July 28 is World Hepatitis Day set by the World Health Organization, and this year’s theme is “Fight Hepatitis, Prevent First”. Viral hepatitis is an important infectious disease caused by a variety of hepatitis viruses, mainly liver lesions, endangering the health of our people. Data show that among the five types of viral hepatitis that endanger the health of the nation, hepatitis B has the highest infection rate and is the most difficult to treat. It is estimated that there are about 90 million carriers of hepatitis B virus in China, of which 28 million are chronic hepatitis B patients; followed by 7.6 million infected with hepatitis C.
Why is today World Hepatitis Day? The answer given by WHO is to commemorate the birthday of Baruch Samuel Bloomberg, the discoverer of the hepatitis B virus, developer of the first hepatitis B vaccine and Nobel Prize winner.
What is the world and our country doing today in terms of hepatitis prevention actions?
World: WHO organizes World Hepatitis Day every July 28 to raise awareness and understanding of viral hepatitis, and in 2015 the theme was established as “Hepatitis Prevention, Act Now”. The reason is that hepatitis is set to overtake AIDS as the sixth leading human health killer. Hepatitis kills between 1.4 million and 1.5 million people worldwide each year, making it the seventh leading cause of death from all types of diseases. WHO is currently working on viral hepatitis prevention and control in the following areas: raising awareness and promoting partnerships; developing evidence-based policies and collecting data for action; promoting prevention of transmission through immunization, safe injections and blood safety; and promoting wider access to hepatitis B surveillance and screening, care, and treatment services.
China: The National Health Planning Commission held a special press briefing to inform the public about the situation and announced that the theme of this year’s Hepatitis Day is “Fight Hepatitis, Prevent First”, emphasizing the urgency of the serious threat hepatitis poses to national health.
”Five brothers”
Viral hepatitis is usually divided into five types: A, B, C, D and E. According to their respective main transmission routes, these “five brothers” can be divided into two categories.
First, mainly through the fecal-oral route (through contaminated hands, food and water, etc.): hepatitis A and hepatitis E
Second, mainly through blood, sexual contact and mother-to-child transmission: hepatitis B, hepatitis C and hepatitis D
The following describes their basic information and prevention methods respectively!
Fecal-oral transmission (transmission through contaminated hands, food, water, etc.)
Hepatitis A
Hepatitis A is a common acute infectious disease of the gastrointestinal tract caused by hepatitis A virus (HAV), with damage to liver parenchymal cells as the main cause. Hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can be debilitating and can lead to severe hepatitis (acute liver failure) with a high mortality rate.
Hepatitis A virus is a micro RNA virus that is resistant to cold, heat, acid and alkali. In general, heating at 100°C for one minute is sufficient to render the hepatitis A virus inactive.
In recent years, the prevention and control of hepatitis A has been effective. Last year, the number of new cases of hepatitis A was 200,000, reaching the lowest level in history. The vaccination rate for the first dose of hepatitis A vaccine reached 90%, and the full vaccination rate for the third dose reached 95%. The infection rate of children with hepatitis A in China has been decreasing significantly year by year.
Transmission.
Hairy ark: the culprit of hepatitis A outbreaks. Foodies living next to the Yangtze River basin have long enjoyed the delicacies of arks and drunken crabs. Eating half-cooked ark meat or with fresh blood ark are not hygienic, easy to catch hepatitis A and other infectious diseases of the digestive system. A study found that the shelled ark is boiled for 45 minutes, but also can not completely kill its body of the hepatitis A virus. The large number of bacteria and hepatitis A virus adsorbed on the gills of the ark can infect the digestive system through the oral mucosa, especially the liver. Therefore, to avoid infection with hepatitis A, please do not eat uncooked food, pay attention to environmental hygiene of food preparation, and wash your hands before and after meals. The feces of infected people can easily spread to others by contaminating water, food, vegetables and toys.
No need to panic.
The disease is cured and its contagiousness is currently observed for a maximum of 30 days after the disease. In other words, we can assume that people who have been cured of hepatitis A for more than 30 days are not contagious to others.
In recent years, due to the improvement of public health, the application of hepatitis A vaccine, and the importance of hygienic food handling, there is only an epidemic or small-scale epidemic of hepatitis A in China.
