Many Nepalis incorrectly think jaundice (yellow discoloration of the white of the eyes) is a disease. Actually, it is often just a symptom/sign, not the diagnosis.
Just like fever often is a diagnosis without a known cause, jaundice too is usually a sign that the liver is unwell. Hepatitis is an inflammation of the liver, and is one of the most common causes of jaundice. Now that several hundred cases of jaundice have been reported in Biratnagar because of contaminated water, viral hepatitis is a timely topic for this week’s health column.
In Nepal the most common version of infectious viral hepatitis is Hepatitis E. Both hepatitis E and A have a faecal-oral route of transmission, which means ingesting something contaminated with faeces. Hepatitis A affects most Nepalis in their childhood. Usually this infection is not jaundice, but just a flu-like illness, lethargy and nausea which are the signature signs of all hepatitis.
The good news is that a single infection with hepatitis A appears to give a lifelong immunity. Most Nepalis will be protected against this common hepatitis for life. However it is doubtful if this immunity after a single infection applies to hepatitis E.
The fascinating discovery of the hepatitis E virus happened during the Soviet occupation of Afghanistan in the 1980s, after an outbreak of unexplained hepatitis at a military camp. An enthusiastic scientist came to the rescue by ingesting a pooled faecal extract from affected soldiers. This scientist became sick and the new virus was detected in his stool.
Both hepatitis A and E have a self-limiting course, and no specific medicines are required, although many do receive Ayurvedic treatment in our country. However when pregnant women are infected with hepatitis E, it may turn deadly and lead to fulminant or life-threatening hepatitis. Luckily, for the last several years we have seen fewer pregnant women infected with this virus than previously. It is possible this could be explained by hepatitis E coming in cyclical outbreaks, and we have just been lucky to not witness these recently.
The best way to prevent both hepatitis A and E is to make sure to wash hands with soap and water, drink only clean water and eat well-cooked food. These proven methods will inhibit transmission of the disease.
In early 2000, the US and Nepal military collaborated with GlaxoSmithKlein to conduct a careful trial on Nepali soldiers which produced a very effective vaccine against hepatitis E. Unfortunately it was never commercially manufactured because there was no financial incentive to produce the vaccine as the disease affected mostly poor people. However, the Chinese soon took up the task as hepatitis E is a scourge in China too. After one of the largest vaccine trials in history, China has produced a very effective, commercially-available hepatitis E vaccine which should soon be available in Nepal.
In contrast, hepatitis B and C are not transmitted by the faecal oral route. Blood transfusion, intravenous drug use or sexual transmission is the usual route of entry. There is a useful vaccine for hepatitis B, but not for C. In 99 per cent of cases of hepatitis B, no anti-viral drug treatment is required as patients recover without specific treatment. Hepatitis C is less benign and may require treatment after infection. But finally, the hepatitis D virus can cause severe complications only when it co-exists with hepatitis B.
Clearly, common viral hepatitis (A to E) can be prevented if we are well-aware of the modes of transmission and take suitable precautions.