27 July 2020 Viral hepatitis are a major cause of death and a public health problem worldwide. These diseases are mainly due to hepatitis A to E viruses, which cause an acute or chronic inflammation of the liver. Hepatitis A Hepatitis A is transmitted mainly via the fecal-oral route after contact with contaminated water and food. With the improvement of basic sanitation, hygiene conditions, access to drinking water and care in the preparation of food, today hepatitis A is a rare disease in Portugal. Most hepatitis A cases in our country are related with travel to countries at risk or sporadic outbreaks in communities of men who have sex with men. Mortality associated with hepatitis A is low, being higher in the elderly and in patients with cirrhosis. There is a safe and effective vaccine against hepatitis A , which is recommended by the Direção Geral da Saúde for: The 2 groups mentioned: travelers to countries at risk and sexual risk behavior groups; Liver transplant candidates; Children on treatments with clotting factors. Hepatitis B It is estimated that there are 250 million people worldwide with chronic hepatitis B, a disease that causes more than half a million deaths each year. The infection can be transmitted: At birth, from mother to child, what is called vertical transmission; Sexually; Percutaneously (accidental inoculation of the virus by injections, pricks on needles) or in a family context in children (close contact, sharing objects such as toothbrushes and nail clippers). Hepatitis B is considered a sexually transmitted disease. The likelihood that the infection will become chronic is higher in children and young people than in adults. When it happens in adults it can progress to cirrhosis and liver cancer. Since the introduction of the hepatitis B vaccine in the National Vaccination Program (PNV) in 1994, the incidence of the disease has decreased significantly. Continuing with the high rate of vaccination adherence it is likely that hepatitis B can be eradicated from in Portugal within a few decades. Some patients with chronic hepatitis are indicated for lifelong treatment , which is done with pills. With this treatment, the risk of cirrhosis and cancer decreases. Hepatitis C Hepatitis C is transmitted percutaneously and in most cases the disease becomes chronic. Hepatitis C is the main chronic viral hepatitis. Since 2015, direct action antivirals have been available in Portugal, which are used in treatments lasting 8-12 weeks, well tolerated and highly effective (> 95% cure). In the early stages of the disease, this treatment prevents progression to cirrhosis. In the more advanced stages, it reduces the likelihood of cancer and death. There is likely to be a benefit, both in individual and public health terms, in screening for hepatitis C (by determining anti-HCV antibodies) to the entire population at least once in their lives. Hepatitis D Hepatitis D affects only people with hepatitis B, is rare and is transmitted percutaneously. It is the hepatitis that most quickly progresses to cirrhosis and has no specific approved treatments. The hepatitis B vaccine is also effective against hepatitis D. Hepatitis E Hepatitis E occurs with two distinct patterns: In Asia and Africa it causes an acute, endemic disease, with transmission similar to that of hepatitis A, and with low mortality except in pregnant women; The sporadic form, more common in developed countries, including Portugal, has its reservoir in animals (pigs) and can cause a chronic disease in immunocompromised patients. Hepatitis E is transmitted via the fecal-oral route. When the values of transaminases related to liver function are altered, the possibility of a viral hepatitis should be excluded. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
