Invest In Eliminating Hepatitis. – Pink Salt Initiative

Invest In Eliminating Hepatitis. – Pink Salt Initiative

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Hepatitis is an inflammation of the liver. The  condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.(World Health Organization [WHO],2018). Hepatitis is easily transmitted and causes high morbidity and prolonged loss of time from school or work.

World Hepatitis Day,is celebrated every  28th of July, which is an opportunity to step up national and international efforts on hepatitis, encourage actions and engagement by individuals, partners and the public and highlight the need for a greater global response as outlined in the WHO’s Global hepatitis report of 2017. July 28th was chosen by  the “World health organization” (WHO) because it was the birthday of Nobel-prize winning scientist “Dr Baruch Blumberg”, who discovered hepatitis B virus (HBV) and developed a diagnostic test and vaccine for the virus.

This year world hepatitis day was celebrated on 28th of July 2019,this global event was held in  Islamabad,Pakistan. The World Health Organization (WHO),urged all countries and partners to promote this year world hepatitis day theme “invest in eliminating hepatitis”,new estimates for additional investments  needed to achieve globally agreed hepatitis elimination goals by 2030,in the context of the universal health coverage was released.

Do you know that?
325 million people are living with viral hepatitis B and  C; 2,850,000people became newly infected in 2017. 80% of people living with hepatitis lack prevention, testing and treatment.
Viral hepatitis B and C affect 325 million people worldwide causing 1.4 million deaths a year. It is the second major killer infectious disease after tuberculosis, and 9 times more people are infected with hepatitis than HIV. Hepatitis is preventable, treatable, and in the case of hepatitis C, curable. However, over 80% of people living with hepatitis are lacking prevention, testing and treatment services.

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Types of Hepatitis
Hepatitis is classified according to its causes which are:

  • Viral hepatitis
  • Nonviral hepatitis
  • Toxic hepatitis
  • Drug-induced hepatitis

Viral hepatitis
Viral hepatitis is a viral infection in which there is necrosis and inflammation of liver cells producing the features of clinical, biochemical and cellular changes. To date,there are five definite types of viral hepatitis causing liver disease have been identified: hepatitis A,B,C,D and E. Hepatitis A and E are similar in mode of transmission (feacal-oral route), while hepatitis B,C and D share same characteristics.

Hepatitis A virus
Hepatitis A virus, was formerly called “infectious hepatitis”, which is caused by an RNA virus of the enterovirus family.
The incubation period is between 2 and 6 weeks, it may be prolonged lasting to 8 weeks.

  • More severe in people older than 40 years.
  • It is transmitted primarily through the feacal-oral route.
  • Ingestion of food or liquids infected with the viral.
  • It is more prevalent in countries with overcrowding or poor environmental sanitation.
  • Children or young adults acquire the infection at school through poor hygiene, hand-to-mouth contact or other close contact.
  • An infected food handler can spread the disease.
  • Consuming water or shellfish from seweage-contaminated waters.
  • It can be transmitted during sexual activity,this more likely with oral-anal contact or anal intercourse and with multiple sexual partners (Goldman & Schafer,2012).

Signs and symptoms of hepatitis A virus. It may occur with or without symptoms,but when symptoms are present,they resembles those of flulike upper respiratory tract infection with low grade fever,anorexia(loss of appetite), jaundice (yellowish coloration of the skin and sclera),dark urine, indigestion,development of strong aversion to the taste of cigarettes or other strong odours.

Diagnosis of hepatitis A:
Enlargement of the liver and spleen, presence of jaundice, hepatitis A antigen in the stool 7 to 10 days before illness and for 2 to 3 weeks after symptoms appear.

Hepatitis B Virus
Unlike hepatitis A virus (HAV), hepatitis B Virus (HBV) is transmitted majorly through blood routes. It has the incubation period of 28-160 days.
It remains the major worldwide cause of liver cirrhosis and cancer. In fact, approximately 15% of those who Develop chronic hepatitis B during adulthood die of cirrhosis or liver cancer.

