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Sunday, 28 July 2013

WHO And World Hepatitis Day, What every one should know about liver ...................81113

July 28 is World Hepatitis Day.

India’s Hepatitis burden is rising due to the use of infected injections and unsterilised medical equipment as well as unsafe blood transfusions. In India, nearly two-thirds of the injections being used are unsafe, posing health hazards for the recipients. Unhygienic use of needles in acupuncture and tattooing also has a significant role in spreading hepatitis, according to experts. There are five main Hepatitis viruses, referred to as types A, B, C, D and E. Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occurs as a result of parenteral contact with infected body fluids. Hepatitis B is also transmitted by sexual contact.
‘Hepatitis B (HBV) and Hepatitis C (HCV) infections are silent diseases that remain asymptomatic for decades. Due to lower awareness, more than 80 percent HCV patients and over 60 percent patients with HBV are diagnosed at a stage when the disease is irreversible,’ Anil Arora, chairman and head of the Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital, New Delhi said.  Ajay Kumar, senior consultant gasteroenterology Indraprastha Apollo Hospitals told IANS: ‘Transmission of Hepatitis through infected syringes and blood is a significant problem in India.’  ‘Most patients in India get the Hepatitis B and C forms in childhood either through mother to child transmission or contact with other siblings,’ he said adding, many times after being infected the problem becomes chronic and they become permanent carriers of the virus.
He added that there was much need to organize a countrywide education campaign among health workers, patients and the community, especially in the rural areas. Anupam Sibal group medical director and senior gasteroenterologist at Apollo, who specialises in paediatric Hepatitis, said immunisation against the disease is an effective prevention method. Under the Universal Immunization Programme (UIP), the government provides Hepatitis B vaccine and the operational cost of vaccination to states and union territories for preventing Hepatitis B infection.  Since April 2005, the government has also introduced auto-disabled (AD) syringes for all vaccinations under UIP in all states. AD syringes are single use, self-locking syringes that cannot be used more than once.
This prevents misuse and contamination and cross- infection through repeated use of unsterile injection or equipment. Routine screening of blood units for Hepatitis B and C has been made mandatory for all blood banks to detect and discard contaminated blood units, a senior health ministry official said. Hepatitis viruses are estimated to be among the top 10 causes of death in India. According to the World Health Organization, 240 million people globally are chronically infected with Hepatitis B and around 150 million are chronically infected with Hepatitis C.
Approximately 500 million people worldwide are living with either hepatitis B or hepatitis C. This means 1 in 12 people suffer from this deadly disease.  As for Hepatitis C, one out of every 100 in India may be chronically infected by the virus and most among these 12 million people do not know they are infected. According to government figures, prevalence of Hepatitis C has been observed to be relatively higher in Punjab, Andhra Pradesh, Puducherry, Arunachal Pradesh and Mizoram.
Interestingly, several studies conducted in these states have highlighted different risk factors which are believed to have led to the relatively higher prevalence of the condition. ‘Hepatitis C usually affects people in the age group of 20 to 60 years while Hepatitis B is most common in the age groups 10 to 60 years,’ Kaushal Madan, senior consultant Hepatologist and Gastroenterologist, Medanta – The Medicity Hospital, Gurgaon said.
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Many associate liver diseases with alcohol, but that’s just one cause, says an expert. Water and food are common carriers of the Hepatitis virus that affects the liver. Ashish Sharma, consultant, internal medicine, Columbia Asia Hospital, Ghaziabad, explains the different types of hepatitis, the symptoms and vaccines available:  

Hepatitis A – It is the most harmless virus of the lot. Contamination of food and water are the prime reasons for the infection. The best way to prevent it is to be careful of what you eat. Avoid unpacked or unsealed food or drinks.

Symptoms: Inflamed liver, no appetite, jaundice, nausea, vomiting and fever.

Vaccine: The vaccine is easily available. It can be taken by anyone above the age of one. Two doses are given at a time, six months apart. It can protect you for at least 20 years.

Hepatitis B - This virus can go undetected for decades before irreversible liver damage has been done. It is usually infected through blood, saliva, unprotected sex and from the mother to the foetus. Cuts are very frequent during shaving, so it is advisable not to share the razor because the blood may dry, but the virus can live for a week.

