World Hepatitis Day
Dr. Joveria Farooqi, Assistant Professor and Consultant Microbiologist
Department of Pathology and Laboratory Medicine
Hepatitis is the inflammation of liver tissue, resulting in yellow discoloration of skin and eyes, and fever. There are several types of hepatitis, divided according to their causes. The most common cause of hepatitis is infectious, mainly by a group of viruses that specifically infect liver e.g., Hepatitis A, B, C, D and E viruses, but sometimes it may occur as part of another infection, like Dengue, Zika, Yellow fever, Crimean Congo fever, malaria, bacterial sepsis etc. Non-infectious hepatitis is usually related to drug toxicity. Hepatitis A, B, D and E can cause acute hepatitis, while B and C can cause chronic hepatitis, liver failure and even liver cancer. Viral hepatitis with HAV, HEV and HBV without HDV is usually subclinical or mild, but sometimes, it can become severe enough to result in hospitalization and possibly even death.
Globally, viral hepatitis resulted in 1.4 million deaths in 2017, with more than 97% related to Hepatitis B and C, including liver failure and cancer (1). In Pakistan, approximately 12 million people suffer from hepatitis B or C, but the majority remain undiagnosed and untreated, leading to continued transmission in the population, complications, and death (2).
It is, therefore, important to diagnose hepatitis early, so that patient can be appropriately managed and monitored to determine response to treatment, and effectively vaccinate uninfected individuals against HBV.
Aga Khan Clinical Laboratories offer tests to diagnose early disease and also assess liver damage through hepatic enzyme levels and blood clotting, as well as specific tests for viral hepatitis. Different Hepatitis B antigens and antibodies can identify if the patient has acute or chronic HBV infection, whether they are infective, recovered, or immune. Antibodies against HAV, HCV, HDV and HEV can presumptively diagnose infection with these agents, while detecting DNA or RNA belonging to Hepatitis B, C and D viruses in serum can confirm it. Measuring the number of virus copies in blood over time can also guide physicians in how well the patient is responding to treatment.
HAV, HEV are transmitted through eating and drinking contaminated foods and drinks, while Hepatitis B, C and D are transmitted by exposure to infected blood and its products, or injury with contaminated sharp objects. The best way to prevent HBV and HCV infection is to adopt sharp-safety practices whenever dealing with blood products, needles, and during surgery through use of gloves, hand hygiene and safe handling of used items and equipment. For oral transmission of HAV and HEV, good hygiene and consuming safe food and water are the most effective measures.
Vaccination is available for HBV and HAV. HBV vaccine is recommended at any age, and boosters may be necessary after 3 years if HBV antibody levels fall. HAV vaccine is offered to individuals travelling to countries with high rates of HAV infection from countries where HAV infection is rare.
1. Thomas DL. Global Elimination of Chronic Hepatitis. N Engl J Med. 2019 May 23;380(21):2041-2050. doi: 10.1056/NEJMra1810477. PMID: 31116920.
2. WHO EMRO | Prevention and control of hepatitis | Programmes | Pakistan. Last updated 2022