Love Your Liver– Hepatitis awareness the Homeopathy way.

Standard

hepatitisWorld Hepatitis Day is recognized every year on the 28th July. This date was chosen to mark the birthday of Professor Baruch Blumberg, awarded the Nobel Prize for his work in discovering the hepatitis B virus.

The Campaigns focus on raising awareness of viral hepatitis within the context of liver health and aim at o improving the knowledge of liver health and viral hepatitis within the general community and create more positive attitudes toward those living with viral hepatitis.
Every year all over the more and more organisations organise campaigns on World Hepatitis Day and one of the organisations created a Guinness World Record attempt for the most people performing the ‘see no evil, hear no evil, speak no evil’ actions within 24 hours.
What Homoeopathy has to offer :
Taking Homoeopathic Medicine can alleviate the associated Signs and Symptoms like nausea, vomiting , loss of appetite , increased bilirubin levels as well as reduce further complications which arise as an outcome of the Hepatitis . We have very good drugs which can reduce the symptoms in the prodromal stage as well as reduce bilirubin levels .
To name a few drugs :
Chelidonium Mother tincture is most effective in decreasing the biluribin levels according to my clinical experience .it is indicated in hepatitis with shooting pain in the liver radiating to every direction
So also Ipecac can be administered in the initial stages of the disease especially when there is marked nausea or Nux Vomica when ailments are from too high living .
Bryonia 30 or Bryonia 200 is for pain in the liver region, stitching type of pain in abdomen associated with excessive thirst and constipation
Carduus m. for vomiting dull headache , dragging pain in rt. Hypochondrium aggravated after lying on left side
Also China off 6 or 30 potency is also otherwise a good drug for debilitating diseases .
Among Indian Drugs Carica Papaya mother tincture improves the appetite , aids in GI complaints .
So why not experience the magical effects of Homoeopathy in alleviating some of the signs and symptoms and speedy recovery in conjunction with other systems of medicine ?
about the author: Dr . Zoya Joao ,I/ C Dept of Pathology , SKHMC ,Public Health Specialist

World Hepatitis Day

Standard

hepatitisJuly 28th is the World Hepatitis day.

Hepatitis A is a liver condition caused by the virus of the same name. It spreads through contaminated water and food, ingested by a person who is not immunized.

This is not chronic, and is very rarely fatal.

This occurs sporadic epidemics worldwide. With a tendency for cyclic  recurrences.

This is one of the most frequent causes of food borne  disease.

The disease has social and economic consequences in the community. It take months for people to recover from illness and return to everyday life.

Geographically, developing countries with poor sanitary condition and hygiene condition have high levels of infection, so much 90% of the children are already infected by the virus before the age of 10, but the infection being very mild it may go undetected. This creates immunity so symptomatic disease rates are low and outbreaks of the epidemic is low. In countries with transitional economies and variable sanitary conditions, though childhood infection is low, the irony is it leads to a more susceptible older age group, so infections can occur in adolescents and young adults, and there is a potential for large out breaks. In developed countries with good sanitary and hygienic conditions, the infection rates are no doubt low, but adolescents and young adults tend to be a high risk group. Here the transmission is through infected needles, unprotected sex, or travelling to high endemicity area without vaccination, and in isolated population of closed religious groups.

Transmission is through  faecal-oral route. This is when the person ingests food or water that has been contaminated with faeces of an infected person. Waterborne infections are however less common. When they do occur they are associated with sewage-contamination or inadequately treated water.

The symptoms show after an incubation period of 14-28 days ranging from mild to sever, there fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark coloured urine and jaundice.—jaundice manifests as yellowing of skin and white of the eyes. All the symptoms may not show up on every patient. The severity and mortality are usually more in adults.

The High risk groups are those who are not vaccinated. Other risks are

  • Poor sanitation
  • Lack of safe water
  • Injecting drugs
  • Living in a household with an infected person.
  • Being an unprotected sexual partner with a person with acute hepatitis
  • Travelling to areas of high endemicity without immunization.

The diagnosis of Hepatitis A is not different from other acute viral hepatitis. HAV- specific IgM and IgG antibodies in the blood help to diagnose the specific virus. Additional tests include reverse transcriptase like polymerase chain reaction but this requires specialized laboratory facilities.