Symptoms: Frequent stomach pain, skin rashes and dark urine.

Vaccine: Newborn babies must be immunized within 72 hours of birth and three injections can be given at the ages of zero, one and six. Protection will last for 25 years.

Hepatitis C - It can go undetected for upto 20 years. It has yet to be proved that it can be passed through sexual contact, but blood-to-blood infection is the general route. Tattooing with unsterilized needles is a definite route of transmitting Hepatitis B and C. If sterilized equipment is not used, the virus may spread.

Symptoms: Poor appetite, jaundice, nausea, disturbed sleep and depression.

 Vaccine: No vaccine is available at the moment.

Hepatitis D - Those who have been infected by Hepatitis B can also be infected with Hepatitis D. 

Symptoms: Fatigue, vomiting, slow fever, dark urine and light stool.

Vaccine: The vaccine used for Hepatitis B can also be used in this case.

Hepatitis E - It can be transmitted through oral route.

Symptoms: Jaundice, appetite and weight loss, nausea, enlarged and tender liver.

Vaccine: No vaccine is available at the moment.
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Rajesh Khanna, India’s first superstar passed away recently. A close friend of his said that he died of liver infection

Kaka’s battle with alcohol is well documented. Though no one wants to say it out loud, it was his drinking habit that probably hastened his early demise. So why is alcohol dangerous to the liver? For that we need to understand how important an organ the liver is 

What does the liver do?

The liver serves so many different functions that till now no single artificial organ or device that can perform all its functions. The liver processes nutrients from your food, gets rid of toxins and even helps your blood clot. The liver is also responsible for providing glucose so that all your bodily functions can take place properly.

What happens when you drink alcohol?

When you drink booze, the liver works overtime to convert ethanol into acetic acid which is then converted into a less toxic form like acetate which we eventually release as urine. However, this means that the liver is diverted from its primary functions like providing glucose. The effects of hangovers like nausea, vomiting, headaches and fatigue is due to this – the lack of glucose or hypoglycaemia. Glucose is also very important for our brain functions and this explains why we are lethargic and have slower cognitive function during hangovers. And these are only the short term effects.

Long term effects of alcohol consumption on liver

The long term effects are far worse. It takes a toll on all liver functions. Along with fatty foods excessive alcohol consumption is one of the primary causes of all liver diseases. The fat deposited due to absorption of alcohol leads to fatty liver disease. It also causes inflammation of the liver which leads to alcoholic hepatitis. Hepatitis is inflammation of the liver and alcoholic hepatitis is one of the first stages of alcohol liver disease and may progress to fibrosis (thickening of connecting tissues) or cirrhosis (a chronic liver disease marked by cell degeneration, inflammation and advanced fibrosis). Though the liver is a remarkably resilient organ (it can function normally even after losing 70% of its mass), cirrhosis of liver leads to its complete shutdown. It prevents the free flow of blood leading to accumulation of waste and toxins in the body. The symptoms of cirrhosis (jaundice, fluid build-up, itching, nosebleeds, red spots, lowered immunity) may occur either simultaneously or gradually. The symptoms of liver cirrhosis are only visible when it has progressed to an advanced stage. By that time very little can be done for the patient.
So think what the alcohol is going to do to your body before you have your next drink.
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The liver is a highly under-appreciated organ.  I’ll try and explain what the liver does, the diseases which can affect it and end with tips to maintain it in top shape.
Your liver is a one and a half kg organ that sits behind your right rib cage. If you did not have your liver, you would not be able to process nutrients like carbohydrates, proteins, fats, vitamins and minerals from your food. Your body would not get rid of all the toxins and microbes. Your blood would probably never clot! The liver plays a vital role in maintaining the body’s metabolic balance.
As the liver performs a variety of important functions it is extremely vulnerable to a variety of metabolic, toxic, microbial, circulatory and cancerous insults. Awareness of the liver’s functions and what all can cause liver disease can help you take the road to great health.
Let’s start with a few commonly known diseases that can affect the liver:
  1. Fatty Liver: This disease was traditionally known to occur in association with excessive alcohol intake but now the non-alcoholic variant is reaching epidemic proportions in the developed countries. Known to occur in association with metabolic syndrome consisting of hypertension, diabetes, obesity and hyperlipidemia this disease occurs because of faulty fat metabolism in the liver. Prevention is the best treatment and if uncontrolled can even end up in liver failure.
  2. Viral hepatitis is an infection of the liver that is caused by a group of viruses that have particular affinity for the liver. Out of these, hepatitis A and E are caused by eating food contaminated with the virus. Hepatitis B, C and D are acquired through blood, body fluids and by unprotected sexual contact.
  3. Alcoholic hepatitis is inflammation (swelling) of the liver due to ingestion of alcohol.
  4. Cirrhosis or scarring of the liver is caused mostly due to alcohol intake, viral infection due to hepatitis B  and C , bile duct disease or iron overload. It is among the top 10 causes of death in the world. The liver ceases to function normally due to irreversible damage. It progresses gradually and can lead to end stage liver disease.
  5. Drug induced damage caused due to the various medicines we take and chemicals we are exposed to. As liver is the major detoxifying organ in the body, it is subject to an enormous variety of drugs and chemicals. Always be careful when consuming medicines. Even over the counter medications like paracetamol can cause fulminant liver failure. Never take medications beyond the recommended dosage. It is always better to consult a doctor before taking medications and follow up at the slightest evidence of ill health. Certain herbal medications could also cause damage to the liver and so can medications for tuberculosis.
  6. Liver cancer can be caused by many factors including viral infections (hepatitis B and C), chronic alcoholism, certain food contaminants, genetic factors, cirrhosis of the liver.
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What are the symptoms of liver disease?

