A surge in waterborne diseases in certain districts of the country such as Badulla, Moneragala and Ratnapura which according to the latest Epidemiology figures, reported the highest number of Hepatitis A patients in recent months, has raised alarm bells prompting immediate action to halt this disturbing trend by the Health Ministry and Epidemiology Unit.
The Sunday Observer spoke to Consultant Epidemiologist of the Epidemiology Unit, Ministry of Health Dr Thilanga Ruwanpathirana to get more insights into this disease and how it can be prevented using simple guidelines.
Excerpts.
Q: The current outbreak of monsoonal rains and floods have reportedly led to a spike in Hepatitis. What is Hepatitis is in simple laymen's language?
A. Hepatitis is a disease of the liver where it inflames the liver cells. It can progress into very serious conditions like scarring of liver tissue, cirrhosis or liver cancer.
Q: What causes it globally and in Sri Lanka particularly ?
A. Hepatitis is is mainly due to viruses, globally. However in Sri Lanka, liver diseases are mainly due to alcohol and non-alcoholic fatty liver.
Q: Are there different types of Hepatitis? If so, what are they?
A. When you consider viral hepatitis, there are five types. They are hepatitis A, B, C, D and E. Hepatitis A is mainly a short-term disease. Hepatitis B and C may be short-term or can progress into a long-term disease in some individuals. The long-term disease is associated with serious liver damage including cirrhosis, liver failure and liver cancer. Hepatitis D has long-term sequelae. It is relatively a rare condition and the treatment success is generally low. Hepatitis E is a rare condition and long-term cases have been reported in immune-suppressed patients.
Q: What kind is most common in Sri Lanka at present?
A. Hepatitis A is the most common form of hepatitis caused by viruses.
Q: Is there a difference in the symptoms that each type presents? If so, what are they?
A. The symptoms of viral hepatitis A, B and C are generally similar. They are fever, nausea or vomiting, diarrhoea, loss of appetite, yellow colour discolouration of eye and skin, dark urine, clay-coloured stool, fatigue and pain in the upper right abdomen.
Q: What is the incubation period? Does it vary for each type?
A. Yes, it does vary. The incubation period refers to the time gap from the first contact with the virus to the first appearance of the symptoms of the disease. The incubation period of Viral Hepatitis A is between 14 to 28 days, and for Hepatitis B, 1-6 months averaging around 4 months. However, the incubation period for Hepatitis C is shorter (6-10 weeks).
Q: Are they long-lasting? If so who are most vulnerable?
A. Hepatitis A usually does not cause long-term effects. However, Hepatitis B and C have long-term effects in some patients if the disease gets into the chronic stages. Liver failure, cirrhosis and liver cancers are some known complications. The chance of getting into the long-lasting stage of hepatitis B is higher in young persons. It reduces with the advancement of age. (Infants - 90 percent, 1-5 years of age 25 percent - 50 percent and in adults 5-10 chance for chronic hepatitis). However, in hepatitis C, those who are more than 50 years of age, male gender, and those who consume alcohol and take immune suppressive drugs run a higher risk of getting into long-lasting stage and complications.
Q: Are people with pre- existing diseases like diabetes, cardiac disease, and hypertension, more at risk than others?
A. People with diabetes are at higher risk for contracting hepatitis B if they share, finger prick instruments used for sugar testing or insulin pens.
Q: Can a pregnant woman infected by Hepatitis transmit it to her unborn child? If so, does it apply to all types of Hepatitis?
A. Hepatitis B and C can spread from the infected pregnant mother to her baby at birth. This is the most common form of transmission of hepatitis from mother to child. However, hepatitis A does not transfer from mother to child during delivery.
Q: What is the most common route that Hepatitis spreads according to its specific type?
A. Hepatitis A and E are spread by ingestion of infected food or water (Feco-oral route)- for example, when a healthy person consumes food or water contaminated with the stools of an infected person.
Hepatitis B, C and D are spread through body fluids (eg. blood or blood products, sexual secretions, etc.). Though the transmission is similar to HIV/AIDs, Hepatitis B transmission is much easier than HIV. Unprotected sexual contacts, unscreened blood or organ transplant, sharing injection needles, razors and toothbrushes, and accidental needle prick injuries could transmit Viral Hepatitis B and C. These two viruses can transmit from mother to child during delivery. However, they do not spread by having a normal day-to-day relationship with an infected person.
Q: Is it true that HIV patients are more vulnerable to Hepatitis than other infections?
A. Yes, because they share the same transmission methods (sexual, blood and blood products, organ transplant etc.). Further, HIV weakens the immune system of the body making them more susceptible to long-lasting disease with more severe complications.
Q: How is hepatitis diagnosed?
A. Viral hepatitis is diagnosed through blood tests by a qualified medical professional.
Q: How do you treat Hepatitis? Does it depend on the degree to which the disease has progressed?
