Study on viral hepatitis provides an overview of the disease in eleven years

The research is part of the Characterization of Viral Hepatitis in Vulnerable Populations project, developed by Einstein within the scope of the Support Program for the Institutional Development of the Unified Health System (Proadi-SUS).

The objective is to generate knowledge to strengthen prevention and care strategies that can help Brazil reach the goal of eliminating viral hepatitis by 2030. The study was published in the international scientific journal PLOS ONE.

Data relating to all viral hepatitis were analyzed: A, B, C, D and E.

“In general, people think more about hepatitis B and C, because they are, in fact, quite common and, in addition to acute hepatitis, they are often chronic hepatitis,” the study coordinator, João Renato Rebello Pinho, a doctor at Einstein's Department of Clinical Pathology, told Agência Brasil this Monday (3).

Hepatitis A

Hepatitis A, for example, is an acute hepatitis, but it can have serious cases. This is a hepatitis that can be prevented by vaccination. Pinho highlighted, however, that hepatitis A has returned to Brazil, mainly transmitted by men.

"It is a new form of contact that has been recognized, which is oral/anal contact, that is, when having sex, people end up contaminating themselves with anal material and the virus. This has caused this disease to reappear in the Brazilian population in general."

According to the expert, the disease began in groups of men who have sex with other men, but soon spread to all unvaccinated populations.

"So, in relation to hepatitis A, it is important to highlight the importance of vaccination, because there are women who also have oral/anal sex. They are also subject to this type of hepatitis.”

On the other hand, he ruled out that the disease is transmitted from person to person through the skin, for example. Person-to-person contagion is more difficult, it needs to be intimate contact.

"In fact, the most common form of contamination by the hepatitis A virus is through food, that is, through contaminated water or contaminated food."

The new form that was described in the last 10 years when these viruses spread around the world occurred mainly due to this sexual behavior. But it does not pass from person to person, like the Covid-19 virus, said the doctor. “It only passes if the person goes to the bathroom, gets their hands dirty and greets someone else.”

In intense family contact, however, Rebello Pinho admitted that contagion could occur. A child who catches hepatitis A is more likely to pass it on to other people because they have all their parents' hygiene care for them. There is, however, no risk of hepatitis transmission through personal contact on the bus, in traffic or on the street. "That's not going to happen. It needs to be very intimate contact."

By region, hepatitis A, which is transmitted orally/fecally, occurs frequently in the Amazon region and in the North and Northeast regions. “It is still common in these regions, except when men are over 18 years old, as we find many cases of hepatitis A in the South, Southeast and Central-West regions, due to this phenomenon of sexual behavior and the lack of vaccination, which is still not free for those over 18 years old.”

Hepatitis B and C

In hepatitis B and C, the main form of contact is sexual. But contact with blood or blood products, especially the use of intravenous drugs, can also transmit hepatitis B and C.

Another important form of transmission is from mother to child during pregnancy and childbirth. Rebello Pinho highlighted that Brazil, in fact, controls hepatitis B very well and has already controlled hepatitis B and HIV transmission from mother to child. “It’s a very rare thing to happen these days.”

Rebello Pinho Emphasized the existence of a vaccine against hepatitis B. Unlike hepatitis A, hepatitis B can be chronic. And both B and C are related to cirrhosis and liver cancer. “Hence the importance of getting vaccinated for hepatitis B.”

For hepatitis B, there are very effective treatments. As for hepatitis C, although the transmission routes are very similar to type B, there is no vaccine. This type of viral hepatitis, on the other hand, has very effective treatments that cure more than 95% of patients.

"In other words, it is a disease that previously had very poor treatments, but now has very good treatments. Ideally, however, the person should not get hepatitis C."

To this end, safe sex and avoiding contact with blood were among the necessary measures, especially with the use of prohibited intravenous drugs.

The researcher recalled that another very common way of transmitting hepatitis C was the use of shared blood transfusion syringes. Today, however, it is very rare to be able to transmit hepatitis B and C through these routes, he said. To prevent hepatitis C, he advised that these behaviors should be avoided.

Hepatitis D

According to João Renato Rebello Pinho, hepatitis D, or Delta, is neglected. “Because it generally occurs in populations of a lower socioeconomic level, which end up being neglected by health systems”.

In Brazil, it is very common in the Amazon region, especially in riverside populations, which are difficult to access and where it is difficult to diagnose. The doctor highlighted that hepatitis B is also more common in Brazil in the Amazon region, although it occurs throughout Brazil.

“Despite having an effective vaccine and treatment, it is a very widespread disease in the Brazilian population, with several sources of the virus in different parts of Brazil and not just in the Amazon region.”

Rebello Pinho explained that hepatitis B and D are related. In the Amazon region, there are populations that have a significant frequency of hepatitis Delta. He clarifies, however, that only those who carry hepatitis D, or Delta, get it.