitis B vaccination to be administered at childbirth.
The liver is the second biggest organ of the human body (next only to the skin), and plays a crucial role in immunity, in processing nutrients, detoxification, excretion and in maintaining the blood’s clotting capacity. When the liver is inflamed or damaged, all these crucial functions get affected.
People at high risk of carrying the virus
* Those who have had a transfusion of blood or blood products prior to the nineties (when screening for the hepatitis virus was not mandatory during transfusions).
* I-V drug users.
* Persons who have had unexplained jaundice in the past.
* Persons with a close relative testing positive for the virus.
* Persons who have had unprotected sex with an infected person.
* Lab technicians, nurses and health care workers who handle needles.
* Since the virus gets transmitted at childbirth too, many among the rest of the population too might be carrying the virus.