What is Hepatitis
Hepatitis is the inflammation of the liver, with or without decompensation of liver functions. It can be caused by viruses, bacteria, chemicals, drugs or toxins. It may be acute or chronic.
Types of hepatitis
Viral Hepatitis is caused by viruses, which mainly affect the liver cells (hepatotropic). These are Hepatitis A to E viruses (HAV, HBV, HCV, HDV & HEV).
Causes of hepatitis
HAV is transmitted by food and water and the disease is self-limiting. Once the patient is cured, there is no long-term effect on the liver. HAV is acquired by almost everyone before the age of 20 years, mostly without any clinical disease. Only 1/1000 persons develop signs and symptoms of hepatitis. All those who get HAV, become permanently immune. Those who get the virus may pass it to others through their feces. There is a vaccine that is available against HAV and it is advised for children In the developing countries.
HEV is acquired mainly by adults through the faeco-oral route. This is also self-limiting without long term effects, however, the immunity after exposure to the virus is not permanent. The disease may be very serious in women who are in the last trimester of pregnancy.
Complications of hepatitis
The HBV, HCV, and HDV may be acquired asymptomatically but it may persist in the liver and may cause chronic liver disease (CLD) with late complications like cirrhosis and even liver cancer. The HBV is cleared by 95% of those who acquire it in adult age if their immune system is intact and functioning well. The HCV may persist in the majority of those persons who are infected with it. These viruses are acquired by the parental route, i.e. blood and body secretions entering the recipient‘s circulation. This may occur through blood transfusions or through the sharing of sharp reusable instruments (contaminated with blood) including razors, blades, syringes, lancets and through needle-stick injuries.
The HBV causes symptomatic acute disease in only 30% of infected adults and the seriousness of the disease varies from person to person. The HBV is transmitted sexually as well as from mother to child during birth. The HCV is less commonly transmitted through sexual contact (only 3-4%). The HDV infects only those who are already infected with the HBV. HDV and HBV, if both acquired, may cause more serious disease. There is a vaccine available against the HBV, which also protects against the HDV.
In cases of known exposure, such as needle-stick injuries or sexual contact, immediate prophylaxis with an immunoglobulin must be given. There is no need for testing all viral hepatitis markers in all cases. There, the judicial selection is required, which may be made on the basis of the available, clinical notes. To avoid the transmission of HAV and HEV, special emphasis should be made on the provision of clean food and drinking water. In cases of HBV, HCV, and HDV, the sharing of needles, syringes, lancets and other sharp instruments without proper sterilization, should be avoided.
Safety precautions should be adopted by medical and paramedical staff as well as their dental counterparts. Any blood donors must be screened properly. Babies born to HBV-carrier mothers should be protected at birth by the administration of the vaccine and a specific immunoglobulin.