Hepatitis A does not have specific treatment. The recovery from symptoms is the recovery and it is very slow, may take several weeks or months. The aim of the therapy is to maintain comfort and adequate nutritional balance including replacement of fluids that are lost due to vomiting and diarrhoea.

Hepatitis A can be prevented by improving sanitation, food safety and immunization.  The spread can reduced by

  • Providing adequate safe drinking water,
  • Proper hygiene practises, like washing the hands before eating.
  • Proper waste and sewage management within communities.
  • Vaccines, though vaccines are not licensed for children below a year.

Comprehensive immunization plan should be adopted for prevention for viral hepatitis. Immunization in children should be a local call.  However healthcare education to improve sanitation and hygiene should be continued. Immunization of travellers to endemic area and people in homosexual relationship is also important. Periodic screening and maybe vaccination of people with debilitating diseases might be considered.

WHO’s work plan for prevention and control of viral hepatitis.

  • Raising awareness and promoting partnership and mobilizing resources.
  • Formulating evidence based policy and data for action
  • executing screening care and treatment.

.

Hepatitis A is a viral disease suffered by at 1.4 misslion people every year. It could range from mild to very sever in intensitiy. It could transmitted either by contaminated food and water or direct contact. It is usually associated with poor sanitation. Vaccines are available to prevent this disease.

 

Hepatitis awareness –Hepatitis E

Standard

hepatitisHepatitis E is the strain of hepatitis caused by hepatitis E virus (HEV) this virus is dominantly transmitted through contaminated drinking water, and is usually self-limiting. It resolves within a period of 4- 6 weeks. Occasionally it might get aggressive enough to leading to acute liver failure and finally death. Globally about 20 million incidents of hepatitis E occurs.

Geographically sporadic cases and outbreaks occur around the world. These outbreaks are usually in countries where access to essential water, sanitation, hygiene and health services are limited leading to several hundreds to thousands of people being affected. Recently war zones and refugee camps are high hit areas.

The epidemiology differs with the genotype of the virus. The genotype 1 is found in developing countries and tends to cause community level outbreaks. While the genotype3 found in developed countries do not cause these outbreaks.

The transmission of HEV is through faecal-oral route due to fecal contamination of drinking water. Other routes include

Food borne transmission from ingestion of products derived from infected animals.
Transfusion of infected blood products.
Vertical transmission from a pregnant woman to her foetus.
Humans are natural hosts for HEV despite this antibodies to HEV are seen some primates and other animal species. Since it is water-borne, some water animals are known to host the virus. Sporadic episodes have been reported after ingestion of uncooked shellfish.

The major risk of HEV is related to poor sanitation.

Symptoms manifest after an incubation period of 3-8 weeks, however the period of communicability is not known. As the HEV is an acute sporadic epidemic disease, the symptoms is most commonly seen in the age group of 15-40yrs. Though in children the disease is so mild and asymptomatic that it could go undiagnosed. The typical signs however are:

Jaundice – yellowing of skin, white of the eyes, dark urine and pale stools.
Loss of appetite anorexia
Pain and tenderness of abdomen
Nausea and vomiting
Fever.
These symptoms are quite indistinguishable from any acute phase of hepatic disorder. In very rare cases this could develop into Fulminant Hepatitis (acute liver failure) and death. The tendency to aggravate to Fulminant hepatitis is more during pregnancy.

Chronic HEV infection has been reported in people with immunosuppression . Reaction of HEV is also known in immunosuppresed individuals.

Diagnosis of HEV is usually based on the detection of specific IgM or IgG as clinically its symptoms are not distinguishable from other acute viral hepatitis. But this requires specialized laboratory facilities. HEV should suspect when the outbreak is waterborne particularly in developing countries more so if the severity is more in pregnant women or if HAV has been ruled out.

HEV has no available treatment, prevention is more effective. The disease is usually self-limiting, hospitalization is generally not required. Hospitalization should be considered for patients of potential Fulminant Hepatitis and pregnant women who exhibit the symptoms.

