• AKUH doctor says Mefenamic acid, not paracetamol, should be used for fever, pain
• People urged to practice good hygiene, use boiled water for drinking, eat properly cooked food, and getting their children vaccinated

KARACHI: A growing number of children reporting to health facilities these days with non-specific signs, such as sore throat, body pains and slight fever are being found infected with the hepatitis A virus, it has emerged.

“Hepatitis A is the second most prevalent disease in the city after Chikungunya right now. Viruses flourish during the transition period when the weather is neither too hot nor too cold,” senior general physician Dr Sajjad Siddiqui said, adding that adults are also being affected by the infection, though children affected in greater numbers.

A highly contagious infection, hepatitis A is an inflammation of the liver that can cause mild to severe illness. Its virus, experts say, is mainly transmitted via the faecal-oral route through contaminated food or water. It’s usually a self-limited illness with no specific treatment.

The experts underscored the need for improving sanitation system across the province, while calling upon the general public to practice good hygiene, including washing hands frequently, using boiled water for drinking, eating only properly cooked food, and getting their children vaccinated against the infection.

Speaking to Dawn, doctors associated with different public and private sector hospitals said that though the cases of hepatitis A are reported throughout the year across the country given the poor state of sanitation, its cases see seasonal spikes.

According to Dr Muhammad Fareeduddin, head of the department of paediatrics at the Indus Hospital, most cases of hepatitis A infection are currently being reported to general physicians who are referring (a bit complicated cases) to paediatricians.

“These days, I am daily examining three to five cases of hepatitis A. Of them, one or two require admission,” he said, adding that he also recently examined a few cases of hepatitis E.

Senior general physicians Dr Altaf Hussain Khatri and Dr Siddiqui say cases of viral fevers including hepatitis A are on the rise in the city.

Dr Arit Parkash, an expert paediatric gastroenterologist at the National Institute of Child Health (NICH), said: “Patients are reporting with hepatitis A from within the city as well as from the interior parts of the province. We are seeing an increase in patients’ recovery time from four to six weeks to two to three months.”

Dr Fyezah Jehan, head of the department of paediatrics and child health at the Aga Khan University Hospital (AKUH), described the situation as highly worrisome given the fact that the hepatitis A virus could infect children of all ages.

“I have talked to my colleagues and doctors [associated with other hospitals] and we all agreed that it’s spreading like an epidemic in the city,” she said.

‘Paracetamol can cause liver complications in hepatitis A’

About her recent clinical experience, Dr Jehan of the AKUH said: “What parents need to know is that this disease can initially present with non-specific signs including loss of appetite, nausea, low-grade fever, weakness and diarrhoea.”

Parents often report to doctors when they noticed signs of jaundice such as yellowing (of the whites) of the eyes, she added.

Paracetamol, she points out, can cause liver complications in hepatitis A and that Mefenamic acid (sold under different names) should be used for fever and pain.

According to her, the fact that an increasing number of children are reporting with hepatitis A infection (across the city) indicates that that water is not being properly filtered and treated at source.

“Poor water, sanitation and hygiene and lack of water treatment are the major reasons for the spread of hepatitis A. Our children are particularly at risk since a majority of them are malnourished,” Dr Jehan said.

Lack of diagnostic kits at public sector hospitals

Dr Mehboob Ali Noonari, who looks after the emergency section of the NICH, said that four to six patients of viral hepatitis are daily reporting at the facility’s emergency department these days.

“Since the diagnostic kits for hepatitis A and hepatitis E are not available at public sector hospitals and patients generally don’t opt for the costly tests, one cannot confirm the exact type of the virus the patient suffers from.

The experts also point out that the number of complicated cases is comparatively higher this year.

Published in Dawn, October 6th, 2024