BackThe ABC of hepatitis
The ABC of hepatitis
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Last month, actor Amitabh Bachchan caused a sensation in the blogosphere and popular media when he blogged that he had liver cirrhosis. Culprit? Not the traditional demon alcohol (Bachchan is a teetotaller), but the “Australia antigen hepatitis", or hepatitis B—“8 years ago during the course of an MRI, they discovered that 25% of my liver had been destroyed by it," the veteran actor wrote on https://bigb.bigadda.com on 23 April. A dramatic revelation, just a month ahead of World Hepatitis Day (on 19 May).
Big B surmises he contracted the disease while shooting Coolie in 1982, when he was given 60 bottles of blood after an accident on the sets.
At the time, screening transfusions for hepatitis B was not yet de rigueur. But blood products aren’t the only avenue; any small cut can lead to infection if you aren’t wary. “Transmission through (even) inanimate objects like a stick of sugar cane or a hard fruit is technically possible from blood or saliva of the first eater if the second person has an abrasion on the gum," says Sanjiv Saigal, chief transplant hepatologist, Sir Ganga Ram Hospital, New Delhi.
The jaundiced view
Yes, so we know more now. We know hepatitis and cirrhosis of the liver can start from more than a food-borne infection or an alcohol habit (although drinking regularly can make you more susceptible, especially to hepatitis A and B).
Also See Kinds of Hepatitis
It’s been a while since medical researcher Saul Krugman peered into blood samples from 4,000 children at a New York school and differentiated between hepatitis A and B in the 1950s. The hepatitis lexicon has been expanding every few years to cover other letters of the alphabet.
Hepatitis, from hepar, the Greek word for “liver", is an inflammation and infection of the liver. Says Ashwini Kumar Setya, senior consultant gastroenterologist and hepatologist, Max Super Speciality Hospital, New Delhi, “Viral hepatitis is caused by five different known viruses."
Hepatitis A
Possibly the most innocuous of the lot and caused by the hepatitis A virus, or HAV, this disease (once popularly called jaundice, which is just a symptom of the infection) is generally caught from infected food and water, so the best way to prevent it is to be careful what you put into your mouth—and not just drinks and foods from street vendors. “Avoid unsealed bottles (of any beverage)," says Arpit Jain, consultant, internal medicine, Artemis Health Institute, Gurgaon. This includes water from purifiers not cleaned regularly, aerated drinks from “fountains" (machines over which the manufacturing company has little control) and juice bars.
Come summer and rains, and the fear of hepatitis A increases. Mothers fret about children picking up the bug from a swimming pool. But most urban swimming pools, says Dr Setya, follow quality control norms for fear of being shut down. What you may need to watch out for, though, is your family gulping seawater on a beach holiday.
Symptoms: Appetite loss, jaundice, nausea and vomiting, fever, enlarged liver
Vaccine: Available. Can be taken by anyone above the age of 1. Two doses needed, the second given at least six months after the first one. Protects children for 14-20 years; adults for 25 years (if you reacted adversely to the vaccine the first time, consult a doctor before taking it again).
Hepatitis B
Hepatitis B virus, or HBV, piggybacks on infected blood and body fluids to enter a new host. According to the World Health Organisation (WHO), HBV has infected one in every three people around the world.
If it manifests immediately, you can actually get quick treatment before much damage has been done. But the chronic infection can be silent for decades before irreversible liver damage is detected, as in Bachchan’s case.
Besides IVs and blood products, it is transmitted through the mucous membrane and saliva. It can be passed on through unprotected sex or from mother to foetus (WHO suggests immunizing any newborn whose mother has HBV, but it should not stop the mother from breastfeeding). Also, say, you have HBV and share a mango with someone—the virus could be passed on if the other person has a lesion in his mouth. And the pit of mango or other stone fruits can itself cause that small cut!
The British Medical Journal reported in March that even acupuncture can spread both hepatitis B and C through infected needles. Aside from the obvious (no sharing needles, and while you’re about it, don’t “do" drugs), be careful not to share blood glucose monitoring meters, for instance. Careless dental procedures and body piercing may lead to HBV, as can a simple manicure or pedicure with unsterilized equipment.
Anil Arora, chairman and head of the department of gastroenterology and hepatology, Sir Ganga Ram Hospital, New Delhi, is also concerned about the sharing of razors. “Blood may dry on razor and contain the live virus for seven days. Since cuts are frequent during shaving, it is never advisable to share a razor," says Dr Arora. Avoid sharing toothbrushes, epilators and earrings too.
Symptoms: The acute version manifests as loss of appetite, nausea, jaundice, weakness, stomach pain, skin rashes and dark urine. The chronic type may have no symptoms for decades, but can show up as cirrhosis later.
Vaccine: Available. Three injections are given (from newborn to adults) at months zero, 1 and 6. These provide protection for at least 25 years. Babies should be immunized within 72 hours of birth, says Dr Arora.
Hepatitis C
Often going unnoticed for up to 20 years in the body, the hepatitis C virus (HCV) can cause fibrosis, or scarring of the liver; and worse, chronic cirrhosis—rather like HBV, except that there is no vaccine for it.
A blood-to-blood disease, scientists are currently not too sure if HCV is also passed on through sexual contact. What they do know is that it is passed on through infected syringes or even infected blood touching an open wound on, say, a paramedic involved in emergency rescue. Dr Jain says, “Tattooing with unsterilized and reused equipment is a definite route of transmission for hepatitis B and C, as well as HIV." Health watchers are also concerned about beauty treatments where abrasive material removes dead cells. HCV thrives for days even on work surfaces where dead skin cells may have fallen. If the spa or salon does not use stringent sterilization techniques, clients may be exposed to the virus.
Symptoms: Poor appetite, jaundice, nausea, disturbed sleep and depression.
Vaccine: None.
Hepatitis D
Optimists may call it good news: “The hepatitis D virus (HDV) hitches a ride on HBV," says Dr Setya. So only those who have been infected by the HBV can catch HDV. The bad news is, when someone gets infected with HDV, the risks to the liver are greater than for someone infected only by HBV. Identified in 1977, HDV is transmitted mostly through infected intravenous injection equipment. Getting immunized against HBV can protect one to some extent from HDV.
Symptoms: Fatigue, vomiting, slow fever, diarrhoea, dark urine and light stool.
Vaccine: The one used for HBV affords some protection.
Hepatitis E
Recognized in 1980, the hepatitis E virus (HEV) can be transmitted through the faecal-oral route, i.e., going through contaminated food and water to end up in your food, including uncooked shellfish, much like HAV. “Hepatitis E is a more serious problem compared to hepatitis A in terms of clinical course, complications and outcome," says Dr Jain.
Although it is by and large self-limiting, this disease can turn dangerous in pregnant women, so nutritional hygiene is important. “Basic Indian customs such as not sharing jhootha food and water can protect you from hepatitis as well as diseases such as typhoid," says Dr Setya.
Symptoms: Jaundice, appetite and weight loss, nausea, enlarged and tender liver.
Vaccine: None
Where are F and G?
An unusual virus found in some patients in Japan in 1991-92 was called HFV since it was not hepatitis A, B, C, D or E, but seemed similar. It is still hypothetical, though, since none of the suspected viruses being studied since the 1990s has been proven to cause hepatitis F.
Isolated in 1995 in the blood samples of a US surgeon, the hepatitis G virus (HGV) does infect humans, but has not been found to cause illness. HGV can be transmitted through unprotected sex, transfusions and by the parenteral route, i.e., piercing skin or the mucous membrane. Says Dr Setya: “So far, it has been isolated but is not of disease-producing magnitude."
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