Prevention is the ideal cure for HEV, this would include

Quality public water supplies – avoid drinking water of questionable quality.
Establishing proper disposal system to eliminate sanitary waste
Maintaining personal hygiene practises, like hand washing with safe water, particularly before and handling food.
Adhering to WHO safe food practises.
If there is a frank epidemic, then identifying the source, mode of transmission would go a long way in prevention. Improving sanitary and hygienic practices is mandatory.

WHO response, is a working group set up in 2013, it networks globally with people working with HEV. These groups identify potential risks and try to prevent the outbreak of the virus. In addition, they work at

Raising awareness, promoting partnerships, and mobilizing resources.
Formulating evidence based policy and data for actions.
o Preventing transmission

o Executing screening care and treatment.

Every year 20 million HEV infections are estimated over 3 million are acute cases, and 56,600 HEV related deaths occur. The disease is usually self-limiting though it can potentially aggravate to Fulminant hepatitis which could be fatal. The mode of transmission is faecal-oral route via contaminated water, it is geographically spread worldwide. China has produced and licensed the first vaccine to prevent hepatitis E though this is not available in the global market as yet.

.

Hepatitis awareness–Hepatitis A

Standard

hepatitisHepatitis A) is a liver disease caused by the hepatitis A virus (HAV).

This happens when food or water contaminated by the HAV is ingested a person who is not immunized to this virus. It is closely associated with unsafe water, inadequate sanitation and poor personal hygiene.

Unlike hepatitis B and C, the infection does not cause chronic liver disease and is rarely fatal, though it cause debilitating symptoms and fulminate hepatitis i.e. acute liver failure which is associated with high mortality.<br />
The occurrences of hepatitis are sporadic, epidemic and have a tendency to be cyclic in recurrence. It is frequently food borne and can resist food-production processes routinely used to inactivate and/or control bacterial pathogens.

A break of HAv can lead to significant economic and social consequences in the community. For it takes weeks or months for people to recover from the illness and return to everyday life. It would also impact the establishment identified as the source of infected food, causing indirect effect on the local productivity.

Geographically the distribution can be characterized as having high, intermediate or low levels of hepatitis. Areas with high levels of infection are seen in developing countries with poor hygiene and sanitation practise most children below the age of 10 have already been infected as the infection is subclinical it goes unnoticed. Infection in older children and adults are rare. Disease rates and outbreak identification is low in these areas. Areas with intermediate infection are seen in developing countries with transitional economy and sanitary conditions are variable. Children could escape childhood infection but become susceptible at an older age. Higher disease rates and large outbreaks could be seen here. Developed countries are areas of low level infection. Here the sanitary and hygiene conditions are good. so infection occurs in a group that is high-risk for Hepatitis in general, they are the injecting-drug users, the homosexual, and people travelling to regions of high endemic potential, or people in isolated closed religious communities.

HAV transmits through the faecal-oral route. That is when a person ingests contaminated food or water. Water borne epidemic are rare, however when they do occur they are associated with sewage contamination or inadequate treatment of water. Transmission through physical contact is a possibility in the case of homosexuals.

The symptoms of HAV usually manifests after 14 — 28 day incubation. This manifestation could range from mild to severe, and the range includes, fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark coloured urine and yellowing of skin and the white of eye. This yellowing is commonly called Jaundice.

The severity of the disease and mortality increases with age. Symptoms and signs are also more pronounced in adults.<br />
Anyone who is not immunized is a high risk person that would be people who are not vaccinated. The risk factors are<br />
• Poor sanitation<br />
• Lack of safe water<br />
• Injecting drugs<br />
• Living in a household with infected person<br />
• Being a sexual partner with an infected person<br />
• Travelling to area of endemic potential without immunization.<br />
Diagnosis–HAV is not clinically distinguishable from other strains; specific detection would require detecting the IgM and IgG antibodies specific to HAV. Additional tests like reverse transcriptase polymerase chain reaction would require specialized laboratory facilities.

There is no specific treatment for HAV, therapy is aimed at maintaining comfort and nutritional balance, replacement of lost fluids due to vomiting and diarrhoea. The recovery is slow and may take several weeks to months.

