In conjunction with World Hepatitis Day on 28 July, learn about hepatitis, a leading cause of liver disease and liver cancer that affects millions of people worldwide. 

Hepatitis is an inflammation of the liver that is caused by a variety of infectious viruses leading to a range of health problems. 

It can also be caused by other factors such as: 

• Fatty liver, 

• Alcohol abuse, 

• Chemicals, 

• Certain medications, and 

• Immune disorders. 

Types of hepatitis viruses can include: 

• Hepatitis A – An acute inflammation of the liver caused by infection with hepatitis A virus. It is spread through the ‘faecal-oral’ route i.e. through by ingestion of food contaminated by faeculent material.
  
  Symptoms can include fever, loss of appetite, dark urine, and yellowing of the skin and eyes (jaundice). 
  

• Hepatitis B – As a major global health problem, the hepatitis B virus is the most common human hepatitis virus in Singapore. About 6% of the Singapore population are hepatitis B carriers, and most hepatitis B infection is acquired during birth and in early childhood.
  
  Symptoms can include fever, jaundice, joint pain, nausea and pain in the right upper abdomen. Hepatitis B is best prevented by vaccination; both children and adults are eligible to receive the hepatitis B vaccine, and in Singapore, children are able to receive hepatitis B immunisation at birth as part of the National Childhood Immunisation Schedule.
  

• Hepatitis C - Hepatitis C is largely asymptomatic (does not show any symptoms). When symptoms do appear, it is usually when advanced liver damage, such as from liver cancer, has set in.
  

Want to get your ABCs right about hepatitis? Get accurate answers from an expert by asking our specialist. This forum is for a limited time only so send your questions in now!

For a deeper understanding of liver and digestive health and disorders, click here.

About Clinical Assistant Professor Rahul Kumar

Currently serving as the Director of Hepatology Service at Changi General Hospital (CGH), Clin Asst Prof Rahul Kumar’s speciality interest is in liver diseases, including viral hepatitis, liver cancer, and liver failure.

After completing his MBBS and MD in India, Dr Rahul completed his basic speciality training in general medicine, and was awarded MRCP (UK) in 2012. He completed advanced speciality training in gastroenterology and hepatology in 2016, and also currently holds the position of Clinical Lecturer at the NUS Yong Loo Lin School of Medicine.

Questions and answers on preventing and treating hepatitis

Dear Doctor

I am a 70 years old lady who has never taken hepatitis vaccination. I did blood test but show antibodies is < 3.

Is it compulsory to take hepatitis b jab as I am so old already. Thanks.

Answer by Clin Asst Prof Rahul Kumar

Vaccination is the best protection against hepatitis viruses. Those who get infected by hepatitis viruses can develop serious complications and, in the long term, may develop liver cancer and/or liver failure.

Seniors aged 65 and above, young children, those with medical conditions, and pregnant women are generally more susceptible to failing seriously ill from infectious diseases.

As your hepatitis B virus antibody levels are less than 3, which is low, it is recommended that you seek advice of your healthcare provider regarding vaccination against hepatitis B.

All vaccines, as with any medicines, can have side effects. Getting vaccinated, however, is much safer than getting the infections or complications that result from these infections.

Dear Doctor, 

I have the following questions regarding about Hepatitis B.

a) After infected with COVID19 in April and recovered, how long do I have to wait before getting a vaccination for hepatitis B?

b) Can a hepatitis B vaccination last for a lifetime?

c) Who are not suitable for a hepatitis vaccine?

Really appreciate your time in helping me with these questions. Thank you.

Answer by Clin Asst Prof Rahul Kumar

There is not much scientific literature about the duration one must wait before getting the hepatitis B vaccine after a COVID-19 infection. It is advisable to speak to your doctor before getting the hepatitis B vaccine, and get a liver panel test, if necessary, to ensure that your liver has recovered from the COVID-19 infection.

After vaccination against hepatitis B, some people develop immunity which lasts for a lifetime. However, in some individuals, the immunity wanes off. After 10 to 15 years of initial vaccination, it is advisable to check your antibody levels. A booster dose of the vaccination might be required for some people.

There are also some individuals who are not suitable for a hepatitis vaccine. This includes those who:

• Have had severe allergic reactions after a previous dose or any component of the hepatitis vaccines;

• Have a yeast allergy;

• Have an allergy to neomycin, which is a component in one of the vaccines.

However, please discuss your concerns with your doctor about getting vaccinated and let them know if you have any allergies.

3. Question by Mabel

Hi Doctor,

I went through 2 courses of Hep B vaccinations but both blood tests indicated that I am not reactive to the vaccines.

What should I do to stay protected from Hep B.

Thanks and appreciate your reply.

Answer by Clin Asst Prof Rahul Kumar

When one is not “reactive to the vaccine”, it indicates that the person did not develop antibodies (which help to confer immunity against the virus) that is usually expected after the vaccinations. Although this is rare, it can happen to some individuals.

In some instances, taking a double dose of the vaccine or using a combination vaccine may work better. It is advisable for you to consult a liver specialist to discuss the possible management and vaccination options.

4. Question by Daniel

Hi Dr,

What type of vaccine do you recommend for hepatitis A, B or C?

Answer by Clin Asst Prof Rahul Kumar

For hepatitis A and B, there are either combined (A+B) or individual (A or B) vaccines available. There is currently no vaccine against hepatitis C. Depending on your antibody levels against hepatitis A and B, your doctor will advise you on the type of vaccine suitable for you.

5. Question by SK Chua

Hello Dr,

How to find out if I'm vaccinated against Hepatitis A/B/C?

Answer by Clin Asst Prof Rahul Kumar

You are able to access your vaccination record via HealthHub using your Singpass account. All Singapore Citizens, Permanent Residents and Long Term Pass Holders aged 15 years and above are eligible for Singpass.

There are also simple blood tests available to check one's vaccination status. The blood tests measure the "antibody levels" against the viruses and can indicate your level of immunity against the hepatitis A and B viruses.