Hepatitis awarenes


hepatitisWorld Hepatitis day July 28th.

Hepatitis is the inflammation of the liver. The condition is self-limiting but sometimes process to scarring called cirrhosis of the liver.  It can also progress to liver cancer.

The most common cause of hepatitis in the world is virus. Through infection, toxicities like alcohol, drugs and some autoimmune diseases can also cause this condition.

Hepatitis could be type A,B, C,D and E. These 5 types are of greatest concern, because they are potential epidemic.

Hepatitis A and E are typically caused by ingestion of contaminated food or water, while B, C and D usually occur as a result of parental contact with infected body fluids. This could happen due to contaminated medical equipments, mother to child at birth, sexual contact or contaminated equipment.

Symptoms of acute infection occurs as jaundice (yellowing of skin and eyes), dark urine, extreme fatigue nausea, vomiting and abdominal pain.

Different hepatitis identified by A, B, C, and E. All these cause liver disease, though vary in important ways.

Hepatitis A Virus (HAV) is present in the faeces of an infected person. This gets transmitted through contaminated water or food. It can spread through certain sexual practises too. If the infection is mild the person recovers and acquires immunity to the strain. It can be severe and life threatening though. The outbreak of this strain is seen in places where sanitation is poor.—vaccines are available for this.

Hepatitis B Virus (HBV) is transmitted through exposure to infected blood, semen and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant in early childhood. Transmission may also occur through transfusions of HBV- contaminated blood and blood products or medical procedural equipment. Health care workers are also at the risk of HBV.

Hepatitis C Virus (HCV) is mostly transmitted through exposure of infected blood. This is transmitted through blood, body fluids, and contaminated medical equipments. Sexual transmission is also possible but it’s less common. There is vaccine for HCV.

Hepatitis D Virus (HDV) infections occur only in those who are infected with HBV. The dual infection of HDV and HBV can result in more serious disease and worse outcome. Hepatitis B vaccines provide protection from HDV infection.

Hepatitis e virus (HEV) is transmitted through consumption of contaminated water or food. HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized an important cause of disease developed countries. Safe and effective vaccines to prevent HEV infection have been developed though not widely available.


Hepatitis awareness–Hepatitis C

hepatitisWorld Hepatitis awareness Hepatitis C

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.

Getting tested:

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.

WHO fact sheet on Blood donations

blood donationBlood Donation 10 facts

This is a share from WHO

  1. Blood donation saves lives and improves health. Voluntary blood donation ensures screening of the donor. So patients requiring transfusion receive safe blood and blood products in time.
  2. Blood transfusions are used to support various treatments. In low-income countries the blood transfusions majorly done for pregnancy related complications, severe anaemia and trauma injuries. In high income countries about 76% of all transfusions are for people over 65yrs and for supportive care, like cardiovascular surgery.
  3. Since blood is an immediate urgent need, its availability is very important. Adequate reliable supply of safe blood can only be assured through voluntary donors.
  4. In 60 countries 100% of the blood donations are from voluntary unpaid donors. But 72 countries still report that 50% of their donors are voluntary unpaid but much of their blood supply is still dependent on family/replacement and paid donors.
  5. 108 million blood donations are collected globally every year. The average blood donation rate is more than 9 times higher in high income countries.
  6. The collection at blood centres vary with the income group. 10,000 blood centres in 168 countries collect blood donation.
  7. The median blood donation rate in high income countries is 36.8 donations per 1000 people. While it is 11.7 in middle-income countries and 3.9 in low-income countries.
  8. Donated blood should always be screened to avoid transfusion transmitted infections like HIV, Hepatitis B and C or syphilis. 25 countries are unable to do due to irregular supply of test kits, short of staff  or basic lab facilities.
  9. A single unit of blood can benefit several patients when the components are separated and delivered on need base.
  10. Unnecessary transfusions increase the risk of the patients to transfusion  transmitted infection and other transfusion reactions.



About Blood Donation

blood donationFacts:

In 2004 50% of the blood donations collected globally came from high income countries.

65% of the blood transfusions are given to children younger than 5yrs in low-income countries while in high income countries 76% of the transfusions are to people over the age of 65yrs.

In high income countries transfusion are more common for supportive care in cardiovascular surgery, transplant surgery, trauma, and therapy for solid and haematological malignancies. While in low-income countries it is often used to manage pregnancy related complications and severe childhood anaemia.

The per 1000 population of blood donations is 36.8 in high income, 11.7 in middle-income and 3.9 in low-income countries.