  • Hepatitis B Virus can be found in blood,saliva,semen and vaginal secretions.
  • HBV can be transmitted through mucous membrabea and breaks in the skin.
  • It can also be transferred from carrier mothers to their infants during birth and close contact afterward, especially in areas with high prevalence (e.g Southeast Asia).
  • Most people (more than 90%) with HBV infection develop antibodies and recover spontaneously within months.
  • In some cases, hepatitis B progress to chronic hepatitis, hepatocellular injury, and inflammation.

Risk factors 

  • Frequent exposure to blood,blood products or other body fluids).
  • Hemodialysis.
  • Health care personnels e.g hemodialysis staff,nurses, doctors, dentists,operating room staff and etc are at risk of needlesticks pricks.
  • Male homosexual and bisexual activities.
  • Close contact with carrier or hepatitis B Virus.
  • Mother-to-child transmission.
  • Multiple sexual partners.
  • Recent history of sexually tranmitted infections.
  • Tattooing.

Signs and symptoms of Hepatitis B Virus (HBV) may occur with or without symptoms. Fever,loss of appetite, arthralgia, heartburn, abdominal pain, generalized body ache weakness and enlarged liver to 12 to 14 cm vertically.

Hepatitis C Virus.
Hepatitis C Virus (HCV) is caused by hepatitis C Virus. It is the most common chronic bloodborne infection nationwide. HCV is prevalence in adults 40 to 59 years of age. The incubation period is variable and may range from 15 to 160 days.
  Blood transfusions and sexual contact are accounted for most cases of hepatitis C Virus but can also be transmitted through sharing of contaminated needles by infusion or injection drugs users and unintentional needlesticks and other injuries.

The signs and symptoms of HCV is smilar to that of HBV but less severe and anteric.

Risk factors

  • Health care workers and public safety workers exposed to needlestick injuries or mucosal exposure to blood.
  • Multiple contacts with a hepatitis C virus-infected person.
  • Children born to women infected with hepatitis C Virus.
  • Illicit infusion or injection drug use.
  • Recipient of blood and its products or organ transplant.

Hepatitis D Virus
Hepatitis D virus (Delta  agent) infection occurs in some cases of hepatitis B. People with hepatitis B virus are at risk of hepatitis D because of the virus HBsAg requirement for its replication.The symptoms of hepatitis D are similar to those of hepatitis B, except that patients are more likely to develop fulminant hepatic failure and to progress to chronic active hepatitis and cirrhosis. It is common among infusion or injection drug users, hemodialysis patients,recipient of multiple blood transfusions and sexual contact. The incubation period varies between 30 and 150 days.

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Hepatitis E Virus
It is believd that hepatitis E virus (HEV) is transmitted through:

  •  Fecal-oral route,majorly through contaminated water in regions with poor sanitation. 
  • Incubation period is variable,estimated to range between 15 and 65days. Generally, hepatitis E resembles  hepatitis A.
  •  It has a self-limited course with an abrupt onser. Jaundice (yellowish coloration of the skin and sclera) is always present but chronic forms do not develop.

Some chemicals such has carbon tetrachloride, phosphorus, chloroform and gold compounds have toxic effects on the liver which results to acute liver cell necrosis or toxix hepatitis when inhaled,injected or taken by mouth.

At the beginning of disease,toxic hepatitis resembles viral hepatitis. Obtaining a history of hepatotoxic chemicals, medications, botanical agents or other toxic agents assist in early treatment and removal of the causative agent. Loss of appetite,nausea,vomiting, jaundice and enlarged liver are the usual symptoms.

  • Recovery from acute toxic hepatitis is rapid if the hepatotoxin is detected early and removed but recovery is unlikely if there is a prolonged period between exposure and onset of symptoms.
  •  There are no effective antidotes, vomiting becomes persistent containing blood, hemorrhages may appear under the skin, delirium,coma and seizures develop and within a few days the patient may die of fulminant hepatic failure.

Drug-induced hepatitis is the most common cause of acute liver failure. The signs and symptoms of sensitivity to a certain medication may occur on the first day of its use or until several months later.

