The prevailing weather is ideal breeding grounds for several water borne diseases, especially hepatitis, raising concerns among health officials of a possible outbreak in the near future.
Dr. Hasitha Wijewantha
The Sunday Observer sought the help of Consultant Gastroenterologist and Hepatologist, National Hospital of Sri Lanka, Kandy, Dr. Hasitha Wijewantha to find out what these diseases were and how they could be prevented effectively with simple rules at little cost.
Excerpts
Q: The current outbreak of monsoonal rain and flooding has reportedly led to concerns of a likelihood of an outbreak of several water borne diseases, especially hepatitis. What are the diseases of the gastrointestinal tract which can occur as outbreaks after monsoonal rain and flooding?
A: Diarrhoeal disease outbreaks are the most common gastrointestinal disease that occur after floods. Contamination of drinking water sources is the main reason. Viruses like rota viruses, adeno viruses and bacteria like salmonella, shigella and Escherichia coli are the common causative organisms. It was reported that the incidence of Typhoid fever which is caused by the bacteria called Salmonella Typhi has increased following monsoonal rains.
Viral hepatitis due to Hepatitis A and E viruses also can occur as outbreaks due to contamination of drinking water sources. Hepatitis E is not common in Sri Lanka but we see patients with Hepatitis A.
Q: Any other common diseases that occur at this time around?
A: Another common disease which occurs after monsoonal rains is leptospirosis or ‘rat fever’ as it is commonly called. Leptospirosis occurs due to direct contact with animals who harbor the organism or environmental contamination by animal urine, mainly rodents.
Q: What are the early signs and symptoms of the diseases that you mentioned?
A : Symptoms of viral diarrhoea are passage of watery stools more than 3 times a day, fever, abdominal pain, nausea and vomiting. Stool frequency can be as high as 20 times a day resulting in dehydration especially in children.
Q: Do patients with bacterial diarrhea have different symptoms than viral diarrhoea ?
A: Patients with bacterial diarrhoea are more ill than patients with viral gastroenteritis. Passage of blood and mucus with stools can be a feature. Fever, abdominal pain and vomiting are other symptoms
Q: Can they be mistaken for some other disease like typhoid or cholera?
A: Cholera has similar symptoms it too causes a severe diarrhoea and may cause severe dehydration which is potentially lethal if untreated.
Typhoid fever is difficult to recognise as diarrhoea is not always present, instead constipation may occur. Other symptoms of typhoid fever are high fever, headache, nausea, abdominal pain and sometimes a skin rash.
Q: What about Rat fever? What are the symptoms to look out for in a person suspected of having it?
A: Leptospirosis (Rat Fever) causes a febrile illness associated with severe muscle pain, headache and sometimes red eye due to sub conjunctival hemorrhages. Leptospirosis can affect the kidneys, liver and lung. It occasionally causes renal impairment
Q: What are the symptoms of viral hepatitis ?
A: Viral hepatitis causes a febrile illness associated with yellowish discoloration of eyes and passage of dark urine. Right sided abdominal discomfort and loss of appetite are other common symptoms.
Q: What should people do if they are suspected to have any of the illnesses you mentioned ?
A: First if you have a diarrhoeal illness the most important step is to drink a lot of water to prevent dehydration. Best way to get an idea about the adequacy of water intake is examining the color and amount of urine passed.
Normally an adult person should pass approximately 1.5 l of urine per day and urine should have no colour, which means colourless like water. If you have fever, vomiting, yellowish discoloration of eyes, low urine output or severe weakness of the body it is very important to seek medical advice from a qualified doctor without delay.
Q: What are the preventive measures that can be taken at individual level to avoid food and water- borne diseases after monsoonal rain and flooding.’
