Hepatitis is inflammation of the liver and is often caused by a virus. Of the viruses responsible, A, B and C are the most serious. Hepatitis A is usually asymptomatic (showing no symptoms) in toddlers and children but can cause serious illness in adults and pregnant women. Hepatitis B and C can lead to chronic disease and are the most common cause of cirrhosis of the liver and liver cancer.
Causes
Hepatitis A is mostly caused by ingesting food or water contaminated by the faeces of people infected with the virus – a growing concern in South Africa, with the collapse of sewerage infrastructure. Dr Anthony Turton of the University of the Free State Centre for Environmental Management reports that “cholera is only one of the risks we are facing from raw sewage in our rivers. Hepatitis A is a waterborne pathogen directly related to sewage-contaminated rivers”. Having anal sex can also put you at risk.
Hepatitis C is caused by exposure to infected blood; and hepatitis B, by contact with any infected body fluids – blood, semen and vaginal fluids. You are at risk if:
- You live with someone who may have hepatitis B or C.
- You were born to an infected mother (the viruses can be passed on in body fluid at birth).
- You are a healthcare provider.
- You have an STI or are at risk of this (having multiple sex partners, not always using condoms).
- You share needles, razors, nail clippers or toothbrushes that may be contaminated with blood.
- You have tattoos or piercings done using unsterile equipment.
Signs
“Acute hepatitis A is usually asymptomatic in infants and children, but may cause fatigue, nausea, loss of appetite, fever and muscle pain in older children and adults,” says Dr Albie de Frey, CEO of The Travel Doctor. “Infection leads to life-long immunity. Acute hepatitis B and C are mostly asymptomatic or with similar mild symptoms. After many months to years, they may cause more distinctive symptoms: dark urine, pale or grey stools, jaundice (yellowing of the skin or eyes), and pain in the upper right abdomen (where your liver lies). If you notice these, see your health provider at once.”
Prevention
Prevention is the safest approach. For hepatitis A, that means making sure the water you drink or bathe in is clean, and always washing your hands after using the toilet or changing nappies, and before preparing food.
For hepatitis B and C, it means using condoms every time you have sex, not injecting drugs and sharing needles, and being careful having tattoos or piercings. It also means getting vaccinated.
Vaccination for hepatitis B has been part of South Africa’s Expanded Programme of Immunisation (EPI) since 1995, given to children at the ages of 6 weeks, 10 weeks, 14 weeks and 18 months. “If you were born before 1995, or did not receive at least three hepatitis B vaccines, you should be vaccinated, as about 40% of South Africans have been infected with this virus and some are carriers that can infect others,” says De Frey. “It’s never too late to vaccinate!”
Vaccination for hepatitis A is not part of the EPI, but it’s recommended within the private health sector as part of the routine childhood immunisation schedule and for all non-immune adults, says Clicks pharmacist Waheed Abdurahman. Two doses provide life-long protection. Speak to your health provider or pharmacy about getting you and your children immunised.
“Roughly 3 million South African adults have not had hepatitis A in childhood and are exposed every time they eat or drink in South Africa, especially with the collapse of water and sanitation,” says De Frey. “Hepatitis A, B and C are all around us, you do not have to travel anywhere else to get infected.”
There is no vaccine yet for hepatitis C, “but very effective (although expensive) treatment is available,” he says.
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