World Hepatitis Day: Experiencing fatigue, joint pain & itching? Time to get vaccinated

Monsoon showers bring much-needed relief from the blistering heatwave in India. Relishing fried pakoras and samosas with a cup of kulhad chai on a rainy day is like a dream come true. But the respite and enjoyment the showers bring come with some challenges too: the season can play havoc on your body.

The liver becomes a highly vulnerable organ around this time of the year as the monsoon triggers multiple water and food-borne infections. People are prone to Hepatitis A and E viruses during the rainy season.

The World Health Organization (WHO) terms viral hepatitis a “serious public health problem” in India. According to the WHO, the Hepatitis E virus (HEV) is the most important cause of epidemic hepatitis, and the Hepatitis A virus (HAV) is more common among children.

While viral hepatitis can affect any age group, Dr Lorance Peter, Director-Gastroenterology & Hepatology of Sakra World Hospital, says young people are more vulnerable to Hepatitis A & E (through the feco-oral route — when faecal matter enters the body through the mouth via contaminated food or fingers). "Hepatitis A and E are self-limiting diseases," he adds.

Dr Neeraj Saraf, Director-Hepatology and Gastroenterology, Institute of Digestive and Hepatobiliary Sciences at Medanta Hospital, Gurugram, clarifies Hepatitis A and E infections can happen to anyone. "There is no certain at-risk population to the diseases," he says.

The National Centre For Disease Control has a name for viral hepatitis - 'The Silent Disease'. It can be asymptomatic in some cases and can damage the liver in later stages. However, Dr Rakesh Patel, Senior Consultant-Gastroenterologist at Hospital, Kalyan, says hepatitis is treatable and curable in its mild form.

On World Hepatitis Day, ETPanache Digital got in touch with health experts to bring you a breakdown about the disease and its types.

What is Hepatitis?
Viral hepatitis is an infection of the liver that can lead to acute or chronic inflammation. The virus-borne disease is categorised into five types — A, B, C, D and E. "Hepatitis D is not found in India. Hepatitis A and E are of similar type, and so are Hepatitis B and C," Dr Saraf says.

Hepatitis A and E are transmitted through contaminated water and unwashed food. Hepatitis E — predominantly found in Africa, Asia and South America — is similar to the infection caused by HAV.

On the other hand, Hepatitis B and C (HBV and HCV) are blood-borne diseases, transmitted through contaminated blood, surgical equipment, needles, blood transfusion, mother to baby during delivery and sexual intercourse. Hepatitis D generally affects people who are also infected with hepatitis B.

Whom Does It Affect?
Viral hepatitis can affect anyone and at any age. HAV and HEV rarely cause severe conditions and last for mostly four-five weeks, Dr Patel. But the viruses can easily affect children. “However, they quickly recover too,” he says.

As far as autoimmune hepatitis is concerned, patients can experience joint pains or other autoimmune disorders.

Dr Peter says children with Wilson's Disease — an inherited disorder that leads to copper accumulation in the liver, brain and other organs — may show abnormal liver function tests (LFTs). In some cases, children present signs of Kayser–Fleischer rings (dark rings encircling the iris) on slit lamp eye examination.

People with non-alcoholic steatohepatitis (NASH), which is an advanced form of non-alcoholic fatty liver disease (NAFLD), obesity, abnormal LFT and uncontrolled diabetes are more vulnerable to contracting hepatitis.

Although alcohol is also a significant problem for liver problems, NAFLD can affect even non-alcoholic drinkers if they have poor lifestyle habits. Currently, it affects almost 25 per cent of the global population. NAFLD is mainly caused by lifestyle changes and habits, including obesity, lack of exercise, stress and other factors.

Common Hepatitis Symptoms To Watch Out For
The common signs of hepatitis include fever, fatigue, vomiting, loss of appetite, joint pains (prodromal symptoms), abdominal pain, unexplained weight loss, clay-coloured or pale stool, itching, flu and yellowing of the skin (which may be a sign of jaundice caused by hepatitis A as well).

While symptoms like fatigue and tiredness can be seen in the early stages, people suffer from high-risk jaundice, and water retention in the belly in an advanced stage. Some people also land up in a coma and can develop liver cancers at a later stage.

When symptoms are ignored, it can lead to severe complications like cirrhosis or scarring of the liver. "It becomes difficult to reverse the condition when they get affected by liver cirrhosis," Dr Patel says.

Several complications can also cause liver failure and cancer. Hence, understanding the symptoms and early diagnosis is critical for preventing hepatitis from becoming fatal.

Dr Saraf says hepatitis B and C don't have any signs or symptoms. The condition may remain silent for 10 years and keep damaging the liver.

In some cases, symptoms of chronic hepatitis can be non-existent. Patients mostly show abnormal liver tests, which may lead to a delay in prognosis and treatment.
When a hepatitis case does not recover, it is termed chronic hepatitis disease.

"When people start experiencing the symptoms, the disease reaches a chronic advanced stage which could only be treated with a liver transplant," he adds.

Prevention Is Better Than Cure
HAV and HEV that cause liver inflammation can be easily managed by maintaining good hygiene and following a healthy diet that includes healthy fluids. People should avoid eating street food and drinking open running water.

The primary prevention for Hepatitis B and C is getting tested if someone is experiencing any symptoms. Additionally, HBV and HCV have a genetic predisposition. If one person has it, the other members could also have the condition and should get tested as early as possible. Also, ensure that the blood transfusion is done safely and from a certified blood bank. The needles used should be fresh. People should follow safe sexual practices to avoid getting the infection.

The mode and type of treatment for hepatitis vary from patient to patient, depending on whether they have an acute or chronic condition. While acute viral hepatitis often goes away without any medications or treatment, patients must rest and get enough fluids. "If symptoms persist for more than two days, it is essential to seek medical attention," says Dr Patel.

There are vaccines available for Hepatitis A and B. People suffering from Hepatitis B, after consulting doctors, should get vaccinated as early as possible, suggest medical experts. Hepatitis C is treated using oral medications (direct acting agents) that are given for 12 weeks. These have a good cure rate. "These highly effective medications were introduced from 2014 onwards," says Dr Peter.

"Vaccination helps to provide 95 per cent protection after three doses,” explains Dr Saraf. "We generally do not advise getting vaccinated for Hepatitis A in the Indian population as the condition gets settled after a few weeks on its own. Additionally, the oral medications prescribed for B and C are effective and help to control the condition as much as possible."

Getting vaccinated, limiting alcohol intake and following good hygiene practices can keep hepatitis at bay.