Hepatitis is a serious, global, health problem. It can cause chronic debilitating illness, cancer and death. This is why World Hepatitis Day is one of only four World Health Organization (WHO) officially-mandated global public health days for a specific disease, the others being for AIDS, tuberculosis (TB) and malaria.

Hepatitis is an inflammatory condition of the liver. There are different types and the severity of symptoms and outcomes varies. Hepatitis can be caused by several things including autoimmune disorders, reaction to medications, drugs, toxins, and alcohol. But by far, the most common cause of hepatitis is viral infection; and that is what this article will be looking at.

Incidence of hepatitis in Southeast Asia (SEA)

The Southeast Asian (SEA) region has one of the world’s highest rates of hepatitis infections.

The WHO estimate that globally around 370 million men, women and children have chronic hepatitis B or C infections, and nine out of 10 remain unaware they are infected; and could inadvertently pass on the infection. A 2019 survey among households in Malaysia found that only 36.9% of households were aware of the dangers of hepatitis B or understood how it was transmitted. A massive increase in vaccinations, screening, diagnosis and care, are needed to prevent even more people becoming infected.

Types of hepatitis

There are several types of viral hepatitis known as A, B, C, D, and E. The most dangerous and even lethal are B and C. While A and E are unpleasant but rarely life threatening, D, on the other hand is very dangerous but can only be contracted by people infected with B.

Hepatitis A & E

The hepatitis A virus (HAV) and Hepatitis E virus (HEV) are common in less developed parts of the world. Both are found in the faeces and blood of infected people. It is most commonly spread when infected faeces contaminate water. Both are highly contagious, even microscopic amounts of HAV and HEV in drinks or on food washed with contaminated water can infect people with the virus.

HAV and HEV rarely develop into chronic or serious conditions with many people – especially young children – having no symptoms at all. Those that are symptomatic might have mild fatigue, nausea, stomach pain, and jaundice. HAV and HEV infection typically last less than two months.

The main differences between HAV and HEV is that there is a vaccine for HAV and travellers to Africa and the less developed parts of SEA and South America are advised to have it. The other difference is that HEV is sometimes contracted by people after eating raw or undercooked pork, venison, wild boar meat, or shellfish. There is currently no widely available vaccine for hepatitis E, although China approved a recombinant vaccine in 2012.

Hepatitis B

Hepatitis B virus (HBV) is the most dangerous of the virus types. It is the leading cause of liver cancer, AKA Hepatocellular carcinoma (HCC), which is the fifth most common cancer worldwide in men and the ninth in women but the second leading cause of cancer deaths.

It was once most commonly spread from mother to baby, hence the widespread introduction of compulsory vaccination for newborn babies in most of the developed world. In adults, infection is most common via blood, semen, or other body fluids; typically, through sexual contact or the sharing of needles, syringes, and other drug-injection paraphernalia.

Not all adults newly infected with HBV have symptoms, but for those that do, symptoms can include fatigue, poor appetite, stomach pain, nausea, and jaundice. For many people who contract it as adults, hepatitis B is a short-term illness but for others, it can become a long-term, chronic infection that can lead to serious, even life-threatening health issues like cirrhosis or liver cancer.

The risk of chronic infection is related to age at infection: about 90% of infants with hepatitis B go on to develop chronic infection, whereas only 2%–6% of people who get hepatitis B as adults become chronically infected. There is no cure for hepatitis B so those with chronic infection should have regular health screening for cirrhosis and liver cancer. The best way to prevent hepatitis B is to get vaccinated.

Hepatitis C

There is currently no vaccine for HCV. Hepatitis C is spread through contact with blood from an infected person. Although it can occasionally be transmitted sexually it is most commonly spread through sharing needles and other drug paraphernalia.

Hepatitis C can be a short-term illness, but for the majority of people infected it becomes a chronic infection. Chronic hepatitis C can result in serious, even life-threatening health problems such as cirrhosis and liver cancer.

People with chronic hepatitis C may show no symptoms for many years; with symptoms only appearing when the liver disease or cancer is already advanced; this is also true of hepatitis B infections.

If you think you may have been exposed to hepatitis C it is important to get tested, because if the disease is detected early, it can be cured in most people with eight to 12 weeks of drug therapy. As there is no vaccine for hepatitis C, the best way to prevent it is by avoiding the risky behaviours such as anal sex, multiple sexual partners, and the sharing of needles that can spread the disease.

Hepatitis D

Hepatitis D virus (HDV) is one of the most severe forms of viral hepatitis. It is a satellite virus or hybrid virus, i.e., it only occurs in people who are also infected with HBV.

Unlike normal viruses HDV can’t infect a cell on its own and has to piggy back on its viral accomplice HBV. It makes infection with HBV much worse, turning quiescent, chronic HBV it into an acute, lethal viral infection; and often an emergency situation.

Hepatitis D is spread via blood or other body fluids either during sex or by sharing drug paraphernalia. It can be an acute, short-term infection or become a long-term, chronic infection. Hepatitis D can cause severe symptoms and serious illness that can lead to life-long liver damage and even death. People can become infected with both hepatitis B and hepatitis D viruses at the same time (known as “coinfection”) or get hepatitis D after first being infected with the hepatitis B virus (known as “superinfection”). There is no vaccine to prevent hepatitis D. However, prevention of hepatitis B with the HBV vaccine also protects against future hepatitis D infection.

The important message from WHO for World Hepatitis Day 2021 is make sure you and your loved ones are vaccinated against HAV and HBV and avoid the risky behaviours that could expose you to HCV and HEV. And if you already are infected with any hepatitis virus have regular screenings for liver disease and liver cancer.

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