16.JUN.2022 6 MIN READ | 6 MIN READ

Been asked to take the hepatitis A and hepatitis B vaccines, but not exactly sure why they’re all that important? Read on to learn more about our liver and how these vaccines play a key role in protecting it from the hepatitis viruses.

Understanding our liver

The liver is one of the most important organs in our body. Cone-shaped and with the ability to regenerate itself, the liver sits in the right upper quadrant of our abdomen and performs some 500 different vital functions that are pivotal to us living life was we know it.

What this all really means, is that it is responsible in regulating chemical levels in our blood by breaking down, balancing and creating nutrients that will eventually be released into the bloodstream.

Additionally, the liver is also where medication we consume when unwell are metabolised and processed into forms that can be easily absorbed by the body. When harmful substances enter the body, the liver breaks down these substances and excretes the by- products into the bile or blood. Bile by-products are excreted in the form of faeces. Blood by- products are filtered out by the kidneys and leave our body as urine.

What is hepatitis A and how is it transmitted?

Hepatitis A virus

Hepatitis A is a liver infection that is caused by the hepatitis A Virus (HAV). This virus belongs to the family of hepatitis viruses that cause liver inflammation. HAV is very contagious and you can contract hepatitis A from contaminated food and water, raw shellfish from water polluted with sewage, eating food handled by infected individuals, touching infected objects as well as being in close contact with infected individuals.

Increased risk of hepatitis A transmission can happen in the following circumstances:

  • Frequent travel or work in areas where hepatitis A is endemic
  • Sexual contact with an infected person
  • Living with an infected person
  • Are HIV-positive
  • Work in settings that expose you to a lot of other people, such as a childcare centre
  • Use of illegal drugs

Symptoms and treatment of hepatitis A

Hepatitis A can be diagnosed through blood tests. The symptoms of hepatitis A may not appear until a few weeks after infection.

Common symptoms include nausea and vomiting, lethargy, abdominal pain or discomfort, low grade fever, loss of appetite, clay-coloured stools, dark urine, yellowing of skin and eyes (jaundice), and an intense itch. In some instances, an infected person may also be asymptomatic.

There is no specific treatment for hepatitis A and the virus typically clears out from the body on its own. Hepatitis A infections can be relatively mild with most patients recovering without sustaining any long-term liver damage. However, a small percentage of infected individuals may suffer severe complications, leading to the eventual loss of liver function.

In rare cases, a liver transplant may be required.

Preventing hepatitis A infections

The consequences may sound severe, but the good news is that hepatitis A can be prevented by vaccination. The vaccination series comprises two doses given 6 months apart.

If you are traveling to countries where hepatitis A is common, here are some safety tips:

  • Drink bottled water
  • Brush teeth with bottled water
  • Peel and wash all fruits with bottled water
  • Do not drink beverages of unknown purity, especially with ice
  • If bottled water is not available, boil tap water before consumption
  • Do not eat raw, or undercooked, fish and meat

Speak with your family doctor should you have any concerns regarding your risks of hepatitis A.

What is hepatitis B and how is it transmitted?

Hepatitis B virus

Similar to hepatitis A, hepatitis B is a liver infection that is caused by the B strain of the hepatitis virus (HBV). Hepatitis B can be contracted through exposure to infected blood, semen or other bodily fluids. The spread of this virus is most prevalent through pregnant women transmitting it to their babies at birth, as well as through the exposure to infected blood. The latter can occur with high-risk behaviours such as unprotected sex and usage of contaminated needles amongst intravenous drug uses, and in healthcare settings.

Symptoms and treatment of hepatitis B

Symptoms of a hepatitis B infection can range from asymptomatic or mild disease to severe illness, where the patient develops liver failure which may eventually lead to death. Common symptoms of an infection include fatigue, nausea and vomiting, abdominal discomfort, and jaundice, although most people do not experience any symptoms.

Hepatitis B infections are categorised as acute and chronic. Treatment for acute hepatitis B is focused on maintaining comfort, hydration and nutritional balance. Your doctor may also decide to temporarily withhold any medication that might worsen liver damage.

Chronic hepatitis occurs when the liver inflammation persists for more than 6 months. Individuals with chronic hepatitis B have an increased risk of liver cirrhosis (scarring), liver cancer, and ultimately liver failure. To prevent this, your doctor will prescribe oral antiviral medication. The medication aims at slowing the rate of progression to cirrhosis, reducing risk of liver cancer and improving long-term survival rates.

