Hepatitis A is making a comeback. On World Hepatitis Day (July 28), doctors at an awareness meet in New Town voiced concern about the development, while discussing several liver diseases and how to counter them. They were speaking at a meet organised by Suraksha Clinic and Diagnostics in Action Area 1.
“Earlier, Indians were expected to develop immunity by the time they attained puberty. This was when we used to stay largely in rural areas. Hepatitis A would present itself as a low-grade infection without symptoms, which the body could fight off and, consequently, develop immunity against. But now with urbanisation, we are growing up in protected city environments and becoming vulnerable to Hepatitis A. Even adults are contracting the disease,” said Dr Kalidas Biswas, head of the hepatology and gastroenterology department at Medical College Kolkata.
On World Hepatitis Day, he urged for Hepatitis A to be given renewed attention. “It may sometimes lead to chronic liver disease but the good news is there is a vaccine to protect us against it and we need to create awareness about it,” he said.
Note on nomenclature
Hepatitis Day is the birthday of B.S. Blumberg, an American researcher who discovered the Hepatitis B virus in 1965 in Australian aborigines. “It used to be called Australia Antigen before the name hepatitis was coined. The incidence of Hepatitis B among Caucasians was minimal. Only those who had low body immunity, especially leukemia patients, contracted the infection.”
Blumberg later got the Nobel Prize for discovering both the virus and the first vaccine against it. “This virus is the biggest enemy of the human liver and can lead to chronic liver disease and hepatocellular carcinoma. But with the vaccine, we have a weapon in hand to fight it,” said Dr Biswas, who also consults at the Kestopur branch of Suraksha.
Hepatitis A and B are both food and water-borne diseases, which have caused epidemics in several countries, including in India.
(L) Dr Kalidas Biswas, head of hepatology and gastroenterology, Medical College Kolkata, Dr Vikash Prakash, consultant, liver and gastrointestinal diseases, Dr Krishanu Saha, radiologist at Suraksha Diagnostics, and Dr Somnath Chatterjee, chairman and managing director, Suraksha Cinic and Diagnostics, at the World Hepatitis Day awareness meet at Suraksha in New Town. Sudeshna Banerjee
Like Hepatitis A, Hepatitis E is food and water-borne. There is no vaccine. But it cures itself through the body’s immunity. “But it can be dangerous in pregnant women. In would-be mothers, the mortality rate can be as high as 25 per cent. So it is a cause for grave concern in their case.”
Effective oral medicines have been invented for Hepatitis C. “We can now promise 100 per cent cure and in some years, we hope the disease will be eradicated,” Dr Biswas said.
But the infection, he said, can still be serious for people who need regular blood transfusions, like those with thalassaemia and have low immunity. “It can cause chronic liver disease which can lead to hepatocellular carcinoma.”
Diabetes link
Almost every house in urban India now has diabetes, the doctors pointed out. Since life expectancy of Indians has increased, lots of diabetics are developing chronic liver disease. “The route to chronic liver disease in their case is fatty lever. It means that there is fat deposition in more than five per cent cells of the liver. The problem with fatty liver disease is it leads to fibrosis and onwards to cirrhosis, which, though rarely, leads to carcinoma,” Dr Biswas said.
He pointed out that blood tests can now detect fibrosis. “If detected early, even fatty liver can now be cured as there are medicines available.”
Other types of complications can also result from fatty liver. A large percentage of liver transplants that take place around the world originate from fatty liver disease. Factors that should be borne in mind to monitor chances of fatty liver disease are complete blood count, lipid profile and blood sugar. Among the lipid profile markers, the most important is triglyceride. “If one’s triglyceride is high, that needs to be dealt with to curb chances of fatty liver disease,” Dr Biswas said.
How to diagnose fatty liver
Suraksha Clinic and Diagnostics launched Liver Insight, a screening package designed for early detection and clinical evaluation of liver health on the occasion.
Describing some of the tests in the package, Dr Krishanu Saha, radiologist at Suraksha Diagnostic Ltd, said: “One can get an ultrasonography of the abdomen, a liver function test and a serology marker done at any laboratory. No prescription is needed for that. If the tests reveal a fatty liver, one can go for a fibroscan, a non-invasive imaging technique that uses sound wave to assess liver stiffness and fat accumulation. If there is stiffness or the blood markers indicate any abnormality, then one needs to consult a hepatologist. A tri-phasic CT scan is done to check for changes in the liver, like ascites or signs of any chronic liver disease, be it cancer or cirrhosis.”
The incidence of fatty liver among Indians is 30 per cent. “This means if 10 people go for an ultrasound scan of the abdomen, three will be found with fatty liver. Of them, 10 per cent will develop MASH (Metabolic dysfunction-associated steatohepatitis). Only 10 cent of those with MASH will get fibrosis. Nothing will happen to the rest of them. How would you know which group you belong to?” asked Vikash Prakash, consultant, liver and gastrointestinal diseases.
He asked one to be alert about discomfort or pain in the right side of the upper abdomen, under the rib cage. “Fifty per cent of such people also feel fatigued. If parents are diabetic, you are genetically predisposed to fatty liver. If you are diabetic, there is 99.7 per cent chance that you have fatty liver,” he explained.
“If there is a visible change in skin colour, it may mean that the liver is not able to handle a sugar spurt. One of the important functions of the liver is to deposit extra sugar as fat,” explained the doctor who practises at Manipal Broadway, Tata Medical Center and DCOSMEDICS in BB Block.
“A person taking rice, or carbohydrates, and no protein or fat, thrice a day may have a normal lipid profile but still develop fatty liver. So you need to continue to monitor through regular check-ups,” Dr Prakash said.
While the patient’s condition is reversible if diagnosed early, it is difficult to reverse it beyond Stage II of cirrhosis. “The focus will then be to control the inciting factors, like hepatitis B or C or fatty liver, blood sugar control etc., to slow down the progress of the disease,” he said.
There are five types of hepatitis. “All forms of viral hepatitis are infectious. If one contracts hepatitis through contaminated food or drinks, then it causes viral hepatitis A or E. One can also contract viral hepatitis B or C through the use of a contaminated needle or unsafe sex. But fatty liver, which may be caused by an uncontrolled diet, diabetes or alcohol consumption, is not infectious,” he added.
He advised people to go for a Hepatitis B antibody test at any laboratory. “The vaccine came in 1999-2000, so many of us might have missed the dose that children now get or their antibody has waned,” Dr Prakash said. “Get a test done. If the count is more than 10, you can simply go home. If it is less than 10, you need to revaccinate,” he summed up.