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Low-Income Countries Have Highest Disease Burden of Acute Viral Hepatitis, Study Reveals

A recent study has revealed that socioeconomic development is inversely associated with acute viral hepatitis or AVH, such that the disease burden is highest among low-income countries.

Low-Income Countries Have Highest Disease Burden of Acute Viral Hepatitis, Study Reveals
Photo: Acute Viral Hepatitis | InStyleHealth

What Is Acute Viral Hepatitis?

Acute viral hepatitis is defined as an inflammation of the liver that is caused by an infection with one of the five hepatitis viruses. The inflammation of the liver in most people, starts suddenly and may last for a few weeks.

What Are The Causes of Acute Viral Hepatitis?

Acute viral hepatitis is normally caused by the five major hepatitis viruses:

  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Hepatitis E

Hepatitis A virus is the most prevalent cause of acute hepatitis, and is followed by hepatitis B virus.

The other viruses somehow, can also cause acute viral hepatitis. These viruses include the Epstein-Barr virus (EBV), which is the virus that causes infectious mononucleosis (mono).

Getting involved in certain activities, like getting a tattoo or body piercing, sharing needles to inject drugs, or having multiple sexual partners, increase the risk of developing acute viral hepatitis.

What Are The Symptoms of Acute Viral Hepatitis?

Acute viral hepatitis will cause anything from minor flu-like illness to fatal liver failure . Occasionally there are no symptoms.

Severity of symptoms and speed of recovery varies from person to person, depending on the particular virus the person has contracted and on the person’s immune response to the infection.

Hepatitis A and C most of the time cause very mild symptoms or none at all and sometimes unnoticeable. Hepatitis B and E are more likely to produce severe symptoms. Infection with both hepatitis B and D (called coinfection) will make more severe symptoms of hepatitis B.

Symptoms of acute viral hepatitis usually start unexpectedly. These symptoms include the following:

  • A general feeling of illness or body malaise
  • A poor appetite
  • Fever or flu-like symptoms
  • Nausea and vomiting
  • Pain in the upper right part of the abdomen, where the liver is located

For people who smoke, having a distaste for cigarettes is a common symptom. Sometimes, for those who are infected especially with hepatitis B, will develop joint pains and itchy red hives on the skin known as urticaria or wheals.

People infected with hepatitis, their appetite, normally, returns about a week after the symptoms started.

Occasionally, the urine becomes dark, after 3 to 10 days, and the stool becomes pale. Jaundice – a yellowish discoloration of the skin and whites of the eyes, will develop. Sometimes, it is accompanied by itching. Symptoms such as these take place because the damaged liver can no longer remove the bilirubin from the blood as it normally does.

Bilirubin is the yellow pigment generated when hemoglobin, the part of the red blood cells that carries the oxygen, is broken down as part of the normal process of recycling old or damaged red blood cells. Bilirubin will then build up in the blood and is deposited in the skin making the skin look yellow and causes itching, and the whites of the eyes making them look yellow. Bilirubin normally is secreted into the intestine as a component of bile, the greenish-yellow digestive fluid produced by the liver, and excreted in stool, which gives the stool its typical brown color.

For people with hepatitis, stools are pale because the bilirubin does not enter the intestine to be eliminated in the stool. Rather, bilirubin is eliminated in urine, allowing the urine’s color to become darker.

The initial symptoms, most of the time, like poor appetite, nausea, vomiting, and fever will usually disappear within a week after its initial appearance. People will feel better even though the jaundice may worsen. Jaundice usually peaks in 1 to 2 weeks, then eventually fades after 2 to 4 weeks. However, jaundice will sometimes take much longer to resolve totally.

Data on four major AVH types, acute hepatitis A, B, C, and E, were accessed from the Global Burden of Disease 2019 study including the corresponding age-standardized incidence and disability-adjusted life year or DALY rates. These analyses were classified by gender, country, and sociodemographic index or SDI.

The age-standardized rates of AVH remained largely stable, from 1990 to 2019, with the exception for acute hepatitis B, which decreased over time. Regarding age-standardized DALY, all four of the AVH types revealed a downward trend per year, specifically the acute hepatitis A, which had seen a DALY plummeted at 73.3%.

In general, age-standardized incidence and DALY rates for the hour AVH types in  2019 were 3,615.9 and 58 per 100,000 person-years, correspondingly. The acute hepatitis A came out to have the heaviest disease burden.

Regarding geographical location, all 4 major AVH types were most common in the West and East Africa and had low burden in North America and most European regions. A country’s socioeconomic status was a strong associate of AVH, further stratifying by SDI has revealed, such that those with high or high-middle SDI had the lowest incidence and DALY rates of AVH. On the other hand, counterparts with low or low-middle SDI had higher disease burden according to study.

Researchers stated that, “An enormous health loss is attributable to viral hepatitis, and many barriers such as inadequate sanitary infrastructure and limited vaccination coverage exist in low-income countries. Therefore, minimizing the burden of AVH is considered an important component for a new global health strategy. Further, a better understanding of the burden of disease is necessary to guide these efforts and to improve public health.”


Source: J Hepatol 2021;75:547-556

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