Preventing hepatitis B Infections

The risk of chronic hepatitis is less than 5% for adults, but about 95% for children. The safest and most effective way of preventing hepatitis B infection is through vaccination, which is why it is one of the immunisations nationally recommended in Singapore. Likewise, adults are also encouraged to have themselves vaccinated. The vaccination series comprises three doses, with the second and third dose at one and six months after the first dose.

Healthy liver tips

The best way to keep your liver healthy is to avoid anything that may harm it!

Here are some ways to achieve liver wellness and possibly reverse the effects of liver damage:

1) Diet and Exercise

It is important to observe a balanced diet, and exercise regularly to maintain a healthy weight. Being overweight or obese puts you in danger of getting non-alcoholic fatty liver disease, a form of liver disease that is becoming more prevalent given our sedentary lifestyles. Regular exercise can help in reducing fat in the liver.

Food-wise, avoid refined sugars, saturated fat, high-calorie meals and refined carbohydrates. Instead, consume more fibre-rich food such as fresh fruits, vegetables, whole grains and cereal.

2) Alcohol in moderation

Drink alcohol in moderation

Excessive alcohol consumption causes multiple health problems, particularly alcohol- induced liver scarring and hardening. Be conscious about having alcoholic beverages in moderation, or better still, avoid alcohol altogether.

3) Be aware of toxins and medications that can damage your liver

Certain substances, such as herbal supplements (including black cohosh and ginseng) and illicit drugs (such as heroin and cocaine) have been known to cause liver injury. Misuse of over-the-counter medication containing acetaminophen can also potentially cause liver damage. It is imperative that we read the contents and instructions carefully before taking any medication to prevent overdose. Persons with existing liver conditions should also consult their doctor before taking medication or supplements.

4) Avoid contaminated needles

Unsafe injection practices are common amongst intravenous drug users, and at some body tattooing and skin piercing parlours. Such high-risk actions can spread diseases such as hepatitis B and C. Therefore, it is important to ensure that sterile needles are used for all procedures that involve any form of skin penetration.

5) Exposure to blood

If you are exposed to another person’s blood, such as in the case of a needle stick injury, please consult your doctor immediately for post-exposure management.

6) Practice safe sex

Having multiple sex partners or engaging in unprotected sex increases one’s risk of getting hepatitis B and C, and other sexually transmitted diseases.

7) Stop smoking

Stop smoking

Smoking has been shown to cause liver cancer, and those infected with hepatitis B or C are at an increased risk. If you need any help to stop smoking, please consult your family doctor.

8) Do not share personal hygiene items

Personal items such as toothbrushes, razors and nail clippers can contain microscopic levels of blood. These objects can be potential routes for disease transmission. As much as possible, avoid sharing personal items with another person.

9) Get vaccinated

The hepatitis virus is the most common cause of hepatitis infections. Vaccines against hepatitis A and B are readily available and proven to be safe and effective. Unfortunately, there is no hepatitis C vaccine available.

Speak to your family doctors for more information about vaccination.

10) Hand hygiene

Always remember to wash your hands before handling food, after a meal, and immediately after using the bathroom. Soap and water are the best way to remove potential viruses that may cause liver damage.

 

Article contributed by Dr Sharon Ngoh, general physician at Parkway Shenton, Broadway Plaza

References

American Liver Foundation. (2021, June 24). 13 ways to a healthy liver. American Liver Foundation. Retrieved February 21, 2022, from https://liverfoundation.org/13- ways-to-a-healthy-liver/

Centers for Disease Control and Prevention. (2020, June 22). Hepatitis A. Centers for Disease Control and Prevention. Retrieved February 21, 2022, from https://www.cdc.gov/hepatitis/hav/index.htm

Johns Hopkins Medicine. (n.d.). Liver: Anatomy and functions. Johns Hopkins Medicine. Retrieved February 21, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/liver-anatomy- and-functions

Mayo Foundation for Medical Education and Research. (2020, August 28). Hepatitis A. Mayo Clinic. Retrieved February 21, 2022, from https://www.mayoclinic.org/diseases-conditions/hepatitis-a/diagnosis- treatment/drc- 20367055

Ministry of Health Singapore. (2021, May). Hepatitis B Vaccine. HealthHub. Retrieved February 21, 2022, from https://www.healthhub.sg/a-z/medications/484/Hepatitis- B-Vaccine

World Health Organization. (2021, July 27). Hepatitis B. World Health Organization. Retrieved February 21, 2022, from https://www.who.int/news-room/fact- sheets/detail/hepatitis-b

16.JUN.2022