July 28th is the world Hepatitis awareness day.
The Hepatitis C virus causes both acute and chronic infection.
Acute is something that is happens quickly, it is usually asymptomatic and rarely life-threatening. About 15-45% of the infected people spontaneous heal within 6 months and do not require treatment. The other 55-85% go into the chronic stage. Of whom 15-30% could develop into cirrhosis of the liver in 20 yrs.
Geographically hepatitis C is found world wide. Though central and east Asia and northern Africa are most affected. The epidemic could be concentrated in high risk populations like people use infected needles, or could be general. There are multiple strains of HCV virus and their distribution.
Transmission is blood borne. And common pathways are
- Use of infected needles.
- Use of contaminated medical equipment without adequate sterilization.
- Transmission of contaminated blood.
- Transmission through body fluids and from mother to her fetus these are however rare.
Hepatitis however does not spread through breast milk, food, water or casual contact like hugging or kissing or share food with an infected person.
Symptoms show after a period of 2 weeks or 6 months of incubation. About 80% of the people do not exhibit any symptoms. Those do exhibit acute symptoms may show fever, fatigue, decreased appetite nausea, vomiting, abdominal pain, dark urine, grey-colored faeces, joint pain and jaundice.(jaundice is the yellowing of skin and whites of the eyes.)
Screening and diagnosis of the early stage is rare, as it is asymptomatic. Many a times it remains undiagnosed until serious liver damage has developed.
The diagnosis of HCV is in 2 steps.
- Screening for anti HCV antibodies with a serological test – this identifies people who have been infected with virus.
- If the serological test is positive, a nucleic aci test for HCV-RNA is needed to confirm chronic strong immune response without the need for treatment. Although no longer infected they will still test positive for anti-HCV infection because 15-45% of the people infected with HCV spontaneously clear the infection.
Once the person is diagnosed of harboring hepatitis C the liver is damaged is assessed for fibrosis and cirrhosis. This can be done by non-invasive test. The treatment plan and disease management is decided after identifying the strain. There are 6 strains of HCV.
Early diagnosis can prevent further destruction from the disease and transmission of the virus. high risk population could periodically be screened for the infection. And high risk include
- People who inject drugs.
- Recipients of blood products from probable unsafe source.
- People undergo going invasive health care procedures in healthcare facilities with inadequate infection control practices.
- People who sexual partners of HCV infected people.
- People using intranasal drugs.
- People who have had tattoos or piercing.
Hepatitis C does not always require treatment as the immune system in most people can clear the infection. When necessary the goal of the treatment is to cure. The cure rate dependents on factors like the strain of virus and treatment given. The appropriate approach of treatment is decided after carefully screening the patient. The current standard treatment is an antiviral therapy which is a combination f interferon and ribavirin. This combination is effective against all the strains. Unfortunately this is poorly tolerated by in some patients and is not widely available globally either. this makes management of the treatment a little complex, many patients do not finish their treatment.
Scientific advances have lead to the development of new antiviral drugs for hepatitis C which is much more effective, safer and better tolerated than existing therapies. These therapies are known as oral directly acting antiviral agents. Therapies simplify hepatitis C by significantly decreasing monitoring requirements and by increasing cure rates. Though the production cost of DAA is low, the intial price set by the pharmaceutical companies are high and access to these drugs could be difficult even in high income countries.
WHO is launching new guidelines for screening care and treatment of persons with hepatitis C in April 2014. These are the first guidelines dealing with hepatitis C treatment produced by WHO and complement the existing guidance on prevention of transmission of blood borne diseases in including HCV.
These guidelines are intended for the policy makers, government officials and others working in low-and middle income countries who are developing programs for the screening, care and treatment of persons with HCV infections. These guidelines will help expand of treatment services to patients with HCV infections as they provide key recommendations in these areas and discuss considerations for implementations.
Prevention of HCV is on three planes, primary, secondary and tertiary. There are no vaccines for HCV so primary prevention of infection depends on reduction of the risk of exposure to the virus, in healthcare settings, and high risk populations, here are some examples of the primary prevention interventions recommended by WHO
- Hand hygiene—including surgical hand preparation, hand washing and use of gloves.
- Safe handling and disposal of sharps and waste.
- Safe cleaning of equipment
- Testing of donated blood
- Improved access to safe blood.
- Training of health personnel.
Secondary and tertiary prevention for infected with the HCV WHO recommends-
- Education and counselling on options for care and treatment.
- Immunization with the hepatitis A and B vaccines to prevent co-infection from hepatitis viruses to protect their liver.
- Early and appropriate medical management and administration of antiviral therapy if appropriate.
- Regular monitoring for early diagnosis of chronic liver disease.
WHO is working in the following areas to prevent and control viral hepatitis.
- Raising awareness, promoting partnerships and mobilizing resources.
- Formulating evidence based policy and data for action.
- Prevention of transmission
- Executing ,screening, care and treatment.
Hepatitis C is a liver disease caused by hepatitis C virus it can be both acute and chronic, and can last from a few weeks to a serious lifelong disease. It is blood borne. Significant number of those who suffer from chronic infection develop liver cirrhosis or cancer. About 350,000-500,000 people die each from HCV. This is curable 50-90%
though diagnosis and accessibility to the treatment is low. The success rate is 5o0-90% though research is on for vaccine against HCV.