On 28 July, World Hepatitis Day is celebrated to raise awareness about viral hepatitis which, left untreated, can lead to liver cancer. The liver is the second largest organ in the human body.
As of April 2022, acute hepatitis of unknown origin was reported among children in the US and Europe. According to the World Health Organisation, around 450 cases were detected worldwide.
However, the cause remains unknown; many experts believe that this outbreak is related to Covid-19.
Dr Neelam Mohan, Paediatric Gastroenterologist and President of Commonwealth Association of Paediatric Gastroenterology and Nutrition, says, “A pattern of increased presence of Adenovirus (a group of viruses which causes common cold, flu, pneumonia, stomach inflammation) was seen in some of the patients, but still the cause is unknown.”
She continues, there are chances that this spike might be the result of a new variant of Adenovirus or increased susceptibility.
As compared to the number of cases in Delhi in 2019, around 2,000 more cases were recorded in 2020. While the cases weren’t fatal, the increased incidence in the number of cases among children has caused concern.
Based on Dr Mohan’s observations, the number of cases in the first six months of 2022 is slightly higher than the number of cases in 2021.
Few cases have been detected in other parts of India. According to a study conducted in Madhya Pradesh, among 475 Covid-19 positive children, 8% had Covid Acquired Hepatitis (CAH).
Types of hepatitis
There are five types of viral hepatitis: A, B, C, D and E. Hepatitis B and C are transmitted through blood via contaminated needles, syringes and blood products, through unprotected sex or from a pregnant mother to the child. Hepatitis A is mostly food borne that is spread through contaminated food and water.
The most common symptoms include jaundice, fatigue and loss of appetite. Hepatitis A and C can be a cause of acute liver disease.
Earlier, hepatitis B and C used to affect almost 5% of the population. “Hepatitis C used to be one of the factors of liver transplants. But now, we have medicines which can cure 95% of the disease…so it is no more a cause for transplants”, adds Dr Mohan.
Severity of the disease
“Nowadays, if we diagnose the patient, unless and until they come in late stages, they don’t require transplants. The disease can be easily managed”, says Dr Dinesh Singal, Gastroenterologist, PSRI Hospital.
He continues, “Interferon was used to treat the disease. When the virus would not respond, we see patients gradually developing cirrhosis and then jaundice because of chronic liver disease. And they would ultimately require liver transplantation.”
In India, alcohol consumption causes one-third of liver transplants and hepatitis among adults. He further says that the only treatment is to stop alcohol consumption.
Effective role of vaccines
Only hepatitis A and B have preventive vaccines; however, administering vaccines for Hepatitis A is not mandatory in India in spite of the vaccine being effective and preventing infection. Hepatitis A usually occurs in children below the age of six; it is a mild disease and the child recovers in 3-4 days.
“Hepatitis A vaccines can be administered to children beyond six years of age, people who have not gotten Hepatitis A infection in childhood, or people who have a liver disease but have never been exposed to Hepatitis A. There is a chance that such people might be prone to serious liver issues; therefore, Hepatitis A vaccine can be provided in such cases”, adds Dr Singal.
Incidence among adults has decreased due to effective treatment methods. “Due to increased awareness, people are being detected early as they get tested frequently. And most of the blood banks legally certify that all the blood components are being tested for Hepatitis B and C. So blood transfusion should not be a problem”, he asserts.
Pregnant mothers who are infected with hepatitis can be a carrier of the disease. Throughout the course of pregnancy, the woman is tested for hepatitis and if she is found positive, precautionary measures have to be taken.
Dr Singal says, “We reduce the viral load in the mother so that she does not transmit the virus to the baby. Soon after birth, we give them a protective V vaccine and an immune globulin, which is called Hepatitis B immunoglobulin.”
In Delhi, according to the vaccination protocol, it is mandatory to get the Hepatitis B vaccine.
Through this methodology, we can prevent infection in newborns. In many parts of India, awareness and education is necessary because Hepatitis B and C can increase just like HIV, which is transmitted through blood and semen.
Awareness and education
Educating the public about these infections is the primary step. People should be made aware of the availability of preventable infections. They should know that Hepatitis B can be completely prevented by just screening your blood and administering a vaccine.
Highlighting the fact that these diseases are treatable is equally important. The initial phase of infection of both Hepatitis B and C may be asymptomatic, which is why people usually come to seek help when there is advanced damage in the liver.
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