Susceptible people: Hepatitis A immunity: people aged 20C40 are susceptible to hepatitis A
Hepatitis A is universally susceptible in the population, which means that people of all age groups can be infected with hepatitis A. However, in recent years, the high incidence of hepatitis A is between the ages of 20 and 40. Why is this?
It turns out that infants and children within 6 months of age have immunity from the immune proteins brought by their mothers; China recommends vaccination against hepatitis A at around 1 year of age, and this immunity can last for 20 years; many older generations of Chinese people have had “latent infection” with hepatitis A in the past, meaning that the virus has attacked their bodies but has not caused any obvious symptoms, and they have some immunity. People between the ages of 20 and 40, on the other hand, are susceptible because their immunity from the vaccine is fading and they do not have previous “latent infections”.
It should be noted that infants, the elderly, and pregnant women have lower immune function and are more likely to have severe hepatitis once infected, and can even be combined with pancreatitis, myocarditis, Guillain-Barre syndrome, and immune anemia.
Of course, hepatitis A is a self-limiting disease, most infected people do not even have any symptoms, the virus can clear itself, the body heals and gains lasting immunity. To date, no chronic cases have been found, there are few severe cases and most patients have a good prognosis.
How to determine if you have hepatitis A.
For hepatitis A, we generally screen for hepatitis A antibody IgM and may suspect hepatitis A if it is positive, with elevated transaminases and a history of unclean food.
Hepatitis E
Hepatitis E virus (HEV) causes disseminated or fulminant viral hepatitis. The most common clinical cases are in adults between the ages of 15-40 years. In rare cases, acute hepatitis E can cause fulminant hepatitis (acute liver failure) and death. The incidence of fulminant hepatitis is highest during pregnancy. Pregnant women are most at risk for obstetric complications and death due to hepatitis E. Mortality due to hepatitis E can be as high as 20% in the last trimester of pregnancy. Hepatitis E is the leading cause of death among adults with acute viral hepatitis, surpassing hepatitis A and hepatitis B.
How to determine if you have hepatitis E.
For hepatitis E, we can also test for hepatitis E antibodies and, of course, nucleic acid (RNA) testing.
Blood, sexual contact and mother-to-child transmission.
Hepatitis B
Hepatitis B is a contagious disease caused by the hepatitis B virus (HBV), with inflammation of the liver as the main lesion and can cause damage to many organs. In China, hepatitis B is the most infectious and harmful viral hepatitis.
The course of hepatitis B is prolonged and can easily turn into chronic hepatitis, cirrhosis and liver cancer.
The rate of hepatitis B infection in children is decreasing
According to the survey, the prevalence of hepatitis B surface antigen among children aged 1-14 years in China has decreased by more than 60% compared to 2006. Among them, the prevalence of hepatitis B surface antigen in children aged 1-4 years fell to 0.32%, down 66% compared to 2006, while the prevalence of hepatitis B surface antigen in adolescents aged 5-14 years fell to 0.94%, down 61% compared to 2006, achieving the WHO Western Pacific Region hepatitis B control target ahead of schedule.
How to determine if you have hepatitis B.
In the case of hepatitis B, the general screening test is the five hepatitis B tests, and if the hepatitis B surface antigen is positive, we can then perform a viral load test.
Hepatitis C.
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). In terms of severity, hepatitis C can present with mild symptoms for only a few weeks, or it can be a lifelong serious liver disease and can lead to cirrhosis or liver cancer.
With more than 7.6 million people infected with the hepatitis C virus and more than 4 million people with chronic hepatitis C, hepatitis C has now become one of the common infectious diseases in China. Moreover, hepatitis C can lead not only to hepatitis itself, but also to cirrhosis and even liver cancer in a significant percentage of patients, which is a very serious hazard. The prevention and control of hepatitis C requires improving public awareness as well as the prevention and control of healthcare-derived infections, while improving clinical treatment and service capacity is also particularly important for the prevention and treatment of hepatitis C.
Public awareness of hepatitis C needs to be improved. Hepatitis C is a powerful player and is known as the “low-profile killer” in the hepatitis community. The scary thing about hepatitis C is that once you have it, there is a 50-85% chance that it will become chronic, and when acute hepatitis becomes chronic, it means an increased chance of developing cirrhosis and liver cancer in the future.
