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Hepatitis means inflammation of liver cells. It is divided into several types according to its cause. In Hong Kong, viral hepatitis as caused by certain viruses is more commonly seen. Less common is hepatitis caused by alcohol, drugs, chemicals or genetic diseases.
There are at least 6 viruses that can cause hepatitis. They are the hepatitis A, B, C, D, E, and G viruses. Hepatitis A and E are transmitted by contaminated food and water; hepatitis B, C, D, and G on the other hand are transmitted by blood or body fluids.
Infection with the hepatitis virus does not result in symptoms until after the incubation period is over. This period differs for different viruses. For example, the hepatitis A virus has an incubation period of only 2 to 6 weeks, and the hepatitis B virus 6 weeks to 6 months.
Symptoms usually develop gradually. Early symptoms and signs are nonspecific and resemble those of the flu. These include mild fever, fatigue, muscle pains, headache, loss of appetite, nausea and diarrhea. They last for 2 to 6 weeks; then the skin and the 'white' of the eyes will become yellow in color. At the same time, the urine also gets darker, almost like tea.
Because most patients of hepatitis do not have specific symptoms and signs, the doctor has to rely on certain blood tests for diagnosis. These tests will help assess the severity as well as the cause of hepatitis.
Most cases of clinical hepatitis recover by themselves. Nevertheless, it is important that the patient has adequate rest, and avoid alcohol or drugs that are potentially harmful to the liver. Very rarely, acute hepatitis may result in death.
In the last 20 years, Hong Kong has experienced a steady fall in the incidence of hepatitis A. For example, annually reported cases of hepatitis A in Hong Kong fell from over 1000 in 1988 to only 117 in 2017. The current situation resembles that of many developed countries. In contrast to many developing countries where people are exposed to the virus as early as a few years old; most people in Hong Kong below the age of 30 have never been exposed, and are therefore susceptible to the virus. This situation provides an opportunity for the virus to rapidly spread in the community. In fact, outbreaks of hepatitis A have occurred in 1992, resulted in more than 3000 cases and 4 deaths.
Hepatitis A is transmitted by the fecal-oral route. In other words, the virus transmits by passing from an infected person’s stool to the water or food eaten by another person. Since the virus can survive in water for more than a year, hepatitis A is often caused by drinking contaminated water, or eating contaminated shellfish like oysters, clams, cockles or mussels. The reason is that shellfish filters the water around them and can concentrate the hepatitis A virus inside them. It is also possible for the virus to be transmitted from person to person through close personal contact.
Patients with hepatitis A usually recover by themselves and become immune to it for life. Symptoms usually disappear in 2 to 8 weeks but in 15% of cases may last as long as 4 months. Rarely hepatitis A results in deaths in those over 40 years old. Ironically, the younger the patient, the less severe are the symptoms. In fact most people who contracted hepatitis A in childhood do not even recall being sick. Hepatitis A does not cause any chronic complications.
In general, prevention of hepatitis A is similar to prevention of other infections that are also transmitted through contaminated food. The key is to be very careful with your personal, food and environmental hygiene.
Wash your hands with soap before preparing and eating food; also wash your hands after going to the toilet.
As for food hygiene, drink only boiled water. The hepatitis A virus is killed by heating to 85 degree Celsius for 1 minute. Therefore all food, especially shellfish, should be carefully cleaned and be cooked at boiling temperature for not less than 5 minutes before eating.
A high standard of environmental hygiene is also necessary to prevent contamination. For example, sewage has to be properly disposed; store your drinking water properly; and keep all your kitchen utensils clean.
Being vaccinated against hepatitis A helps produce antibodies to the virus. People who have been vaccinated will therefore be immune to hepatitis A as long as they have the antibodies. Similarly, injection of immunoglobulin will also confer temporary protection.
The hepatitis A vaccine is essentially an inactivated form of the virus. Being vaccinated against hepatitis A helps produce antibodies to the virus. As adults who are over 30 years old may already developed immunity against Hepatitis A, hepatitis A serostatus should be checked before vaccination so as to avoid unnecessary injections.
A complete course of vaccination requires 2 injections, given 6 months to 18 months apart. Like any medicine, hepatitis A vaccine could possibly cause adverse reactions. These reactions are usually mild and often last for only one to two days. The most commonly seen undesirable effect is injection site soreness.
Anyone who has ever had a severe life-threatening allergic reaction to the previous dose of hepatitis A vaccine or allergy to any vaccine component should not get another dose. Anyone who is moderately or severely ill should postpone the shot.
