The ABC of hepatitis

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The ABC of hepatitis

This deadly virus has damaged the Big B’s liver. As the hepatitis lexicon
expands down the Roman alphabet, it pays to be wary of sharing a mango or a
drink on a beach holiday
Benita Sen

Last month, actor Amitabh Bachchan caused a sensation in the blogosphere and
popular media when he blogged that he had liver cirrhosis. Culprit? Not the
traditional demon alcohol (Bachchan is a teetotaller), but the “Australia
antigen hepatitis”, or hepatitis B—“8 years ago during the course of an
MRI, they discovered that 25% of my liver had been destroyed by it,” the
veteran actor wrote on http://bigb.bigadda.com on 23 April. A dramatic
revelation, just a month ahead of World Hepatitis Day (on 19 May).
Big B surmises he contracted the disease while shooting Coolie in 1982, when
he was given 60 bottles of blood after an accident on the sets.

At the time, screening transfusions for hepatitis B was not yet de rigueur.
But blood products aren’t the only avenue; any small cut can lead to
infection if you aren’t wary. “Transmission through (even) inanimate
objects like a stick of sugar cane or a hard fruit is technically possible
from blood or saliva of the first eater if the second person has an abrasion
on the gum,” says Sanjiv Saigal, chief transplant hepatologist, Sir Ganga
Ram Hospital, New Delhi.
The jaundiced view

Yes, so we know more now. We know hepatitis and cirrhosis of the liver can
start from more than a food-borne infection or an alcohol habit (although
drinking regularly can make you more susceptible, especially to hepatitis A
and B).
Also See Kinds of Hepatitis
It’s been a while since medical researcher Saul Krugman peered into blood
samples from 4,000 children at a New York school and differentiated between
hepatitis A and B in the 1950s. The hepatitis lexicon has been expanding every
few years to cover other letters of the alphabet.

Hepatitis, from hepar, the Greek word for “liver”, is an inflammation and
infection of the liver. Says Ashwini Kumar Setya, senior consultant
gastroenterologist and hepatologist, Max Super Speciality Hospital, New Delhi,
“Viral hepatitis is caused by five different known viruses.”

Hepatitis A

Possibly the most innocuous of the lot and caused by the hepatitis A virus, or
HAV, this disease (once popularly called jaundice, which is just a symptom of
the infection) is generally caught from infected food and water, so the best
way to prevent it is to be careful what you put into your mouth—and not just
drinks and foods from street vendors. “Avoid unsealed bottles (of any
beverage),” says Arpit Jain, consultant, internal medicine, Artemis Health
Institute, Gurgaon. This includes water from purifiers not cleaned regularly,
aerated drinks from “fountains” (machines over which the manufacturing
company has little control) and juice bars.

Come summer and rains, and the fear of hepatitis A increases. Mothers fret
about children picking up the bug from a swimming pool. But most urban
swimming pools, says Dr Setya, follow quality control norms for fear of being
shut down. What you may need to watch out for, though, is your family gulping
seawater on a beach holiday.

Symptoms: Appetite loss, jaundice, nausea and vomiting, fever, enlarged liver
Vaccine: Available. Can be taken by anyone above the age of 1. Two doses
needed, the second given at least six months after the first one. Protects
children for 14-20 years; adults for 25 years (if you reacted adversely to the
vaccine the first time, consult a doctor before taking it again).

Hepatitis B

Hepatitis B virus, or HBV, piggybacks on infected blood and body fluids to
enter a new host. According to the World Health Organisation (WHO), HBV has
infected one in every three people around the world.
If it manifests immediately, you can actually get quick treatment before much
damage has been done. But the chronic infection can be silent for decades
before irreversible liver damage is detected, as in Bachchan’s case.
Besides IVs and blood products, it is transmitted through the mucous membrane
and saliva. It can be passed on through unprotected sex or from mother to
foetus (WHO suggests immunizing any newborn whose mother has HBV, but it
should not stop the mother from breastfeeding). Also, say, you have HBV and
share a mango with someone—the virus could be passed on if the other person
has a lesion in his mouth. And the pit of mango or other stone fruits can
itself cause that small cut!
The British Medical Journal reported in March that even acupuncture can spread
both hepatitis B and C through infected needles. Aside from the obvious (no
sharing needles, and while you’re about it, don’t “do” drugs), be
careful not to share blood glucose monitoring meters, for instance. Careless
dental procedures and body piercing may lead to HBV, as can a simple manicure
or pedicure with unsterilized equipment.

