Break The Chain Of Viral Hepatitis

---

Many people do not realise that the hepatitis virus can cause chronic liver disease and even lead to liver cancer. This World Hepatitis Day, Dr Chua Siew Houy highlights what Malaysians need to know to break the chain of infection.



When it comes to one’s health and prevention of disease, few people think of protecting their liver because – let’s face it – many people do not even know what this essential organ does.

Dr Chua Siew Houy
It may therefore come as a surprise to learn that the liver is both an organ and a gland, performing a wide range of functions to keep the body healthy. For example, it helps to clean toxins from blood and stores glycogen for energy. It also produces bile, which helps to break down proteins, carbohydrates and fats. [1]

However, these important functions can be threatened by the hepatitis virus, of which there are five – hepatitis A, B, C, D, and E. Any of these can cause the liver to become inflamed.

“Hepatitis A and E are usually spread when people consume infected food and/or water, often due to conditions where personal hygiene or sanitation is poor. This is known as the faecal-oral route. The hepatitis A virus (HAV) can remain infectious on hands for several hours, on foods for several days, and on frozen foods, surfaces, and in faeces for several months. Consuming undercooked animal liver is the most common cause of hepatitis E. Meanwhile, hepatitis B, C and D viruses are transmitted through infected blood and other bodily fluids, with hepatitis B (HBV) being commonly passed from an infected mother to her child during pregnancy or childbirth. Other forms of transmission of hepatitis B, C and D viruses include unprotected sex with an infected partner, sharing of needles and other exposure to contaminated blood. The hepatitis D virus (HDV) is known as a ‘satellite virus’ as it relies on HBV to replicate. Hence, it can only infect people who are also infected with HBV” said Dr Chua Siew Houy, a general physician and rheumatologist at IMU University.

Silent yet Deadly
Hepatitis A, B and C are common in Malaysia and most cases are self-limiting but Dr Chua advises that we should not take it lightly – approximately 1 million individuals are chronically infected with HBV, which accounts for over 80% of liver cancer in Malaysia. [2]



As viral hepatitis infections can be asymptomatic, many remain unaware that they are infected. More worrisome is the fact that, even without symptoms, these individuals are still contagious and could unknowingly infect others, said Dr Chua. Meanwhile, those who do experience symptoms may have:
fever fatigue loss of appetite nausea and/or vomiting abdominal pain dark urine jaundice (yellowing of the skin/eyes) pale-coloured stool
The only way to confirm viral hepatitis is to get a blood test. As many are asymptomatic, viral hepatitis is often discovered incidentally through routine screening tests. In a community-based chronic hepatitis B (CHB) screening campaign in Malaysia, it was found that only approximately 13% of the people who were tested positive for CHB were aware of having hepatitis B.[3] Therefore, to close the gap and break the chain of infection, screening and vaccination are important, alongside a healthy lifestyle.

Turning the Tide of Hepatitis
Vaccination is an effective method to protect against both HAV and HBV, with the hepatitis B vaccine given to infants within 24 hours of birth. Thereafter, the follow-up doses are given in a combination vaccine at 2, 3 and 5 months of age. [4]

Those who are unsure of their vaccination status or at higher risk of HBV should be screened for their immune status and consider booster doses if needed, advised Dr Chua. These include:
patients with chronic liver disease those who are immunocompromised intravenous drug users men who have sex with men travellers to areas of high endemicity healthcare workers
Treatment is available for viral hepatitis to eradicate the virus and prevent liver disease progression. Expectant mothers who test positive for hepatitis B, especially those with a high viral load, can be given antiviral medications, alongside hepatitis B vaccination and immunoglobulin injections for their child immediately after birth to reduce the risk of perinatal HBV transmission, and thus minimise the child’s risk of developing CHB later in life. While there is no vaccine available for hepatitis C, effective treatment is available in the form of direct-acting antivirals (DAAs), an effective therapy with a success rate of more than 95%,[5] she said.

To further reduce the risk of infection to yourself and avoid passing it to others, it is important to practice good personal hygiene and practice a safe and healthy lifestyle. This begins in the home with:
avoiding contact with infected blood and bodily fluid cleaning blood spills with bleach covering any wounds or cuts discarding blood-stained items (including feminine hygiene products) in separate plastic bags to avoid contamination ensuring good sanitation washing hands thoroughly with soap and water before eating and after using the toilet
In addition, it is also important to:
avoid high-risk activities such as unprotected sex and injecting drugs ensure that any needles used for acupuncture, body piercing and tattoos are new and sterile [6] make careful food choices, as hepatitis A and E are often transmitted through contaminated food and water, especially in foods like raw shellfish wash fruits and vegetables before eating [7],[8]
“All these precautions – screening, vaccination, and lifestyle – are important to help reduce the risk of infection and prevent hepatitis from spreading further among our population,” said Dr Chua. “Remember, vaccination not only protects yourself but others too, especially the ones closest to you.”

[1] Cleveland Clinic. Liver. https://my.clevelandclinic.org/health/articles/21481-liver
[2] Raihan R. Hepatitis in Malaysia: Past, Present, and Future. Euroasian J Hepatogastroenterol. 2016 Jan-Jun;6(1):52-55. doi: 10.5005/jp-journals-10018-1167. Epub 2016 Jul 9. PMID: 29201726; PMCID: PMC5578560.
[3] Lim, Zz., Teo, J.s., Tan, AC. et al. Awareness and treatment of chronic hepatitis B in Malaysia-findings from a community-based screening campaign. BMC Gastroenterol 22, 374 (2022). https://doi.org/10.1186/s12876-022-02458-9. https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-022-02458-9#
[4] MyHealth, Ministry of Health Malaysia. Immunisation Schedule. http://myhealth.moh.gov.my/en/immunisation-schedule/
[5] Ministry of Health Malaysia. Clinical Practice Guidelines: Management of Chronic Hepatitis C in Adults. https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-022-02458-9#
[6] Hepatitis B Foundation. Prevention Tips for Hepatitis B. https://www.hepb.org/prevention-and-diagnosis/prevention-tips/
[7] MyHealth, Ministry of Health Malaysia. Hepatitis A. http://myhealth.moh.gov.my/en/hepatitis-a-4.
[8] Medline Plus. Preventing hepatitis A. https://medlineplus.gov/ency/patientinstructions/000422.htm

---