Prevention of hepatitis C Since hepatitis C is transmitted in much the same way as hepatitis B, you can help avoid infection by using some of the same precautions. Always use barrier protection during sexual contact; practice good personal hygiene; and never share needles, razors, toothbrushes, or pierced earrings with anyone. All donated blood is screened for the virus. Currently there is no vaccine against hepatitis C though there are a number under development. The most effective therapy for hepatitis C is a drug combination consisting of pegylated interferon and ribavirin (UCSF, 2020): Pegylated interferon is taken weekly as an injection and ribavirin is a twice-daily tablet. The treatment is a form of chemotherapy and the ability to tolerate it varies widely for each person. Hepatitis D (HDV) The delta virus (also known as hepatitis D ) is a defective virus that may cause infection only in the presence of active hepatitis B infection. The symptoms and routes of transmission are similar to those of hepatitis B infection but are particularly significant with intravenous drug abusers and pregnant women. Hepatitis D may be acute, coming on suddenly with severe symptoms, and may end without treatment. It is considered chronic if it lasts for six months or longer. Chronic hepatitis D develops gradually, and the virus may exist in the body for months without any symptoms. As the virus continues to develop, severe complications may occur including cirrhosis. Hepatitis E Hepatitis E (HEV) is a viral infection that causes liver disease. It is estimated that 20 million cases exist worldwide with 3.3 million symptomatic cases. This virus is transmitted through the fecal-oral route and is common in East and South Asia and is often found in contaminated water and undercooked meat. It may be spread through contaminated blood and pregnant mothers may pass it to babies. There are four types of the virus, with genotypes 1 and 2 infecting humans and genotype 3 and 4 affecting animals, like pigs and deer, that may infect humans. It usually lasts from two to six weeks before re-solving but can develop into acute liver failure which can be fatal. There is a vaccine developed and used in China, but it is not available elsewhere. There is no real treatment for HEV, but for some immune- suppressed patients, ribavirin antiviral drugs and interferon in some cases have been effective. Medications are used to manage symptoms, which include: ● An initial phase of mild fever, reduced appetite (anorexia), nausea, and vomiting, lasting for a few days; some persons may also have abdominal pain, itching (without skin lesions), skin rash, or joint pain.
A patient's response will depend on the particular type of hepatitis C, known as the "genotype." In the U.S., genotypes 1, 2 and 3 account for most cases. Interferon-ribavirin cures about 40% of genotype 1 cases and 80% of cases with genotype 2 or 3. Other factors that improve a patient's chances of cure include low viral level, normal liver function and normal weight. In most people, interferon-ribavirin causes flu-like symptoms with muscular aches, irritability, loss of appetite, and depression. Rashes and hair loss also may occur. Interferon and ribavirin both reduce blood cell counts, which may require dose reduction or discontinuation of treatment. Regular laboratory testing during the treatment is essential. Some people find they cannot continue to work on this regimen, which lasts either 48 weeks for genotype 1 or 24 weeks for genotypes 2 and 3. Finally, the cost of the medication is high, making insurance coverage essential. There is no vaccine or cure, but the disease can be prevented, if the person is not infected with hepatitis B, through HBV immunization, blood and injection safety procedures, and other practices to prevent HBV transmission. HBV immunization will not protect against HDV if the person is already infected with HBV. The current treatment guidelines recommend the use of pegylated interferon alpha for at least 48 weeks (WHO, 2019a). Response to treatment may be low but can slow the progression of the disease and help prevent liver failure. ● Jaundice (yellow color of the skin and whiteness of the eyes), with dark urine and pale stools. ● A slightly enlarged, tender liver (hepatomegaly). (WHO, 2019b) Prevention Prevention is the most effective approach against the disease. At the population level, transmission of HEV and hepatitis E disease can be reduced by: ● Maintaining quality standards for public water supplies. ● Establishing proper disposal systems for human feces. (WHO, 2019b) On an individual level, infection risk can be reduced by: ● Maintaining hygienic practices. ● Avoiding consumption of water and ice of unknown purity. (WHO, 2019b)
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