The hepatitis – not only the C, which is the best known, but also the others – are still today a global health problem. «The attention of the scientific community in this area is directed to viral hepatitis which can be acquired orally, such as hepatitis A and hepatitis E, but above all to those which can be transmitted parenterally, i.e. hepatitis C, hepatitis B, theDelta hepatitis» he declares Claudio MastroianniPresident of the Italian Society of Infectious and Tropical Diseases – SIMIT.
In Italy, great strides are being made in the prevention and treatment of these pathologies. As regards hepatitis B, for example, our country represents a real example, “given the compulsory vaccination at birth introduced in 1991, thanks to which the virus is almost absent in the under 40 population”, continues the specialist. «A new specific effective drug was recently approved for Delta hepatitis, but an expansion of the screening of subjects with hepatitis B, on which the Delta virus is grafted, is needed». For hepatitis C, on the other hand, important screening campaigns have been launched to bring out the hidden cases and, to date, “HCV can be definitively eradicated in 98% of people, thanks to the new direct-acting antiviral drugs (DAA ».
At the moment, two paths are being taken to combat hepatitis in Italy and in the rest of the world: «on the one hand, diagnostic tests and pathways for starting treatment, increasingly rapid and simplified, to be carried out within the liver centres; on the other, screening activities to discover the submerged”, he explains Vincent Calvaruso, National Secretary of the Italian Association for the Study of the Liver – AISF. “The problem, in fact, is that it is often not easy to recognize the onset of the disease, especially in asymptomatic subjects”.
Hepatitis A
Hepatitis A is generated by virus HAV and is transmitted via the fecal-oral route. In most cases it is due toingestion of contaminated foodabove all fish or raw foods prepared without respecting hygiene standards. The virus can be found both in mussels (oysters, mussels, raw clams), and in other foods that have not been washed well or cooked with contaminated water and obviously in water and ice (therefore beware of drinks with ice, smoothies, unpeeled fruit , raw vegetables or unsealed bottled water).
The patient can transmit the virus only in the incubation period and in the initial period of the disease. As a precaution, all items used in the bathroom, kitchen and the patient’s undergarments should be disinfected or washed at 90 degrees to kill the virus.
Symptoms
Asymptomatic forms are frequent in children and during possible epidemics, but it usually begins with flu-like symptoms. At first it was a lot tiredthere is loss of appetiteOften fever, diarrhoea, vomiting and indigestion. In some cases, it takes overjaundice: the eyeballs and skin turn yellow due to the high levels of bilirubin in the blood, there may be itching and fatigue increases.
Diagnosis
The objective consequences of high bilirubin in the bloodwhich is the cause of yellowish eyes and skin, orange-brown urine and very pale stools, would be sufficient for the diagnosis of hepatitis A. However, the liver specialist may use an ultrasound to evaluate liver enlargement and garlic blood tests to analyze the anti-virus A IgM and IgG immunoglobulins, the values of transaminases and Gamma GT enzyme, clotting times, the amount of bilirubin and other general parameters such as a blood count.
Cure
There are no specific antivirals, so the cure is based on rest and a specific diet. Especially in the beginning it is necessary not to make any effort of any kind and hydrate with two liters of water between meals. Better to have 4-5 meals a day and very light ones, based on carbohydrates, which are more digestible because they are immediately transformed into sugars, and without fats, which would tire the liver. Dairy products, sausages, fatty meats, sweets and alcohol are prohibited but allowed fruits, vegetables, cereals and olive oil. Animal proteins should be taken two to three times a week to help the liver regenerate. Vitamin supplements are also useful (Vitamin E above all) and natural antioxidants for the liver, such as turmeric, the sillimarin and dandelion.
Hepatitis B
Hepatitis B is a disease that affects the liver and which in Italy has over 1,600 new cases a year. It is caused by virus HBV which in 95% of cases triggers an infection acute that heals in a few months. In the remaining 5%, the virus is not completely eradicated and the infection becomes chronic. HBV is transmitted through direct contact with infected body fluidssuch as blood, saliva, semen, vaginal secretions, breast milk.
Symptoms
The most characteristic symptom is the yellowish color (jaundice) of the tongue, sclera of the eye and skin, associated with tiredness, weakness, loss of appetite, weight drop e fever. In some cases the disease may be asymptomatic.
Diagnosis
The diagnosis is made through the blood testswhich detect the presence of specific markers (transaminases, antigens and antibodies).
