Hepatitis B and C are viral infections of the liver. Both can inflict chronic damage to the liver, resulting in chronic sickness, liver failure, and death. Lack of awareness among people makes them inadvertently acquire or transmit the infection. The hepatitis virus gains entry in the body by transfusion of contaminated blood and blood products containing the virus, or by unsterilised needles and syringes used for injections. People using injections for addictions are at high risk for infection. Tattoos made by contaminated needles, pricking of ears, dental interventions, haircuts or shaves with infected tools can all lead to infection. Hepatitis B spreads by unprotected sexual intercourse. Spread of Hepatitis C by unprotected sexual intercourse is controversial. However, sexual activity involving trauma to the soft part covering of the anus or genital parts can facilitate the spread of infection. Presence of ulcers and or discharge over the delicate sex organs, facilitates the acquisition of both hepatitis B and hepatitis C. Immune depressed persons like those with HIV infection or uncontrolled diabetes are more susceptible to acquire them, if exposed. The infection can pass from mother to child during pregnancy. After getting infected by one of these viruses, one may not have any problem initially. Vague unexplained fatigue or loss of appetite may be the only symptoms. But during this period, the individual is capable of transmitting the infection to others. As liver damage starts, overtime, a person starts getting sick. There is loss of appetite, nausea and vomiting, jaundice, (yellow discolouration of eyes), generalised itching, one or more of these symptoms. Later on, gradual destruction of hepatic cells occurs, what is known as hepatic cirrhosis. Due to cirrhosis, there is accumulation of fluid in the abdomen (ascites) causing distensions swelling over the body as the disease progresses. Due to deranged liver function, deficiency of proteins and clotting factors occurs. There may be bloody vomit and or bloody stool due to deficiency of clotting factors. Fat and glucose metabolism of the body is deranged. Nutrition of a person is affected due to anorexia and protein deficiency, making one sicker. External or internal bleeding further aggravates the illness. With further liver damage, mental state is altered. Then one gradually slips into a coma and dies. Sickness progresses more rapidly in people having liver damage due to other factors like alcohol, pain killer drugs, exposure to heavy metals, and etcetera. Diagnosis of hepatitis B and C is made by serological tests and PCR (polymerase chain reaction) for the virus. Treatment is by antiviral drugs which are effective in controlling the disease progress, unless it is very advanced. Vaccination is available for hepatitis B, but not for hepatitis C. Ultimate treatment when cirrhosis or liver cancer has developed remains a liver transplant. This is a very expensive and cumbersome procedure and not available easily. In a nutshell, it can be said that if a person gets infected by hepatitis B or C, he or she is bound to lose quality of life. Therefore, it is better to prevent this illness. Use of clean sterilised tools for any intervention, minimises the risk of acquiring viral hepatitis. Safe, protected sexual activities help in preventing Hepatitis C. Moreover, if somebody has any suspicion of hepatitis B or C, it is better to get tested rather than delay the diagnosis, thus exposing liver to further damage. Ministry of Health in Rwanda has initiated very good policy for prevention, diagnosis and management of hepatitis B and C, down till community level. Now with greater awareness among people, easily available vaccines and tests, prevalence is bound to decrease. Dr Rachna Pande, Specialist, internal medicine rachna212002@yahoo.co.uk
