Life & Health

Three patients recently visiting Bir Hospital’s Liver unit, in the out-patient department, OPD, showed symptoms of viral hepatitis. Continuous rainfall and uncollected garbage in the city were the usual suspects behind these cases seen over the weeks.

What are the symptoms of viral hepatitis? Fever, loss of appetite, nausea, vomiting, pain on the right side of the abdomen, increment in level of bilirubin and liver enzymes. 

For those wanting to learn more about the hepatitis virus, it shows up in five primary strains, according to doctors. They are types A, B, C, D and E. Of these, A and E are common in Nepal. 
People get hepatitis A and E from drinking water contaminated by faeces of other infected people. With proper care, patients can see hepatitis A and E subsiding on their own, the doctors say. 

“But in Nepal, people eat different herbs and drink herbal juices before coming to the hospital with severe health conditions,” said Dr Jaishi. 

To make people aware of the strains and treatments of hepatitis, World Hepatitis Day is marked on July 28 every year. This year’s theme for the day was: Bringing hepatitis care closer to you.
“The cause of viral hepatitis is the intake of contaminated food and water,” Dr Bikash Jaishi, consultant hepatologist at Bir Hospital explained. “Uncollected garbage plays a significant role in contaminating water resources.”   

The disease is mostly seasonal. 

“When there is rainfall the rainwater mixes with sewage. The polluted water contaminates our water resources. The underground water too gets contaminated,” said Birendra Prasad Gupta, PhD, assistant professor of virology, Central Department of Biotechnology, Tribhuvan University. 

Hepatitis B and C 

Hepatitis B and C are viral infections that attack the liver and can cause both acute and chronic conditions.

Hepatitis B is most commonly transmitted from mother to child during birth and delivery, as well as through contact with blood or other body fluids during sex with an infected partner, unsafe injections or exposures to sharp instruments.

The hepatitis C virus is a blood borne virus. It is most commonly transmitted through the reuse or inadequate sterilisation of medical equipment, especially syringes and needles in healthcare settings; transfusion of unscreened blood and blood products; and injecting drug use through the sharing of injection equipment, according to WHO. 

WHO estimated that in 2019, approximately 290 000 people died from hepatitis C, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer).

In 2019, hepatitis B led to an estimated 820 000 deaths, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer).

“If hepatitis B and C worsen then there is a risk of liver cirrhosis, chronic hepatitis infection and liver cancer. The infection is mostly detected in Nepal during mandatory health check-ups for foreign employment,” said Dr Jaishi. 

Unlike acute viral hepatitis, these three infections cause chronic hepatitis. Hepatitis B, C and D are responsible for over 95 percent of hepatitis deaths, the WHO says.

In Nepal, most of the cases of Hepatitis B and C are diagnosed when blood is tested to acquire a health certificate for foreign employment and/or when blood tests are done before any kind of surgery, said Jaishi. 

Hepatitis D virus (HDV) is a virus that requires hepatitis B virus (HBV) for its replication. This is quite uncommon in Nepal. 

Availability of vaccines 

To lessen the severity of the infection from hepatitis and risk of liver cirrhosis, vaccine for hepatitis B is available. But the vaccine should be taken before one gets the infection. 

One must take three doses of the vaccine — if one dose is taken today then the other dose should be taken after a month, according to Dr Jaishi. “The third dose should be taken after six months.”

WHO estimates that 296 million people were living with chronic hepatitis B infection in 2019, with 1.5 million new infections each year. 

Myth busters 

Myth: People should not consume turmeric when she or he suffers from hepatitis.
Fact: Turmeric consumption has nothing to do with hepatitis. 

Myth: Hepatitis is jaundice. 
Fact: Jaundice is a condition in which the skin, whites of the eyes and mucous membranes turn yellow because of high level of bilirubin. Bilirubin is yellowish pigment that is made during the normal breakdown of red blood cells.

Myth: Intake of several herbs and their juices helps people get rid of hepatitis A and E.
Fact: They damage liver. Such items should not be consumed. Instead doctors advise nutritious food items. 

Healthcare

• Drink boiled water
• Eat properly cooked food
• Wash hands regularly 
• Maintain personal health and hygiene