A: The main step is to use only boiled water for drinking and avoid raw food consumption, eat only well cooked food. When you eat fresh fruits make sure to wash them thoroughly. And when there have been frequent power failures avoid buying food items like meat and dairy products which need uninterrupted refrigeration to remain fresh. Protect prepared food from flies by properly covering them. Wash hands with soap and water before handling food and after going to the toilet.
Q: For the benefit of those whose knowledge of such diseases is limited could you tell us what Hepatitis is in simple layman language?
A: Hepatitis means inflammation of the liver causing damage to the liver cells. Hepatitis can occur due to a multitude of causes including viruses, alcohol, certain drugs, herbs and due to other medical disorders. When liver cells are damaged there can be fever, yellowish discolouration of eyes, passage of dark color urine, right sided abdominal pain and loss of appetite.
Q: Are there different types of hepatitis? I was told there were five types. Your comments?
A: Yes, there are five types of viruses. Hepatitis A, B, C, D, and E. Hepatitis A and E are transmitted through contaminated food and water. Hepatitis B and C are transmitted through blood and blood products. Hepatitis D occur only in patients with hepatitis B and mode of transmission is same as Hepatitis B
Q: What is the most common type/s in Sri Lanka?
A: The commonest type of viral hepatitis in Sri Lanka is Hepatitis A. However it is not as common as in our neighbouring South Asian countries. We are a country with intermediate prevalence of hepatitis A.
Hepatitis B and C prevalence is also much lower in Sri Lanka when compared with the rest of the Asian countries.
Hepatitis E is transmitted through contaminated food and water. It is common in our neighboring South Asian countries like India and Nepal. Indigenous transmission of Hepatitis E is not reported in Sri Lanka. A few cases have been reported in people who had travelled to India and Nepal.
Q: What are the short term and long term effects of each type?
A. Viral hepatitis A and E are short term self-limiting illnesses.
Hepatitis A is asymptomatic most of the time when it occurs in childhood. Adult hepatitis A causes a febrile illness with yellowish discolouration of eyes, loss of appetite and right sided abdominal discomfort. In healthy adults it is cured completely without a long term sequelae. However in pregnant women and people with weak immune systems it can cause liver failure which can be lethal.
Hepatitis B also causes illness similar to Hepatitis A during the initial period. In most healthy adults symptoms get better after several days to couple weeks’ time and virus becomes undetectable in blood. In a minority of patients (around 10 percent) Hepatitis B causes a difficult to treat long term infection.
Unlike Hepatitis A when hepatitis B is acquired in childhood there is a higher chance of causing difficult to treat long term disease. In patients with a weak immune system also there is a higher chance of long term disease.
Q: What are the earliest symptoms of Hepatitis C ?
A: Unlike other hepatitis viruses Hepatitis C doesn’t cause symptoms during the initial period in most people. It is incidentally detected most of the time when blood is tested due to some other reason.
It causes a slow low grade liver damage over a long period of time which results in chronic liver disease in most untreated people. Good news is if Hepatitis C is detected early a complete cure can be achieved in more than 80 percent of people with proper use of drugs
Q: How is Hepatitis diagnosed?
A: Hepatitis is inflammation of the liver causing damage to the liver cells. Most of the time it causes the symptoms I mentioned earlier. And also it can easily be detected when you do liver function tests even when asymptomatic.
If you have abnormal liver function tests it is strongly recommended to consult a qualified doctor. After analysing your symptoms, signs and initial investigation results, the doctor would advise you to get the appropriate hepatitis tests.
Q: Is there an injection to prevent hepatitis? If so, where is it available free to all?
A. Yes. There are vaccines for Hepatitis A and Hepatitis B.
Hepatitis B vaccine is given free to all children through the extended program of immunisation in Sri Lanka. For adults who are at risk of Hepatitis B the vaccine is given in government hospitals free of charge.
Hepatitis A vaccine is not available free of charge in the government sector. But you can take it on recommendation by a doctor from the private sector. There is a combined Hepatitis A and B vaccine also which gives protection against both Hepatitis A and B.
