Hepatitis

Hepatitis is inflammation of the liver tissue. If hepatitis resolves within six months, it is called acute, if it lasts longer than six months, it is chronic. Acute hepatitis may resolve on its own, progress to chronic hepatitis, or (rarely) result in acute liver failure. Chronic hepatitis may progress to liver scarring (cirrhosis), liver failure, and liver cancer.

The hepatitis virus has five primary strains that are categorized as types A, B, C, D, and E. While they all contribute to liver disease, they differ in crucial areas such as mechanisms of transmission, sickness severity, geographic distribution, and prevention strategies. Hepatitis A and E are mainly spread by contaminated food and water. Hepatitis B is mainly transmitted sexually, but it can be transmitted from mother to baby during pregnancy or birth and spread through infected blood. Hepatitis C is commonly spread through infected blood, as can occur during needle sharing by intravenous drug users. Hepatitis D can only infect people already infected with hepatitis B.

Epidemiology

The most frequent cause of liver cirrhosis, liver cancer, and fatalities from viral hepatitis is a combination of types B and C, which cause chronic disease in hundreds of millions of people. An estimated 354 million people worldwide live with hepatitis B or C, and for most, testing and treatment remain beyond reach. The highest burden of disease is in the Eastern Mediterranean Region and European Region, with 12 million people chronically infected in each region. In the South-East Asia Region and the Western Pacific Region, an estimated 10 million people in each region are chronically infected. Nine million people are chronically infected in the African Region and 5 million in the Region of the Americas.

Symptoms

Since the symptoms of hepatitis are not fully manifested, it has a wide spectrum of effects, ranging from severe liver failure. While some people or animals with hepatitis do not have any symptoms, others develop yellow discoloration of the skin and whites of the eyes (jaundice), loss of appetite, vomiting, fatigue, abdominal pain, and diarrhea.

Diagnosis

The diagnosis of hepatitis is made based on the patient’s symptoms, medical history, blood tests, imaging, and liver biopsy data. In general, blood tests and recollection of the person are sufficient for the diagnosis of viral hepatitis and other acute causes of hepatitis. For other causes of hepatitis, especially chronic causes, blood tests may not be helpful. In this situation, liver biopsy is the gold standard for diagnosis: histopathological analysis can reveal the precise extent and pattern of inflammation and fibrosis. A biopsy is not typically the first diagnostic test because it is invasive and is associated with a small but significantly increased risk of bleeding in people with liver damage and cirrhosis. Therefore non-invasive, much more rapid, and relatively cheaper option of diagnosis, RT-qPCR, is preferable.

Prevention

  • To prevent contamination of food with human feces, that is, ensure food hygiene (protection from hepatitis A and E).
  • Avoid contact with someone else’s blood and body fluids (protection from hepatitis B, D, and C).
  • Vaccinate against hepatitis A and B (a vaccine for C and E is not available).

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