Cure
In the acute phase they are needed at least a month of rest it’s a light diet, low in fat and protein, rich in simple and complex carbohydrates. In the chronic phase they are used antiviral drugs, which work by inhibiting the production of the virus. The latest generation molecules are entecavir e tenofovir: available in pills, they should be taken once a day, for many years and often for life. After one or two months of treatment, the HBV DNA is no longer detectable in the blood.
Despite this, in 90% of people the virus remains in the liver cells in a latent form (inactive carriers) and therefore it is necessary to check it by a hepatologist, who will perform a visit once a year and prescribe blood tests and a ultrasound of the liver. The remaining 10% of people, after 4-5 years of taking medications, completely destroy the virus.
Prevention
The disease is prevented with the Vaccinemandatory in Italy since 1991 for newborns (until 2003 also for twelve-year-olds), which is administered in 3 doses by intramuscular injection and provides in almost all cases (99%) lifelong immunity.
Hepatitis C
Hepatitis C is a chronic liver disease caused by the virus HCVwhich is transmitted through direct contact with infected blood. The infection destroys the liver cells and the liver reacts by setting up repair mechanisms. The lost tissue is replaced by a new, fibrous one, which forms real scars. In the long run this process compromises the functionality of the organ up to lead, in the most advanced stage, to liver cirrhosis. Hepatitis C is diagnosed with a blood test for the HCV virus.
“The screening to bring out the undeclared of hepatitis C cases represent a good practice that in recent years has brought Italy in line with the WHO’s goal of eliminating the virus by 2030. More than 250,000 treatments carried out to date demonstrate this “. intervenes Massimo AndreoniScientific Director of the Italian Society of Infectious and Tropical Diseases – SIMIT.
«The availability of the 71.5 million euros allocated in 2020 has given us a great opportunity, unfortunately held back by the pandemic. The extension until 31 December 2023 was useful for increasing the number of diagnoses but a second one is needed, for at least a couple of years. Also it should also involve other segments of the population: not only drug addicts, prisoners and those born between 1969 and 1989, but also the previous age cohorts, with reference to those born between 1948 and 1968, in which the virus can lurk. Only in this way will it be possible to eliminate hepatitis C in our country by 2030», continues the specialist.
Symptoms
Often the disease is at all asymptomatic, so much so that many years can pass before arriving at a diagnosis. In other cases the disease manifests itself with fever, nausea, fatigue, pain in the liver, stomach pain, jaundice.
People most at risk
In Italy we have two categories of patients. The most numerous are the over-50who contracted the virus many years ago through health procedures carried out without adequate supervision, as in the case of transfusions of infected blood or the use of needles and instruments that are not perfectly sterilized. THE young, however, represent a smaller group. For them there are several risk factors: the drug addictioni relationships unprotected sexbut also tattoos e piercing done without respecting the hygienic-sanitary rules.
Cure
Are available antiviral drugs with direct action which, after a cycle of variable duration (from 2 to 3 months), eliminate the virus and lead to healing. That’s enough to not get infected do not share tools such as a razor or nail scissors and be very careful if you need to dress a wound. If infected blood comes into contact with our skin at a point where it is damaged or has micro-lesions, then contagion is possible.
Epatitis D
The hepatitis D virus (HDV) needs the simultaneous presence of the B virus in order to reproduce. Consequentially, this infection can only develop in people with hepatitis B.
Symptoms
The infection can manifest itself in two ways: if it is simultaneous by viruses B and D, a clinically similar hepatitis to B occurs; if instead there is a superinfection of virus D in a chronic carrier of hepatitis B, then a new, sometimes fatal, acute form develops.
Cure
As far as the treatment of hepatitis D is concerned, the available drugs are scarcely effective (therapy with interferon allows a response in less than 15-20% of cases).
Hepatitis E
Hepatitis E is a liver disease caused by the HEV virus: in most cases it is asymptomatic or present mild symptoms. However in some cases, especially in those who already have liver damage or in immunosuppressed patients, it can lead to liver failureeven with a fatal outcome.
Infection
While it’s not as prevalent as other foodborne illnesses, hepatitis E is cause of growing concern in the EU. In the past it was believed that the main source of infection was thecontaminated water drank while traveling outside the EU. However, we now know that the main source of disease transmission in Europe is food. The main carriers of the HEV virus are the domestic pigsas well as i boarstherefore those who consume theirs are at risk raw or undercooked meat: the virus, in fact, is inactivated by the heat of cooking.