The safety of hepatitis A vaccine for pregnant women has not been determined. Although there is no evidence that it is harmful to either pregnant women or their unborn babies. If the client is pregnant, it is preferable to inform the doctor.
For arrangement of hepatitis A vaccination, please consult your family doctor.
Hepatitis A vaccine is not licensed for children younger than one year of age.
Hepatitis A is common in many developing countries. In general, the less hygienic the area is, the higher the chance of infection.
If you are traveling out of the country, be careful about the following things:
These simple measures can effectively prevent travellers from getting hepatitis A infection or other gastrointestinal diseases including food poisoning, dysentery and cholera.
In addition, travellers can consider hepatitis A vaccine or immune globulin injection. The hepatitis A vaccine series should be started at least 4 weeks before traveling to provide the best protection. Persons who get the vaccine less than 4 weeks before traveling may consider getting a shot of immune globulin which gives immediate but temporary protection.
For arrangement of vaccination and other health advice, please consult your family doctor.
The chance that an employee in the food industry becoming infected with hepatitis A is the same as for the rest of the population. However, food handlers play a strategic role in controlling the spread of the infection in the community.
In its early stage, hepatitis A does not give rise to any symptom or sign. Therefore, if a food handler is infected, he will easily spread the infection to his friends, family and customers, if he does not observe a high standard of hygiene.
Whether or not a food handler should receive the hepatitis vaccine is a personal decision. A food handler who has been vaccinated will not be infected with hepatitis A and will not be able to spread the infection to others. However, it is still important for any food handler, vaccinated or not, to observe hygiene in order to prevent all other infections that are spread in the same way as hepatitis A.
There is not enough scientific evidence at the present moment to help us decide who should and who should not receive the hepatitis A vaccine. Before getting the vaccine, a person should consider the following facts:
It is estimated that there are up to 257 million people worldwide who have become carriers of hepatitis B. The carrier rate varies in different countries. Hepatitis B prevalence is highest in the WHO Western Pacific Region and the WHO African Region, where 6.2% and 6.1% respectively of the adult population is infected. However, only 0.7% of the population of the WHO Region of the Americas is infected. In the last twenty years, the carrier rate in Hong Kong has gradually fallen from 10% to 8%. There are more male than female hepatitis B carriers.
The hepatitis B virus is found in the body fluids of an infected patient or carrier, mainly in blood, amniotic fluid, semen and vaginal secretions. These fluids are therefore infectious and can transmit the infection. However, since the quantity of the virus in saliva, urine and tears is much lower, the chance is low that these fluids can ever infect other people.
One common way the virus is transmitted from one person to another is through contact between blood and an open wound. For example, a needle that has just been used to draw blood from a hepatitis B carrier can infect another person if he is accidentally stuck with this needle. The chance of infection in this situation can be as high as 30%. On the other hand, transfusion carries almost no risk of transmitting hepatitis B because the blood bank has routinely screened all donated blood for the hepatitis B virus since 1978.
Another way of infection is from mother to baby, the so-called perinatal or vertical transmission. The baby is at a much higher risk than an adult to become a carrier after the infection. In Hong Kong and Mainland China, this is the most common way of infection. However, hepatitis B is not spread through breast milk, and mothers who are hepatitis B carriers may continue breast feeding their babies. Unprotected sexual contact is also a major cause of infection, especially in many developed countries. An occasional cause of transmission is through the sharing of such personal items as razors and shavers which may have been contaminated with blood stain.
The most effective means of prevention is through vaccination with the hepatitis B vaccine. But remember that hepatitis B is only one of the many bacteria and viruses that can be transmitted by blood and body fluids. Whether you are vaccinated or not, you should take the same precautions when you come into contact with body fluids.
The hepatitis B vaccine is composed of the surface antigen of hepatitis B. The vaccine does not carry any risk of transmitting other infections because it is made by genetic engineering. After injection into the human body, the vaccine stimulates the production of the hepatitis B surface antibody. The complete course of vaccination takes a total of three injections. The second injection is given 1 month after the first, and the third injection 5 months after the second. Serious side effects after administration of the hepatitis B vaccine are rare. The most common side effects are soreness at the point of the injection, and slight fever. About 90 to 95% of people will gain immunity to hepatitis B after a full course of vaccination. Studies show these people who successfully develop antibodies after vaccination need not be given booster in the future. It is because the immune system has a memory capacity. Even if the antibody level falls to low levels in the future, the immune system can rapidly produce antibodies again if it encounters the virus.-95%
Before you receive the vaccine, you should preferably have blood test to see if you have been exposed to the virus before. Only people who have never been exposed to hepatitis B should be vaccinated. If you are already a carrier of the virus, vaccination will not work, although it does not do any harm either. A blood test might also show that you already have natural immunity to hepatitis B because of previous exposure to the virus. In this case, vaccination is unnecessary.
