Eliminate Hepatitis.

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Today is the WHO 7th World hepatitis Day and in the spirit of the WHO's global campaign to eliminate Hepatitis, the purpose of this article is to answer common questions and provide key information on Hepatitis -what it is, its symptoms, the burden of the disease, and its management.

What is Hepatitis?
Firstly, hepatitis is an inflammatory condition of the liver the largest solid organ in the body. The liver is responsible for detoxification, metabolism of various food substances, excretion, production of hormones, storage of glycogen, etc.

What Causes Hepatitis?
There are various causes of hepatitis both infectious and non-infectious. The most common cause is viral with five hepatotropic viruses leading the train worldwide. These are Hepatitis A, B, C, D and E. Other viruses include yellow fever virus, adenoviruses, herpesviruses, Ebola virus, Lassa fever virus, etc.
Hepatitis can also be caused by some parasites(trypanosomes, Leishmania, Plasmodium, Echinococcus, etc), bacteria( Neisseria, Bartonella, salmonella, campylobacter, rickettsia species, Treponema, and mycobacteria species among others) and toxins including industrial toxins, herbal concoctions, food supplements and drugs like paracetamol, antiretrovirals, drugs used in the treatment of tuberculosis, antibiotics, anticonvulsants, etc.
Alcoholic hepatitis is associated with long term consumption of alcohol. Alcoholic consumption is the leading cause of cirrhosis in the United States. While moderate use of alcohol is not implicated in the cause of hepatitis, excessive use over a long period of time is harmful and can lead to liver disease where alcoholic hepatitis-acute or chronic can progress to cirrhosis and even cancer.
Other causes of hepatitis include autoimmune causes where there is an abnormal immune response to native liver cells, genetic deficiencies and reduced blood flow to the liver (liver shock).

Adopt practices that ensure good personal and food hygiene.@ayomipoAMIOLA #Showyourface Click To Tweet The commonest cause of hepatitis worldwide is viral, especially from the five hepatotropic viruses mentioned above. In 2015, according to the WHO, 325 million people worldwide are living with chronic Hepatitis and in the same year, 1.34 million people died globally from viral Hepatitis.

What are the Routes of Transmission of Viral Hepatitis?
While all these viruses target the liver and cause similar symptoms, they are transmitted differently. Hepatitis A and E are contracted when one ingests contaminated food and water. The viruses are present in the faeces of infected persons and if unhygienically disposed, one can be infected unwittingly. Hepatitis B, C and D are transmitted via other ways.
Hepatitis B virus is transmitted through contact with infected body fluid such as blood, saliva, semen, vaginal fluid, menstrual fluid, etc. There can be a mother to child transmission; sexual intercourse, blood(unscreened) transfusion, sharing of sharps and needlestick injuries especially in the healthcare setting are also risk factors.
Hepatitis C is transmitted also when one comes in contact with infected blood or blood products. Sexual transmission though possible is not very common. Hepatitis D infection occurs only in the presence of Hepatitis B because the D virus can't multiply in the absence of the B virus. Hepatitis D is transmitted primarily through blood.
What is the Manifestation of Hepatitis?
The manifestation of hepatitis ranges from a complete lack of symptoms to a self-limiting prodromal illness and to features of chronic liver disease and finally liver failure. In the setting of acute viral hepatitis, patients present with fever, malaise, nausea, poor appetite, joint pains etc. Most will also have yellowness of the eyes and the skin and passage of darkly coloured urine, some may lose weight. However, in about four weeks or so, there is a resolution.
Chronic hepatitis, on the other hand, presents with these features after many years of infection and based on the extent of the liver damage, there may be features such as significant weight loss, abdominal swelling, swelling of the legs, abnormal bleeding, deterioration of brain function and death.
Can Viral Hepatitis Be Prevented?
The management of Hepatitis is two-pronged with prevention being more important and cheaper than treatment.
While there are currently no vaccines against Hepatitis C and E, and Hepatitis A vaccines are not readily available in Nigeria, the impact of Hepatitis B vaccine in the prevention of Hepatitis B infection is sensational. The vaccine is 95% effective in preventing infection and the development of chronic disease and liver cancer due to hepatitis B.
Children born to women who have chronic hepatitis B should have Hepatitis B immunoglobulin and Hepatitis B vaccine within 12 hours after birth to prevent infection. Children who have thus been immunised have no risk of transmission via breast milk.
Other important prevention strategies aimed at behavioural change. Since the route of transmission of hepatitis A and E is primarily feco-oral, the acquisition of proper hygienic practices, provision of clean and potable water and safe handling and disposal of sewage are the mainstay of prevention.
Concerning Hepatitis B, C and D, prevention is aimed at provision of safe blood for transfusion, safe needle and sharps practices in health care settings, abstaining from intravenous drug abuse and safe sexual practices in addition to vaccination in uninfected people.
In Non-infectious Hepatitis, prevention is targeted at reducing exposure to toxins that are hepatotoxic. This includes a reduction in alcohol intake, abstaining from illicit use and abuse of drugs, herbal concoctions and dietary supplements.

