ACCORDING to the Pan American Health Organization/World Health Organization (PAHO/WHO), “the global burden of disease and mortality from viral Hepatitis is high. An estimated 57 per cent of liver cirrhosis cases and 78 per cent of primary liver cancer cases result from hepatitis B or C viruses’ infections.”

In recognition of the importance of the public health problem posed by the disease, the 63rd World Health Assembly designated July 28 as World Hepatitis Day and requested an integrated response in the fight against hepatitis.

This undertaking continues to offer an opportunity to the Americas for the integrated approach to viral hepatitis as a recognised public health problem.

Hepatitis is a medical condition defined by the inflammation of the liver and characterised by the presence of inflammatory cells in the tissue of the organ.
The disease may occur with limited or no symptoms, but often leads to jaundice, poor appetite, and anxiety. The two main classes of Hepatitis are ‘acute’ and ‘chronic’. The disease is classified as acute when it lasts less than six months and chronic when it lasts longer.

Guyana has been supporting this initiative since its implementation. Testing is offered at most of the country’s laboratories, including both private and public sector facilities.
The country has one of the leading vaccination programmes, offering 16 different antigens and has a coverage of over 90 per cent.

According to the Minister of Public Health, Dr. George Norton, “for the past number of years Guyana has not reported any vaccine preventable diseases… for over five years, now we are doing well in preventing diseases that are caused by virus.”

He added: “As a matter of fact, Guyana is considered number 3 among 75 countries in the evaluation of effective vaccine management.

In 2014, the National Public Health Reference Laboratory (NPHRL) carried out 5456 such tests, of which 158 were positive.

According to Carol Trotman, NPHRL’s Quality Manager, individuals will present themselves to a clinician and depending on the signs and symptoms presented by the patient, the doctor or clinician can decide to do a Hepatitis B antigen test, and then this sample is taken off and sent to the reference laboratory.
She added that the institution does not perform phlebotomy. However, it does offer screening but only for those samples which were referred from the other health institutions. This is for the purpose of confirmation.
After the samples have been tested, the results are then returned to the respective institutions, where treatment is then administered if needed.
As Guyana joins with the rest of the world to celebrate World Hepatitis Day 2015 under the theme, “Prevent Hepatitis, Act Now!” Minister Norton has reaffirmed his commitment to the fight against the disease and to strive for an even higher quality of care for the country’s people in this regard.
Further, the Ministry also commenced a three-day workshop on Expanded Programme on Immunisation.

CLASSES OF HEPATITIS
Acute hepatitis can be self-limiting, but in some cases can also progress to chronic hepatitis, or, rarely, cause acute liver failure. The initial symptoms of this type of hepatitis are non-specific and flu-like. It is common to almost all acute viral infections, and may include malaise, muscle and joint aches, fever, nausea or vomiting, diarrhoea and headache.

Acute viral hepatitis is more likely to be asymptomatic in children; general symptoms may last for 1–2 weeks before jaundice develops. The total illness can last for several weeks.
This class of the disease can see a small proportion of individuals with the disease progress to acute liver failure, in which the liver is unable to remove harmful substances from the blood, and which will result in confusion and coma, due to hepatic encephalopathy (altered level of consciousness) and produce blood proteins leading to peripheral edema and bleeding.
Meanwhile, chronic Hepatitis may have no symptoms, and may over time progress to fibrosis (scarring of the liver) and cirrhosis (chronic liver failure). It is important to note that cirrhosis of the liver increases the risk of developing hepatocellular carcinoma, a form of liver cancer. This may cause non-specific symptoms such as malaise, tiredness, and weakness or it can have no symptoms at all. The presence of jaundice indicates advanced liver damage.
Extensive damage to and scarring of liver lead to weight loss, easy bruising and bleeding, swelling of the legs, and accumulation of fluid in the abdomen.
Cirrhosis may lead to various complications including hepatic encephalopathy and kidney dysfunction. Women with autoimmune Hepatitis may experience abnormal menstruation, lung scarring, and inflammation of the thyroid gland and kidneys along with acne.

TYPES OF HEPATITIS

However, viral Hepatitis is the most common cause of liver inflammation worldwide. This is caused by the five unrelated hepatotropic viruses: Hepatitis A, B, C, D and E.
Hepatitis A is caused by ingesting infected food or water. The food or water is infected with a virus called HAV (Hepatitis A virus). Anal-oral contact during sex can also be a cause. Nearly everyone who develops Hepatitis A makes a full recovery; it does not lead to chronic disease.
However, Hepatitis B is the most common viral hepatitis worldwide, affecting about 10 per cent of the adult population in endemic areas and causing approximately 780,000 deaths per year worldwide.
It is a Sexually Transmitted Disease (STD) that is caused by Hepatitis B Virus (HBV) and is spread by contact with infected blood, semen, or with other body fluids.
It is most often transmitted vertically in areas of high incidence, perinatally (the period around childbirth, primarily five months before and one month after birth) from mother to baby, or horizontally by being exposed to infected blood or blood products. However, the administration of the Hepatitis Vaccination within 24 hours of birth can prevent transmission from an infected mother. A baby can also become infected through the mother’s milk if infected.
This can be transmitted through unprotected sexual intercourse with an infected person, sharing of needles and syringes etc.
Hepatitis is surrounded by several contributing factors, one of these being excessive alcohol consumption. Alcoholic Hepatitis usually develops over years of long exposure to alcohol. Alcohol intake (in excess of 80 grams of alcohol per day in men and 40 grams per day in women) is associated with development of alcoholic Hepatitis.
Interestingly, a large number of medications and other chemical agents can cause Hepatitis. Research has shown that paracetamol is the leading cause of acute liver failure in the United States.
In addition, Hepatitis C is usually spread through direct contact with the blood of a person who has the disease, while only a person who is already infected with Hepatitis B can become infected with Hepatitis D. With regard to Hepatitis E, a person can only become infected by drinking contaminated water.

DIAGNOSIS & PREVENTION

Diagnosis is made by assessing an individual’s symptoms, physical exam, and medical history, in conjunction with blood tests, liver biopsy, and imaging.
Vaccines are available to prevent Hepatitis A and B. Hepatitis A immunity is achieved in 99 – 100 per cent of persons receiving the two-dose inactivated virus vaccine. The Hepatitis A vaccine is not approved for children under one year.
Vaccines to prevent Hepatitis B have been available since 1986 and have been incorporated into at least 177 national immunisation programmes for children.
Immunity is achieved in greater than 95 per cent of children and young adults receiving the three-dose recombinant virus vaccine. Also, adults over 40 years of age have decreased immune response to the vaccine
The World Health Organisation (WHO) recommends vaccination of all children, particularly newborns, in countries where Hepatitis B is common to prevent transmission from the mother to child.
 

A GINA Feature by Shivanie Rampersaud