Prevention is possible with improved sanitation, food safety and immunisation. Organization of proper sewage disposal, regular personal hygiene practise and of course vaccination. However no vaccine is authorized for children below a year. A single dose provides immunity after a 2 weeks or a maximum of a month after exposure. This can be administered as a part of child immunization program, and for travellers to high endemic potential areas.<br />
The immunization effort should be part of a comprehensive plan for the prevention and control. Planning for large-scale immunization programs should involve economic evaluations and consider alternative or additional prevention methods such as improved sanitation and health education for improved hygiene practise.

The inclusion of HAV as part of childhood immunization schedule should be the call of the local preventive health care. Some countries use two dose system while many countries are comfortable with single dose inactivated hepatitis A. The vaccine is particularly recommended for high risk group like—

• Travellers to endemic area.<br />
• Male homosexuals<br />
• People with chronic liver disease<br />
WHO works to prevent and control viral hepatitis by<br />
• Raising awareness, promoting partnerships and mobilizing resources<br />
• Formulating evidence based policy and data for action.<br />
• Prevention of transmission<br />
• Executing screening. Care and treatment.<br />
Hepatitis A is a liver disease that ranges from mild to severe. Globally 1.4 million cases are reported every year.HAV is transmitted through ingestion of contaminated food, water or through direct physical contact with an infected person. HAV endemics are associated with lack of safe water and poor sanitation. These epidemics could cause significant economic loss as recovery is slow. Improving sanitation and personal hygiene along with vaccination are the effective ways of combating the disease.

 

Protection From Hepatitis B– Hepatitis awareness.

Standard

hepatitisHepatitis awareness – Protection from HBV.

The hepatitis B Virus (HBV) interferes with the functions of the liver and activates the immune system.  This triggers a specific reaction. The consequence of pathological damage to the liver results in the liver becoming inflamed. Though most individuals overcome this infection, a small percentage cannot, as a result they remain chronically infected. These patients are high risk as they could potentially develop into cirrhosis of the liver or even liver cancer.

HBV transmits through blood or body fluids from an infected person, just like HIV does, and is 50-100 times more infectious.  One could infected HBV by—

  • Prenatal transfer that is from mother during pregnancy
  • Child-to- child transmission
  • Unsafe blood and blood component transfer
  • Sexual transfer
  • Contaminated healthcare equipment

Of these the prenatal and reuse of unsterilized needles and syringes dominate.

Earlier almost all children of developing countries developed HBV but with the widespread use of hepatitis B vaccine, outstanding record of safety and effectiveness has been achieved.

Over one billion doses have been used worldwide since 1982 and the affectivity has been 95%.  Once vaccinated the protection lasts for 20yrs. But as of today there are no boosters recommended by WHO.

 

 

Hepatitis awareness– Hepatitis B Virus.

Standard

hepatitisJuly 28th is world Hepatitis awareness day.

Hepatitis Awareness – Hepatitis B Infection caused by Hepatitis B Virus (HBV) is potentially life threatening and a major global health hazard. It could cause chronic liver disease putting people to a high risk of cirrhosis of the liver and liver cancer. About 240 million harbour chronic liver infection i.e. is long-term liver infection and more 780000 people die annually as a consequence of this. Since 1982 vaccines are available against this., it is has a 95% efficacy rate.

Geographically high rates of infections are found in Amazon and southern parts of eastern and central Europe. Middle east and Indian subcontinent as an estimate of 2-5% of the general population of the chronically infected, while western Europe documents less than 1% of the population. Prevalence’s are highest in sub-Saharan Africa and eastern Asia. People are infected during childhood and 5-10% are chronically infected. HBV causes an acute illness with symptoms that could last for several weeks. Yellowing of the skin and eyes, dark urine, extreme fatigue, nausea, vomiting, and abdominal pain are seen.

The transmission of HBV is usually from mother to child or person to person in early childhood.  This- accounts for more than one-third of the chronic infections in areas of endemicity. Sexual transmission, transmission through contaminated needles are also high in areas of endemicity. HBV can survive for 7 days outside the human host, and if it comes in contact with a person who is not immunized it can cause infection.  But it is not spread through contaminated food or water, nor can it be contracted by casual contact. The virus takes about 30- 180 days to incubate, and  virus may be detected 30 -60 days after infection.

