Module 6 Libre : L’ABC des hépatites
Module 6:
Contents
LEARNING OBJECTIVES
At the end of this module, the participant will be able to:DEFINITION - TERMINOLOGY
The word Hepatitis comes from the Greek: Hepar = liver and the suffix -itis = inflammation
Hepatitis is an inflammation of the liver that affects 71 million people worldwide (according to the WHO).
The liver is an essential organ with a complex metabolism. It continues to function even when two thirds of it has been damaged. It is very slow to complain. As a result, people with hepatitis often ignore it and have few or no symptoms.
It is estimated that about 1/3 of those affected are unaware of it.
ABCS OF HEPATITIS
HEPATITIS A, B, C
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FORMS OF VIRAL HEPATITIS
The virus of a viral hepatitis enters the liver cells, called hepatocytes, and multiplies there.
The immune system reacts by destroying the infected cells, which causes inflammation of the liver.
As with HIV, hepatitis can go undetected for some time and not show any symptoms, which is why it is important to be screened!
Symptoms characteristic of liver inflammation are sometimes observed at the time of infection.
They can last for several weeks:
- Fever
- Loss of appetite, vomiting, abdominal pain
- Yellowing of the whites of the eyes and skin (jaundice)
- Pale stools
- Dark urine
- Great fatigue
Normal liver
Inflammation of the liver (Hepatitis)
- Acute hepatitis is said to occur within 6 months of infection with the hepatitis virus, while chronic hepatitis occurs when the virus remains in the body for more than 6 months.
- As the symptoms are the same for all forms of hepatitis, it is impossible to distinguish the different forms during the acute phase.
Hepatitis A and E viruses rarely become chronic and resolve without any sequelae.
Hepatitis B and C viruses can become chronic and the affected person may develop serious complications such as cirrhosis or liver cancer many years later.
Development of a liver affected by hepatitis:
Healthy liver
Fibrosed liver
Cirrhosis
Liver cancer
! The earlier hepatitis is detected, the better it can be cured or slowed down.
FORMS OF VIRAL HEPATITIS
HEPATITIS A VIRUS= HAV
Hepatitis A is a liver infection caused by the hepatitis A virus (HAV). It is very common in areas with poor hygiene.
Transmission of HAV is most often via the faecal-oral route:
Through ingestion of water or food contaminated with the faeces of a person with HAV. Ex:
- Water contaminated with viruses in the faeces of people with hepatitis A, such as inadequately treated wells and water
- Food prepared with dirty hands by an infected person (lack of hygiene or lack of opportunity to wash hands after bowel movements)
- Raw food that has been in contact with unsafe water
by close contact with an infected person, such as oral or anal sex. However, HAV is not transmitted through ordinary person-to-person contact
There is a safe and effective vaccine recommended when travelling to countries where sewage treatment is not guaranteed. Hand hygiene and water sanitation also play an important role.
None, as there is no chronic course. In most cases, hepatitis A is completely cured without treatment. The person is then immune for the rest of his or her life. However, it is possible that HAV infection can lead to complications and even death of the infected person.
HEPATITIS B VIRUS =HBV
Hepatitis B is transmitted by the hepatitis B virus - HBV. It can lead to life-threatening liver infections and is a real public health problem. It is the number one sexually transmitted infection in the world.
In Africa (south of the Sahara) and in Asia (south-west) it reaches very high levels.
It is a highly contagious infectious disease: the hepatitis B virus is 50 to 100 times more infectious than HIV!
Transmission HBV is most often transmitted through blood and other body fluids:
- Unprotected sexual intercourse with an infected partner (vaginal fluid, seminal fluid, menstruation and saliva)
- Sharing needles and drug use paraphernalia
- Needle stick or dirty sharp object
- Unhygienic tattoos and piercing
- From mother to child during pregnancy, childbirth and/or breastfeeding
- Sharing sex toys
There is a safe and effective vaccine against HBV and antiviral prophylaxis during pregnancy. In Luxembourg, infants are routinely vaccinated. The risk of exposure to the virus should also be reduced.
There is no specific treatment for acute hepatitis B (the first 6 months). In about 90% of cases of hepatitis B, the body's own defences overcome the virus, the liver returns to normal and the person is immune for life.
In about 10% of cases, hepatitis B can develop into chronic hepatitis and must be treated with antiviral drugs.
HEPATITIS C VIRUS = HCV
Hepatitis C is a liver disease caused by the hepatitis C virus - HCV. It is one of the major causes of liver cancer.
The hepatitis C virus is transmitted through blood. There is therefore a risk of contamination if contaminated blood enters through an opening in the body, e.g. a mucous membrane or wound.
BY DIRECT BLOOD ROUTE:
- Sharing of all consumption and preparation equipment: (syringe, filter, spoon, snorting equipment)
- Needle stick or dirty sharp object
OTHER
- Sharing of hygienic utensils (razor, nail clippers, toothbrush)
- Unprotected sex where there is blood
- Tattoos piercing, micro-dermal implants under unsanitary conditions
- Mother to child (<4%)
Unlike HIV, the hepatitis C virus is more virulent and resistant. It can survive for a long time in dried body fluids.
There is no vaccine against hepatitis C! The risk of exposure to HCV can nonetheless be reduced by not sharing drug paraphernalia or hygiene utensils (razor, toothbrush) and by using a condom.
A new infection is usually asymptomatic and does not always need to be treated, as about 30% (15%-45%) of infected people spontaneously clear the virus within 6 months of infection without receiving any treatment.
For the remaining 70% (55% to 85%), the infection will progress to the chronic form of the disease. Without treatment, the risk of cirrhosis of the liver is 15% to 30% over a period of 20 years and therefore treatment is necessary.
Current treatments cure more than 95% of HCV infections and are of short duration (12-24 weeks). However, they are still quite expensive.
It is important to have a rapid screening or blood test if a person has been exposed to HCV in order to access medical follow-up and treatment if necessary.
FORMS OF VIRAL HEPATITIS
SCREENING - TREATMENT
Screening test
The screening test mainly concerns Hepatitis B and C. It is done at the earliest 3 months after the risk, by blood test or by rapid diagnostic test (RDT).
Treatment
There is no treatment during the acute phase of viral hepatitis.
The mild form requires rest and a normal diet.
There are very good treatments for chronic hepatitis C today. Treatment used to be long and painful with limited efficacy and significant side effects. Fortunately, new therapeutic approaches specifically targeting the Hepatitis C virus have been developed in recent years. Thanks to these direct-acting antivirals, antiviral therapy is now showing very good results. The treatment takes between 12 and 24 weeks, and more than 95% of those treated can be cured of a chronic infection.
But the treatments are expensive and unfortunately not available everywhere in the world. Moreover, after the cure there is no immunity and one can therefore be reinfected with the hepatitis C virus.
(Source: Institut Pasteur France)