New Delhi, March 22, 2021: On World Water Day, while we all should aim to save the most precious gift and a vital life source, we must also focus on improving water supplies and hygiene. You must be wondering why, so let me explain the impact of poor water hygiene on health. Worldwide, 2.2 billion people lack access to safely managed drinking water, and 4.2 billion people lack safe sanitation. Unsafe hygiene practices are widespread, compounding the effects on people’s health. The impact on child mortality rates is devastating, with more than 2,97,000 children under five die annually from diarrhoeal diseases due to poor sanitation, poor hygiene, or unsafe drinking water.
In India, the problem of unsafe water is a substantial public health concern. Apart from illnesses such as diarrohea, jaundice, etc., unsafe water also contributes to Hepatitis A & E. Both these diseases are associated with inadequate and unsafe water supplies, poor sanitation & hygiene, leading to infection and inflammation of the liver.
What is Hepatitis A and E? Hepatitis A and E viruses are RNA virus, which primarily infects the liver, causing inflammation of the liver (Acute Hepatitis). Infection with Hepatitis A & E is usually self-limiting.
How is the infection acquired? Hepatitis A or E is spread primarily through food or water contaminated by faeces from an infected person (feco-oral route). It enters the liver from our gut and is then excreted again by our gut into the stool, thus completing the infection cycle.
Who are at risk for Hepatitis A or E? Not everyone who’s infected will have any evidence of this disease, as it may go unnoticed (asymptomatic disease). But still, these people can excrete viruses in their stool and continue to infect others (carriers).
Asymptomatic disease: India being a developing nation with poor sanitation conditions, more than 95% of children below five years of age are usually infected with these viruses, with an asymptomatic course. Thus, in India, antibody to Hepatitis A virus is nearly universally detectable by adolescence, and antibody to HEV increases during young adulthood to reach about 40% in adults.
How does it spread? Hepatitis A is usually spread person-to-person through food or water contamination. An infected person’s hands can become the source of infection after using the bathroom. The virus then spreads by direct contact or by food, beverages or other objects that the infected person handled. An infected individual can transmit the virus to others as early as two weeks before the symptoms begin to appear.
Symptomatic disease: International travellers to India, children from high-income families are at risk of developing Hepatitis A or E infection because they do not eat much from the streets and have not developed the required antibodies resulting in fever, stomach-ache and jaundice.
What are the symptoms of Hepatitis A or E?
- Stomach upset
- Loss of appetite
- Dark yellow urine
- Yellowish eye & skin called jaundice
Why is it dangerous? Unlike Hepatitis B & C, Hepatitis A does not cause Chronic Liver Disease and is rarely fatal. But it can cause debilitating symptoms and Fulminant Hepatitis (Acute Liver Failure), which is often fatal. Fulminant Hepatic Failure leading to death is seen in 1.8 % adults, and 10% in pregnant ladies.
Most people with Hepatitis E get better within a few months. Usually, it doesn’t lead to long-term illness, or Liver damage like other forms of Hepatitis do. But Hepatitis E can be dangerous for pregnant women or anyone with weak immune systems, including the elderly or ill.
How to prevent it? The best approach is to take all precautions to avoid Hepatitis and ensure safe drinking water for all. Make sure that your water source is clean and well maintained. Apart from this, follow this:
- Hand sanitation: Frequent handwashes before meals and after using the washroom.
- Avoid eating outside, especially if you are pregnant.
- Hepatitis A vaccine: Vaccinate your children below six years (consult a paediatrician about this).
If you identify any of the above symptoms, kindly meet your Gastroenterologist for timely treatment and care to resolve the infection with expected full recovery.
(Dr Sonali Gautam, Consultant-Gastroenterology, Hiranandani Hospital, Vashi, a Fortis network hospital; Image from Pixabay)