A. Hepatitis A can be treated and cured in a shorter duration while Hepatitis B and C need long-term treatment. Certainly, the duration of the treatment depends on the degree of the disease progression and its complications. All the latest drugs are available in Sri Lanka and they are free at government hospitals. The ultimate treatment for cirrhosis, which is the transplantation of the liver is also available in government hospitals in Sri Lanka.
Q: If mild, can patients be treated at home?
A. The decision of the place of treatment has to be taken by the treating physician. Generally, during the initial phase, the patient needs to be hospitalised for the assessments and commencement of the treatment. Depending on the clinical condition and the response to treatment, the physician will decide the length of stay in the hospital.
Q: What should be given to such patients food-wise?
A. Foodwise , generally, processed foods should be avoided during the hepatitis treatment and recovery period. Oily foods such as fast foods are also best to be avoided.
Q: Are there drugs that should be avoided when treating a Hepatitis patient? If so why?
A. All the drugs which you ingest go through the liver. The Liver acts as a filter to remove unnecessary chemicals and toxins. During liver disease, the normal functions of the liver can be deranged. Therefore, it is best to stick to the drugs prescribed by your physician. Especially, avoid over-the-counter drugs like pain killers, antibiotics or supplements.
Q: Are certain types of Hepatitis reversible? If so which types fall into this category and who are those who fall into these categories?
A. Hepatitis A is curable and the liver damage is completely reversible. In Hepatitis B, the majority clear the disease by themselves within the first 6 months from the exposure. However, 5-10 percent of the adults go into the long-term or chronic stage associated with liver scarring, cirrhosis, liver failure and liver cancers. In Hepatitis C, the possibility of going into the chronic stage is more than 50 percent.
In addition, there are many other agents which cause irreversible long-term liver damage leading to scarring, cirrhosis, liver failure and liver cancer. (e.g., Alcohol, certain medications, toxic metals, autoimmune liver diseases) For example, irrespective of the cause, the damage done by cirrhosis to the liver is rarely reversed. Reversal depends on the timing of the diagnosis; the causative agent is completely removed by proper treatment and habits like alcoholism and smoking which aggravate liver damage is completely ceased.
Q: Are there simple hygienic rules that one can follow to prevent Hepatitis?
A. Always drink boiled cool water. Consume home-cooked food as much as possible to prevent hepatitis A. Limit your sexual activities to a single faithful partner to prevent hepatitis B and C. Seek medical advice early if you have symptoms of viral hepatitis as mentioned earlier.
Q: What are the interventions taken by the Epidemiology Unit and Health Ministry to prevent its spread?
A. We have initiated general prevention and control measures for all types of Viral Hepatitis. Following are the specific control and prevention measures for Hepatitis
A: *Water Quality Surveillance where water samples from each MOH office in the country are sent for bacteriological testing to the water quality labs in the Ministry of Health, once a month. This helps us identify the drinking water sources which are contaminated by faeces and take action. The value of drinking boiled cool water and proper disposal of human faeces has been constantly reiterated during the health education talks. Improvement of sanitary facilities is a mandatory component of the PHI’s duty list.
* We also have a vaccine for Hepatitis A. However, it is not given in the National Immunisation Program and is reserved for use in uncontrollable outbreak situations. However, it is available in the private sector in the country.
B. Following are the specific measures for Hepatitis B and C.
*Child Vaccination through the National Immunisation Program - Three doses of hepatitis B containing Pentavalent vaccine is given to all children in the country at 2, 4 and 6 months of age to provide full protection.
*Adult high-risk groups are vaccinated. e.g., hospital staff, medical and nursing students. Again, neither syringe nor a needle in the country is used twice under any circumstance.
* All the donated blood is screened before transfusion by the National Blood Transfusion Service for Hepatitis B and C to assure 100 percent safety.
C. No vaccines are available for Viral Hepatitis C, D or E
Q: Briefly summarise the Do’s and Don’ts to minimise hepatitis risks.
A. If you have Hepatitis A and E
Do's
1. Hand washing – before eating, after defecation, and before preparation of food.
2. Drink boiled water
3. Eat hygienically prepared food
4. Clean green leafy vegetables well in salt water before consuming
Don’ts
1. Consume Street food
2. Keep cooked food uncovered
If you have Hepatitis B, C and D
Do's
1. Vaccinate your child with Hepatitis B containing vaccine, all three doses at the correct intervals.
2. If you are engaging in high-risk activities (eg. health professionals who work with patients, medical students, nurses), get Hepatitis B adult vaccination if not vaccinated during childhood.
3. Limit sexual activities to a single, faithful partner or use condoms.
Don’ts
1. Share needles, razors, toothbrushes, nailcare tools or pierced earrings
2. Reuse needles and make sure that the equipment used in body piercing, tattooing, manicures and pedicures are properly sterilised or disposable type
3. Donate blood if you are found to be positive for Hepatitis B, C or D
4. Go to places with inadequate hygienic practices for tattooing and body piercing
Q: Finally, do you have a hotline which the public can reach for more information on Hepatitis?
A. Yes, further information can be obtained from the following telephone numbers during office hours (0112695112, 0112681548) or can visit our website (www.epid.gov.lk).