Features of hepatitis C
1. Incognito and asymptomatic.
After HCV infection, patients generally do not develop any symptoms. The degree of chronicity is so high that less than 20 percent of patients can spontaneously clear the virus. If left untreated, most patients will have HCV in their bodies for the rest of their lives.
2. Silent progression.
Chronic hepatitis C progresses silently and slowly, with about 10% to 20% of patients developing cirrhosis within 20 years. Once it progresses to cirrhosis, the 5-year survival rate of patients drops to 50%, which means that half of the patients will die every 5 years because of cirrhosis of hepatitis C. The annual incidence of liver cancer in patients with cirrhosis C is also as high as 1% to 4%, which means that 1 to 4 out of every 100 patients with cirrhosis C will develop liver cancer every year.
3. Late detection.
Once the symptoms of hepatitis C appear, they often have already progressed to cirrhosis or even liver cancer. Therefore, compared to other causes of hepatitis, hepatitis C should never be detected by symptoms alone, but more emphasis should be placed on early screening.
4. Curable.
Now, a class of drugs that can directly antiviral drugs are listed in Europe and the United States. These drugs can directly inhibit the protease of HCV; the drugs can also inhibit the RNA (genetic material of the virus) polymerase of the virus. In short, by preventing the smooth replication of the virus, the cure rate increases to more than 95% and hepatitis C becomes a curable disease. These new drugs have fewer side effects than conventional treatment options and can also be used as antiviral therapy for patients with hepatitis C cirrhosis. Happily, these new anti-HCV drugs are already in phase III clinical trials in China, and their official launch is imminent.
How to determine if you have hepatitis C.
For hepatitis C, we can check the hepatitis C antibody test, and if it is positive, we can further check the viral load. It takes ten years or so; and the percentage of deterioration is more than 50%, while hepatitis B is less than 10%.
Hepatitis D
Hepatitis D, is an infectious disease caused by the co-infection or overlap of hepatitis D virus (HDV) and hepatitis B virus (HBV), mainly liver damage. Hepatitis D virus is a defective virus that cannot exist on its own and must rely on the hepatitis B virus to complete its replication. Therefore, it can only be infected at the same time as the hepatitis B virus, or only in people who are already infected with the hepatitis B virus.
This is how hepatitis should be prevented
The six factors that cause liver cancer include viral hepatitis, heredity, environment, alcohol, etc. If there is hepatitis, definitely the patient’s liver function is not normal anymore, and transaminases are found to be elevated, and viral hepatitis is suspected before further investigation. If there is an elevated transaminase, there is definitely inflammation in the liver. There is a wide range of hepatitis, including viral hepatitis, but also alcoholic hepatitis, drug-related hepatitis or autoimmune factors, which can cause elevated transaminases. In China, the incidence of hepatocellular carcinoma caused by viral hepatitis is decreasing, while the incidence of hepatocellular carcinoma caused by alcohol is increasing year by year.
1. Vaccination is the first choice for prevention. After the hepatitis B vaccine is administered to high-risk groups such as hepatitis B virus carriers, people who have frequent contact with blood, and homosexuals, it is necessary to regularly check whether antibodies are produced in the body. Since everyone is not “sensitive” to the hepatitis B vaccine, some people have “antibodies” that last for years, while others need a booster shot to “wake up” the antibodies. Therefore, it is important to test regularly after the hepatitis B vaccination, especially for people who are obese, smokers and drinkers, who have poor immunity to the hepatitis B vaccine and need to be monitored regularly.
Newborns should be vaccinated within 24 hours of birth. First of all, the risk of infection is higher in this group of newborns, especially if the mother is hepatitis B surface antigen positive or if she is surrounded by people infected with hepatitis B virus, so the risk of infection is higher in this group of newborns. In addition, the risk of infection in newborns is also very serious, because the immune system of newborns is not yet established, and after infection, they are prone to develop a chronic hepatitis B virus carrier status, so the prevention of newborns is very important.
