World Hepatitis Day: Know more about the liver disease that affects over 300 in Mumbai this year

Mumbai recorded 55 cases of hepatitis in the month of July until today and total 308 cases in a period of seven months, January 1 to July 24, 2022, according to the Municipal Corporation of Greater Mumbai (MCGM) latest health notification. Given that in 2021, the city had registered 308 cases in a period of 12 months until December, it is not incorrect to say that there would be a surge in the total number of hepatitis cases until December 2022.

Hepatitis is an infectious disease primarily affecting the liver causing an inflammation of the organ, that can lead to liver failure or liver cancer if not treated at its early stages. Among the five types of Hepatitis viruses: A, B, C, D and E, according to the World Health Organisation, Hepatitis B, C and D are found to be chronic and are responsible for over 95 per cent of hepatitis deaths globally. According to WHO's 2016 data, every year 1, 15,000 Indians die of hepatitis B related complications.

According to Dr Alisha Chaubal, consultant - hepatology and liver transplant at Global hospital, "A person dies every 30 seconds from a hepatitis related illness and even in the current Covid-19 crisis, we can't wait to act on viral hepatitis."

The WHO aims to achieve elimination of hepatitis by 2030 and July 28 is annually observed as World Hepatitis Day to initiate a dialogue about the disease, increase awareness and up the action to prevent it. Mid-Day Online reached out to city-based expert Dr Tehsin A Petiwala, consultant gastroenterologist, endoscopist and hepatologist at Masina hospital to know more about the disease, which affects many, but is discussed less.

Which is the most common type of hepatitis viruses Indians are more likely to get infected with?
The common viruses causing hepatitis are type A, B, C, E, among which Indians are mainly affected by Hepatitis E. Hepatitis A is transmitted by consumption of contaminated food or water, while Hepatitis B and C are transmitted through blood products, unprotected sex or by mother to child transmission.

Both hepatitis A virus (HAV) and hepatitis E virus (HEV) tend to occur in epidemic outbursts in places where hygiene is an issue or isolated sporadic cases. Both these viruses are excreted through the faeces of infected persons and get transmitted to healthy persons if they consume such contaminated food or water. Outbreaks often occur during the rainy season or follow periods of flooding, when the chances for contamination of drinking water with sewage increase. Given the sanitation and sewage conditions in Mumbai, especially during rains, it is a high risk area for such infections.

Please tell us something about acute and chronic Hepatitis and the symptoms for both.
All the above-mentioned viruses can cause acute hepatitis, that is an acute illness causing fever, malaise, fatigue, loss of appetite, vomiting, diarrhoea, and abdominal pain. Patients may also report yellowish discoloration of their sclera (icterus) and /or skin (jaundice) and dark-coloured urine. The viruses get cleared from the body due to an immune fightback, generally in a month's time, but can extend even longer up to 6 months in certain cases.

Hepatitis A and E are cured in this manner and illness is self-limiting lasting less than 6 months, but a small proportion (10 to 20 percent) of Hepatitis B and a vast proportion (60-80 percent) of Hepatitis C patients go on to harbour the illness for lifetime, and thus the infection is called Chronic Hepatitis.

Hepatitis B and C are many times detected during routine health check-ups or as a pre-operative investigation. This is due to the fact that the patients don't develop jaundice after the exposure thus having a mild febrile illness which is considered as a simple viral fever. Hence it is important even in healthy persons to check for Hepatitis B and C.

Chaubal adds that one must avoid unnecessary medications like Acetaminophen / Paracetamol against vomiting. These types of hepatitis can be diagnosed by simple blood tests and an abdominal sonography. A non-invasive test called liver elastography or fibroscan can let us know the exact extent of liver damage without resorting to a liver biopsy. If detected in a timely fashion hepatitis can be treated by medical means, else they might require a liver transplant.

Are specific age-groups more prone to be diagnosed with Hepatitis?
An individual can get infected at any age, although there are certain high-risk groups which are prone to Hepatitis B and C such as healthcare workers, intravenous (IV) drug users, tattooing, persons born in endemic areas, and sex workers or persons having sex with multiple partners. People living in areas with improper sanitation conditions are also at a higher risk of getting infected with Hepatitis A and E.

According to Chaubal, children are more prone to get hepatitis A and E which are transmitted through infected food, water. According to latest WHO estimates, the proportion of children under five years of age chronically infected with HBV dropped to just less than one percent in 2019 down from around five percent in the pre-vaccine era ranging from the 1980s to the early 2000s. Hepatitis B can be prevented by vaccines that are safe, available and effective.

Since the symptoms are similar to regular flu, how does one understand the severity of the condition?
The symptoms are similar to regular flu like illness, but dark yellow coloured urine, yellow eyes, abdominal pain and unremitting fever with vomiting are clues to hepatitis. These persons must get themselves investigated and treated accordingly.

Are there any lifestyle changes one can adopt to prevent the infection?
The lifestyle changes that are needed to prevent the infection are based on the mode of transmission as discussed. Hence better sanitation, drinking filtered water, avoiding unhygienic food will help in preventing the food borne hepatitis A and E.

A safe sexual practice that is using condoms, making sure new sterile needles are used for ear or body piercing, tattoos, and acupuncture and avoid direct contact with blood and body fluids will be useful to prevent Hepatitis B and C.

Please elaborate on the vaccination course in India for Hepatitis. According to you, is there enough awareness about the disease?
In India, Hepatitis B is covered under Universal Immunisation Programme, thus it is administered at birth. Hepatitis A vaccine is indicated for all transplant candidates with chronic liver or kidney disease or given on demand to high-risk groups, but not included in the Universal Immunisation Programme. Both these vaccines give lifelong immunity.

There are no vaccines available for Hepatitis C and E, although there are very effective antiviral medicines available for Hepatitis C which provides complete cure. A natural infection with Hepatitis A, E and B (acute self-limiting infection) ensures lifelong immunity.

Overall, due to the silent nature of the disease and endemic proportions of hepatitis B and C, it is better to get oneself checked routinely for these as early treatment for these can prevent a chronic liver disease. More effort is needed in this direction for tracking asymptomatic carriers as they pose a significant threat to themselves and others. Unfortunately Hepatitis B and C virus haven't caused much public awareness as much as HIV, in spite of having safe and effective treatments for them.

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(Disclaimer: This article is not intended as a substitute for professional medical advice, diagnosis or treatment. Mid-day Online does not in any way endorse the accuracy, completeness, efficacy or timeliness of any advice or line of treatment mentioned in this article. Readers must always seek the advice of a certified medical practitioner and/or a mental health professional before deciding on or starting any course of treatment.)