Hepatitis

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hepatitis

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Viral hepatitis is an inflammation of the liver that can cause numerous health problems and, in some cases, even death. Hepatitis is caused by infection with a virus. There are 5 main viruses responsible for hepatitis, called types A, B, C, D and E. Although these viruses all cause hepatitis, they all have different characteristics, especially in terms of disease severity, mode of transmission, prevention and, when available, treatment1.

Hepatitis A

1) Definition

Hepatitis A is an inflammation of the liver caused by the hepatitis A virus (HAV). The main mode of transmission of this virus is ingestion by an uninfected (or unvaccinated) person of water or food contaminated with the fecal matter of an infected person. The disease is closely associated with unsafe food and water, poor sanitation, poor personal hygiene and oro-anal sex. 2

Hepatitis A, unlike hepatitis B and C, does not lead to chronic liver disease, but on rare occasions it can cause fulminant hepatitis, which is often fatal2.

According to the WHO, in 2016, 7134 people died from hepatitis A2.

2) Transmission

The virus is not spread by ordinary person-to-person contact. HAV is transmitted mainly by the fecal-oral route, i.e. when an uninfected person ingests water or food contaminated with the fecal matter of an infected person. For example, when an infected person goes to the toilet, doesn’t wash his or her hands and prepares food for family members2.

HAV can also be transmitted by sexual contact with an infected person (oral-anal intercourse) 2.

3) Symptoms

Symptoms can range from mild to severe, depending on the case: fever, dizziness, loss of appetite, diarrhea, nausea, abdominal discomfort, dark urine, yellow eyes and skin. Symptoms are generally more prevalent in adults than in children, and the severity of the disease increases with age2.

4) Treatment

There is no cure for hepatitis A. It may be necessary to wait several weeks, or even months, for symptoms to subside and disappear. If the disease does not progress to a severe form, hospitalization is not necessary2.

5) Prevention

Several hepatitis A vaccines are available to protect against HAV. Vaccination against hepatitis A is particularly effective and well tolerated. It provides protection for 10 to 20 years and can be administered from the age of one3.

Hepatitis B

1) Definition

Hepatitis B is an inflammation of the liver caused by the HBV virus. It is one of the major human diseases: a total of 2 billion people are thought to have been infected by the virus4. The WHO estimates that 296 million people were suffering from hepatitis B in 2019, and that 820,000 people died from it in the same year5.

2) Symptoms

Most people infected with HBV have no symptoms. When symptoms do occur, they are very similar to those of the flu: loss of appetite, digestive problems, nausea, vomiting, fatigue, fever. Some symptoms are suggestive of liver inflammation: dark urine, yellow skin and eyes4.

In the most serious cases, hepatitis develops into long-term complications, notably acute liver failure, which can lead to death5.

3) Transmission

The hepatitis B virus is generally transmitted by blood, saliva, sexual contact and during childbirth, from mother to child. Hepatitis B can develop through close contact with an infected person, unprotected sex, the use of contaminated needles or syringes, unsafe transfusions and childbirth. Hepatitis B is extremely contagious: HBV is 50 to 100 times more infectious than AIDS4.

4) Treatment and vaccine

There is no treatment for acute hepatitis to improve the chances of recovery, but there is a highly effective vaccine to prevent its occurrence. Three injections of this vaccine protect 98% of those vaccinated against hepatitis B. In 90% of those vaccinated, protection lasts for at least 10 years, and even for life4.

Hepatitis C

1) Definition

The hepatitis C virus (HCV) can cause both acute and chronic infections. Acute HCV infections are generally symptom-free, and most do not progress to life-threatening disease. It is estimated that around 30% (15-45%) of people infected with HCV spontaneously eliminate the virus within 6 months of infection, without any treatment6.

2) Symptoms

People infected with the hepatitis C virus generally have no symptoms. When symptoms do occur, they generally resemble those of other hepatitises: fatigue, nausea, abdominal pain, dark urine, yellowing of the skin and eyes, etc. It is estimated that 15-45% of acute hepatitis cases will progress to a recovery, while 55-85% of infected patients will develop a chronic infection4,6.

3) Transmission

The hepatitis C virus is transmitted by blood. This most often occurs through :

– Incomplete reuse or sterilization of medical equipment, particularly syringes and needles

– Transfusion of untested blood or other contaminated blood products

– Injection drug use, particularly when sharing injection equipment from one person to another

– Childbirth: the virus is transmitted from mother to child

– Sexual practices involving exposure to blood

It is estimated that risky injections (particularly of drugs), carried out with contaminated and unsterilized equipment, or the transfusion of contaminated blood products, are responsible for 2 million new HCV infections every year4,6.

4) Treatment

There is no vaccine to prevent the onset of hepatitis C or HCV infection. On the other hand, effective treatments have been developed to encourage recovery in infected individuals. Direct-acting antivirals (DAAs) are particularly effective. Treatment duration varies from 12 to 24 weeks, and over 95% of those treated are cured of chronic HCV infection4,6.

Hepatitis D

1) Definition

Hepatitis D is an inflammation of the liver caused by the HDV virus. To exist and replicate, HDV needs HBV. This means that a person cannot be infected with HDV unless he or she has already been infected with HBV, or is currently infected with HBV. Simultaneous infection with HBV and HDV is considered the most serious form of chronic viral hepatitis, as it can rapidly progress to death from liver damage and hepatocellular carcinoma7.

