Types of hepatitis and their effects on children and adults

Hepatitis is the swelling and inflammation of the Liver. The following are some of its causes:

1. Infection: Most commonly viral hepatitis, but bacteria can also cause it.
2. Autoimmune: Immune cells of the body attack cells of the Liver.
3. Damage from alcohol and other poisonous substances.
4. Drugs: For example overdose of pain relief medication.
5. Hereditary causes: For example, the Wilson’s disease and Alpha 1 Anti-Trypsin Deficiency.

Hepatitis may start and improve within six weeks, (Acute Hepatitis) or may cause a long-term disease (Chronic Hepatitis). In some cases, it may lead to damage or failure of the Liver and cancer.

The common viruses responsible for this are Hepatitis A, 8, C, D, E and G.

Hepatitis A (HAV)
According to the World Health Organization (WHO), this is a Liver illness caused by Hepatitis A virus (HAV). It is spread through faecal-oral transmission. This means that one gets it from contaminated water and food. This illness is linked to poor sanitation and personal hygiene.

A person with Hepatitis A infection has jaundice (yellowness in the eyes and skin) diarrhoea, vomiting, nausea and fever. It is normally self-limiting; has no treatment and evidence shows that diet and bed rest are not helpful either. There is a vaccination given to close family members of a child with Hepatitis A but this is not in the mainstay management of the infection.

It is estimated that the disease affects 1.4 million people yearly worldwide. It can greatly impact negatively on the social and economic welfare of a community. Different from Hepatitis Band C, Hepatitis A is rarely fatal and usually does not lead to a serious Liver disease. This disease though can lead to incapacitating symptoms.

Hepatitis B (HBV)
Its mode of transmission is similar to that of HIV, the virus that causes Aids.

1. From mother to child during pregnancy and delivery.
2. Sexually.
3. From contaminated blood transfusions.
4. Injections with contaminated needles and syringes.

In Kenya and other developing countries, most children get infected by their mothers or close contact with secretions of an infected person. In the developed world, it is endemic among drug users as they share syringes and needles and people who have unprotected sex, especially among men who have sex with other men.

Fifty per cent of infants who get infected vertically from their mothers become asymptomatic carriers. They are at risk of developing chronic Liver disease, Liver cirrhosis (scarring of the Liver) or Liver cancer.

According to WHO, the Hepatitis B virus can cause a severe illness coupled with symptoms that persist for several weeks. The symptoms include yellowing of the eyes and skin (jaundice), extreme exhaustion dark urine vomiting and abdominal pain. It may take months or a ‘ year for the symptoms to disappear.

WHO indicates that 90 per cent infants and children aged between one to four years have a 30 to 40 per cent likelihood of developing chronic Liver disease due to Hepatitis B. Twenty five per cent of adults who get infected in childhood die from HBV-related Liver cancer and Cirrhosis. Ninety per cent healthy adults who become infected will heal completely within six months.

Treatment is not very successful. Currently, anti-viral drugs are used. Interferon treatment gives a success rate of 50 per cent. Generally, the best management of the disease is to make the patient comfortable. Vaccination for hepatitis B is routinely given to all children in Kenya. There is a birth dose, then three different doses at six, 10 and 14 weeks.

Hepatitis C (HCV)
This disease is caused by a Hepatitis C virus (HCV) that passes the disease to the Liver. It is transmitted mostly through infected blood. This could be through blood transfusions, use of contaminated instruments like needles and tattooing. It was the most common cause of post- blood transfusion Hepatitis but nowadays, all blood for donation is screened before transfusion to ensure it is free from the virus.

It is still common among intravenous drug users who share needles and syringes. Transmission from mother to child is very rare unless the mother has HIV. The World Health Organization estimates that those infected get recurring infections.

About 20 to 50 per cent of people infected develop Liver disease, which then leads to Liver Cirrhosis, failure or Liver cancer. Globally, it is estimated that 170 million people are infected with Hepatitis C.

Treatment of the disease is done through a combination of antiviral therapy while prevention is done through screening, testing of blood and organ donors, control of infection and safe injection practices in health facilities.

Hepatitis D
According to WHO, this disease is also known as Hepatitis Delta. It is caused by the Hepatitis Delta Virus (HDV). It is not infectious. It is normally a co-infection with hepatitis B and in which cases progression to liver failure and cirrhosis is very likely.

It is spread through broken skin or contact with infected blood sexually or through contaminated instruments. Sometimes, one may have a viral infection but not from the above infections. It is known as non A-G viral infection.

Severe Hepatitis D may lead to Liver Cirrhosis or Liver cancer. There is no antiviral treatment for this disease, thus liver transplant is regarded as the best option for chronic Hepatitis D.

The most important point to remember about Hepatitis is vaccination! vaccination! vaccination! It works better than treatment.

Hepatitis E (HEV)
Is considered a waterborne disease and like Hepatitis A, it is spread through faecal-oral route through contaminated food or water. Its spread through person- to-person contact is rare and there are no facts to support transmission via sexual intercourse or blood transfusion.

Most cases arise in places with poor sanitation practices. Common symptoms of Hepatitis E include yellow skin and eyes (jaundice), dark urine and pale stool, nausea and vomiting, fever, loss of appetite, abdominal pain and an enlarged tender Liver.

There is no vaccine available for Hepatitis E but prevention is regarded as the best remedy. This is done by encouraging proper personal hygiene, maintaining water supplies and frequent removal of waste from habitat.

FACT
Fifty per cent of infants who get infected vertically from their mothers become asymptomatic carriers. They are at risk of developing chronic Liver disease, Liver cirrhosis (scarring of the Liver) or Liver cancer.

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