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What is Hepatitis ? 

It’s the swelling of liver as a response to injury by any infection. Most commonly it’s due to the common viruses like Hepatitis A & E (Due to contaminated water or food), Hepatitis B & C (Due to the blood related spread). Both hepatitis viruses can damage liver that can vary from mild jaundice to life threatening liver failure and death.  


What is Jaundice? 

Jaundice is the most common symptom of liver disease. It presents yellow color of eye; yellow skin and sometimes-affected person also notice yellow vision too. Most commonly with jaundice there is a decrease in appetite, loss of interest in food, weakness and occasional fever and mild pain in the abdomen. Generalized itching, passage of whitish stool (instead of yellow stool) and severe abdominal pain warrants immediate medical attention.  Jaundice is not a disease, it’s a symptom and indicates liver problem. So, whenever you find yourself or anyone with jaundice, it needs immediate attention to find the cause and remedies. Never go for any treatment like traditional medicine or alternative medicine treatment without any diagnosis, it causes more damage to liver and further deterioration in jaundice instead of recovery. 

What is Hepatitis A &E? 

It’s the most common cause of jaundice outbreak in the community. Hepatitis A is more common in children and hepatitis-E in adults. These infections are mainly due to contaminated water and unhygienic food. The summer and rainy season often showed a massive rise in the number of cases. Jaundice with fever and loss of appetite and weakness are the main symptoms. The patient needs to visit a doctor and do a test, to know the severity. But otherwise, no restriction in food items to be kept, no medicine needed and strictly avoid any locally made drugs. Most of the cases recover well with diet and rest. The pregnant female develops more severe liver problem and death rate is 20times higher than the other person. So, any pregnant female with jaundice needs close monitoring. As this hepatitis spread by contaminated water and poor hygiene, multiple members of the family, many families in a village or town affected at the same time. 

Water borne hepatitis (A&E)-how to prevent? 


As rightly said, hepatitis A &E spread by water. The infected person passes the viruses in their stool. The water contaminated by it, lack of adequate sterilization and unhygienic practices made it spread from one to another. The first the child can get vaccinated for hepatitis A vaccination, but this vaccine is not helpful for adults. Simple practice of boiling the water or use of bleaching powder is effective. Avoid vendor/street/roadside foods that are not hygienic (ensure the food vendor is using gloves and properly handling them, not infected with Hepatitis A &E). It is best possible to avoid uncooked food/ unpacked food or salad on roadside and unhygienic conditions. At community level-ensure supply of safe drinking water, well maintained drainage system for sewerage, the water supply maintained periodical checkup for leakage or contamination, 

Hepatitis B-what is it and why its problematic ? 

Currently it affects 3% of population i.e., 40 million Indians. About 15–25% of them suffer from cirrhosis and liver cancer and may die prematurely. Infections occurring during infancy and childhood have the greatest risk of becoming chronic. Of the 2.6 Crore (26 million) infants born every year in India, approximately 10 Lakhs (1 million) run the life-time risk of developing chronic  
HBV infection-the problem is that 90% of the public don’t aware of the infection and detected on routine evaluation. There is a need for awareness, detection, and public health measures to prevent disease transmission and decrease the burden of the disease. 

Hepatitis –C what is it and why it’s problematic? 

It is a virus infection of the liver and mostly blood borne i.e., by contaminated blood transfusion, surgery, needle prick, unsafe syringe, and injecting drug abusers. It is the most infectious virus i.e., 100 times more chance infection than HIV. Once infected in 85% cases it becomes chronic liver disease may progress to cirrhosis and liver cancer in a period of 15-20 years. But often remain asymptomatic and early diagnosis and the recently available drugs make the treatment easy and effective. India is estimated at between 0.5% to 1.5% of population i.e., about 1 Crore Indians.  With available effective drugs it can be cured. And patients can revert to a complete normal lifestyle if detected and treated early. This has been planned globally to eliminate hepatitis C by 2030. 

Hepatitis B most commonly comes from mother-how to tackle it? 

