21-27 June 2013 #661

Holding off hepatitis

Prevent hepatitis A and E this monsoon by drinking clean water and avoiding outside food
Dhanvantari by Buddha Basnyat, MD

Three issues that will make headlines in Nepal this monsoon are elections, flash floods, and possible outbreaks of hepatitis E. While hepatitis B and C are transmitted through blood transfusion, intravenous drug use or sexual activity, hepatitis A and E are spread primarily by drinking water that is contaminated with faeces. As Kathmandu’s leaky mains become more susceptible to contamination in the rainy season, hepatitis A and E outbreaks are very common this time of the year.

Almost everyone over the age of 10 who grew up in Nepal has had at least one run in with Hepatitis A. The infection is often characterised by a flu-like illness, instead of jaundice, lethargy, and nausea, which are the signature symptoms of all other hepatitis.

The good news is that a single infection with hepatitis A guarantees lifelong immunity with protective antibodies. However, it is not clear whether this lasting immunity also applies to hepatitis E.

The hepatitis E virus was first discovered during the Soviet occupation of Afghanistan in the 80s, after an outbreak of unexplained hepatitis at a military camp. A pooled faecal extract from affected soldiers was ingested by an enthusiastic scientist of the research team. This scientist fell sick and the new virus was detected in his stool.

Although many patients in Nepal resort to Ayurvedic treatment, both hepatitis A and E have a self-limiting course and specific medication is not required. There is a hepatitis A vaccine, but patients who have lived here all their lives don’t require it.

In expectant mothers, hepatitis E infection may lead to fulminant hepatitis - acute liver failure – and turn deadly. Fortunately, for the last several years we have seen less number of pregnant women infected with this virus. It is possible that hepatitis E comes in outbreaks and Nepal has simply been lucky not to experience this epidemic. The other good news is that Hecolin, the world’s first commercial hepatitis E vaccine, is now available in China and will arrive in the Nepali market soon.

For 99 per cent of hepatitis B cases, no anti-viral drug treatment is required as patients recover without specific treatment, but a vaccine does exist. Hepatitis C is less benign and may require treatment after infection. The final form of hepatitis, D, usually co-exists with hepatitis B and leads to severe complications.

The secret to avoiding these common viral hepatitis is to be aware of the modes of transmission and take suitable precautions. For hepatitis A and E, the single most important preventive measure is drinking clean boiled water, eating hot food, and avoiding salads when eating out.

Read also:

A narrow escape

Creaking joints

Nepali diarrhoea

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