WHILE speaking at a medical conference on hepatitis C in Penang some years ago, Tan Sri Dr Mohamed Ismail Merican, the former Director-General of Health, was approached by a woman who suspected she could have the disease.
Dr Ismail explained that he couldn't tell just by looking at her, but if she had had a blood transfusion in the past (before 1994) then there was a risk.
The woman had indeed undergone a blood transfusion and when they tested her, she did have hepatitis C.
Dr Ismail, who's now a consultant hepatologist and internal medicine specialist at Prince Court Medical Centre, says with hepatitis C, sometimes, the only symptom one may experience is fatigue and fatigue can be attributed to many other things.
Hepatitis is inflammation of the liver and caused by different types of viruses - A, B, C, D and E.
Dr Ismail says in Malaysia, we mainly have hepatitis A, B and C. In some cases patients may not exhibit any symptoms, while in other cases, as with hepatitis A for example, there may be signs.
"It depends on the type of hepatitis and normally hepatitis A is very symptomatic while B and C are rather asymptomatic."
Some people may have hepatitis B or C without being aware of it, he adds.
For this reason, during health screenings or check-ups it's crucial that people get tested for hepatitis B and C too. Dr Ismail says there is a general tendency to check for hepatitis B, but not usually C.
Since hepatitis A is spread through contaminated food and water, those who eat out frequently, particularly at food stalls or hawker centres are advised to get vaccinated to protect themselves.
Dr Ismail says while hepatitis A doesn't cause chronic liver disease, it can make you very sick.
"For three to four months you may not be able to function normally but if you survive that particular episode you won't get chronic liver disease. On the other hand, hepatitis B and C can cause chronic liver disease."
Since there are vaccines for hepatitis A and B, it's advisable for people to first check whether they have antibodies for these two conditions.
If for example, they do have antibodies for hepatitis A, then they don't need vaccination but if they don't, they should take the vaccine which comes in two doses.
The same applies to hepatitis B. If they don't have antibodies, they should take the vaccine which comes in three doses.
The hepatitis B vaccine is the only vaccine that can actually cure a patient with hepatitis B stresses Dr Ismail.
In Malaysia, almost 80 per cent of liver cancer cases are due to hepatitis B so this is one cancer (hepatitis associated liver cancer) that can be prevented through vaccination.
However, many people are still not aware about vaccination for hepatitis.
"I have patients who are not aware of vaccination and those that think taking the hepatitis A vaccine will protect them against hepatitis B as well and vice versa. We have to inform them that there are different types of vaccines and each vaccine has a different function."
However, in Malaysia, babies born after 1989, are given free hepatitis B vaccination so they are protected.
Dr Ismail says with hepatitis A, the younger generation may not have antibodies and may be more affected, but that doesn't mean the elderly won't get it.
Hepatitis B patients meanwhile usually have a family history of the disease or there may be a family history of liver cancer.
"For hepatitis C, if you are an intravenous drug user or have had blood transfusions before 1994, you may be at increased risk."
While there is no vaccine available for hepatitis C, Dr Ismail says an oral treatment (8-12 weeks) is now available and patients can get cured.
Like with any disease, early detection of hepatitis ensures a better outcome which is why screening and check-ups are crucial.
- *Virus is transmitted through contaminated food and water or through direct contact with an infectious person.
- *Often associated with unsafe water or poor sanitation and hygiene.
- *Symptoms range from mild to severe and include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-coloured urine and jaundice.
- *Those who recover will have lifelong immunity.
- *Vaccination available.
- *Causes chronic infection and high risk of death from cirrhosis and liver cancer.
- *Virus is transmitted from mother to child during delivery, through contact with blood or body fluids during sex with an infected partner, unsafe injections or exposure to sharp instruments.
- *Most cases do not show any symptoms when newly infected.
- *Vaccination available.
- *Causes both acute and chronic hepatitis.
- *Ranges in severity from mild to serious or lifelong illness including liver cirrhosis and cancer.
- *Virus is bloodborne and transmitted through through exposure to blood from unsafe injection practices, unsafe healthcare practices, unscreened blood transfusions, injection drug use and sexual practices that lead to exposure to blood.
- *No vaccine available
Source: World Health Organisation - www.who.int/health-topics/hepatitis