As per the National Viral Hepatitis Control Program (NVHCP), in India, an estimated 40 million people suffer from Hepatitis B, and 6 to 12 million people suffer from Hepatitis C. Hepatitis B virus is also responsible for around 70 per cent of liver cirrhosis and 80 per cent hepatocellular carcinoma in the country.
Viral Hepatitis is a systemic infection affecting liver predominantly by any one of the hepatitis viruses. Most common viruses causing are Hepatitis A, B, C, D, E and G. Other less common causes are by Cytomegalovirus, Epstein-Barr virus, Herpes Simplex virus and Falciparum Malaria. 0n exposure to the virus, about two-thirds of patients do not develop any symptoms. Others may develop fulminant and fatal acute infections on one hand, and from subclinical persistent infections to rapidly progressive chronic Liver disease leading to Cirrhosis and Hepatocellular Carcinoma.
It spreads through the feco-oral pathway and is linked to poor sanitary conditions. HAV infection is frequent in underdeveloped countries such as India during childhood, resulting in mild hepatitis and posing little danger during pregnancy.
HBV is transmitted through needle stick injuries, tattooing, piercing, and contact with contaminated blood and body fluids such as saliva, vaginal and seminal secretions. Acute infection is manifested by flu-like symptoms. Approximately 90% of individuals have spontaneous resolution of acute infection, 5-10% would become chronic carriers.
It is often transmitted from mother to child at birth (perinatal transmission) or through exposure to maternal blood, vaginal secretions during delivery or acquired during breastfeeding. If a patient tests positive for Hepatitis B virus, HBV antiviral medication should be continued during the pregnancy and after delivery.
Pregnant women may experience fatigue, nausea and vomiting, abdominal pain or discomfort, loss of appetite, low-grade fever, dark urine, and joint pain. In addition the routine screening for Hepatitis B is done in pregnant women.
HEV can also be transmitted through feco-oral route. Pregnant women with Hepatitis E, especially those in their second or third trimesters, are at increased risk of acute liver failure, foetal loss and death.
In most cases , acute or chronic HBV infection in pregnancy is not different from that occurring in non- pregnant women. Out come of maternal infection is strictly dependent upon the stage of the disease. Patients with advanced disease may develop jaundice, rupture of oesophageal varices, liver failure.
Maternal infection with viral Hepatitis can lead to increased incidence of low birth weight and preterm births. During your pregnancy, pregnant women undergo blood tests for 3 infectious diseases: hepatitis B, HIV and syphilis. Babies born to a mother with hepatitis B have a greater chance of developing chronic hepatitis if they are not properly treated at birth. It is very important that pregnant people know their hepatitis status in order to prevent passing the virus on to their newborn baby during delivery.
MEASURES FOR PREVENTION
Improving hygiene conditions and providing safe, clean drinking water helps in preventing HAV and HEV spread. Active screening of high-risk groups for HBV, HCV infection helps in identifying carriers and preventing community transmission.
Awareness about Viral Hepatitis, their modes transmission and preventive measures among community helps to curb these infections.
In addition, screening of blood and blood products, as well as routine testing of tissue and organ donors, are part of the HBV and HCV infection prevention approach.
Vaccination is the most effective method of preventing HAV and HBV because these are vaccine- preventable diseases.
(Dr Naresh Purohit is Epidemiologist And Advisor- National Viral Hepatitis Control Programme. The views expressed here are of the author)