World Hepatitis Day
“Over 290 million people worldwide are living with viral hepatitis unaware [1].”
World Hepatitis Day is recognised yearly on July 28th (Fig. 1), the birthday of Nobel Prize winner Dr. Baruch Blumberg (1925–2011). Dr. Blumberg discovered the hepatitis B virus in 1967 and went on to develop the first hepatitis B vaccine two years later [2]. World Hepatitis Day was first launched in 2008 by the World Hepatitis Alliance, before the United Nations formally recognised the event in 2010. It is one of the eight official disease-specific world health days designated by the World Health Organization [3].
Though COVID-19 presents the world with a serious viral problem today, we cannot ignore the ones we already live with, such as the hepatitis viruses. Organisations, such as, Centers for Disease Control and Prevention, World Hepatitis Alliance, and the World Health Organization commemorate World Hepatitis Day to raise awareness for viral hepatitis. It creates an opportunity to educate people about the burden of these infections, the actions which people can take to prevent these infections, and the efforts in place to combat viral hepatitis around the world [2].
Figure 1: World Hepatitis Day: 28th July
Hepatitis is a general term referring to inflammation of the liver, for which there are many causes. Some may be infectious (bacterial, fungal, viral and parasitic organisms) and others, noninfectious (e.g. drugs, alcohol, metabolic diseases and autoimmune diseases) [4]. The focus of this article is on viral hepatitis; the main types are a group of infectious diseases known as hepatitis A, B, C, D and E which cause both acute (short-term) and chronic (long-term) liver disease in millions of people.
Both viral hepatitis B and C can be sexually transmitted, and affect 325 million people worldwide, causing about 1.4 million deaths annually. Approximately, 9 times more people are infected with hepatitis than HIV, and it is the second most deadly infectious disease after tuberculosis. Over 80% of people infected with hepatitis are lacking the required prevention, testing and treatment services; it's no wonder that in recent years, deaths from tuberculosis and HIV have been declining, but deaths from hepatitis are on the increase [5]!
The Main Types of Viral Hepatitis
Viral hepatitis has been recognised as a major public health problem; each type of virally transmitted hepatitis is caused by a different virus.
Hepatitis A
Hepatitis A Virus (HAV) is a small non-enveloped RNA virus. Its mode of transmission is the fecal-oral route (i.e mostly transmitted by consuming food or water contaminated by feces from a person infected with HAV) [6]. Hepatitis A is very contagious and spreads even when ingested in microscopic amounts. The symptoms appear 2-6 weeks after initial infection and can be mistaken for that of influenza; they include: fatigue, fever, nausea, abdominal pain, and jaundice [7].
Unlike hepatitis B and C, it is always acute (short-term) and doesn’t develop into potentially fatal conditions, such as chronic hepatitis or cirrhosis. The best preventive measure is to get vaccinated, however, following good hygiene is also an effective measure [7].
Hepatitis B
Hepatitis B Virus (HBV) is a double stranded hepadnavirus, and it is transmitted when the blood, semen or bodily fluid of an infected person enters the body of an uninfected person [6]. This can happen in many ways: sexual contact; contact from mother to child at birth; or the sharing of sharp objects, like needles, syringes and other injection equipment. The mode of transmission is similar to that of HIV; yet hepatitis B is nearly 100 times more infectious [7]. Symptoms do not occur in all new HBV infected individuals, but in cases where they do, symptoms include: abdominal pain, fever, dark urine, nausea, fatigue and jaundice. Today, hepatitis B is endemic in many countries [2].
For some, the hepatitis B may be a short term illness (acute), but for others it can be long-lasting (chronic):
In an acute hepatitis B infection the illness lasts less than six months. The immune system, in most cases, clears out acute hepatitis from the body, and the infected person recovers in a few months [2]. Most adults who get hepatitis B have an acute infection, but this can lead to chronic infection [8].
In a chronic hepatitis B infection the illness lasts for about six months or longer. This is most likely in an immune-compromised person, where it is more likely that the virus will linger because the immune system can’t fight off the infection [8]. The chronic infection may last a lifetime, possibly leading to severe, life-threatening illnesses, such as, cirrhosis and liver cancer [2].
Precautions taken to reduce risk of hepatitis B include being cautious about body piercing and tattooing, knowing the HBV status of a sexual partner and not engaging in unprotected sex [7]. Although there is no cure for hepatitis B, the symptoms can be managed. The most effective preventive measure is getting the HBV vaccine; the vaccine is recommended for all healthcare and medical personnel worldwide.
Hepatitis C
Hepatitis C virus (HCV) is an enveloped single-stranded RNA virus and, like hepatitis B, it is transmitted by exposure to infected body fluids e.g. blood [6]. It is known as a silent killer because many who live with the disease do not even know. Today, over 250 million of the world’s population have this infectious disease [7].
For some people, hepatitis C is a short-term illness, while for others it may be long-term. Chronic hepatitis C can result in life-threatening problems, and alarmingly some people with chronic hepatitis C may not have any symptoms, or even feel sick: when symptoms do appear, it is usually due to an advanced liver disease [2]. Various studies have shown that in the first years of infection with hepatitis C, more than 1 out of 3 patients developed cirrhosis and liver cancer [7]. Hepatitis C is the leading indication for liver transplant in many countries [9].
Hepatitis C virus infection can be prevented by avoiding risky behaviours, and taking precautions such as: not engaging in unprotected sex; knowing a partner’s sexual history; and not sharing needles. There are antiviral medications for treatment of both acute and chronic hepatitis C, but there is currently no vaccination for hepatitis C [2].
