Author: Dr Dipankar Das, Consultant Gastroenterology

What is hepatitis and its prevalence:

Hepatitis is Inflammation in your liver Inflammation is your body’s response to an infection or injury. Many things can injure your liver and trigger hepatitis such as heavy alcohol use, autoimmune disorders, drugs, or toxins. However, the most frequent cause of hepatitis is due to a viral infection, referred to as "viral hepatitis." 

Several different strains of viruses can cause hepatitis. Viral hepatitis is caused by five different viruses (hepatitis A, B, C, D, and E).

Here we will be mainly focusing on the viral hepatitis as it is the most prevalent cause of morbidity & mortality worldwide. WHO estimates that 254 million people were living with chronic hepatitis B infection in 2022, with 1.2 million new infections each year. In 2022, hepatitis B resulted in an estimated 1.1 million deaths, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer).

In India, as per latest estimates, 40 million people are chronically infected with hepatitis B and six to 12 million people are chronically infected with hepatitis C.

Viral hepatitis can be of acute (short term) caused by Hepatitis A , E  & chronic  (long term involvement)  caused by Hepatitis B &C. Hepatitis D (HDV) is only found in people already infected with hepatitis B (HBV); however, the dual infection of HBV and HDV can cause a more serious infection and poorer health outcomes, including accelerated progression to cirrhosis. 

Hepatitis A : 

It is caused by the hepatitis A virus (HAV) and has a worldwide distribution. HAV is typically transmitted by the fecal-oral route (either via person-to-person contact or consumption of contaminated food or water). Risk factors for HAV transmission include residence in or travel to areas with poor sanitation, household or sexual contact with another person with hepatitis A, exposure to daycare centers, exposure to residential institutions, and intravenous drug use.

 Most adults with HAV infection have symptomatic illness which begins with abrupt onset of nausea, fever, malaise, and mild abdominal pain and jaundice. Hepatitis A is usually a self-limited illness that does not become chronic. Treatment is mainly Supportive.

it is diagnosed with some blood tests like Anti HAV IgM and LFT.
 The primary tool for protection against hepatitis A prior to exposure is vaccination. For individuals at risk for hepatitis A exposure who are allergic to the hepatitis A vaccine or are <12 months of age, passive immunization via immune globulin may be given.  For prevention maintaining proper hand hygiene and sanitation is of utmost importance.

Hepatitis E:

Hepatitis E, caused by infection with hepatitis E virus (HEV), is the commonest cause of acute viral hepatitis among adults in India. 

 Hepatitis E has some resemblance to hepatitis A in that it is spread through similar means, particularly contaminated water.

patients with HEV infection may be asymptomatic or may develop nonspecific viral syndrome with or without jaundice.Most of those affected have complete resolution with no residual liver damage, except for some persons who develop Acute liver failure specially during pregnancy who may succumb.
We do some blood tests anti HEV IgM & LFT for diagnosis. Even though vaccines exist, they are not available everywhere.

Hepatitis B:

Hepatitis B is inflammation of your liver caused by infection with the hepatitis B virus.
one can get hepatitis B from contact with blood, spit, semen, or other body fluids from a person infected with HBV. Someone with HBV can spread it even if they don't feel sick. The most common ways for this to happen include:
 i) Sharing needles, syringes, or drug injection equipment Sharing toothbrushes, razors, or medical equipment (such as glucose monitors)
ii) Direct contact with the blood or open sores of a person who is infected
iii) Sexual contact with a person who is infected
iv) Contact with blood from needlesticks or sharp instruments used by a person who is infected
v) From the birthing parent to an infant during pregnancy and delivery
HBV transmission can happen through saliva, but it doesn’t spread through kissing, hugging, sharing food or water, sharing utensils, coughing , sneezing, or nursing.

Acute vs. Chronic Hepatitis B

Acute hepatitis B. This is a short-term illness you get, usually within the first 6 months after you've been exposed to HBV. Many people with acute hepatitis B have either no or only mild symptoms. But some people have severe symptoms and need to go to a hospital. Some people who are exposed to HBV before adulthood are able to fight the virus off without any treatment. For most patients, treatment is mainly supportive

Chronic hepatitis B: This is a prolonged ( more than 6months) infection with HBV. People with chronic hepatitis B usually had an acute case that they weren't able to fight off.immunocompetent adults, the likelihood of progression to chronic HBV infection is less than 5 percent. The younger you are when you're infected with HBV, the more likely it is that you will have a chronic infection. About 90% of infants who are infected go on to get a lifelong infection, but this risk goes down as a child gets older.
Chronic hepatitis B can cause serious health complications, such as liver damage, cirrhosis, liver cancer, and death.

Hepatitis D: Hepatitis D only happens to people who are infected by the hepatitis B virus. If you are vaccinated against hepatitis B, you will be protected against hepatitis D virus.

Hepatitis C:

Hepatitis C is another cause of chronic viral hepatitis. A person can get hepatitis C from:
•    Sharing dirty needles.
•    Being in direct contact with infected blood.
•    Getting needle stick injuries.
•    Having sex with an infected person (less common).
For most people who get hepatitis C – up to 85% – the illness moves into a chronic stage (longer than 6 months). This is called a chronic hepatitis C infection and can lead to serious health problems like liver cancer or cirrhosis. 

Many patients with chronic hepatitis B & C are asymptomatic and only when they devlops symptoms like swelling of the abdomen, Malena  as a consequence of decompensated cirrhosis they seek physician attention and come to know about the diagnosis. while others have nonspecific symptoms such as fatigue , malaise joint pain. Some patients experience exacerbations of the infection which may be asymptomatic, mimic acute hepatitis, or manifest as hepatic failure.

For diagnosis of hepatitis B other than Liver functions test we test Hepatitis B surface antigen ( HBsAg) ,HBV DNA quantitative, and other tests to know the activity of the virus in body.
Similarly for Hepatitis C we need to test antiHCV antibody for screening & HCV RNA for confirmation.
For both Hepatitis B & C , there are oral treatments available now a days. While there are definite short term course for hepatitis C , we need to give long term treatments for hepatitis B managementt with regular follow up examinations.

There are no vaccine available for hepatitis C prevention till now. But for hepatitis B there are safe and effective vaccines which is also covered under national immunisation programme 
In India, hepatitis is a growing concern, leading to severe liver diseases if left untreated. This World Hepatitis Day, on 28th July  ,  Let's together 'Take action. Test, treat, vaccinate.'  
Get tested regularly. If needed, start treatment immediately. Vaccination is crucial to prevent hepatitis. Don't wait—protect your liver and your life.
  
Remember, alcohol abuse, IV drug use, unhygienic lifestyle, ignoring proper hand wash and unprotected sex can be a reason for you to suffer from hepatitis. Make healthy choices for your liver.

A healthy liver means a healthier you.  If you have any of symtoms mentioned above, or high risks factors get tested and seek consultations with our gastroenterology experts at ARHI Hospital and regain your liver health.