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Prognosis good for Hep B, C with screening, vaccines

Prognosis good for Hep B, C with screening, vaccines

Effective medicines and awareness have helped bring down the incidences of hepatitis B and C
Effective medicines and awareness have helped bring down the incidences of hepatitis B and C in society effectively | Photo by Anantha Subramanyam K

When Rahul’s grandmother needed to undergo urgent surgery, he willingly came forward to donate blood. But little did he know that this altruistic act would lead to his engagement being called off.

Soon after the donation, the blood bank informed him that his blood had tested positive for hepatitis B. Since one of the modes of transmission for Hep B and C is sexual contact, his fiancée’s family suspected the worst and called off the wedding.

And all for nothing.

Today, hepatitis B and C are curable with a high degree of success and there is also a vaccine for Hep B.


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What is hepatitis?

“Hepatitis is an umbrella term for liver diseases which are alphabetized as Hep A, B, C, D and E,” says Prof (Dr) Anil Arora, chairman and HoD, Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, New Delhi. “While Hep A and E are transmitted through the oral route and are acute in nature, Hep B and C are transmitted through the percutaneous route (through penetration of skin, mucosa or blood) and can turn the infected person into a chronic carrier until such time that they exhibit symptoms themselves.”

Hepatitis A and E

You can contract Hepatitis A and E through unhygienic food or contaminated water, known in medical terms as the fecal-oral route.  In fact, if you contract Hep A before the age of 20, recovery is largely incident-free, and you also become immune to it for life. The best prevention is to avoid potentially harmful food and drink. A Hep A vaccine is also available.

“Hep A and E are what we generally call acute jaundice,” says Dr Arvinder Soin, chairman and chief surgeon at the Medanta Liver Transplant Institute, Gurugram, Haryana. “The patient’s skin pallor becomes yellow, the bilirubin count is high, and the liver function tests come deranged. But 95 to 97 per cent of cases are self-limited and heal within a few weeks with the right medication. But in three to four per cent patients, there is severe liver failure, the albumin count goes down, they require hospitalisation and, eventually, may need a liver transplant.”

Pregnancy and Hep E

“Women in their third trimester need to be extra careful because if they contract Hep E at this time, the mortality rate is high,” says Prof Arora.

Dr Soin recalls having to perform a liver transplant on patients who came with Hep E in their third trimester. “We had to perform a hysterotomy first to remove the baby from the womb like a Caesarian section,” he says. “The baby was put in the neo-natal incubator because in the third trimester the fetus is not fully developed. Then the liver transplant was performed on the mother.”

Hep B and C

The more dangerous hepatitis versions are Hep B and C. “The good news, however, is that these are now treatable,” Dr Soin says. “We now have a vaccine for Hep B which is administered as a part of our national immunisation programme. We also have very effective medicines to treat both Hep B and C. Hep C treatment requires only one tablet a day for just a few months and in the case of Hep B also there is one daily tablet that must be taken for about two years.”

Spread of Hep B and C

Hepatitis B and C spread much in the same way as HIV – through blood transfusions, platelet transfusion, use of infected needles during ear or nose piercing, acupuncture, dental treatment, IV drug abuse or sexual contact.

Chronic carriers

“Once you are infected with Hep B, 95 per cent cases will develop symptoms of acute hepatitis within six months and recover,” says Prof Arora. “Five per cent cases will become chronic carriers and display symptoms only after as long as 20 years. These symptoms may be jaundice, swollen liver, scarred or fibrotic liver and at later stages this becomes cirrhotic liver. In the case of a Hep C infection, there is an 80 per cent chance that the patient will develop chronicity.”

Screening and vaccination

“The Hep B vaccine is cheap and readily available,” Dr Soin says. “Everyone should be vaccinated against Hep B. Screening for both Hep B and C should be done to ensure that we can detect cases before the liver is damaged. In fact, a lot of employers are now demanding a screening report or mandating a Hep B vaccine before they make new hires.”

Screening is important because until as recently as 2001, blood banks were not testing donor blood for Hep C. So, anyone who has had a blood transfusion before that is at a stage where they may start showing the impact of chronicity if the blood they got was infected.

Screening is especially important for pregnant women and for newborns. “If an infected mother gives birth to a baby who is also positive, there is a 95 per cent chance for chronicity, which means that by the time the child is 20 or 25 years old, he will suffer from liver cancer,” says Prof Arora. “But if this child is vaccinated at birth, there is a 95 per cent chance that he will be safe. Hence screening for this category is of utmost importance.”

It is mandatory to screen pregnant women in India.


Early detection is important because effective treatment protocols now exist.

“It is easier to treat if the patient comes to us early when he may have an inflamed liver or a swollen liver,” says Dr Soin. “When the patient comes late, the damage to the liver is irreversible. With early detection, we can treat patients of Hep C with antiviral medicines that have a 99 per cent cure rate where earlier it was only about 40 per cent.” When detected late, 20 to 25 per cent cases can present as liver cancer, he says.

Prof Arora is quite hopeful that research going on the US will eradicate Hep C by 2030. “The researchers there are hopeful that by 2030 Hep C will cease to exist, becoming the first virus in the world to be completely eradicated,” he says.

Living with Hep B or C

Most patients can live normal lives with the current single-tablet daily dose treatments for Hep B and C. These medicines have very minimal side effects.

“You cannot get Hep B or C by hugging, by shaking hands or even normal close contact,” says Dr Soin. “Even in mouth-to-mouth kissing, you have a one-fifth chance of contracting the virus.”

So, did Rahul’s in-laws really need to break off the engagement?

“In case one partner is detected with Hep B or C, the couple can still live together till the patient is cured,” says Dr Soin. “They can have sexual relations by following safe-sex protocols and wait till the medication brings down to viral load and it is negative for the virus before planning a child. The uninfected partner can get vaccinated for Hep B and be safe.”


Dr Soin says that the outlook for Hep B and C is quite good since the incidences are on a decline. “We saw a spike in 2015-16,” he says. “This was largely people who may have got infected between 1985 and 2000. But now there is a decline. Fifteen years ago, the most prevalent reason for a liver transplant was Hep C and Hep B was the number three reason. Now Hepatitis B and C are the last two reasons for liver transplant.”

The message, however, is that awareness, screening and vaccination are a must.

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