Hepatitis B transmitted by blood. The most common route being mother to bay transmission (most cases), surgery, blood product transfusion, tattoo are the other causes. The transmission of hepatitis B from mother to baby mainly occurs during pregnancy or immediately after pregnancy. When it is infected with the newborn, most of the kids develop chronic infection and early age liver cirrhosis and cancer.  All pregnant mothers should be tested for hepatitis B during pregnancy (now this is done routinely and free of cost at all Gov. hospital) and free compulsory hepatitis B vaccine is being given to all newborn (Mission Indra Dhanush by Gov of India). Those mothers who detected hepatitis B pregnancy should consult doctor and must take medication which is safe and effective in preventing disease transmission. All delivery of hepatitis B positive mother should be institutional, so that the newborn will get special injection under supervision of a doctor. This will further minimize even any chance of infection transmission effectively. 

Hepatitis and married life- no worries!!! 

Hepatitis is not a disease that will hamper your daily life activities, physical activities, or married life. A common problem is the nonrectifiable stigma for marriage and physical relationships. Hepatitis C effective treatment in 3-6 months cures the infection. Hepatitis C transmission by sexual contact is very minimal too. For hepatitis B normal married life, sexual relationship and childbearing is possible. Never to be panic for it, be it male or female. Effective treatment, vaccination of the opposite partner is needed. The transmission by normal sexual route, oral secretion or body fluid is minimal. 

What is family screening-what, whom and when to do? 

As we discussed hepatitis B is mostly transmitted from mother to baby. So in family brothers and sisters, maternal side uncles or aunt or grandmother may also be infected. They are mostly asymptomatic or have an occult infection.  So routine screening followed by vaccination for all the persons is the best policy.  Else with detection of a hepatitis B infection in a patient, his/her immediate family members, should be immediately tested for possible infection, if detected then can be managed else need vaccination. Mother, siblings (brothers& sister), spouse (husband or wife) and maternal side first-degree relatives need to go for a family screening.  

Strategies to reduce hepatitis burden in society  

Using vaccines –  For hepatitis-B; 3 doses of vaccine for nonvaccinated person, booster single dose for selected cases (low protective titer, more than 10 years from last vaccination, defaulters). 


Improving blood safety-  Ensuring the availability of safe blood and blood products.  


Enhancing infection prevention and control in health care settings –  safe injection practice, single use syringe, more use of disposable items and reducing unnecessary injection and educating employee regularly on these issues and effective sharps and waste management are important.


Preventing mother  to child transmission of viral hepatitis –  hepatitis B virus testing in young women, care of pregnant women with chronic hepatitis B virus infection, delivery of hepatitis B virus vaccine to the infant within 24 hours of birth, safe delivery practices, strengthened maternal and child health services, and interventions to prevent transmission based on antiviral treatment are crucial. 


Birth-dose vaccination is a key intervention for prevention of hepatitis B virus infection in infants


Promoting safer sex-  Safer practices like minimizing the number of sexual partners, consistently and correctly using male and female condoms and to avoid male to male sex are few to be ensured or encouraged. 


Expanding treatment-  Effective antiviral agents against viral hepatitis B and C should be offered to the poorest of poor at an affordable price or free of cost and steps needed to address the compliance also needed.  


Tailoring services for different populations and locations – high risk groups like people who inject drugs, migrants, hemodialysis patients, people who undergo skin-piercing procedures including tattooing, sex workers and men who have sex with men needs special attention towards early detection, treatment and vaccination and legal provision for the containment of infection. So that these groups will get maximum services for the highest impact 


Linking and integrating hepatitis services with other health services-  like that for sexually transmitted infections, HIV, reproductive health, drug dependence and blood safety etc. so that the message can reach maximum people in an effective manner.  


Strengthening community-based services-  Involving NGOs, public figures, celebrities, and people of social repute as brand ambassador. Periodic meetings, seminars, street plays, distribution of printed materials, television or multimedia advertisements will convey the message.  


Involving people living with viral hepatitis-  Actively engaging affected populations, can act as a powerful force in addressing discrimination, and bring trust upon the services offered them via these people like brand ambassadors.