Hepatitis is an umbrella term used to describe inflammation of the liver. This disease can be caused by hepatitis viruses or other factors such as alcohol, drug abuse, or autoimmune disorders. Hepatitis is often considered a silent killer because most patients do not initially experience signs or symptoms of the disease. It is usually detected very late in its progression, which severely limits treatment options and quality of life. Complications of hepatitis can include liver cirrhosis and liver cancer, both of which can be fatal.
The World Health Organization (WHO) 2024 Global Hepatitis Report reveals that infectious hepatitis is one of the leading causes of infectious deaths, with a staggering 1.3 million deaths annually worldwide. On average, about 3,500 people die daily from Hepatitis B and Hepatitis C infections. The same report also estimates that about 6,000 people are newly infected each day globally. The implementation of the Malaysian National Strategic Plan for Hepatitis B and C is an example of steps being taken to curb hepatitis infections and reduce mortality.
Symptoms for hepatitis
Patients with chronic hepatitis typically exhibit symptoms once liver function has deteriorated. Common symptoms include fever, nausea, vomiting, body aches, stomach pain, poor appetite, and jaundice, which is the yellowing of the skin and the sclera (the white part of the eyes).
Types and causes of hepatitis
Among infectious hepatitis, five strains of the hepatitis virus have been identified which are A, B, C, D, and E. All five are of major concern as they pose a severe threat to public health, potentially causing outbreaks that can cripple healthcare institutions and result in deaths:
- Hepatitis A and E are transmitted through ingestion of food or water contaminated with hepatitis virus.
- Hepatitis B, C, and D are transmitted from a carrier through shared needles, unprotected sexual activities, and during childbirth. Unvaccinated children are particularly vulnerable if there is exposure to body fluids from close contact with carriers, such as family members.
In Malaysia, more emphasis is placed on preventing Hepatitis B and C due to their severity in causing deaths both locally and globally.
Vaccination to prevent hepatitis B in Malaysia
Hepatitis B vaccination for infants has been introduced in Malaysia since 1989. This vaccination consists of three doses given at birth (within 24 hours), at 1 month, and at 6 months of age. A study conducted locally in 2010 showed that individuals born after 1989 have much lower rates of exposure to the hepatitis virus compared to those born before the vaccination program. This underscores the adage that prevention is better than cure.
Treating Hepatitis B and C
Hepatitis B and C treatment is generally started for chronic hepatitis patients or severely ill viral hepatitis patients with liver failure. Before starting treatment, patients will be assessed for the severity of their illness and the presence of other chronic infections. The goal of treatment is to slow the progression of cirrhosis, reduce the incidence of liver cancer, improve survival rates, and reduce transmission to others.
Most patients who start treatment will be given oral antiviral tablets. These antiviral tablets can be classified into nucleoside reverse transcriptase inhibitors (NRTIs) and direct-acting antivirals (DAAs). These medicines work by slowing down or stopping the hepatitis virus from replicating, thereby reducing the number of viruses in the body and subsequently slowing the progression of liver damage. Some patients might be treated with a single agent, while others might require a combination of antivirals.
It is important for patients on such regimens to comply with their medicines by not missing any doses, taking the medicines at the scheduled times, and using reminders or alerts to prevent missed doses. Consistently taking the antivirals ensures that there is always adequate concentration of medicine in the body to suppress the virus and its replication. Failure to adhere to the medicine schedule will result in lower concentrations of the medicine, leading to treatment failure.
If a patient experiences any side effects from the antivirals, it is important to seek medical attention. Doctors and pharmacists can assist patients in managing side effects or adjusting the treatment regimen. Some commonly experienced side effects include headaches, lethargy, and nausea.
Advice to the public
Everyone, including hepatitis patients, is always advised to maintain healthy lifestyle habits. This includes eating balanced meals, staying hydrated, and keeping active. It is important to avoid or reduce alcohol consumption and to seek advice from a doctor or pharmacist before starting any medicines, supplements, or traditional treatments.
It is advisable not to share personal items like nail clippers, toothbrushes, shavers, and trimmers. Practicing safe sex will also reduce the transmission of infections. Hepatitis patients are not allowed to donate blood to prevent the transmission of the disease.
Individuals exposed to the risk of hepatitis infection are strongly recommended to undergo hepatitis viral screening, which will assist in starting early treatment. Parents are advised to ensure their children receive the full hepatitis B vaccination as per the National Immunisation Programme.Any further enquiries regarding medicines can be submitted to the National Pharmacy Call Center, NPCC through 1-800-88-6722 on Monday to Friday, from 8am to 5pm except on public holidays.
This article was prepared by Shangeetha Selarajoo (Pharmacist) from Hospital Putrajaya for Bahagian Amalan dan Perkembangan Farmasi (BAPF), KKM x The Malaysian Medical Gazette Series. It is hoped that this collaboration will help propagate information regarding medication to the general public.
References:
- https://www.worldhepatitisday.org/
- https://www.cochrane.org/ms/CD011644/LIVER_rawatan-perubatan-bagi-jangkitan-virus-hepatitis-c-akut
- https://www.beritaharian.sg/kesihatan/hepatitis-%E2%80%9Cpembunuh-senyap%E2%80%9D
- https://www.mmgazette.com/virus-hepatitis-b-c-ketahui-hepatitis-bertindak-sekarang-professor-madya-dr-ahmad-najib-azmi/
- https://www.who.int/news-room/q-a-detail/what-is-hepatitis
- https://www.webmd.com/hepatitis/faq-viral-hepatitis
- https://www.cdc.gov/knowhepatitisb/faqs.htm
- https://www.uspharmacist.com/article/the-pharmacists-role-in-identifying-treating-and-preventing-chronic-hepatitis-c
- https://www.healthline.com/health/hepatitis#causes
- https://www.mayoclinic.org/diseases-conditions/hepatitis-c/diagnosis-treatment/drc-20354284
- https://hepatitisc.net/treatment/direct-acting-antivirals
- https://www.cdc.gov/hepatitis-c/treatment/index.html
- https://www.mayoclinic.org/diseases-conditions/hepatitis-b/diagnosis-treatment/drc-20366821
- https://www.cdc.gov/hepatitis-b/treatment/index.html
- https://quest3plus.bpfk.gov.my/pmo2/detail.php?type=product&id=MAL20032401A
- https://go.drugbank.com/drugs/DB09102
- National Strategic Plan For Hepatitis B And C Malaysia 2019 – 2023