World Hepatitis Day: An opportunity to raise awareness

World Hepatitis Day is observed on 28th of July every year to commemorate the birthday of Nobel Laureate Baruch Samuel Blumberg, who discovered the hepatitis B virus. In India, according to latest estimates, 40 million people are chronically infected with hepatitis B while 6 to 12 million people are chronically infected with hepatitis C. Hepatitis E (HEV) is the most important cause of epidemic and endemic hepatitis, though hepatitis A (HAV) is more common among children. Hepatitis cause 1.4 million death annually.

So, what is viral hepatitis anyway? Hepatitis is caused by a virus that leads to inflammation of the liver. It can happen to anyone-it is not found amongst one set of people or in one location. Did you know that five different viruses, namely A, B, C, D and E cause hepatitis? Hepatitis may be caused by drugs, alcohol use or autoimmunity or be part of certain medical conditions as well.

It is disturbing that 300 million people are living with viral hepatitis completely unaware. This year, the theme for World Hepatitis Day is “find the missing millions” and aims to promote people to get their blood tested and detect the undetected. Over 100 countries are participating in it to advocate for the elimination of the disease. This day is also celebrated to raise awareness and to strengthen efforts on prevention, screening and treatment of viral hepatitis. In fact, in 2015, viral hepatitis was included in the Sustainable Development Goals (SDGs) and in 2016; the world’s first global hepatitis strategy to eliminate the disease was approved.

Viral hepatitis B and C are the leading cause of liver cancer and is also a common reason for the transplantation of the liver. The good news is that hepatitis A and B infections can be prevented through vaccines. A combination vaccine is available that guards against hepatitis A and B. There is no vaccine for hepatitis C, though it is now curable because better treatment is available. There is no vaccine for hepatitis D and E.

Here are some preventive measures you can take to prevent hepatitis:

• Practice good hygiene and safe sex.
• Drink safe water and food made safe by boiling, filtering and avoiding eating in unhygienic places.
• Eat foods from all food groups in healthy portions like low-fat dairy, whole grains, lean proteins, vegetables, fruits and healthy fats.
• Eat foods with high fibre such as vegetables, fresh fruits, lentils, beans and whole grains to keep your liver healthy.
• Limit red meat
• Limit fatty foods, foods and drinks that are high in salt and sugar and fried or processed foods.
• Maintain a healthy weight range so that the liver can function better.
• Limit intake of alcohol. There is no safe limit of alcohol for people with fat in liver.

The following tests can confirm a diagnosis in case hepatitis is suspected:

Blood tests: Initial blood tests can assess liver function by checking the levels of certain liver proteins and enzymes. They can diagnose hepatitis B, C A and E viruses.

Further specialised tests detect the viral load in blood and genotype of viruses.
Ultrasonography of abdomen: tells us about the appearance of liver and presence of fluid in abdomen.
Liver biopsy: This can detect and measure the extent of liver damage and the possibility of cancer.
Elastography: This test measures the liver’s stiffness by emitting sound waves.
Paracentesis: Abdominal fluid is extracted and examined in order to identify the cause of fluid accumulation.

After this, there are tests to follow up liver disease and development of tumour.

CT scan and MRI are useful in some situations

Treatment of hepatitis depends on the diagnosis.

Every nation has committed to eliminating hepatitis by 2030. Continued collaboration is important to raise awareness about it. Without a massive scale-up in diagnosis, the treatment rates will fall and the infection rates will rise, leaving the elimination as nothing but a pipe dream.

We are at a critical junction, where this is our best chance to eradicate this cancer-causing disease. Our opportunity to eliminate viral hepatitis by 2030 will be lost if we do not empower everyone to understand that prevention is possible and encourage positive action to prevent hepatitis.

We, at P. D. Hinduja National Hospital and Medical Research Centre are screening people with a simple blood test for hepatitis B and C in accordance to this year’s theme of World Hepatitis Day.