Most people do experience any symptoms when the infection is in the acute phase, however, some people have presented  with yellowing of the skin and eyes, dark urine, extreme fatigue, nausea, vomiting and abdominal pain, these symptoms last for several weeks. Some people harbour the disease in a chronic form which has the potential to progress into liver cirrhosis or liver cancer. Healthy individuals have a recovery of 90% and  are completely rid of the virus within 6 months.

The risk of HVB becoming chronic depends on the age that a person gets infected. Children exposed below the age of 6yrs tend to develop chronic infection. Less than 5% of healthy adults who contract HBV become chronic. Of 15-20% of the adults who became chronically infected from childhood, die of HBV related liver disease like cirrhosis or cancer.

As diagnosis is not possible on clinical grounds, blood tests would be required. This helps to identify chronic and acute condition,by focusing on the HB surface antigen HBsAg. WHO recommends that all blood donations should be screened so that it is transferred to the recipient.

There is no specific treatment for Hepatitis B.  Care is aimed at maintaining adequate nutritional balance, and comfort this includes replacement of fluids lost due to vomiting and diarrhoea. People with chronic hepatitis B can be treated with drugs, including interferon and antiviral agents. Treatment can slow with progression  to cirrhosis and cancer and improve long-term survival . liver cancer is the most fatal complications of hepatitis B and occurs at an age when people are most productive and have family responsibilities.

The HB- vaccine is the mainstay for prevention. WHO recommends that it should be administered as soon as possible preferable within 24hrs. Of birth.  The birth dose should be followed by 2-3 doses. The dosage would a first one at birth while the 2nd and 3rd given at the same time as the 1st and 3rd dose of DTP. All children and young adults below the age of 18yrs should receive the vaccine if they live in a country where there is low or intermediate endemicity. High risk people should also be vaccinate. The high risk people are—

  • People who require constant blood or blood product transfers,
  • People interned in prisons.
  • Drug abusers,
  • Household and sexual contacts of people with chronic HBV infection
  • People with multiple sexual partners, health workers and others exposed to blood and blood products through work.
  • People who are not vaccinated, but are travelling to areas of endemicity.

Since its debut in 1982 billion doses of hepatitis B is in used worldwide. Since 1992 many member states have made it part of their vaccination schedule.

The WHO is working in the following areas to prevent and control viral hepatitis.

  • Raising awareness, promoting partnerships and mobilizing resources.
  • Formulating evidence based policy and data for action
  • Prevention of transmission
  • Promoting access to screening and care treatment services.

Hepatitis B is a viral that attacks the liver and can cause both acute and chronic disease. The virus is transmitted through contact with blood or other body fluids from an infected person. About 780,000 people die each year as a consequence of hepatitis B. Hepatitis B is an important occupational hazard for health workers. It is preventable by using a vaccine.

World Hepatitis awareness Hepatitis C

Standard

hepatitisJuly 28th is the world Hepatitis awareness day.

The Hepatitis C virus causes both acute and chronic infection.

Acute is something that is happens quickly, it is usually asymptomatic and rarely life-threatening. About 15-45% of the infected people spontaneous heal within 6 months and do not require treatment. The other 55-85%  go into the chronic stage. Of whom 15-30% could develop into cirrhosis of the liver in 20 yrs.

Geographically hepatitis C is found world wide. Though central and east Asia and northern Africa are most affected. The epidemic  could be concentrated in high risk populations like people use infected needles, or could be general. There are multiple strains of HCV virus and their distribution.

Transmission  is blood borne. And common pathways are

  • Use of infected needles.
  • Use of contaminated medical equipment without adequate sterilization.
  • Transmission of contaminated blood.
  • Transmission through body fluids and from mother to her fetus these are however rare.

Hepatitis however does not spread through breast milk, food, water or casual contact like hugging or kissing or share food with an infected person.

Symptoms  show after a period of 2 weeks or 6 months of incubation. About 80% of the people do not exhibit any symptoms. Those do exhibit acute symptoms may show fever, fatigue, decreased appetite  nausea, vomiting, abdominal pain, dark urine, grey-colored faeces, joint pain and jaundice.(jaundice is the yellowing of skin and whites of the eyes.)