Mother-to-infant transmission was the major route of hepatitis B infection in Hong Kong. Since 1983, the then Medical and Health Department has been testing pregnant women for hepatitis B, and giving free vaccination to susceptible newborn babies. This programme was extended to cover all newborn infants in 1988. All babies born in Hong Kong now routinely receive the hepatitis B vaccine for free.
To reduce the risk of mother-to-infant transmission, babies born to hepatitis B carrier mothers should receive hepatitis B vaccine along with an additional dose of hepatitis B immunoglobulin (HBIG) within 24 hours after birth. The success rate exceeds 90%.
It is important to know that a full course of vaccination consists of 3 doses. The first dose is given to the newborn baby either in the hospital or maternity home. The second dose is given at the age of 1 month, and the third dose given at 6 months of age. Both of these will be given in the Maternity and Child Health Centres.
In 1992, a campaign was launched to cover preschool children born in the period from 1986 to 1988.
In other words, all children in Hong Kong should have been vaccinated against hepatitis B before they enter school.
In carriers of hepatitis B, the virus exists in the blood, semen and vaginal secretions in sufficient quantities to transmit the infection. In the health care setting, a health care worker stands a chance of being infected after contact with blood and needles. For this reason, it is recommended that a health care worker should know his own status regarding hepatitis B. If he is susceptible to hepatitis B infection, he should receive the full course of vaccine without delay.
Although vaccination is important, health care workers should also observe the principle of standard precautions. Under this principle, all blood, whether it is from known hepatitis B carriers or not, is treated as potentially infectious, and is therefore handled with care. If a health care worker observes standard precautions, he will be protected from all blood-borne infections. On the other hand, the hepatitis B vaccine prevents nothing but hepatitis B only.
Department of Health offers free hepatitis B vaccination to children under age of six. Adults requiring Hepatitis B vaccination are advised to consult their family doctor for the charges and respective arrangement. In addition, the following groups of people are at higher risk of the infection and they should also receive the vaccine. They are:
It is important to remember that if you show signs of allergy after the first dose of vaccine, do not receive further injections. Allergy is rare, and may be manifested as hives, shortness of breath or even shock.
If your blood tests are positive for the hepatitis B surface antigen, and if this lasts for more than 6 months, then you are a carrier of hepatitis B. Most hepatitis B carriers are healthy and without symptoms. Even a doctor's checkup will probably find nothing.
However, a carrier is a source of the infection. In a carrier the virus is found in large quantities in blood, vaginal secretions, and semen. A carrier is therefore fully capable of transmitting the virus to other people, whether he has symptoms or not.
Although most hepatitis B carriers are without symptoms and major liver disease, a small proportion will gradually develop chronic hepatitis, and later cirrhosis or liver cancer. As a matter of fact, up to 25% of all carriers may eventually develop liver cirrhosis or liver cancer, complications that can lead to death.
If you are a carrier of hepatitis B, there are certain things you can DO to maintain your health.
As a hepatitis B carrier, there are also certain precautions that you should pay attention to, so that you DO NOT transmit the infection to others. Remember the followings:
Today there is no definitive treatment that can eradicate the virus from a carrier. A carrier usually carries the virus for the rest of his life, but he is healthy as long as no complications develop. Doctors recommend periodic checkup and blood tests to look out for the development of complications. Of course, if you have symptoms of hepatitis, you should see your doctor right away.
Treatment aims at preventing cirrhosis, liver failure and liver cancer. It is highly individualized. Before treatment is started, the doctor usually has to assess the degree of liver damage that is present. To this end, he will perform some blood tests and a liver ultrasound. In some cases, a liver biopsy in which liver tissue is sampled for examination may be necessary. Now, long term medication can effectively suppress hepatitis B virus replication, improve liver function, hence reduce the risk of liver scarring, cirrhosis, and even liver failure and liver cancer. Drugs used to treat hepatitis B include two main groups, namely injecting interferon and oral anti-viral agents. Different parameters including liver function tests and the amount of viruses in the blood are used to gauge the response as appropriate. Patients should not stop taking the drugs themselves, because stopping the drug treatment inappropriately may lead to flares, or even liver failure.