It is also necessary for adults to be vaccinated against hepatitis B. The hepatitis B virus is mainly transmitted through blood or body fluids. For adults, because adults are more socially active and active, many adults can be infected with the hepatitis B virus through the use of blood or blood products, or through drug use, or through unclean sexual intercourse. In addition, some adults go to beauty stores with substandard hygiene to get tattoos and ear piercings, all of which have the risk of spreading the hepatitis B virus. So the risk of adults being infected with the hepatitis B virus is still very high.
2. Be sure to use safe syringes and use as few injections as possible in favor of oral medications. Unsafe blood, unsafe injections and sharing of drug injection equipment can all cause hepatitis infection.
3. People at high risk of infection should be screened more frequently and treated promptly
What people are at risk for chronic disease?
The likelihood of a hepatitis B virus infection becoming a chronic disease depends on a person’s age at the time of infection. Children under 6 years of age infected with hepatitis B virus are most likely to become chronically infected: about 80%-90% of infants infected with the virus in the first year of life become chronically infected; 30%-50% of children infected before age 6 become chronically infected. Less than 5% of healthy adults infected with hepatitis B virus become chronically infected; 20-30% of chronically infected adults develop cirrhosis and/or liver cancer.
Caution
What do I need to be aware of if my mother is a carrier of hepatitis B virus during pregnancy?
If the mother is already pregnant, she should pay attention to two aspects, one for the mother and one for the future mother-to-child blockade.
For the mother, because she is a hepatitis B carrier herself, she should also monitor her liver function regularly during pregnancy to see if there are any changes in viral replication, so the pregnant mother should have regular liver function tests and viral load tests, and deal with any changes in time. Of course, other routine gynecological examinations are the same, except that some more tests for hepatitis B should be done.
For the child, the main concern is mother-to-child interruption. After the baby is born, hepatitis B vaccination should be given in time. For a mother with hepatitis B virus, it depends on her viral load. If she has a high viral load, the risk of transmission to her child is still higher compared to a mother with a low viral load.
According to the current interruption method, ordinary newborns are vaccinated against hepatitis B. For mothers who are positive for hepatitis B surface antigen, the newborns should be vaccinated with hepatitis B vaccine and injected with high potency hepatitis B immune globulin. At present, when these two methods are used together, the success rate of blocking newborns of hepatitis B surface antigen positive mothers can reach more than 90%, so most mothers do not have to worry too much, as long as they are tested in a regular hospital and normal blocking measures are taken after the newborn is born, most of them can be blocked successfully.
What are the bad habits that affect liver function?
One is to stop drinking, all kinds of alcohol we do not recommend, some people say I drink some beer, red wine, in fact, no matter what wine, are not recommended.
The second is to live a regular life and avoid staying up late. Mental and psychological relaxation is also very important, some people live a stressful life, overwork, irregular diet, stay up late, although not a direct damage to the liver, but the recovery of liver function is not good.
Third, the diet, for chronic hepatitis, or a balanced diet, there is no need to deliberately supplement what or what to avoid, carbohydrates, vitamin food, vegetables and so on are available, to maintain a balanced diet, do not malnutrition, nor excess, excess, some fat people will get fatty liver, fatty liver will also cause transaminases to rise, and then combined with hepatitis B, then in the end is caused by hepatitis B or The fatty liver can also cause elevated transaminases and then combined with hepatitis B. So is it caused by hepatitis B or fatty liver? It will also give us some interference in judging the condition, so we still need to avoid excessive obesity.
There are also drugs, some patients love to take a lot of drugs, drug-related liver injury also has a trend of increasing year by year, if you are not sure when using drugs, you should consult a hepatologist, especially for some liver injury, take anti-tuberculosis drugs, anti-depression, treatment of bone and joint disease, some drugs can still cause liver damage, or to consult a doctor. Including some Chinese medicine, especially oral Chinese medicine for osteoarthrosis and skin diseases, can still cause liver damage, so you must be careful with the medication and it is best to consult a doctor.
Here are the misconceptions people have about hepatitis
Myth 1: All hepatitis is contagious
Among the common causes of hepatitis, in addition to viral hepatitis, there are many kinds of non-infectious hepatitis, such as alcoholic hepatitis, simple fatty liver, drug-related liver injury, and autoimmune liver disease.
