This July 28th is the International Hepatitis Day. WHO aims to raise awareness about the diverse causes of hepatitis through this day. Each year since 2016, Hepatitis day has a theme; this year’s theme is “ELIMINATE HEPATITIS”, and under this directive, all participating countries (194) are encouraged to build momentum, hold governments accountable and be active.
All participating countries adopted the World Health Organization’s (WHO) global strategy to eradicate hepatitis B and C. Unfortunately, few of these have actually been following it.
For 2018, the main focus of the campaign is on “Finding the Missing Millions”. Nearly 90% of people living with hepatitis B or C don’t know they are infected, which results in many deaths each year due to complications. This could be prevented through a more aggressive approach to diagnosis and access to care. The campaign is a three-year global strategy that aims to break the barriers that block access to diagnosis.
As a small contribution to this effort, we’ll do our best to offer you reliable information about this condition, beginning with what it is and its most common causes and manifestations.
What is Hepatitis?
Hepatitis is simply an inflammation of the liver. Sometimes this condition can stop progressing after a certain point or it can lead to scarring of the liver (fibrosis), cirrhosis (a more severe, irreversible and chronic stage) or even liver cancer.
Viruses cause most cases of hepatitis, but alcohol, drugs and autoimmune diseases can also lead to inflammation of the liver.
Types of Hepatitis
There’re 2 main types of hepatitis, Chronic and Acute.
Acute hepatitis is a temporary inflammation of the liver that in most cases is not considered a serious condition and has no long-term effects.
Chronic hepatitis is a lasting inflammation of the liver that with time causes liver damage.
Sometimes, acute hepatitis can become chronic, although the frequency of such a phenomenon is unknown.
Viral hepatitis is simply an inflammation of the liver resulting from a viral infection that can be either acute or chronic. Right now there are 5 known hepatitis viruses; Hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and hepatitis E virus (HDV).
Caused by the HAV and the main form of transmission is through ingestion of contaminated food or water. This virus causes an acute inflammation. Most people infected don’t even notice it or feel the need to go to the doctor. The inflammation last for a short time and then it disappears without leaving any lasting impact.
People infected with HAV become immune after their first encounter with this pathogen, earning it a very low place in the WHO list of priorities; however, in some cases, inflammation last more than expected and the condition becomes chronic, creating a much greater danger for the infected.
People from developing countries are at a higher risk of infection due to poor sanitation. In the case of Pakistan, most, if not all domestic sources of water are contaminated with HAV.
The HBV is acquired by sharing bodily fluids with an infected individual. It can mostly result by sharing needles, bites, piercing of the flesh, sharing personal items like toothbrushes or having sexual intercourse with an infected person. Even infected women can spread the virus to their children during pregnancy or breastfeeding.
HBV also starts as a mild illness but this one is much more likely to become chronic in nature, leading to liver damage.
Once infected with the virus there’s no cure, only treatments. The main way to control this disease is through vaccination. The HBV vaccine is 95% effective.
Pakistan’s situation with HBV is serious. Incidence ranges anywhere from 1.4% to 11%, with an average of 2.4% of the population being infected.
The inflammation caused by HCV infection becomes chronic quite frequently. The disease is spread in the same way than HBV. However, with this virus 1 of every 4 infected individuals will develop cirrhosis which can eventually lead to liver cancer.
Infection with HCV is the most frequent cause of hepatitis worldwide. In Pakistan HCV is an important problem. In any given area, the incidence of HC is anywhere from 0.3% to 32%, with an average of 3% of the population being infected.
This one spreads in the same way that HBV and HCV, however it can only affect individuals already infected with HBV. This is called co-infection.
HDV is endemic for Pakistan, Punjab in particular has very high levels, 88% of all HBV-infected individuals are also co-infected with HDV.
HEV is very similar to HAV in that both cause acute inflammation of the liver that resolves itself in a short time. As mentioned before, even mild cases of viral hepatitis have a chance of becoming chronic.
In Pakistan, around 15% of all domestic sources of water have tested positive for HEV.
Some toxic substances can also cause inflammation of the liver, however, the viral causes are much more common and difficult to avoid.
To summarize, hepatitis is an extremely important healthcare issue for the Pakistani population. Viral hepatitis is the most common type of hepatitis. HB and HC being the most dangerous manifestations of the disease, however, HD and HE are much more frequent and their respective viruses are ubiquitous in the environment. This can be dangerous in the long-term. Vaccination is the best option to fight against the dissemination of this disease.