Viral hepatitis has hit the news recently because deaths from this disease are now more common than deaths from HIV, malaria and TB. A recent study tracked illness, disability and death from hepatitis for 13 years from 1990 to 2013. Alarmingly, while deaths from other infectious diseases have fallen, global deaths from hepatitis have increased from 890,000 in 1990 to 1.45 million in 2013. This puts hepatitis as the 7th leading cause of death in the world. To combat this, The World Health Assembly came together in May 2016, and adopted the first “Global Health Sector Strategy on Viral Hepatitis, 2016-2021” to put into place measures to reduce the number of new infections by 90%, and decrease deaths due to viral hepatitis by 65% by 2030.
Although this disease is alarmingly common, and extremely dangerous, it is not one that is widely spoken about in the news. It isn't as dramatic as diseases such as Ebola or malaria. It doesn't kill straight away, and instead takes many years. Hepatitis means inflammation of the liver. Liver inflammation can be acute, or chronic. Although the acute phase can make you feel very unwell, chronic liver failure as a result of hepatitis is actually far more dangerous, and results in the majority of deaths.
The World Health Organisation (WHO) estimates that around 240 million people are chronically infected with hepatitis B, and it is responsible for more than 686,000 deaths a year. Shockingly, recent estimates suggest that around 30% of the world’s population have been infected with Hepatitis B at some point in their lives therefore it is a major public health problem globally. In areas of the world where there is a lot of hepatitis B (East Asia, sub Saharan Africa and parts of the Middle East and Indian subcontinent) the most common form of transmission is from mother to child, or from child to child. It is spread by exposure to infected blood, saliva, and other bodily fluids. Dodgy tattoo parlours, razors with infected blood, reuse of needles, or sexual contact are other common routes of infection.
Hepatitis B can cause both acute and chronic hepatitis. 95% of otherwise healthy adults will eliminate the virus in the acute phase, but in infants and children the story is very different. 30-50% of children infected before their 6th birthday, and 80-90% of infants infected in the first year of life fail to get rid of the virus completely. This leads to chronic infection and sustained liver damage from both the virus, and the constant inflammatory response to the virus. Hepatitis B kills by causing scarring in the liver, and in 30% of cases it leads to cirrhosis or liver cancer. Treatment during the acute phase is not usually necessary because, in most cases, there are no symptoms at all. Some people, however, have acute illness with symptoms of liver inflammation such as:
- Feeling tired and unwell
- Nausea and vomiting
- Aching joints
- Yellowing of the skin, gums and eyes (jaundice)
- Stomach pain, especially in the upper right area
- Pale stool and dark urine
- Loss of appetite
In these cases treatment is aimed at reducing the symptoms of disease. Unfortunately there is no cure, and treatment in the chronic phase is limited to reducing the amount of virus carried and thus lowering the risk of developing secondary complications.
If you are at risk of catching hepatitis B, you should make sure you receive the extremely effective vaccine that is available. The WHO recommends that all infants receive the vaccine as soon as possible after birth, especially in countries where there is a really big disease problem. 3 or 4 doses of vaccine may be needed to ensure complete protection, but once you’ve got it, the protection is probably lifelong. Over a billion doses of hepatitis B vaccine have been used since 1982 and, as of 2014, 184 Member States vaccinate infants as standard. Hopefully we’ll begin to see the benefits of this massive education and vaccination program in the coming years!