Screening and diagnosis of the early stage is rare, as it is asymptomatic.  Many a times it remains undiagnosed until serious liver damage has developed.

The diagnosis of HCV is in 2 steps.

  • Screening for anti HCV antibodies with a serological test – this identifies people who have been infected with virus.
  • If the serological test is positive, a nucleic aci test for HCV-RNA  is needed to confirm  chronic strong immune response without the need for treatment. Although no longer infected they will still test positive for anti-HCV  infection  because 15-45% of the people infected with HCV spontaneously clear the infection.

Once the person is diagnosed of harboring hepatitis C the liver is damaged is assessed for fibrosis and cirrhosis. This can be done by non-invasive test. The treatment plan and disease management is decided after identifying the strain. There are 6 strains of HCV.

Getting tested:

Early diagnosis can prevent further destruction  from the disease and transmission of the virus. high risk population could periodically be screened for the infection. And high risk include

  • People who inject drugs.
  • Recipients of blood products from probable unsafe source.
  • People undergo going invasive health care procedures in healthcare facilities with inadequate infection control practices.
  • People who sexual partners of HCV infected people.
  • People using intranasal drugs.
  • People who have had tattoos or piercing.

Hepatitis C does not always require treatment as the immune system in most people can clear the infection. When necessary the goal of the treatment is to cure. The cure rate dependents on factors like the strain of virus and treatment given. The appropriate approach of treatment is decided after carefully  screening the patient.  The current standard treatment is an antiviral therapy which is a combination f interferon and ribavirin.  This combination is effective against all the strains.  Unfortunately this is poorly tolerated by in some patients and is not widely available globally either. this makes management of the treatment a little complex, many patients do not finish their treatment.

Scientific advances have lead to the development of new antiviral drugs for hepatitis C which is much more effective, safer and better tolerated than existing therapies. These therapies are known as oral directly acting antiviral agents. Therapies simplify hepatitis C by significantly decreasing monitoring requirements and by increasing cure rates.  Though the production cost of DAA is low, the intial price set by the pharmaceutical companies are high and access to these drugs could be difficult even in high income countries.

WHO is launching new guidelines for screening care and treatment of persons with hepatitis C in April 2014.  These are the first guidelines dealing with hepatitis C treatment produced by WHO and complement the existing guidance on prevention of transmission of blood borne diseases in including HCV.

These guidelines are intended for the policy makers, government officials and others working in low-and middle income countries who are developing programs for the screening, care and treatment of persons with HCV infections. These guidelines will help expand of  treatment services to patients with HCV infections as they provide key recommendations in these areas and discuss considerations for implementations.

Prevention of HCV is on three planes, primary, secondary and tertiary. There are no vaccines for HCV so primary prevention of infection depends on  reduction of the risk of exposure to the virus, in healthcare settings, and high risk populations,  here are some examples of the primary prevention interventions recommended by WHO

  • Hand hygiene—including surgical hand preparation, hand washing and use of gloves.
  • Safe handling and disposal of sharps and waste.
  • Safe cleaning of equipment
  • Testing of donated blood
  • Improved access to safe blood.
  • Training of health personnel.

Secondary and tertiary prevention for infected with the HCV WHO recommends-

  • Education and counselling on options for care and treatment.
  • Immunization with the hepatitis A and B vaccines to prevent co-infection from hepatitis viruses to protect their liver.
  • Early and appropriate medical management and administration of antiviral therapy if appropriate.
  • Regular monitoring for early diagnosis of chronic liver disease.

WHO is working in the following areas to prevent and control viral hepatitis.

  • Raising awareness, promoting partnerships and mobilizing resources.
  • Formulating evidence based policy and data for action.
  • Prevention of transmission
  • Executing ,screening, care and treatment.

Hepatitis C is a liver disease caused by hepatitis C virus it can be both acute and chronic, and can last from a few weeks to a serious lifelong disease. It is blood borne. Significant number of those who suffer from chronic infection  develop liver cirrhosis or cancer. About 350,000-500,000 people die each from HCV.  This is curable 50-90%

though diagnosis and accessibility to the treatment is low. The success rate is  5o0-90% though research is on for vaccine against HCV.