Hepatitis

HEPATITIS-B Hepatitis-B is a disease of liver caused by the infection of the Hepatitis B virus. It is also known as the Australian Antigen and it's only natural host is man. It is atleast 100 times more infectious than HIV. This virus causes destruction of liver tissue and may lead to Hepatocellular Carcinoma in later life. Hepatitis B is prevalent throughout the world particularly in Africa and Asia and reported to be leading killer as every 2 million deaths are reported.

It is reported that one in every 20 people in India is a carrier of this deadly virus. Approximately 49-68% of chronic liver disease. 80% of all liver cancers and about 1% of all adult deaths can be traced to Hepatitis B.
India has second largest pool of carriers in the world i.e. 43 million chronic carriers out of which 10% are highly infectious.
Hepatitis C virus or the parenterally transmitted non-A-non-B virus is an RNA virus, usually seen in association with blood transfusions and contact with blood and other body fluids. Over 60% of the infected may develop chronic liver disease.

PEOPLE AT RISK?

1. High Risk
   Due to profession Dental, medical and paramedical personnel because their profession exposes them to the risk of dealing with blood and body fluids of patients who may be carriers.
2. Due to illness
   1. Patient like Thalassemics and Haemophillies who receive blood related products.
   2. Patients on dialysis.
3. Due to sexual or social habits
   1. Heterosexual with multiple sex partners
   2. Homosexuals and prostitutes.
   3. Intravenous drug users.
   4. People who undergo tattooing.
4. Others
   1. Infants born to Hepatitis-B infected mothers.
   2. Family members of Hepatitis-B carriers.

Modes of transmission This virus is primarily transmitted through infected blood, saliva, semen, tears, vaginal secretions and sweat.
HBV is transmitted both percutaneously and nonpercutaneously. Percutaneously through cut and open wound. Nonpercutaneous transmission includes transfer of infectious bodily secretions, such as saliva, blood and crevicular fluid.

Major routes of transmission
1. Perenteral / Percutaneous
   During transfusion of infected blood and through infected needles.
2. Horizontal
   Between person to person because of accidental contact.
3. Vertical
   From infected mother to child.
4. Sexual
   Between sexual partners.

Course of infection
Incubation period between 40 - 180 days and onset is gradual. Once an individual is infected 90% develop acute Hepatitis B.

Symptoms
1. General Malaise
2. Nausea
3. Vomiting
4. Fever
5. Headache
6. Fatigue
7. Anoerxia
8. Abdominal Pain

In many patients the disease is not accompanied by jaundice while minority develop significant jaundice. Most patients recovers uneventfully but in a few patients the disease follows as severe course known as fulminant Hepatitis.

Risk of developing of fulminant Hepatitis are:
• Age more than 60 days
• Females
• Pregnancy
• Recurrent infections
• Immuno-compromised state

DIAGNOSIS is done by Serological tests.

TREATMENT
There is no effective treatment. The only treatment reported with variable succes is through the use of Interferons.

PREVENTION
• Stringent screening procedure of blood in blood banks.
• Use of disposable syringes and needles.
• Wearing of masks and gowns by Medical and Paramedical personnel.
• Proper sterilization of medical equipment.
• Practice of safe sex.
• Routine Hepatitis B vaccination.

It is heartning to mention that many Philanthropic Organisations have started organising Hepatitis B vaccination camps for masses as they have realised this menace should be tackled at national level making it a mass movement. Prevention of transmission through immunophylaxis. There is is no cure for this infection. The only solution is prevention. Prevention may be achieved by one of the two means:
a) Active immunization through the administration of a vaccine against Hepatitis B.
b) Passive immunization through the administration of a Hepatits B Immunoglobulin (HBIG)

The vaccine available are:
1. Plasma derived vaccines.
2. Genetically Engineered vaccines.
3. Engerix-B - Should be injected intra-muscularly.