Avoid Con­tam­i­nated Food, Wa­ter, Un­pro­tected Sex

The Guardian (Nigeria) - - HEALTH - By Paul Adun­woke

HEPATITIS is an in­flam­ma­tion of the liver. The virus can be self-lim­it­ing or can progress to fi­bro­sis scar­ring. The dis­ease could also be caused by ex­ces­sive con­sump­tion of al­co­hol and cer­tain drugs, among oth­ers. Au­toim­mune dis­eases can also bring it about.

Health ex­perts ex­plained that there are dif­fer­ent types of hepatitis in­fec­tions: A, B, C, D and E, among oth­ers. These five pose great con­cern be­cause of the sever­ity of the ill­nesses, and po­ten­tial for out­breaks and epi­demic spread.

Dr. Modupe Akinyinka, a Se­nior lec­turer and Con­sul­tant, Pub­lic Health Physi­cian De­part­ment of Com­mu­nity Health and Pri­mary Health Care, La­gos State Univer­sity Col­lege of Medicine, said Hepatitis A and E are typ­i­cally caused by in­ges­tion of con­tam­i­nated food or drink, while B, C and D could oc­cur as a re­sult of shar­ing sharp in­stru­ments that have been in con­tact with in­fected body flu­ids.

She said: “Com­mon modes of trans­mis­sion of these viruses in­clude re­ceipt of con­tam­i­nated blood or blood prod­ucts, in­va­sive med­i­cal pro­ce­dures, us­ing con­tam­i­nated equip­ment or dur­ing un­pro­tected sex­ual in­ter­course. Hepatitis B is through mother to child trans­mis­sion at birth, from fam­ily mem­ber to child, as well as sex­ual con­tact.

“There­fore, peo­ple should avoid un­safe, con­tam­i­nated food and wa­ter. They should also avoid shar­ing such sharp ob­jects as nee­dles, blades and clip­pers. It is also im­por­tant to avoid pa­tron­age of quack med­i­cal per­son­nel and fa­cil­i­ties.”

Dr. Chuk­wuma Ogun­bor, a Con­sul­tant Fam­ily Physi­cian ex­plained that clin­i­cal pre­sen­ta­tion of vi­ral hepatitis is sim­i­lar re­gard­less of eti­ol­ogy (causes).

He said: “The signs and symp­toms of vi­ral hepatitis vary from a mild flu-like ill­ness to ful­mi­nant hepatitis, which is of­ten fa­tal. The clin­i­cal fea­tures of a typ­i­cal at­tack can be di­vided into three phases. These in­clude Pro­dro­mal phase, which be­gins with anorexia (loss of ap­petite), malaise, nau­sea and vom­it­ing. There may be fever, which is of­ten mild. Be­cause of the sim­i­lar­ity be­tween these symp­toms and malaria at the early stage, the di­ag­no­sis is usu­ally missed. High in­dex of sus­pi­cion is re­quired at this stage to iden­tify the cause.

“Viruses are ma­jor causes of hepatitis. They are clas­si­fied as hepatitis viruses A to G, cy­tomegalovirus (CMV), Ep­stein Barr Viruses (EBV), yel­low fever virus, in­clud­ing HIV. Vi­ral hepatitis is a global health prob­lem of pub­lic health con­cern. It has been es­ti­mated that about 10 to 12 per cent of the pop­u­la­tion has vi­ral hepatitis. Acute vi­ral hepatitis is a dis­ease of young adults, while chronic vi­ral hepatitis is found more in older age groups. High preva­lence of chronic car­rier of Hepatitis B Virus is found in drug addicts, pros­ti­tutes and other groups at high risk of in­fec­tion, such as health work­ers. Vi­ral hepatitis is clas­si­fied based on the du­ra­tion of the dis­ease. This may be acute or chronic.”

