Hepatitis outbreaks in children reported across the world can be associated with COVID-19 infections: Dr. Arvinder Singh Soin

But once hepatitis has progressed to significant liver damage, scarring and cirrhosis then it may not be completely reversible, Dr. Soin told Financial Express.com.

World Hepatitis Day, Liver diseases, Liver disorders, Hepatitis day, health news,
Dr. Arvinder Singh Soin, Chairman, Institute of Liver Transplantation and Regenerative Medicine, Medanta Hospital

Every year on July 28 World Hepatitis Day is observed with the objective to raise global awareness of hepatitis and encourage prevention, diagnosis and treatment. According to the World Health Organization (WHO), approximately 1.5 million people are infected with HAV each year. Hepatitis is caused by several viruses, viruses like Hepatitis A, B, C, D, and E, which can harm the liver. While Hepatitis A and E generally cause acute hepatitis, Hepatitis B and C cause chronic liver infection. Hepatitis D virus infection commonly occurs with Hepatitis B virus infection.

According to experts, in India, chronic hepatitis B affects between 1.4 percent and 2.7 percent of the population overall. The prevalence of HCV infection in India is estimated at between 0.5% and 1.5%. The majority of new cases are brought on by vertical Hepatitis B transmission. Financial Express.com reached out to Dr. Arvinder Singh Soin, Chairman, Institute of Liver Transplantation and Regenerative Medicine, Medanta Hospital and he talked about the ongoing Hepatitis outbreak among children across the globe, causes, treatments options, and preventative measures that should be taken to keep the liver healthy. Excerpt:

What are the causes of Hepatitis?

There are two types of hepatitis. Acute hepatitis happens in a few days and then gets okay in ninety-five percent of the cases and chronic hepatitis. The two common causes of acute hepatitis are hepatitis a and e – both of which are spread by infected water and food. Now if someone gets yellowness of their eyes and then this is associated with excessively yellow urine and then you go to a doctor, and they do a liver function test (LFT) and if they find that the LFT is deranged – this would be hepatitis A or E. You do not need to be alarmed – with supportive treatment the condition will resolve in two to three weeks and the patient will be fine. The liver will fully recover.

Chronic hepatitis is more serious, however. In India, there are four main causes of chronic hepatitis – one is alcohol-related hepatitis, non-alcoholic fatty liver disease which develops into hepatitis, hepatitis B, and hepatitis c. Alcoholic hepatitis develops when someone consumes excessive amounts of alcohol for more than seven to eight years, excessive amounts mean more than 14 units a week for men and more than ten units a week for women. Each unit of alcohol can be measured as a glass of wine, a mug of beer, or 30 ml of whiskey. Initially, alcoholic hepatitis presents itself as fatty liver. And when there is inflammation in that fatty liver then it is called hepatitis. If excessive alcohol is still consumed, it can further develop into fibrosis, cirrhosis, liver failure, and liver cancer. So, to prevent this – do not have excessive alcohol and have it in moderation.

The other kind of hepatitis is because of non-alcoholic fatty liver disease – in people with obesity, diabetes, a bad lipid profile and high cholesterol. NAFLD is present in nearly 35% of all adults. But 20% of these patients will eventually develop inflammation of the liver and half of them will progress to even early grades of scarring and fibrosis and again half of these will progress to cirrhosis and people who progress to cirrhosis, or a scared liver can suffer from liver cancer and liver failure. The obvious ways to prevent hepatitis due to NALFD is to control diabetes, cholesterol, and weight. Do not have a sedentary lifestyle, ensure 30 minutes of exercise a day, a healthy diet and ensure there is no lack of movement.

Next is hepatitis B and C – these are two viral infections that can be transmitted through blood or bodily fluid, much like AIDS. In fact, it can be transmitted through needles, syringes, dialysis machines, infected blood, and sexual transmission can be prevented by taking a vaccination. But there is no vaccination for hepatitis C, so precautions have to be taken to prevent its spread through body fluids and blood. These two viruses are much better controlled now as opposed to ten years ago and that is because there are effective medicines available for hepatitis B and C along with the hepatitis B vaccination. Their prevalence has reduced.

What is the prevalence of Hepatitis in India? What are the challenges of treating and diagnosing Hepatitis in India?

In rural spaces, expertise and facilities may not be available for diagnosing and treating hepatitis – in that case people travel to bigger cities or now they seek help online – 70% of India is now connected through the internet to online facilities at most of the major hospitals in the country. So, they can do tele consults and seek online help. Generally, when hepatitis is suspected, the doctor will ask you to do a liver function test, ultrasound of the abdomen, and sometimes a fibrosis scan and they will prescribe the medicine to treat the early cases of hepatitis. But once hepatitis has progressed to significant liver damage, scarring and cirrhosis then it may not be completely reversible.

The world is currently facing a new outbreak of unexplained acute hepatitis infections affecting children. What are the possible reasons? According to you, what are the possibilities of such an outbreak in India?

Worldwide over there have been several cases of unexplained cases of hepatitis in children and these have been associated with COVID infections. Even India is seeing these cases, and these happen to children 2 months after exposure to COVID. About a third of these children will have a history of having COVID two to three months previously, whereas the other children may have had exposure to COVID infection through their parents and family members, but they may not have been documented to have had COVID infection themselves. Typically, what happens is that these children will become jaundiced, jaundice is typically yellowness of the eyes and usually happens in any liver disease. They have nausea, loss of appetite and if a liver function test (LFT) is done then it will be elevated and in extreme cases these children may develop severe liver disease and liver failure. But usually this does not become severe. Only in ten to fifteen percent cases do they develop full-fledged liver failure and may not survive besides being in ICU or liver transplant unit. Usually associated hepatitis will be treatable by liver experts with special care and the child will usually respond to medicines.

What are the measures that need to be taken to prevent Hepatitis?

Non-alcoholic fatty liver disease can be prevented by living a healthy lifestyle – a good diet, controlling sugar, maintaining weight, lipid profile, and cholesterol. Ensuring that you get enough exercise, and drink enough water. A balanced nutritious diet with olive oil, whole grain cereals, pulses, and fish – do not have processed food, red meat, excessive sweet food, and excessive alcohol. Hepatitis B can be prevented by taking the vaccine against it. Hepatitis C can be prevented by ensuring that all medical facilities test the blood in the blood bank, use disposable needles and syringes, and they have good cleaning protocols for dialysis machines and if someone is known to have hepatitis B and C infection, they can sexually transmit that infection and so the sexual partner should use barrier method contraception.

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