Alcoholic hepatitis: caused by long-term heavy alcohol consumption.
Simple fatty liver: due to excessive deposition of fat in the liver cells.
Drug-induced liver injury: the main cause is irrational use of drugs.
Autoimmune liver disease: belongs to the same category of connective tissue diseases as lupus erythematosus and rheumatoid arthritis.
These above-mentioned liver diseases are not contagious.
In addition, because various types of hepatitis often lead to abnormal liver function (most commonly elevated transaminases and/or bilirubin), the public often feels that “abnormal liver function” or “jaundice” is itself infectious. In fact, these symptoms are only the result of hepatitis and are not contagious.
Misconception 2: Hepatitis patients need to be “isolated
Among the common viral hepatitis, hepatitis A and hepatitis E are infectious diseases of the digestive tract and need to be isolated by means of meal sharing and fecal disinfection. Hepatitis A virus is excreted in the feces of patients and can cause sporadic epidemics or pandemics by contaminating water, food, and utensils.
Contamination of food during production is also a cause of hepatitis A transmission. For example, contamination of sandwiches, orange juice, salads and finished meat foods with hepatitis A virus is a major cause of hepatitis A epidemics in developed countries.
There have also been pandemics of hepatitis E caused by contaminated water sources, but currently it is more common to see disseminated cases due to food contamination.
Prevention of these two types of GI-transmitted hepatitis should be done by
Children living in groups in kindergartens and schools are at high risk of contact transmission of hepatitis A. They should be educated to develop good hygiene habits of washing their hands after defecation.
Pay attention to meal hygiene. For some foods that can easily carry pathogenic bacteria, such as snails, shells and crabs, they must be cooked and steamed thoroughly, and eliminate bad eating habits such as eating raw, semi-raw and directly after pickling.
Misconception 3: Daily contact can transmit hepatitis B and C
Daily contact does not transmit hepatitis B or C. Contact without blood exposure, such as shaking hands, hugging, sharing office supplies, living in the same dormitory, eating in the same restaurant and sharing toilets, will generally not transmit hepatitis B or C. Epidemiological and experimental studies have not found that either hepatitis can be transmitted by blood-sucking insects (mosquitoes, bedbugs, etc.).
Both types of hepatitis are transmitted primarily through blood, vertical mother-to-child transmission, and sexual contact.
They are transmitted through broken skin and mucous membranes, mainly due to the use of non-sterile medical devices, invasive procedures and surgeries, and unsafe injections, especially drug injections. Other diseases such as pedicures, tattoos, ear piercing, sharing razors and toothbrushes, and accidental exposure of medical personnel at work can also be transmitted.
Mother-to-child transmission of hepatitis B occurs mainly during the perinatal period, mostly through contact with the mother’s blood and body fluids during delivery. With the use of hepatitis B vaccine combined with hepatitis B immunoglobulin, mother-to-child transmission has been greatly reduced. Mothers infected with hepatitis C can also transmit it to their newborns during delivery, and it is recommended that women with hepatitis C should have children after they are cured.
Unprotected sexual contact with a person who is a carrier of hepatitis B or C virus may result in infection. The risk of being infected is higher if accompanied by other sexually transmitted diseases, especially AIDS.
Misconception 4: Hepatitis B must develop into chronic
If the hepatitis B virus has not been cleared after 6 months of infection, it is called chronic hepatitis B infection. Age at the time of infection is the most important factor affecting chronicity. The risk of chronicity is as high as 90% for those infected in the perinatal period, while the rate drops to 50% in infancy (0-5 years) and only 5-10% of adults who become infected develop chronic infection.
Therefore, chronic hepatitis B can be controlled by doing a good job of blocking mother-to-child transmission of the hepatitis B virus and vaccinating infants and children against hepatitis B.
Misconception 5: Hepatitis B is inherited from the mother to the child
Hepatitis B is a family gathering phenomenon, often manifested by the presence of the hepatitis B virus infection between the mother and child or siblings at the same time. Therefore, many hepatitis B patients mistakenly believe that this is a hereditary disease, and even afraid to marry and have children.
