Hepatitis: Avoid contaminated food, water, unprotected sex

Hepatitis is an inflammation of the liver.

The virus can be self-limiting or can progress to fibrosis scarring.

The disease could also be caused by excessive consumption of alcohol and certain drugs, among others. Autoimmune diseases can also bring it about.

Health experts explained that there are different types of hepatitis infections: A, B, C, D and E, among others.

These five pose great concern because of the severity of the illnesses, and potential for outbreaks and epidemic spread.

Dr. Modupe Akinyinka, a Senior lecturer and Consultant, Public Health Physician Department of Community Health and Primary Health Care, Lagos State University College of Medicine, said Hepatitis A and E are typically caused by ingestion of contaminated food or drink, while B, C and D could occur as a result of sharing sharp instruments that have been in contact with infected body fluids.

She said: “Common modes of transmission of these viruses include receipt of contaminated blood or blood products, invasive medical procedures, using contaminated equipment or during unprotected sexual intercourse. Hepatitis B is through mother to child transmission at birth, from family member to child, as well as sexual contact.

“Therefore, people should avoid unsafe, contaminated food and water.

They should also avoid sharing such sharp objects as needles, blades and clippers. It is also important to avoid patronage of quack medical personnel and facilities.”

Dr. Chukwuma Ogunbor, a Consultant Family Physician explained that clinical presentation of viral hepatitis is similar regardless of etiology (causes).

He said: “The signs and symptoms of viral hepatitis vary from a mild flu-like illness to fulminant hepatitis, which is often fatal.

The clinical features of a typical attack can be divided into three phases.

These include Prodromal phase, which begins with anorexia (loss of appetite), malaise, nausea and vomiting. There may be fever, which is often mild.

Because of the similarity between these symptoms and malaria at the early stage, the diagnosis is usually missed.

High index of suspicion is required at this stage to identify the cause.

“Viruses are major causes of hepatitis.

They are classified as hepatitis viruses A to G, cytomegalovirus (CMV), Epstein Barr Viruses (EBV), yellow fever virus, including HIV.

Viral hepatitis is a global health problem of public health concern.

It has been estimated that about 10 to 12 per cent of the population has viral hepatitis.

Acute viral hepatitis is a disease of young adults, while chronic viral hepatitis is found more in older age groups.

High prevalence of chronic carrier of Hepatitis B Virus is found in drug addicts, prostitutes and other groups at high risk of infection, such as health workers.

Viral hepatitis is classified based on the duration of the disease. This may be acute or chronic.”

Ogunbor said Icteric phase begins after three to 10 days of onset of symptoms.

The patient notices itching with passage of dark urine and later on jaundice.

The recovery phase is when the jaundice peaks about one to two weeks from onset and then disappears over a period of two to four weeks.

He said: “Signs are often few, consisting only of jaundice and an enlarged, tender liver. Occasionally, the spleen may be enlarged.

The non-viral causes of hepatitis include the malaria parasite, systemic fungal infections, toxoplasmosis, leptospirosis and rickettsial organisms.

“However, certain drugs have been known to also cause hepatitis. These include paracetamol. Liver damage caused by paracetamol has been on the rise recently, which could be attributed to abuse of the drug.

People abuse paracetamol for the slightest pain. Use of herbal concoctions is also one of the leading causes of liver damage.

Others include anti-TB drugs and some drugs used for controlling blood pressure, such as methyldopa.

“Excessive and prolonged use of alcohol is also a major cause of liver damage. Investigations usually include Liver function test to check for liver enzymes, clotting profile, full blood count, urine analysis, ultrasound of the liver and viral screening for hepatitis viruses.

Mode of treatment depends on the stage of the disease.

“Treatment of uncomplicated acute viral hepatitis is supportive, such as bed rest, avoidance of alcohol and normal diet. Fulminant hepatitis is treated with anti-liver failure regimen. Chronic Hepatitis B Virus and hepatitis C virus require both supportive and antiviral therapy.

“The prevention and control of Hepatitis viruses transmitted by the faeco-oral route such as hepatitis A and E depends on good sanitation and hygiene. In the case of transmission via blood and blood products, proper screening of blood before transfusion should be done. Observing universal precautions is pertinent.

“Every Nigerian should be vaccinated against viral hepatitis.

Newborn babies should be vaccinated for hepatitis B virus, as part of their routine immunisation via the National Programme on Immunisation (NPI).

This comprises three doses given at birth, about one month after and at six months.

A booster dose is given at five years. Adult dosage follows similar pattern.

Individuals not immunised, but exposed via blood contact from an infected person should have hepatitis B immunoglobulin injection immediately.”

Dr. Emuobor Odeghe, a Consultant Physician and Gastroenterologist with Lagos University Teaching Hospital (LUTH), said some people may not show any sign or symptom, while others may present with fever, yellowness of the eyes, tiredness, fatigue, poor appetite, body aches, vomiting, light coloured stools, dark coloured urine and abdominal pain.

He said: “If it progresses to liver cirrhosis, there may be swelling of the abdomen, vomiting of blood, confusion or coma, or even development of liver cancer.

Hepatitis could be acute, lasting less than six months.”

Odeghe said there is an effective vaccination for hepatitis B virus, and it is recommended that all newborns take the first dose within 24 hours of birth.

Older children and adolescents should also be vaccinated, if they haven’t been.

“People should avoid self-medication and herbal/traditional remedies. 

It is also important to maintain a healthy lifestyle with regular physical exercise, healthy diet, and weight control/loss. They should also go for regular health checks,” he said.