Ogun­bor said Ic­teric phase be­gins af­ter three to 10 days of on­set of symp­toms. The pa­tient no­tices itch­ing with pas­sage of dark urine and later on jaun­dice. The re­cov­ery phase is when the jaun­dice peaks about one to two weeks from on­set and then dis­ap­pears over a pe­riod of two to four weeks. He said: “Signs are of­ten few, con­sist­ing only of jaun­dice and an en­larged, ten­der liver. Oc­ca­sion­ally, the spleen may be en­larged. The non-vi­ral causes of hepatitis in­clude the malaria par­a­site, sys­temic fun­gal in­fec­tions, tox­o­plas­mo­sis, lep­tospiro­sis and rick­ettsial or­gan­isms.

“How­ever, cer­tain drugs have been known to also cause hepatitis. These in­clude parac­eta­mol. Liver dam­age caused by parac­eta­mol has been on the rise re­cently, which could be at­trib­uted to abuse of the drug. Peo­ple abuse parac­eta­mol for the slight­est pain. Use of herbal con­coc­tions is also one of the lead­ing causes of liver dam­age. Oth­ers in­clude anti-tb drugs and some drugs used for con­trol­ling blood pres­sure, such as methyl­dopa.

“Ex­ces­sive and pro­longed use of al­co­hol is also a ma­jor cause of liver dam­age. In­ves­ti­ga­tions usu­ally in­clude Liver func­tion test to check for liver en­zymes, clot­ting pro­file, full blood count, urine anal­y­sis, ul­tra­sound of the liver and vi­ral screen­ing for hepatitis viruses. Mode of treat­ment de­pends on the stage of the dis­ease. “Treat­ment of un­com­pli­cated acute vi­ral hepatitis is sup­port­ive, such as bed rest, avoid­ance of al­co­hol and nor­mal diet. Ful­mi­nant hepatitis is treated with anti-liver fail­ure reg­i­men. Chronic Hepatitis B Virus and hepatitis C virus re­quire both sup­port­ive and an­tivi­ral ther­apy.

“The pre­ven­tion and con­trol of Hepatitis viruses trans­mit­ted by the faeco-oral route such as hepatitis A and E de­pends on good san­i­ta­tion and hy­giene. In the case of trans­mis­sion via blood and blood prod­ucts, proper screen­ing of blood be­fore trans­fu­sion should be done. Ob­serv­ing uni­ver­sal pre­cau­tions is per­ti­nent.

“Ev­ery Nige­rian should be vac­ci­nated against vi­ral hepatitis. New­born ba­bies should be vac­ci­nated for hepatitis B virus, as part of their rou­tine im­mu­ni­sa­tion via the Na­tional Pro­gramme on Im­mu­ni­sa­tion (NPI). This com­prises three doses given at birth, about one month af­ter and at six months. A booster dose is given at five years. Adult dosage fol­lows sim­i­lar pat­tern. In­di­vid­u­als not im­mu­nised, but ex­posed via blood con­tact from an in­fected per­son should have hepatitis B im­munoglob­u­lin in­jec­tion im­me­di­ately.”

Dr. Emuo­bor Odeghe, a Con­sul­tant Physi­cian and Gas­troen­terol­o­gist with La­gos Univer­sity Teach­ing Hos­pi­tal (LUTH), said some peo­ple may not show any sign or symp­tom, while oth­ers may present with fever, yel­low­ness of the eyes, tired­ness, fa­tigue, poor ap­petite, body aches, vom­it­ing, light coloured stools, dark coloured urine and ab­dom­i­nal pain. He said: “If it pro­gresses to liver cir­rho­sis, there may be swelling of the ab­domen, vom­it­ing of blood, con­fu­sion or coma, or even de­vel­op­ment of liver can­cer. Hepatitis could be acute, last­ing less than six months.”

Odeghe said there is an ef­fec­tive vac­ci­na­tion for hepatitis B virus, and it is rec­om­mended that all new­borns take the first dose within 24 hours of birth. Older chil­dren and ado­les­cents should also be vac­ci­nated, if they haven’t been.

“Peo­ple should avoid self-med­i­ca­tion and herbal/tra­di­tional reme­dies. It is also im­por­tant to main­tain a healthy life­style with reg­u­lar phys­i­cal ex­er­cise, healthy diet, and weight con­trol/loss. They should also go for reg­u­lar health checks,” he said.

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