Can Hepatitis be Treated?
Treatment of Hepatitis is based on its cause, its severity and its presentation (acute or chronic). Hepatitis A and E infection are self-limiting and rarely becomes chronic, hence treatment is majorly supportive and includes bed rest, adequate hydration and proper nutrition. In pregnant women, however, with Hepatitis E, hospitalisation should be considered.
In cases of acute Hepatitis B infection, most healthy persons clear the virus without any long lasting effect, however in the cases of those who develop acute hepatitis, treatment is majorly supportive. The use of antivirals is indicated in very severe cases of acute infection.

In chronic Hepatitis B infection, the WHO recommends the use of

oral antiviral drugs for the treatment of the condition. However, in most people treatment is not curative but rather suppresses the growth of the virus, limits its replication and reduces damage to liver cells. In this case, treatment is often lifelong.
Hepatitis C infection is rarely symptomatic and more rarely severe. Most people mount a good immune response and clear the virus and people with chronic infection rarely develop liver disease. In cases where treatment is needed, the cure can be achieved and over 95% of people with hepatitis C can be completely cured within 2-3 months of starting therapy with antiviral medications.
Hepatitis D is very difficult to treat and there is currently no effective antiviral treatment for it. So to treat is to prevent by Hepatitis B immunisation.

We all have roles to play in the fight against Hepatitis. @ayomipoAMIOLA #Showyourface Click To Tweet

How do we Eliminate Hepatitis?
Eliminating Hepatitis requires that individuals, communities and the government play different roles all targeted towards prevention and treatment of hepatitis. There is a need for screening the general population and providing vaccines to uninfected persons; thus a general population screening is recommended with a vaccinate-after-screening policy for those who are uninfected and especially for persons who are at increased risk of contracting the virus.
Antiviral drugs for the treatment of Hepatitis are quite expensive, hence government must play a role not only in championing preventive measures but also provision of treatment at affordable prices. This will include but is not limited to innovative diagnostic research, therapeutic research and drug trials that will provide novel therapies for the prevention and treatment of Hepatitis. Also, necessary diagnostic modalities and available drugs should be made universally available and affordable to individuals and families in the society. Since Viral Hepatitis is a contagious, vaccination of uninfected persons must be championed rather than isolation or discrimination or stigmatization.
Finally, individuals and communities must adopt practices that ensure good personal and food hygiene; safe sexual practices must be encouraged and sharps and needles must be safely used and disposed of. Blood transfusion services must ensure screening of blood and blood products before transfusion.
In conclusion, we all have roles to play in the fight against Hepatitis and the Vision of an Hepatitis-free world.
References: WHO fact sheets on Hepatitis.

Ayomipo Jeremiah Amiola is the Medical Officer-in-Residence at the Owode Egba General Hospital Owode Egba Ogun State, Nigeria. Passionate about Public Health, he is a strong advocate of Public Health education and Community Mobilisation for the achievement of Health for All. You can connect with him Linkedin Facebook,

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