According to recent statistics, there are about 300 million people worldwide who are suffering from hepatitis presently. Nations across the world observe World Hepatitis Day on July 28 to call upon people to take preventive action and raise awareness about the disease. On this occasion, we took the opportunity to interview Dr. Ravichand Siddachari who is currently associated with Manipal Hospital, Bengaluru. Dr. Siddachari has over ten years of experience as a surgical gastroenterologist and specialises in surgical oncology, general surgery, liver transplantation and hepatopancreatico-biliary surgery and laparoscopic and endoscopic procedures.

What is Hepatitis?

Hepatitis means inflammation of the liver. The term “Hepatitis” is derived from Latin. “Hepar” means liver and “itis” means inflammation. Hepatitis is commonly caused by viruses such as A, B, C, D and E. There are also other causes of hepatitis such as autoimmune, medications and alcohol. In hepatitis, the liver is damaged by any one of the above mentioned causative agents and the person gets symptoms such as fever and malaise initially and then develops jaundice. 

What is the population of people in India suffering from Hepatitis?

As per WHO statistics, about 40 million people in India are affected with Hepatitis B and about 12 million with Hepatitis C. Hepatitis B and C are chronic diseases while Hepatitis A and E self-limiting acute infections that lead to epidemic hepatitis. However, very small percentage of Hepatitis A and E can lead to fulminant hepatitis leading to death without a liver transplant. Hepatitis A and E occur in the low socio-economic groups and in countries with poor sanitation and hygiene. 

What is the population of the people in the world suffering from Hepatitis?

Worldwide about 1.4 million people get affected with Hepatitis A annually. About 2 billion people have evidence of either past or current infection. Hepatitis B leads to 6,50,000 deaths annually due to liver disease. An estimated 70 million people are infected with hepatitis C. Hepatitis E is seen mostly in south East Asia and Africa. About 1-2 million people are affected annually. 

What causes this disease?

As mentioned above five types of viruses cause the viral hepatitis. Non-viral hepatitis are autoimmune hepatitis, alcoholic hepatitis, drugs and toxins causing hepatitis. 

Hepatitis A and E are transmitted by oral route. The virus is ingested with contaminated food or water. They cause acute hepatitis. Hepatitis B and C are blood borne diseases. They are transmitted through blood transfusions, contaminated syringes, sexual contacts and also from parents to off springs. 

How is Hepatitis diagnosed?

As mentioned above, Hepatitis A and E are present in acute forms. The patients would have recently become infected through consumption of contaminated food or water. Patients develop severe fatigue, nausea and vomiting and fever initially and later develop jaundice. 

Hepatitis B and C are usually chronic. Most people with Hepatitis B would have inactive infection called as carrier status. Only five to ten percent of patients may develop chronic liver diseases. The diagnosis is usually incidental during health checkups or screening. Some patients with Hepatitis B develop acute fever, jaundice, rashes and sometimes joint pain. Hepatitis C is similar to Hepatitis B. There is no acute form and in extreme cases, patients present features of chronic liver failure such as jaundice, swelling of belly and feet, vomiting of blood or confusion and loss of consciousness. 

Once clinically suspected  blood tests confirm the diagnosis. 

What are the latest treatments available in India for the hepatitis disease?

Hepatitis A and E are usually self-limiting with most patients recovering fully. Hepatitis A is usually mild and patients recover spontaneously. Hepatitis E in pregnant women can be severe with case fatality rate of 15-20 percent. Hepatitis A can be severe in children less than five years and adults more than 50 years. Treatment is usually supportive with hepatoprotector medications.

A very small percentage of patients with Hepatitis A and E can develop fulminant hepatitis requiring liver transplantation to save life. These patients deteriorate rapidly and may lose their life within a week from the time of presentation without a liver transplant. 

Hepatitis B and C can be cured with medicines. Patients who already are suffering from cirrhosis or liver cancer need liver transplant. Liver transplant is the treatment for end stage liver diseases with success rates of more than 90 percent.

What are the tips to prevent hepatitis?

Hepatitis A and E are contracted from contaminated food and water. Therefore, hygiene is the most important factor in prevention of this infection.

• Don’t ‘eat street food and water.
• Drink boiled and cooled or bottled water. 
• Do not eat salads and uncooked food.
• Wash hands before eating and after going to toilet.
• Vaccination: vaccine is available for Hepatitis A. Kids are advised to take vaccines and is also part of immunisation programme. Adults visiting endemic areas should get vaccinated. There is no vaccine for Hepatitis E. 

Hepatits B and C are transmitted through blood and also if you come in contact with other body fluids such as semen. 

• Prevention is to use disposable syringes and use protection during sexual intercourse. 
• Vaccine is available for Hepatitis B and is part of national programme. All family members of the infected persons should be screened for Hepatitis B/ C. Infected persons should receive treatment and non-infected person should get vaccinated. 

Currently there is no vaccine for Hepatitis C 

What are the symptoms of hepatitis disease?

Fatigue, nausea, vomiting, generalised body ache, fever and joint pain. At later stages they develop jaundice, itching, dark coloured urine, mental changes such as excessive sleep during the day and sleeplessness at night. 

What is your message on this world hepatitis day?

Prevention is the key. All these diseases can be prevented. 

Hygiene is the most important factor. We are responsible for our own problems. Stay clean and  keep your surroundings clean. Wash hands before eating food and after going to toilet. Hepatitisis is a treatable disease and hence consult specialist. Vaccinate your kids for Hepatitis A and B. Get screened for Hepatitis B and C and get treated if virus is detected. Those with chronic illness should be consulting specialists and be on surveillance as these patients are at high risk for developing liver cancer. Liver cancer is most commonly not detected in early stages. World can be free of hepatitis viruses if you follow simple rules. 

How is India faring in treating the disease in comparison to the other countries?

We in India have all the medications for treating these diseases. Hepatitis A and E need supportive medications only as they recover spontaneously. Very small percentage of patients develops severe liver failure needs liver transplants to save life. 

Hepatitis B and C can be cured with medicines. Some patients may later develop liver failure or liver cancer and these patients need liver transplant. Liver transplant is the treatment for end stage liver diseases with success rates of more than 90 percent. 

We have all facilities and state of the art hospitals to deal with liver problems.