 This depends on the onset and rapidity of progression of liver damage.
In case of acute liver damage (due to drugs, toxins, viral hepatitis A, B or E), there may be fever with yellowish discoloration of sclera (the white of the eye), skin and urine. In most cases this may be self-limiting. In a small percentage, this may progress to fulminant liver failure leading to coma, altered blood clotting, kidney failure, secondary infections and may even require liver transplantation.

In chronic liver damage (due to hepatitis B, C or alcohol), the symptoms would be more gradual in onset:
  • Jaundice or yellowish discoloration of skin and the white of the eye.
  • Swelling especially in the legs and feet due to low protein levels.
  • Enlargement of breasts known as gynecomastia (in a male).
  • Reddish spider like discolorations (spider nevi) beneath the skin especially over the chest.
  • Accumulation of fluid (ascites) in the abdomen giving it a protruded appearance.
  • Problems with clotting of blood
  • Vomiting of blood or blood in stools
  • Altered senses with change in behavior, confusion, forgetfulness and other symptoms related to the brain also known as hepatic encephalopathy.
  • Gradual worsening of kidney function
The above symptoms are not comprehensive and it is best to consult a doctor at the earliest onset of any of the above.

 Tips for a healthy liver:

Diet and Alcohol: A balanced diet with low fat content would be well suited to prevent fatty liver. Alcohol is best avoided.
Exercise: Plays a role in controlling cholesterol and in the metabolism of fat thus indirectly protecting the liver.

Vaccination: Hepatitis B is preventable by vaccination. Three shots of the hepatitis B vaccine taken over three months can provide long term protection against the dreaded disease.

Hygienic food and drinking water: Hepatitis A and E are known to spread via the oral route. Think twice before having road side delicacies! Boil the water that you intend to drink. It is the best way to prevent communicable diseases.

Avoid self-medication: Various drugs can damage the liver if taken indiscriminately

Regular check-ups: Once diagnosed with liver disease, be regular in follow ups with the doctor. Reversible damage can become irreversible if neglected.
 This World Liver day, let’s strive not to abuse our liver, one of the most useful organs that we have. Let’s treat it with the love and respect it deserves. 
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Extra weight and insulin resistance are bigger risk factors  for a fatty liver than moderate amounts of alcohol, warn researchers.

 
It has long been known that large amounts of alcohol can cause fatty liver, which leads to cirrhosis – the most common liver ailment in the western world. However, recently research has shown that obesity and insulin resistance can also cause fatty liver, which in turn is closely associated with diabetes, high blood pressure, and cardiovascular disease.