Besides medications, hepatitis B carriers should also have adequate rest, balanced diet, and abstain from alcohol. They should also be careful with drugs that may hurt the liver.
Besides hepatitis A and B, there are at least 4 other types; hepatitis C, D, E and G.
Hepatitis E is similar to A and are both enteric infections. Hepatitis E infection can be caused by drinking contaminated water, ingestion of undercooked meat, animal liver or shellfish. Neither hepatitis A nor hepatitis E gives rise to chronic complications. Notification from acute Hepatitis E infection has been increasing in recent years. In 2017, 64 cases were reported to the Department of Health, as compared with 11 cases in year 2000. Currently, there is no specific treatment for acute hepatitis E. Prevention is the most effective approach against the disease. Hepatitis E infection can be prevented by good personal hygiene, washing your hands before touching food and observing food safety by not eating undercooked meat, animal liver and shellfish.
Hepatitis C spreads in a very similar way as hepatitis B, but it is not as common as hepatitis B. Unlike hepatitis B, there is no vaccine available against hepatitis C. The vast majority of people who get hepatitis C have no symptoms but they carry the virus for the rest of their lives. Doctors test for hepatitis C carriers by testing for the hepatitis C antibody. In Hong Kong, it is estimated that 0.5% of the general population carry hepatitis C. Like hepatitis B carriers, some hepatitis C carriers may develop chronic hepatitis, liver scarring and cancer. Today, the vast majority of hepatitis C infection can be cured through treatment. If blood test reveals that you are a hepatitis C carrier, you should consult a doctor for assessment and monitoring of your liver status, so as to formulate a treatment plan. Traditional drug treatment for hepatitis C includes pegylated interferon and ribavirin. The cure rate is about 60%. Besides, oral “direct-acting antivirals” treatment usually takes 8 to 12 weeks. These medicines are not only better tolerated, but also more effective. They can achieve cure rates of above 95%. With successful elimination of virus, the risk of liver damage and development of liver cancer will be significantly reduced.
The routes of hepatitis D transmission are the same as for hepatitis B: percutaneously or sexually through contact with infected blood or blood products. Hepatitis D is a unique virus. It needs the hepatitis B virus to survive and replicate. For this reason, hepatitis D is limited to people who are already carriers of hepatitis B and vaccination against hepatitis B prevents hepatitis D coinfection. In Hong Kong, hepatitis D is quite rare, the majority of cases being found in people who shoot drugs. Vertical transmission is possible but rare. Hepatitis D will accelerate and aggravate the liver damage caused by hepatitis B.
Hepatitis G was first described in 1995. Little is known about how common hepatitis G is in Hong Kong. As it is mainly transmitted by contaminated blood or body fluids, the same precautions that you take against hepatitis B should also protect you from hepatitis G.
What we mean by needlestick injuries are wounds caused by needles or sharp objects that have been contaminated with blood or other body fluids. This happens in the health care setting. These wounds should be handled immediately and properly, not only to prevent infection but also to minimize the transmission of blood borne infections like hepatitis B, C and the AIDS virus, HIV. For example, a needle that has been contaminated with blood of a hepatitis B carrier can transmit the virus to a person after a needlestick injury. The risk may be as high as 30%. For hepatitis C and HIV, the risks are 2% and 0.3% respectively.
After a needlestick injury, you should clean the wound thoroughly and cover it properly with bandage. Further treatment may be given in the emergency room of a hospital. The attending doctor will usually order a tetanus shot. He will also give you advice on the transmission risks of hepatitis and HIV. If you are already vaccinated against hepatitis B and developed immunity, there is no chance that you will be infected by this virus. For those of you who have not been vaccinated, your doctor may give you a shot of hepatitis B antibodies if he thinks that the risk is high. No vaccine or antibodies are available against hepatitis C or HIV. But if the needle has been contaminated with HIV, your doctor may advise you to take some oral medicines for as long as 4 weeks. These medicines will help lower the chance of HIV infection.
Another important aspect of managing a needlestick injury is to monitor for infection with blood-borne viruses. As a baseline, you need to be tested for hepatitis B, C, and in some cases HIV. Then after 6 months, you will be tested again. In some cases, your doctor might order some more tests to test for less common infections.