A genetic disease is a disease caused by a change in the genetic material. An infectious disease, on the other hand, is a disease caused by an otherwise healthy individual who is infected by an infectious agent. Obviously, hepatitis B is not caused by an error in the patient’s genetic material, but by infection with the hepatitis B virus.
Newborns are exposed to large amounts of maternal blood during delivery, which is the cause of mother-to-child transmission of hepatitis B. Also intrauterine infection may occur during pregnancy when there is a break in the blood vessels on the surface of the mother’s uterus, as in the case of placental abruption, which allows leakage of maternal blood into the fetal blood circulation. It can be seen that mother-to-child transmission, regardless of the cause, is actually the transmission of the hepatitis B virus from the mother to the next generation through the internal route. Therefore, hepatitis B is an infectious disease, not a genetic disease, and can be blocked by hepatitis B vaccination and hepatitis B immunoglobulin.
Myth 6: If hepatitis B cannot be cured, there is no need to treat it
There is no way to cure hepatitis B with current technology and drugs, but it can be effectively controlled. Long-term systematic treatment can stabilize the disease and improve the quality of life.
Just as good control of blood sugar and blood pressure will reduce cardiovascular, renal and retinal complications, the risk of cirrhosis, liver cancer and all kinds of liver failure will be greatly reduced by controlling the hepatitis B virus in a person’s body to very low levels through treatment.
Misconception 7: Blind faith in ancestral prescriptions and modern high-tech packaging
Some of these advertisements claim to be ancestral prescriptions and deceive under the guise of traditional medicine. Others are under the guise of modern high technology, such as laser, nano, cell, etc. These treatment technologies are indeed under exploration and research, but have not really reached the level of clinical application.
Misconception eight: eat drunken shrimp will not get hepatitis
Eat more drunken shrimp, beware of hepatitis A, hepatitis E to find you. For viral hepatitis, hepatitis A and hepatitis E are transmitted in a similar way, both through fecal-oral transmission. Once the feces of hepatitis A patients or virus carriers contaminate the water source, it will affect the growing environment of food. Once this food is consumed by people, it can cause infection of the virus. Many people think that the drunken way of marinating seafood shellfish, can play a sterilization effect, but in fact, this is only to play a flavoring effect, the parasites inside will still not be killed.
It is important to note that when processing seafood, it is best to use a special cutting board, never use a cutting board to cut both seafood and cooked food, so as not to infect cooked food with germs hidden within the texture of the board, causing the spread of viruses.
Hepatitis A can be a large outbreak, while most of hepatitis E is a small epidemic. In general, some patients with hepatitis A in the acute stage will have jaundice, weakness and poor appetite, while some patients will not have jaundice but will have pain in the liver area accompanied by fever.
Misconception 9: Exercise can prevent hepatitis
The pathogenesis of viral hepatitis is still unclear. Instead of preventing hepatitis, people with liver disease should take rest and are not recommended to do high-intensity physical exercise.
Misconception 10: Eating garlic prevents hepatitis
Many people believe that garlic is antibacterial and antiviral, so they use garlic to prevent hepatitis, and some people even eat garlic every day after they have hepatitis. There is no evidence-based basis for eating garlic to prevent hepatitis. Eating garlic regularly may have a certain effect on lowering blood lipids, but this practice is extremely detrimental to hepatitis patients because garlic has little effect on the hepatitis virus, and on the contrary, some components of garlic have a stimulating effect on the stomach and intestines, which can inhibit the secretion of intestinal digestive juices and affect food digestion, thus aggravating nausea and many other symptoms in hepatitis patients. In addition, the volatile components of garlic can lower the red blood cells and hemoglobin in the blood, etc., and may cause anemia, which is not conducive to the treatment of hepatitis.
Misconception 11: If you don’t have pain in the liver area, you don’t have liver disease
Many people feel that suffering from fatty liver is not painful and it takes a long time to develop into steatohepatitis, so they do not pay much attention to it. In fact, once fatty liver is diagnosed, some inflammatory changes or fibrous deposits in the liver may be found if precise tests such as puncture are performed. Therefore, there is no too clear line between fatty liver and steatohepatitis. Therefore, experts recommend that once people have fatty liver, they need to intervene to treat it immediately without delay.