  •  The onset is abrupt,with chills,fever,rash,pruritus(itching), arthralgia,loss of appetite, nausea, jaundice,dark urine and an enlarged and tendered liver.As soon as the offending medication is stopped, symptoms may gradually subside. However,the reactions can be severe or fatal even if the medication is withdrawn. 
  • Drugs causing drug-induced hepatitis includes analgesics, anesthesics , antidepressants, anticonvulsants,rheumatic and antituberculosis drugs.
  • Liver transplantation is an option for drug-induced hepatitis,but the outcome may be unsuccessful as with other causes of liver failure.

Prevention of Hepatitis

Hepatitis A

  • Proper home and community sanitation.
  • Effective handwashing.
  • Good personal hygiene.
  • Effective health supervision to schools, dormitories,hostels, barracks and camps.
  • Vaccination for travellers to developing countries, illegal drugs users, homosexual men, people with chronic liver diseases and health care workers.
  • Pre-exposure vaccination for all children 12-23 months of age and existing immunization programs for children 2-18 years of age( 3 doses,the second dose is given 1 month after the first and the 3rd doses is given 6 to 12 months later).

Hepatitis B

  • Vaccination for person at risk for infection by sexual,mucosal or percutaneous exposure to blood.
  • Vaccination should be given to international travellers to regions with high or intermediate levels of endemic hepatitis B virus infection.
  • Infants should be vaccinated regardless of the mother’s hepatitis B status.
  • Screening of blood donors and blood products.
  • Disposable syeinges,needles and lancents should be used.
  • Avoid high-risk behaviors.
  • Make use of standard precautions in the health care settings.
  • Use barrier precautions (gloves,gowns etc) in situations or contact with blood or body fluids.

Hepatitis C

  • Use barrier precautions in health care settings.
  • Use barrier precautions (gloves,gowns etc) in situations or contact with blood or body fluids.
  • Early testing.
  • Avoid sharing of toothbrushes and razors.
  • Use condoms during sexual intercourse.
  • Hand hygiene.
  • Reduce contact with blood or blood-containing secretions.
  • Health workers should handle blood of patients ad potentially infective.
  • Dispose used needles properly.
  • Use barrier precautions (gloves,gowns etc) in situations or contact with blood or body fluids.


  • Fulminant hepatic failure.
  • Chronic hepatitis.
  • Liver cirrhosis.
  • Cancer of the liver.

Know. Prevent. Test. Treat. Eliminate Hepatitis.

Are you at risk? Get tested! Early testing means early treatment to prevent illness and to save your life.


  • There is no specific treatment or therapy for viral hepatitis Recovery from symptoms following infection may be slow and may take several weeks or months.
  • Hospitalization is unnecessary in the absence of acute liver failure. Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhea.
  • Adequate rest to assist the liver cell  regenerating.
  • Adequate diet (food high in calories,high-protein, low-fat diet and vitamins) for healing and liver cell regenerating.
  • Avoid consumption of alcohol.
  • Avoid of unnecessary medications. Acetaminophen / Paracetamol and medication against vomiting should not be given.
  • There are no specific drug therapies for treatment of viral hepatitis,but supportive therapy may be used to help decrease the active viral replication such as antiemetics e.g dimenhydrinate (Dramamine) and neucleosides analogs e.g Lamivudine (Epivir).

Hepatitis (A  and B) vaccine

Nearly 100% of people develop protective levels of antibodies to the virus within 1 month after injection of a single dose of vaccine. Even after exposure to the virus, a single dose of the vaccine within 2 weeks of contact with the virus has protective effects. Still, manufacturers recommend 2 vaccine doses to ensure a longer-term protection of about 5 to 8 years after vaccination.

Millions of people have received injectable inactivated hepatitis A vaccine worldwide with no serious adverse events. The vaccine can be given as part of regular childhood immunizations programmes and also with other vaccines for travellers.

For Further Reading:

American Association for the study of Liver Diseases (AASLD) 703-299-9766

Brunner and Suddath(2015) Textbook of Medical-Surgical Nursing (13th edition).

Medical -Surgical Nursing; Assessment and management of Clinical problems (11th edition) pg 1088-1100

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