Hepatitis refers to inflammation of the liver, which can lead to acute or chronic health problems or complications that can be potentially fatal. According to the World Health Organisation (WHO), the global burden of hepatitis is mainly due to Hepatitis B and Hepatitis C infections with about 354 million people living with these infections worldwide.
There are many causes of hepatitis which can broadly be divided into two types based on how it’s caused: infectious and non-infectious. Infectious causes are primarily due to viral, bacterial, fungal and parasitic infections. Whereas non-infectious hepatitis can be caused by alcohol, drugs, autoimmune disease and metabolic issues.
There are many types of viral hepatitis, with the 3 most common being, hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis C virus (HCV). Other viruses that cause hepatitis include the hepatitis D virus (HDV), hepatitis E virus (HEV), adenovirus, cytomegalovirus (CMV) and Epstein-Barr virus (EBV).
Symptoms of viral hepatitis depend on whether it is an acute infection or chronic infection. Symptoms of acute hepatitis include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain and jaundice. Chronic viral hepatitis such as Chronic Hepatitis B or Chronic Hepatitis C can be asymptomatic or cause mild non-specific symptoms. Diagnosis of viral hepatitis can be confirmed by laboratory tests through the presence of deranged liver enzymes and positive serological tests of the respective hepatitis viruses.
The risk factors of viral hepatitis depend on the type of hepatitis and its transmission routes. The mode of transmission of HAV and HEV is through ingestion of contaminated food or water, hence this is a higher risk for those living in poorly sanitised areas. However, the mode of transmission for HBV and HCV is by contact of bodily fluid of the infected person – either sexual transmission or vertical transmission from mother to baby during childbirth, as well as exposure to infected blood products through transfusion.
On the other hand, non-viral hepatitis is mainly caused by alcohol consumption, drugs, toxins, as well as autoimmune diseases such as Autoimmune Hepatitis.
Treatment of hepatitis depends on its underlying cause and differs from one cause to another. In many acute viral hepatitis cases, treatment is predominantly by supportive care, whereas for Chronic Hepatitis B and Chronic Hepatitis C, specific antiviral therapy can be started for a certain duration of time. In non-viral hepatitis, treatment is by discontinuation of the offensive drug, avoidance of toxins, or treatment of the underlying autoimmune disease. Not all cases of hepatitis have specific treatment and many cases only require supportive care while the liver recovers from its underlying disease.
Certain lifestyle changes can help prevent occurrence of hepatitis or assist liver recovery. For example, alcohol avoidance and discontinuation of hepatotoxic substances (which are chemicals that cause liver injury) can help with recovery of hepatitis from acute liver injury due to the offensive agents. In infectious hepatitis, safe needle usage and safe sexual practice can reduce risk of hepatitis.
Prevention of viral hepatitis, in particular HBV and HCV infections, can be achieved by public education and awareness of the disease risk factors, early disease detection during routine antenatal screening or during pre-employment medical examination (to prevent further transmission), or by vaccination for certain hepatitis viruses as well as employing harm reduction strategies in certain high risk groups.
There are vaccines available for the prevention of acute Hepatitis A, and the development of Chronic Hepatitis B. However, there is currently no available vaccine for HCV, HDV and HEV.
Harm reduction strategies among targeted high-risk groups can help prevent HCV transmission. Hence education of safe needle usage and avoidance of needle-sharing among intravenous drug users is considered an important prevention strategy.
World Hepatitis Day is annually observed on 28th July to promote and raise public awareness on hepatitis in particular viral hepatitis. Screening for Chronic Hepatitis B and Chronic Hepatitis C, particularly among high-risk populations, helps early detection of the disease to allow for early treatment to prevent long-term disease-related complications.
The World Health Organisation aims to reduce new hepatitis infections by 90% and deaths by 65% by 2030. It has also set a target for eradication of Hepatitis C by 2030.
Dr. Mohd Johan Bin Mohd Johari
Consultant Internal Medicine Physician
Columbia Asia Hospital – Setapak