As per research, as little as over a glass of wine for men and just over half a glass of wine per day for women was sufficient to bring about a fatty liver condition, But more recent studies are now showing that moderate amounts of alcohol daily don’t cause fatty liver, reports the journal Annals of Medicine.
In their study, 44 individuals participated and were randomised to either abstain entirely from alcohol or drink one glass of red wine per day for women and two glasses for men for three months.  Before and after the trial, the subjects provided blood samples, and the fatty content of the liver was measured with state-of-the-art magnetic resonance imaging (MRI).”It turned out that the amount of fat in the liver was linked with obesity and insulin resistance and was almost not at all affected by the red wine. Specifically, after three months, none of the wine drinkers had developed fatty liver or elevated liver transaminases,” said Kechagias, liver specialist at the university.

What’s more, the harmful LDL cholesterol was 16 percent lower at the end of the study in those who drank red wine compared with total abstainers. ”There is a strong correlation between moderate intake of alcohol and decreased risk of cardiovascular disease,” said Nystrom.
So, stay away from fatty food, get good exercise and if you drink, stick to moderate amounts for a healthy liver.
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Q: What is hepatitis?
A: Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. There are five main hepatitis viruses, referred to as types A, B, C, D and E. These five types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread. In particular, types B and C lead to chronic disease in hundreds of millions of people and, together, are the most common cause of liver cirrhosis and cancer.
Hepatitis A and E are typically caused by ingestion of contaminated food or water. Hepatitis B, C and D usually occur as a result of parenteral contact with infected body fluids. Common modes of transmission for these viruses include receipt of contaminated blood or blood products, invasive medical procedures using contaminated equipment and for hepatitis B transmission from mother to baby at birth, from family member to child, and also by sexual contact.
Acute infection may occur with limited or no symptoms, or may include symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

Q: What are the different hepatitis viruses?
A: Scientists have identified five unique hepatitis viruses, identified by the letters A, B, C, D, and E. While all cause liver disease, they vary in important ways.

Hepatitis A virus (HAV) is present in the faeces of infected persons and is most often transmitted through consumption of contaminated water or food. Certain sex practices can also spread HAV. Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections. However, HAV infections can also be severe and life threatening. Most people in areas of the world with poor sanitation have been infected with this virus. Safe and effective vaccines are available to prevent HAV.

Hepatitis B virus (HBV) is transmitted through exposure to infective 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, contaminated injections during medical procedures, and through injection drug use. HBV also poses a risk to healthcare workers who sustain accidental needle stick injuries while caring for infected-HBV patients. A safe and effective vaccine is available to prevent HBV.
Hepatitis C virus (HCV) is mostly also transmitted through exposure to infective blood. This may happen through transfusions of HCV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. Sexual transmission is also possible, but is much less common. There is no 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 a more serious disease and worse outcome. Safe and effective hepatitis B vaccines provide protection from HDV infection.
Hepatitis E virus (HEV), like HAV, 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 as an important cause of disease in developed countries. Safe and effective vaccines to prevent HEV infection have been developed but are not widely available.

What is World Hepatitis Day?

At its 2010 meeting, the World Health Assembly resolved that July 28 should be designated as World Hepatitis Day. World Hepatitis Day is an opportunity for education and greater understanding of viral hepatitis as a global public health problem, and to stimulate the strengthening of preventive and control measures of this disease by nations around the world.

Why is it needed?

Hepatitis is one of the most prevalent and serious infectious conditions in the world, but many people – including health policy makers – remain unaware of its staggering toll on global health.

What makes hepatitis a global health problem?

About 1 million deaths per year are attributed to viral hepatitis infections. Together, hepatitis B virus (HBV) and hepatitis C (HCV) are the leading cause of liver cancer in the world, accounting for 78 percent of cases.
Nearly one out of every three people in the world (approximately 2 billion people) has been infected by HBV, and one in twelve live with chronic HBV or HCV infection. While most people who have been infected with these viruses are unaware of their infection, they face the possibility of developing debilitating or fatal liver disease at some point in their lives and unknowingly transmitting the infection to others.
HBV/HIV and HCV/HIV coinfections are an increasing problem in countries with HIV epidemics and among injecting drug users. For co-infected persons being treated with HIV antiretroviral medicines, underlying viral hepatitis is becoming a major cause of death.

What are the different hepatitis viruses?