2) Transmission

Like the hepatitis B virus, transmission of the hepatitis B virus requires contact through the skin or mucous membranes with the blood or bodily fluids of an infected person. Contamination can therefore occur through the use of contaminated needles or syringes, unprotected sexual intercourse, tattoos, piercings or shaving with contaminated equipment. Transmission from mother to child during childbirth is possible, but rare7,8.

3) Symptoms

In most cases, patients with simultaneous acute infection with hepatitis B virus and hepatitis D virus will have symptoms similar to those of other acute viral hepatitis: fever, fatigue, nausea, vomiting, dark urine, yellowing of the eyes and skin7.

4) Prevention and treatment

Since the hepatitis D virus cannot exist without the hepatitis B virus, it is essential to protect oneself against infection by the hepatitis B virus in the first place. A person immunized against hepatitis B will therefore not be able to become infected and develop hepatitis D. That’s why it’s imperative to be vaccinated against hepatitis B. As a reminder, three injections of the vaccine protect 98% of those vaccinated against hepatitis B. In 90% of those vaccinated, protection lasts for at least 10 years, and even for life4.

In the event of infection, treatments are available. Their response rate tends to be low, but treatment is associated with a lower probability of disease progression7.

Hepatitis E

1) Definition

Hepatitis E is an inflammation of the liver caused by infection with the hepatitis E virus (HEV). This virus is transmitted mainly via contaminated water. The infection generally heals spontaneously within 2 to 6 weeks, but in some cases can progress to a serious or even fatal illness: fulminant hepatitis.

The WHO estimates that 20 million people are infected with HEV every year, and that 44,000 died in 20159.

2) Transmission

The HEV virus is transmitted mainly through contaminated water. The disease is more common in low- and middle-income countries where access to sanitation and water supply infrastructure is limited, and access to hygiene and health services is more difficult9.

3) Symptoms

Children infected with hepatitis E generally show no symptoms, making diagnosis difficult. On the other hand, in adults aged 15 to 40, symptoms may develop that are similar to those of other hepatitises: fever, fatigue, loss of appetite, digestive disorders, itching, dark urine, yellowing of the skin and eyes… These symptoms usually last 1 to 6 weeks. In rare cases, hepatitis E can progress to fulminant hepatitis, which can lead to death9.

4) Prevention and treatment

Prevention is the most effective way to tackle HEV infection. Transmission of HEV can be reduced by applying quality standards to public water supplies, and by installing water treatment systems that eliminate human faecal matter. On a personal level, everyone can reduce the risk of infection by being very rigorous about their hygiene (systematic hand-washing, etc.) and by avoiding consuming water or ice without being certain of the source9.

In the event of infection, there is no specific treatment to cure hepatitis E. In most cases, the disease resolves and heals itself. Hospitalization will be necessary in the event of progression to fulminant hepatitis, or for pregnant women9.

 

 

Sources :
  1. Organisation Mondiale de la Santé – Hépatite – https://www.who.int/fr/health-topics/hepatitis#tab=tab_1
  2. Organisation Mondiale de la Santé – Hépatite A – https://www.who.int/fr/news-room/fact-sheets/detail/hepatitis-a#:~:text=L’h%C3%A9patite%20A%20est%20une%20inflammation%20du%20foie%20provoqu%C3%A9e%20par,f%C3%A9cales%20d’un%20sujet%20infect%C3%A9
  3. Ministère de la Santé et de la Prévention de la France – L’hépatite A – https://sante.gouv.fr/soins-et-maladies/maladies/maladies-infectieuses/hepatites-virales/article/l-hepatite-a
  4. Institut Pasteur – Hépatites virales – https://www.pasteur.fr/fr/centre-medical/fiches-maladies/hepatites-virales
  5. Organisation Mondiale de la Santé – Hépatite B – https://www.who.int/fr/news-room/fact-sheets/detail/hepatitis-b#:~:text=L’h%C3%A9patite%20B%20est%20une%20infection%20h%C3%A9patique%20potentiellement%20mortelle%20caus%C3%A9e,foie%20pour%20les%20personnes%20expos%C3%A9es
  6. Organisation Mondiale de la Santé – Hépatite C – https://www.who.int/fr/news-room/fact-sheets/detail/hepatitis-c
  7. Organisation Mondiale de la Santé – Hépatite D – https://www.who.int/fr/news-room/fact-sheets/detail/hepatitis-d#:~:text=L’h%C3%A9patite%20D%20est%20une,en%20l’absence%20de%20VHB
  8. Société Nationale Française de Gastro-Entérologie – Hépatite D – https://www.who.int/fr/news-room/fact-sheets/detail/hepatitis-d#:~:text=L’h%C3%A9patite%20D%20est%20une,en%20l’absence%20de%20VHB
  9. Organisation Mondiale de la Santé – Hépatite E – https://www.who.int/fr/news-room/fact-sheets/detail/hepatitis-e#:~:text=L’h%C3%A9patite%20E%20est%20une,cas%20symptomatiques%20d’h%C3%A9patite%20E.
POI 0711-09/22