Anil Arora, chairman and head of the department of gastroenterology and
hepatology, Sir Ganga Ram Hospital, New Delhi, is also concerned about the
sharing of razors. “Blood may dry on razor and contain the live virus for
seven days. Since cuts are frequent during shaving, it is never advisable to
share a razor,” says Dr Arora. Avoid sharing toothbrushes, epilators and
earrings too.

Symptoms: The acute version manifests as loss of appetite, nausea, jaundice,
weakness, stomach pain, skin rashes and dark urine. The chronic type may have
no symptoms for decades, but can show up as cirrhosis later.
Vaccine: Available. Three injections are given (from newborn to adults) at
months zero, 1 and 6. These provide protection for at least 25 years. Babies
should be immunized within 72 hours of birth, says Dr Arora.

Hepatitis C

Often going unnoticed for up to 20 years in the body, the hepatitis C virus
(HCV) can cause fibrosis, or scarring of the liver; and worse, chronic
cirrhosis—rather like HBV, except that there is no vaccine for it.
A blood-to-blood disease, scientists are currently not too sure if HCV is also
passed on through sexual contact. What they do know is that it is passed on
through infected syringes or even infected blood touching an open wound on,
say, a paramedic involved in emergency rescue. Dr Jain says, “Tattooing with
unsterilized and reused equipment is a definite route of transmission for
hepatitis B and C, as well as HIV.” Health watchers are also concerned about
beauty treatments where abrasive material removes dead cells. HCV thrives for
days even on work surfaces where dead skin cells may have fallen. If the spa
or salon does not use stringent sterilization techniques, clients may be
exposed to the virus.

Symptoms: Poor appetite, jaundice, nausea, disturbed sleep and depression.
Vaccine: None.

Hepatitis D

Optimists may call it good news: “The hepatitis D virus (HDV) hitches a ride
on HBV,” says Dr Setya. So only those who have been infected by the HBV can
catch HDV. The bad news is, when someone gets infected with HDV, the risks to
the liver are greater than for someone infected only by HBV. Identified in
1977, HDV is transmitted mostly through infected intravenous injection
equipment. Getting immunized against HBV can protect one to some extent from
HDV.
Symptoms: Fatigue, vomiting, slow fever, diarrhoea, dark urine and light stool.
Vaccine: The one used for HBV affords some protection.

Hepatitis E

Recognized in 1980, the hepatitis E virus (HEV) can be transmitted through the
faecal-oral route, i.e., going through contaminated food and water to end up
in your food, including uncooked shellfish, much like HAV. “Hepatitis E is a
more serious problem compared to hepatitis A in terms of clinical course,
complications and outcome,” says Dr Jain.
Although it is by and large self-limiting, this disease can turn dangerous in
pregnant women, so nutritional hygiene is important. “Basic Indian customs
such as not sharing jhootha food and water can protect you from hepatitis as
well as diseases such as typhoid,” says Dr Setya.
Symptoms: Jaundice, appetite and weight loss, nausea, enlarged and tender
liver.
Vaccine: None

Where are F and G?

An unusual virus found in some patients in Japan in 1991-92 was called HFV
since it was not hepatitis A, B, C, D or E, but seemed similar. It is still
hypothetical, though, since none of the suspected viruses being studied since
the 1990s has been proven to cause hepatitis F.

Isolated in 1995 in the blood samples of a US surgeon, the hepatitis G virus
(HGV) does infect humans, but has not been found to cause illness. HGV can be
transmitted through unprotected sex, transfusions and by the parenteral route,
i.e., piercing skin or the mucous membrane. Says Dr Setya: “So far, it has
been isolated but is not of disease-producing magnitude.”