Scientists have identified five unique hepatitis viruses, identified by the letters A, B, C, D, and E. While all cause liver disease, they vary in important ways.

Hepatitis A virus (HAV) is present in the faeces of infected persons and is most often transmitted through consumption of contaminated water or food. Certain sex practices can also spread HAV. Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections. However, HAV infections can also be severe and life threatening. Most people in areas of the world with poor sanitation have been infected with this virus. Safe and effective vaccines are available to prevent HAV.

Hepatitis B virus (HBV) is transmitted through exposure to infective 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 childhood1. Transmission may also occur through transfusions of HBV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. HBV also poses a risk to healthcare workers who sustain accidental needle stick injuries while caring for infected-HBV patients. A safe and effective vaccine is available to prevent HBV.

Hepatitis C virus (HCV) is mostly also transmitted through exposure to infective blood. This may happen through transfusions of HCV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. Sexual transmission is also possible, but is much less common. There is no 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 a more serious disease and worse outcome. Safe and effective hepatitis B vaccines provide protection from HDV infection.

Hepatitis E virus (HEV), like HAV, 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 as an important cause of disease in developed countries. Safe and effective vaccines to prevent HEV infection have been developed but are not widely available.

Why is it important for people to know if they are infected with a form of viral hepatitis?

Early diagnosis provides the best opportunity for effective medical support. It also allows those infected to take steps to prevent transmission of the disease to others, for example by adopting safe sex practices. It allows lifestyle precautions to be undertaken to protect the liver from additional harm, specifically, by eliminating alcohol and certain drugs which are toxic to the liver.

How can viral hepatitis be prevented?

  • Safe and effective vaccines are widely available for the prevention of HAV and HBV infection.
  • Screening blood used for transfusion can prevent transmission of HBV and HCV.
  • Sterile injection equipment protects against HBV and HCV transmission.
  • Safer sex practices, including minimizing the number of partners and using barrier (condom) protective measures has been shown to protect against HBV and HCV transmission.
  • Harm reduction for injection drug users prevents HBV and HCV transmission.
  • Safe food and water provide the best protections against HAV and HEV.

How is viral hepatitis treated?

Antiviral agents active against HBV exist. Treatment of HBV infection has been shown to reduce the risk of liver cancer and death. It is estimated that 20–30% of persons with HBV infection could benefit from treatment. However, drugs active against HBV are not widely available or utilized in persons infected with HBV. Currently recommended antiviral agents used for treatment of human immunodeficiency virus (HIV) infection do not adequately suppress HBV, which is of great concern for the estimated 10% of the HIV-infected persons in Africa who are co-infected with HBV.
HCV is generally considered to be a curable disease but for many persons this is not a reality. Scientific advances and intense research and development have led to the development of many new oral antiviral drugs for HCV infection. A great number of HCV specific oral drugs are in the late stage of development; some have been recently registered. These are more effective and better tolerated. Much still needs to be done to ensure that these new treatment advances lead to greater access and treatment responses in resource constrained areas of the world.

What is WHO doing to support the fight against viral hepatitis?

 

WHO has worked closely with Member States to achieve some very notable achievements in hepatitis prevention. In 2009, over 91% of Member States now include the hepatitis B vaccine in their infant immunization programs and over 70% of infants received 3 doses of this vaccine which provides them with life-long protection from this one virus.
WHO is assisting countries in ensuring the safety, availability, and quality of blood and blood products.
Policy guidance and guidelines on best practices are available for all injections including phlebotomy and lancet procedures. They enable countries to establish safe injection and phlebotomy services, train health care workers on best injection and phlebotomy practices and ensure that patients and health workers are safe when receiving or giving an injection or a phlebotomy.
More needs to be done to prevent and control viral hepatitis. We must ensure that those already infected with viral hepatitis have timely access to testing, care and effective treatments to delay development of disease and prevent disability.
WHO is working in the following areas:
  • raising awareness, promoting partnerships and mobilizing resources
  • evidence-based policy and data for action
  • prevention of transmission
  • screening, care and treatment.
To accomplish this mandate, WHO will take a health systems approach, including developing new approaches at WHO and mobilizing much needed resources.
WHO will work in close collaboration with all our partners to prevent and control viral hepatitis.



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