Hepatitis means “inflammation of the liver”. Nausea, loss of appetite, jaundice ( yellowing of the eyes and skin ), abdominal discomfort and tea colored urine are the most common symptoms. However, it is often detected in asymptomatic individuals during health checks. There are many causes of hepatitis, including infection ( eg viruses like hepatitis A, B, C ), medications, traditional herbs, alcohol, excessive weight, inherited diseases, some types of cancer and even industrial poisons. The critical issue is finding the reason for the hepatitis as the treatment and seriousness of the illness will depend on the identified cause. In this article we focus on 3 viruses that cause hepatitis.
Hepatitis A
This is a virus infection acquired through consumption of fecally contaminated water or food, particularly shellfish. It can also be transmitted through oral-anal sex with a recently infected individual. While the affected person may feel unwell for many weeks, the disease is almost always self limiting, rarely threatens life and will not result in any serious long term complications. Once the individual recovers from the infection, he can no longer infect another individual and should be immune ( ie protected ) to future hepatitis A re-infecions. Vaccination for hepatitis A is available and this will provide life long protection. Infection by Hepatitis A is very common. In Singapore, by the age of 50 years, about 90% would have been exposed to the virus.
Hepatitis B and C
Unlike hepatitis A, these are virus infections which can potentially cause life long infection with complications ( liver failure, liver cancer ). Such infected patients are called carriers. In the initial stages, they are usually completely asymptomatic. Infected individuals can feel and look perfectly normal. This explains why many individuals do not realize they have been previously infected by these viruses until tests are performed, either during general health checks, blood donation or insurance related screenings or when pregnant.
Progression is very slow and complications with symptoms become apparent only after many years to even decades after the initial infection. By the time symptoms are noticed, liver damage is usually already severe.
About 3% of Singaporeans are hepatitis B carriers. Carriage rates vary between countries eg China 43%, Taiwan 20%, Philippines 17%, Australia 1%, Japan 3%. Hepatitis C is much less common in Singapore. Only about about 0.4-1.7% of Singaporean are hepatitis C carriers.
These viruses are acquired;
- Through sexual intercourse with or contact with the blood of an infected person. Hepatitis B is more infectious than Hepatitis C. Sexual promiscuity and having multiple sexual partners are known high risk factors. Blood contact most commonly occurs during acupuncture, tattooing or piercings performed with contaminated needles. Sharing of needles by drug addicts or those experimenting with “mainlining lifestyle drugs” is another mode of infection. In less developed medical services, contaminated blood products and even improperly sterilized surgical / dental equipment may serve as sources of infection. Sharing of razors, toothpicks, toothbrushes, nail clippers, combs with an infected person can also potentially transmit the viruses
- During delivery, the baby can also be infected through contact with the blood of a hepatitis B carrier mother. This is a common mode of transmission for hepatitis B and can largely be prevented by timely medical treatment of the newborn at birth. Transmission while the baby is still in the womb is documented but is probably rare. Pregnant mothers should therefore be screened for Hepatitis B so that the appropriate precautions are taken at birth to protect the newborn. Hepatitis C transmission during birth can also occur but is much less common than Hepatitis B.
Early detection of hepatitis B and C carriers is important as it allows counseling, life style modifications and close follow up to detect complications in their earliest stages. Specific treatment for carriers are now available for hepatitis B and hepatitis C, but not all patients will benefit from treatment. Consultation with a liver specialist is advised to determine if treatment is necessary and beneficial.
Close contacts and family members of carriers should undergo screening.
This article was written by;
Dr Cheong Wei Kuen
MBBS (S’pore), MMed (Int Med), MRCP (UK), FAMS (Gastroenterology)
Consultant Physician & Gastroenterologist
No comments:
Post a Comment