Hepatitis

Hepatitis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer.

Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.
There are 5 main hepatitis viruses, referred to as types A, B, C, D and E.
These 5 types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread.
In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.
Hepatitis a and e are typically caused by ingestion of contaminated food or water.
Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids.
Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.
Acute infection may occur with limited or no symptoms or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.
Identified by the letters A, B, C, D, and E. While all cause liver disease, they vary in important ways.

This virus present in the faeces of infected persons and is most often transmitted through consumption of contaminated water or food.
Certain sex practices can also spread HAV.
Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections.
However, HAV infections can also be severe and life-threatening.
Most people in areas of the world with poor sanitation have been infected with this virus.
Safe and effective vaccines are available to prevent HAV.

The hepatitis A virus is transmitted primarily by the faecal-oral route; that is when an uninfected person ingests food or water that has been contaminated with the faeces of an infected person.
In families, this may happen though dirty hands when an infected person prepares food for family members.
Waterborne outbreaks, though infrequent, are usually associated with sewage-contaminated or inadequately treated water.
The virus can also be transmitted through close physical contact with an infectious person, although casual contact among people does not spread the virus.

The incubation period of hepatitis A is usually 14–28 days.
Symptoms of hepatitis A range from mild to severe, and can include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-coloured urine and jaundice (yellowing of the skin and whites of the eyes).
Not everyone who is infected will have all of the symptoms.
Adults have signs and symptoms of illness more often than children. The severity of disease and fatal outcomes are higher in older age groups.
Infected children under 6 years of age do not usually experience noticeable symptoms, and only 10% develop jaundice.
Among older children and adults, infection usually causes more severe symptoms, with jaundice occurring in more than 70% of cases.
Hepatitis A sometimes relapses.
The person who just recovered falls sick again with another acute episode. This is, however, followed by recovery.

Cases of hepatitis A are not clinically distinguishable from other types of acute viral hepatitis.
Specific diagnosis is made by the detection of HAV-specific Immunoglobulin G (IgM) antibodies in the blood.
Additional tests include reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA, and may require specialised laboratory facilities.

There is no specific treatment for hepatitis A.
Recovery from symptoms following infection may be slow and may take several weeks or months.
Most important is the avoidance of unnecessary medications. Acetaminophen / Paracetamol and medication against vomiting should not be given.
Hospitalization is unnecessary in the absence of acute liver failure.
Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhoea.

In May 2016, The World Health Assembly adopted the first “Global Health Sector Strategy on Viral Hepatitis, 2016-2021”.
The strategy highlights the critical role of Universal Health Coverage and the targets of the strategy are aligned with those of the Sustainable Development Goals.
The strategy has a vision of eliminating viral hepatitis as a public health problem and this is encapsulated in the global targets of reducing new viral hepatitis infections by 90% and reducing deaths due to viral hepatitis by 65% by 2030.

This virus transmitted through exposure to infective blood, semen, and other body fluids.
HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant 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.

This virus is mostly transmitted through exposure to infective blood.
This may happen 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.

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

Mostly transmitted through consumption of contaminated water or food.
HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized as an important cause of disease in developed countries.
Safe and effective vaccines to prevent HEV infection have been developed but are not widely available.