Coming Together to Fight Viral Hepatitis

World Hepatitis Day

On the 28^th July 2017, the world is brought together for the annual World Hepatitis Day (WHD). WHD aims to improve the global awareness of viral hepatitis via campaigns and events throughout the globe and step up the national and international efforts to tackle the disease via improved access to screening and treatment.

WHD is one of just four disease-specific awareness days endorsed by the World Health Organisation, and 2017 will mark its 17th year. Last year’s campaign was a huge success, involving 174 countries and 106 governments across the world.¹

September 2015 marked the first ever World Hepatitis global summit, a unique opportunity to gather together policy makers, government and healthcare professionals from around the world and develop an international strategy to tackle the disease. In the same month, the United Nations assembly also listed reducing communicable diseases such as hepatitis as one of their health-related Sustainable Development Goals. Targeting communicable diseases is essential in alleviating poverty and facilitating global development.

The WHD 2016 theme followed on from this, focusing on ELIMINATION and included the “Know Hepatitis – Act Now” campaign, a mandate to eliminate hepatitis by 2032. They started the #NoHep social media campaign, aimed to unite the world in acting together to terminate the disease by improved detection, treatment and care.

How big is the problem?

Each year 1.4 million people die from viral hepatitis and 400 million living with the disease remain at risk of complications.²

Hepatitis B is the commonest virus worldwide, with the highest prevalences in sub-Saharan Africa and East Asia, where between 5–10% of the adult population is chronically infected.³Public Health England estimated that there were 457 acute cases of hepatitis B in England in 2015.⁴ There is considerable uncertainty about the number of people with chronic hepatitis B in the UK but the British Liver Trust estimates reports this to be 1 in 350 people.⁵It is thought that 95% of people with new chronic hepatitis B in the UK are migrants who became infected in their country of birth. The remaining 5% of UK-acquired infections were due to mothers infecting their babies in childbirth, or between adults.⁶

Latest figures show there are 216,000 people living with hepatitis C in the UK. Prevalence of both diseases is higher in inner-city areas, particularly London.⁷

What is viral hepatitis? ⁸

Viral hepatitis is liver inflammation caused by a virus. The most common viruses that affect the liver are hepatitis A, B, C, D and E although other viruses such as a Cyclomegalovirus (CMV) and Epstein-Barr Virus (EBV) may also cause inflammation. Some infections will pass and the liver will recover, but some may be long-term (chronic) leading to scarring of the liver called cirrhosis and in some cases, even liver cancer. A summary of the different viruses is listed below:

Hepatitis A

Hepatitis A is common in areas with poor sanitation. It is caught by eating or drinking food or water contaminated by faeces of an infected person. Most of the time, Hepatitis A only causes an acute (short) illness that lasts a few weeks and a full recovery can be expected.

Hepatitis B

Hepatitis B is acquired through contact with contaminated blood or bodily fluids, such as saliva, vaginal fluid and semen. It can therefore be transmitted through sharing needles and razors, through unprotected sexual intercourse and from maternal transmission in childbirth. If you get a tattoo or a piercing in an unlicensed facility that doesn’t use clean needles, you are also at risk of acquiring hepatitis B.

Hepatitis B can cause either an acute or a chronic infection. If the infection lasts more than 6 months, this is a chronic infection. Sadly 90% of babies infected (from their mothers in childbirth) and 5-10% of of adults will go onto develop chronic hepatitis B infection. Those infected with chronic hepatitis B have a 1 in 5 chance of getting scarring of the liver and a 1 in 20 chance of getting liver cancer.

Hepatitis C

Hepatitis C is normally acquired through contact with infected blood. However, it is possible to also become infected through contact with bodily fluids. In the UK, 90% of people infected with Hepatitis C have become infected from injecting drugs, or from sharing drug taking equipment like spoons and snorting devices.

Hepatitis D

Hepatitis D is only found in people already infected with hepatitis B, as it needs the hepatitis B virus to survive. Hepatitis D is spread through blood or sexual contact. Chronic infection with hepatitis D increases the risk of liver complications such as cancer and cirrhosis.

Hepatitis E

The last of the hepatitis viruses is spread via consuming food or drink contaminated with the faeces of an infected person. It normally only causes an acute infection that resolves spontaneously.

How do you know if you have hepatitis?

Acute hepatitis may cause the following symptoms:

Nausea and vomiting and loss of appetite
Fatigue and weakness
Fever
Abdominal pain
Yellow skin (jaundiced)
Itchy skin
Dark urine and pale stools

Long-term (chronic) hepatitis may not necessarily cause any symptoms until it leads to damage of the liver. The liver is an essential organ for the body, with several important functions. It helps digest food, cleans up the blood by removing toxins, acts as an energy store and metabolises drugs, to name but a few of its roles.

How can I be tested for hepatitis?

Being tested for hepatitis is simple – your GP or healthcare professional can arrange a blood test.

How do you treat hepatitis?

During an acute infection, supportive treatment can be offered for those who feel unwell. This includes hydration, rest, pain killers and anti-sickness medications. Avoid alcohol and any medicines that may further aggravate the liver.

Hepatitis A and E viruses do not normally require treatment as the infection tends to be short-lived and the body clears the virus spontaneously.

Treatment for long-term Hepatitis B infection includes antiviral medication and a medication called peginterferon, that stimulates the immune system to attack the virus. Treatment aims to slow viral replication and therefore prevent complications for occurring. Occasionally clearance is achieved.

Hepatitis C treatment aims to completely eradicate the virus and is normally a combination of peginterferon and ribavirin, an antiviral medication. Treatment length is anywhere from 12 to 48 weeks. Success of treatment depends on which strain or genotype of the virus you have, but cure rates can be as high as 90%.⁸

There is no specific treatment for acute or chronic Hepatitis D, although peginterforon may help. There are no current effective antiviral medications.

How can I prevent myself from getting hepatitis?

You can protect yourself from Hepatitis B, C and D by practicing safe sex and avoiding sharing needles and other drug taking paraphernalia. Avoid sharing toothbrushes and razors which may contain infected blood.

A vaccination is available for people who have a high risk of becoming infected with hepatitis B, such as babies born to infected mothers, those travelling to high risk areas, and those who inject drugs. There is also a Hepatitis A vaccine, but no Hepatitis C vaccine.

If you think you have been exposed to Hepatitis B, you can prevent the infection from developing if you seek medical advice early. Having a Hepatitis B vaccination and Hepatitis B immunoglobulins (antibodies against the virus) can stop you from becoming infected. This is most effective if given in the first 48 hours after exposure.

For babies born to infected mothers, a hepatitis B vaccination within the first 24 hours of life and sometimes immunoglobulins will prevent the child from being infected.

How can I get involved with World Hepatitis Day?

Check out: http://worldhepatitisday.org for campaign ideas!

References