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Hepatitis: Knowing and managing it

By Paul Adunwoke
23 July 2017   |   3:35 am
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.

Blood tests can determine whether you have viral hepatitis, and if so, which kind?

Ahead of World Hepatitis Day coming up on Friday, July 28, the disease has been described as an inflammation of the liver. The virus, which can be self-limiting, can also progress to fibrosis scarring. Alcohol, certain drugs, and autoimmune diseases are some of the causes of hepatitis.

Health professionals said there are five kinds of hepatitis infections: types A, B, C, D and E. These are of great concern, due to their severity, the illnesses and death they cause, as well as the potential for outbreaks and epidemic spread. Hepatitis A and E are typically caused by ingestion of contaminated food or water, while hepatitis B, C and D are caused as a result of parenteral contact with infected person’s fluids. Common modes of transmission for these infections include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment. Hepatitis B is usually through transmission from mother to baby at birth, from family member to child, as well as by sexual contact.

The health condition may occur with limited or no symptoms or may include such symptoms as jaundice, yellowing of the skin and eyes, dark urine, extreme fatigue, nausea, vomiting and abdominal pains.

Hepatitis A Virus (HAV) is present in the faeces of infected persons and is most often transmitted through consumption of contaminated water or food. Sexual intercourse can also spread the disease. Infections are in many cases mild, with most people making a full recovery and remaining immune from further infections.

However, HAV infections can also be severe and life-threatening. Most people with poor sanitation have been infected with this virus. Safe and effective vaccines are available to prevent HAV.

Hepatitis B Virus (HBV) is transmitted through exposure to infective blood, semen, and affected person’s fluids. HBV can be transmitted from infected mothers to child at the time of birth or from family member to child in early childhood. Transmission may also occur through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. HBV also poses a risk to healthcare workers, who sustain accidental needle stick injuries while caring for infected-HBV patients. Safe and effective vaccines are available to prevent HBV.

Hepatitis C virus (HCV) is mostly transmitted through transfusions of HCV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. Sexual transmission is also possible but is much less common. There is no vaccine for HCV.

Hepatitis D virus (HDV) infections occur only in those who are infected with HBV. The dual infection of HDV and HBV can result in a more serious disease and worse outcome. Hepatitis B vaccines provide protection from HDV infection.

Hepatitis E virus (HEV) is a common cause of hepatitis outbreaks in developing parts of the world. Dr. Emuobor Odeghe a Consultant Physician and Gastroenterologist, with Lagos University Teaching Hospital (LUTH) Idi-Araba, Lagos, stated that some infected persons may not have any signs or symptoms, while others may have fever, yellowness of the eyes, tiredness, fatigue, poor appetite, body aches, vomiting, light coloured stools, dark coloured urine, abdominal pain. 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 means inflammation of the liver. It could be acute, lasting less than six months, or chronic, which lasts at least six months. Alcohol, herbal and traditional remedies, certain drugs, for instance, paracetamol, some of the drugs for tuberculosis, some antibiotics, obesity; diabetes mellitus and autoimmune conditions, among others may be added causes.”

Odeghe said preventive measures include, screening of blood and blood products before transfusion, avoiding sharing of sharp objects, avoiding unsafe sex and avoiding needle stick injuries for health workers. 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 already been.

“People should please avoid self-medication and herbal/traditional remedies. “Other preventive measures, include avoiding excessive alcohol, maintaining a healthy lifestyle with regular physical exercise, healthy diet, and weight control/loss.

“Hepatitis B could be transmitted sexually. However, it is very important to note that in our environment, most people who have chronic hepatitis B virus infection acquired it in early childhood, typically from other infected means, such as, household contact and with other children through skin wounds, rashes, injuries, and sharing of personal items, such as toothbrushes. Others got the infection from their infected mothers. Transmission of hepatitis B virus through sex is not common in this environment.”

Dr. Chukwuma Ogunbor, a Consultant Family Physician, disclosed that clinical presentation of viral hepatitis is similar regardless of aetiology (causes). 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, and these include: Prodromal phase, which begins with anorexia or loss of appetite, malaise (feeling unwell or sick), 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. Viral hepatitis is a global health problem of public health concern. It has been estimated that about 10 to 12 per cent of Nigerians 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 state 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 noted that 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. During recovery phase, the jaundice peaks in about one to two weeks from onset and then disappears over a period of two to four weeks. 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 cause hepatitis. These include Paracetamol. Liver damage caused by paracetamol has been on the rise recently. People abuse Paracetamol for any slight 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 are usually done to check for the 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.”

Ogunbor stated that the best way to prevent hepatitis is to avoid contact with blood or blood product with persons with hepatitis virus. Every Nigerian, he said, should be vaccinated against viral hepatitis. Newborn babies should be vaccinated for hepatitis B virus as part of routine immunisation via the National Programme on Immunisation (NPI). It comprises three doses given at birth, about one month after and at six months. A booster dose is given at five years. Adult dosage also follows similar pattern. For those not immunised, exposure via blood contact with an infected individual should have hepatitis B immunoglobulin injection immediately.

He said: “Prevention and control of hepatitis viruses transmitted by faeco-oral route, depends on good sanitation and hygiene. Blood and blood products, as well as proper screening of blood before transfusion should be done. Observing universal precautions is pertinent. People should live a moderate lifestyle and go for regular health checks.”

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