Hepatitis D
Hepatitis D (also known as “delta hepatitis”) is caused by Hepatitis D Virus (HDV) - a single-stranded, highly defective RNA virus that requires the presence of HBV for its propagation [6]. It is spread through infected blood, contaminated needles and sexual transmission, and may cause an acute or chronic infection. It can cause severe symptoms or illness, leading to lifelong liver damage or even death.
Hepatitis D viral infection can be acquired the same time as hepatitis B: about 5% of the people who carry HBV probably also have delta hepatitis [7]. When a person is infected with both hepatitis B and D at the same time, it is known as a coinfection. In a situation where a person becomes infected with hepatitis D after being infected with hepatitis B it is called superinfection: the dual infection can result in a more serious disease [2, 5].
For hepatitis D, no antiviral medication or vaccine exist at this time, but since it requires viral particles of HBV for its propagation, getting the hepatitis B vaccine also protects from hepatitis D infection [2].
Hepatitis E
Hepatitis E Virus (HEV) is a single stranded, non-enveloped RNA virus [6]. Its mode of transmission is the fecal-oral route. In developing countries, hepatitis E infections are usually acquired from drinking water contaminated with the feces of an infected person. In developed countries, this type of hepatitis is not common. Many infected individuals have no symptoms, especially children. When symptoms do occur, it is similar to that of hepatitis A, and can include: fatigue, nausea, stomach pain, poor appetite and jaundice [2].
Except for the rare occurrence of chronic hepatitis E in immunocompromised people, most people recover from hepatitis E without complications [2]. Hepatitis E is associated with more severe infection, or even death in pregnant women (particularly during their third trimester) [10].
Prevention of a hepatitis E infection relies mainly on the availability of good drinking water and on good sanitation. The boiling and chlorination of water inactivates the virus. There is currently no vaccine available for hepatitis E [2].
Our Responsibility in Eradicating Hepatitis
We can raise awareness and prevention via advocacy:
Youths can become hepatitis advocates with organisations such as NOhep.
You can raise awareness through word of mouth, or using your social media pages to display campaign materials, such as social media graphics, posters and videos.
Assess your personal risk, and that of your local community, and take action:
There are various online tools that allow us to assess our risk of infection e.g. New York State Hepatitis Risk Assessment.
Locating the nearest vaccine provider, and informing family, friends and other members of the community.
Volunteering:
The United Nations has identified volunteering as an important tool for the fulfilment of the UN Sustainable Development Goals by 2030, so a good way to get involved is by volunteering in organisations aimed at combating hepatitis by ensuring screening, care, and treatment are harmonised.
You can also donate to organisations fighting for a hepatitis free world.
Getting involved with government policy:
Youths can play a role in advancing their local government's work in achieving national viral hepatitis goals.
Youths should also urge their government to keep their promise to eliminate hepatitis by 2030.
As an intern in a medical centre’s laboratory, I have seen many patients come in for marriage compatibility tests, and medical fitness tests for school and employment. Some of these people were infected with hepatitis and were unaware until they came for a test. It is our collective responsibility to find the “missing millions” - the (at least) 290 million people worldwide who are unaware that they are affected with hepatitis [1].
World Hepatitis Day should be used to promote awareness of this killer disease. As global citizens, we should all play our part by knowing our status, raising awareness, and helping to reduce the risk of this disease. Today is not just a day to talk about hepatitis B and C but to shed light on the other less frequently discussed hepatitis viruses: A, D and E. Everyone should take an active role in this fight so we can one day live in a “hepatitis-free future”!
References
[1] Anon. World Hepatitis Alliance, 2020. [online]. Available: https://worldhepatitisday.org. [Accessed: 20 July 2020].
[2] Anon (July, 2015) "World Hepatitis Day — July 28th”, CDC [Online]. Available: https://www.cdc.gov/hepatitis/awareness/worldhepday.htm. [Accessed: 21 July 2020].
[3] Anon. "World Hepatitis Day", Timeanddate [Online]. Available: https://www.timeanddate.com/holidays/un/hepatitis-day. [Accessed: 20 July 2020].
[4] N. S. Samji. (2017). Viral Hepatitis, Emedicine [Online]. Available: https://emedicine.medscape.com/article/775507-overview#a2. [Accessed: 21 July 2020].
[5] Anon (September, 2019) "What is hepatitis?", WHO. [Online]. Available: https://www.who.int/news-room/q-a-detail/what-is-hepatitis. [Accessed: 21 July 2020].
[6] A. J. Zuckerman, “Hepatitis Viruses,” in Medical Microbiology. 4th edition, S Baron Galveston (TX): University of Texas Medical Branch at Galveston; 1996.
[7] Anon (June 2019). "Hepatitis: Types, Symptoms and Treatment Information”, Disabled World, [Online]. Available: https://www.disabled-world.com/health/hepatitis/. [Accessed: 21 July 2020].
[8] Anon. What Is Hepatitis B?”, Hepatitis B Foundation [Online]. Available: https://www.hepb.org/what-is-hepatitis-b/what-is-hepb/acute-vs-chronic/ [Accessed: 22 July 2020].
[9] K. R. Bhamidimarri, S. K. Satapathy, P. Martin. “Hepatitis C Virus and Liver Transplantation,” Gastroenterology & Hepatology, vol. 13, no. 4, pp. 214–220, 2017.
[10] S. A. Chaudhry, N. Verma and G. Koren. “Hepatitis E infection during pregnancy,” Canadian family physician Medecin de famille Canadien, vol. 61, no. 7, pp. 607–608, 2015.
