As done every year, the World Hepatitis Day was observed on July 28 to raise awareness about hepatitis and its complication, prevention and treatment. The date was chosen because it is birth anniversary of Noble prize winning scientist Dr Baruch Blumberg, who discovered hepatitis B virus and developed a diagnostic test and vaccine for the virus.
Hepatitis is an infection of the liver. The hepatitis can be self limiting or can progress to liver cirrhosis or liver cancer. The goal of the Hepatitis Day 2019 was to find the missing millions to eliminate viral hepatitis by the year 2030.
Hepatitis is most serious public health disease which affects liver -- an organ of the body vital for maintaining almost all metabolic activities. One cannot lead a healthy life without normal liver function. Viral hepatitis is the commonest cause of liver infection. Hepatitis B virus (HBV) is 100 time more infectious than HIV/AIDS.
According to ICMR report, it is estimated that currently about 40-45 million people are HBV carriers and 10 million are infected with HCV in India. Viral hepatitis is leading cause of liver cirrhosis and cancer. Hepatitis virus is of five types, hepatitis A virus (HAV), B virus (HBV), C virus (HCV), D virus (HDV) and E virus (HEV).
HAV is the most common cause of acute hepatitis in the world. HBV and HCV are chronic viral infections. According to global hepatitis report 2017, HBV and HCV are the major public health problems. It is more in Asian and African countries probably due to prevailing low socio-economic conditions leading to poor hygiene and sanitation.
Hepatitis A/ E that spread mainly through contaminated food and water while hepatitis B/C are spread by body fluids, blood transfusion, use of infected needle and syringe and through mother to child transmission during early childhood.
Most of the persons suffering from viral hepatitis do not develop any obvious symptoms in the initial period but later on complications occur with serious liver problems like liver damage (cirrhosis), cancer and liver failures which need liver transplant.
If the patient, in addition to viral hepatitis, is suffering with alcoholic and/or drug induced hepatitis then the problem gets exacerbated. The drug induced hepatitis usually caused in our country is due to anti tuberculosis drug, anti epileptic drug and certain painkiller drugs which can cause serious damage to the liver.
Hepatitis can reduce the appetite, give feeling of nausea and vomiting, cause low to high grade fever and jaundice. Jaundice is accompanied by the yellow discoloration of eye sclera (white part of the eye), of urine and stool and at extreme stage yellow discoloration of skin which is easy seen in fair coloured skin people.
Viral hepatitis A, B and C can be diagnosed by your symptoms, physical examination and blood tests. Ultrasound, CT scan and biopsy of liver are also used for making the diagnoses.
Hepatitis A and E usually are acute and self limiting which resolve within few weeks. It needs no specific treatment but supportive treatment like good nutritious diet and adequate rest. Hepatitis E can sometimes be dangerous especially in pregnant woman and also men leading to liver failure and death. Over 90 per cent of hepatitis C can be completely cured within 3-6 months of treatment.
Hepatitis A and E are easily prevented by practicing personal hygiene and public sanitation. In our country where basic hygiene and sanitation is lacking, avoidance of eating food from unhygienic roadside vendors will prevent hepatitis infection to a large extent.
Vaccines are available for protection against hepatitis A and B viruses but not against hepatitis C. Unfortunately there are no specific drugs for treating hepatitis A and E, however there are effective antiviral drugs to treat hepatitis B and C infection.
There is no treatment for hepatitis D but it can be prevented by hepatitis B immunisation. Hepatitis E is caused by hepatitis E virus (HEV). It can lead to acute liver failure. The infection is caused by contaminated food or water or uncooked or under-cooked meat in epidemic areas.
Hepatitis B and C virus can spread after sharing of the needle which is quite common practice in drug addicts. It can also spread through the sharing the infected razor blade. The shaving of hair is the common practice in our country.
Most of the people especially in the rural areas are getting the beard and scalp shaved apart from haircuts from common barbers, hence during the shaving the customer should demand for the use of clean razor and of new razor blade because it is quite common to get cut in skin during the shaving of hair especially if the barber is not attentive to his job.
As HBV and HCV are found in blood and body fluids, they spread through infected needle, infected blood and blood product and other body secretions.
It can be prevented by using single use disposable needle and syringe and transfusing the screened blood from the authorised blood bank and disposing infected material through appropriate medical waste disposal authorities and having safe sex using protective measures.
Hepatitis B is an occupational hazard for a health worker. Surgeons have ethical obligation to render care to the hepatitis infected patients and same to other patients. The risk of transmission of HBV from patient to the surgeon is greater than that of surgeon to patient. High viral consultation indicates increased risk of transmission. The actual risk of hepatitis B and C are many times more than the HIV infection in health care workers. About 37.6 per cent of HBV, 39 per cent of HCV and 4.4 per cent of HIV in health care workers around the world are due to needle stick injury.
A study by a French surgeon estimated that general surgeons have 6.9 per cent life time risk of contracting HCV and 0.15 per cent life time risk of contracting HIV. Being an orthopaedic surgeon, I can say for sure that orthopaedic surgeons are more vulnerable to getting unintentional injury due to needle stick or sharps than any other surgeon because an orthopaedic surgeon deals with many neglected orthopaedic deformities and many sharp tip instruments and implants in addition to general instruments. The fracture ends are often sharp and surgeon or assistant are at greater risk of getting an injury during reduction of fracture.
Needle stick or sharps injury can be prevented by observing safe practice habits during work and getting vaccinated against infection. Surgeons should continue to use highest standard of infection control, universal safety precautions and accepted measures to prevent blood exposure.
(The author is an orthopaedic and joint replacement surgeon based in Dehradun)