73 countries collect 90% of their blood supply from voluntary unpaid donors while 72 countries collect more than 50% from paid or family replacement sources. The over donation from voluntary unpaid donors has increased of 8.6 million from 2004 to 2012

Of the 156 countries reporting blood donations, only 43 produce plasma derived medicinal products through fractionation of plasma collected in the countries while the others import PDMP from abroad.

About Blood Donors:

Gender profiling of blood donors shows30% of the donors are women. While 20 of the reporting countries show less than 10% donations from women.

Age profiling shows more young people donate blood in low and middle-income groups when compared to high income countries.

Donors could be either, voluntary i.e. unpaid, paid or family replacement.

Voluntary donors are the safest group of donors as the prevalence of blood borne disease is the lowest in this group. These groups can assure a stable base of regular safe supply of blood. World Health Assembly promotes the development of this blood system, so that self-sufficiency can be achieved in low and middle-income countries. 60 countries report 100% of their blood supply from voluntary unpaid blood donors, while 25 countries still report collecting paid donations.8 are high income countries, 48-middle income and 16 low-income countries.

Of the 72 countries whose 50% of the blood supply is still dependent of family replacement

Blood Supply

About 108 million blood donations are collected worldwide, of which more than half come from high income countries. There 168 countries reporting, and about 10,000 blood centres, the collection varies according to income group.

Screening of the Blood

The prevalence of transfusion-transmissible infections through blood donation is considerably lower in income countries as compared to middle and low-income one It is a recommendation from WHO that all blood donations should be screened for infections before use. Particularly screening for HIV, Hepatitis B and C, and syphilis.

About 25 countries are not able to screen for either one or more of these infections, the major barrier being non-availability of test kits.

In the high income countries 97% of these screening laboratories are monitored through external quality assessment compared to 33% of middle-income countries and 16% of low-income countries.

Processing Blood

Whole blood transfusion is blood collected in an anticoagulant and is stored in an unmodified state.

When processed into components like red cell concentrates, platelet concentrates, plasma and cryoprecipitate, it can meet the needs of more than one patient.

45% of the blood collected in low income countries is separated into components while 80% separation occurs in middle-income and 95% in high income.

Plasma Derived Medicinal Products: (PDMP)

World health assembly resolution, urges the member states to establish, implement and support a sustainable blood and plasma program nationally that would make them self-sufficient. The individual governments are responsible for ensuring the availability of immunoglobins and coagulation factors which help to prevent and treat various serious conditions worldwide.

43 countries of the reporting 156 countries are self-sufficient when it comes to PDMP through fractionation. Of which 35 countries carry out fractionation within the country, while 8 countries outsource it.

Clinical Use Of Blood:

Patients are exposed to the risk of transfusion transmitted infection due to the practise of unnecessary and unsafe transfusion.

WHO recommends haemovigilance a system developed to monitor and improve safe transmission in hospitals.

111 countries have national guidelines for appropriate clinical use of blood. About 70% of the hospitals performing transfusions in high income countries have this in place the same goes for 50% of middle and low income countries.

WHO Input:

WHO aims to make blood transfusion available and safe. It recommends the following integrated strategy to ensure both availability and safety—

  1. Establishment of a national blood system with well-organized and coordinated blood transfusion services, effective evidence-based and ethical national blood policies with the goal of achieving self-sufficiency, and legislation and regulation, that can provide sufficient and timely supplies of safe blood and blood products to meet the transfusion needs of all patients.
  2. Collection of blood, plasma and other blood components from low-risk, regular, voluntary unpaid donors through the strengthening of donation systems, the phasing out of family/replacement donation, the elimination of paid donation, and effective donor management, including care and counselling.
  3. Quality-assured screening of all donated blood for transfusion-transmissible infections (TTI), including HIV, hepatitis B, hepatitis C and syphilis, confirmatory testing of the results of all donors screen-reactive for infection markers, blood grouping and compatibility testing, and systems for processing blood into blood products (blood components for transfusion and plasma derived-medicinal products), as appropriate, to meet health care needs.
  4. Rational use of blood and blood products to reduce unnecessary transfusions and minimize the risks associated with transfusion, the use of alternatives to transfusion, where possible, and safe and good clinical transfusion practices, including patient blood management.
  5. Step-wise implementation of effective quality systems, including quality management, standards, good manufacturing practices, documentation, training of all staff and quality assessment.

Through its Blood and Transfusion Safety programme, WHO supports countries in developing national blood systems to ensure timely access to safe and sufficient supplies of blood and blood products and good transfusion practices to meet the patients’ needs. The programme provides policy guidance and technical assistance to countries for ensuring universal access to safe blood and blood products and work towards self-sufficiency in safe blood and blood products based on voluntary unpaid blood donation to achieve universal health coverage.


Reference WHO fact sheets.