What is Viral Hepatitis?

Togetherhepatitis B and Crepresent one of the major threats to global health. Hepatitis B and C are both ‘silent’ viruses, and because many people feel no symptoms, you could be infected for years without knowing it. If left untreated, both the hepatitis B and C viruses can lead to liver scarring (cirrhosis). If you have liver cirrhosis, you have a risk of life-threatening complications such as bleeding, ascites (accumulation of fluid in the abdominal cavity), coma, liver cancer, liver failure and death. In the case of chronic hepatitis B, liver cancer might even appear before you have developed cirrhosis.

In some cases, a diagnosis is made too late and the only option is a liver transplant. If you think you have been at risk, it is important that youget testedas soon as possible and, if diagnosed, consider your treatment options and self-management strategies.

Patients withhepatitis Binfection can also be infected with a second virus known as hepatitis delta virus, hepatitis D virus or simply HDV. You can find out more about hepatitis D athepatitis-delta.org

The Difference Between Hepatitis B and C

  • While there is a vaccine that protects against hepatitis B infection, there is no vaccine available for hepatitis C
  • Both viruses can be contracted though blood-to-blood contact
  • Hepatitis B is more infectious than hepatitis C and can also be spread through saliva, semen and vaginal fluid
  • In the case of hepatitis B, infection can occur through having unprotected sex with an infected person. Please note that this is much rarer in the case of hepatitis C
  • While unlikely, it is possible to contract hepatitis B through kissing. You cannot contract hepatitis C through kissing
  • Neither virus is easily spread through everyday contact. You cannot get infected with hepatitis B or C by shaking hands, coughing or sneezing, or by using the same toilet. There are different treatments for the two viruses. While treatment can control chronic hepatitis B, it can often cure hepatitis C
  • Even if treatment is not an option for you, you can do something about your disease. A healthy lifestyle is important. Alcohol, smoking, eating fatty foods, being overweight or extreme dieting (eating no food at all) may worsen your liver disease. Therefore, try to avoid all alcohol, stop smoking, eat a low fat diet with enough fruit and vegetables, and reduce your weight if necessary

Hepatitis B

The World Health Organization (WHO) recognises that hepatitis B is one of the major diseases affecting mankind today. Hepatitis B is one of the most common viral infections in the world and the WHO estimates that two billion people have been infected with the hepatitis B virus and approximately 350 million people are living with chronic (lifelong) infections. 500,000 – 700,000 people die every year from hepatitis B.

The hepatitis B virus is highly infectious and about 50-100 times more infectious than HIV. In nine out of ten adults, acute hepatitis B infection will go away on its own in the first six months. However, if the virus becomes chronic, it may cause liver cirrhosis and liver cancer after up to 40 years, but in some cases as little as five years after diagnosis.

The hepatitis B virus is transmitted between people through contact with the blood or other body fluids (i.e. saliva, semen and vaginal fluid) of an infected person. Although not all people will have any signs of the virus, those that do may experience the following symptoms:

  • Flu-like symptoms
  • Fatigue
  • Nausea
  • Jaundice (yellowing of the skin)
  • Stomach ache
  • Diarrhoea/dark urine/bright stools
  • Aching joints

Unlike hepatitis C, there is a vaccine that canprevent infection. If you think you are at risk, you should get vaccinated as soon as possible.

Hepatitis C

Hepatitis C is different from hepatitis B in that the virus more frequently stays in the body for longer than six months, and therefore becomes chronic. Four out of five people develop a chronic infection, which may cause cirrhosis and liver cancer after 15–30 years. There are approximately 170 million people chronically infected with hepatitis C worldwide. In 2000, the WHO estimated that between three and four million people are newly infected every year.

Hepatitis C is mainly spread through blood-to-blood contact and, similarly to hepatitis B, there are often no symptoms but if they are present can include:

  • Flu-like symptoms
  • Fatigue
  • Nausea
  • Aching muscles and joints
  • Anxiety and depression
  • Poor concentration
  • Stomach ache
  • Loss of appetite
  • Dark urine/bright stools

For more informationon risks, prevention and treatment ofhepatitis B and C, please download ourPatient Leaflet

Viral hepatitis

Introduction:

Hepatitis is a serious inflammation of the liver, usually due to a virus. It can also be caused by an overactive immune system, and from drugs, alcoholism, chemicals, and environmental toxins. In the United States, viral hepatitis usually appears as type A, B, or C. Two other types -- D and E -- are rare in the U.S.

Type A is the most common form of viral hepatitis. It often affects school aged children. The disease is usually transmitted when someone ingests fecal matter through contaminated food or water. You can also get hepatitis A by having sex with someone who has the virus. A person who has hepatitis A can be contagious before they even know they have the disease. Unlike other forms of viral hepatitis, the virus doesn' t stay in your body once you recover. The best way to prevent hepatitis A is with a vaccine and good hygiene.

Hepatitis types B and C affect people of all ages. Most people who become infected with hepatitis B get rid of the virus within 6 months. This type of short infection is known as an "acute" case of hepatitis B. About 10% of people infected with the hepatitis B virus develop a chronic, life long infection. People with chronic infection may or may not have symptoms. Those who do not develop symptoms are referred to as carriers. You can get hepatitis B through contact with infected blood and body fluids. Having chronic hepatitis B increases your chance of permanent liver damage, including cirrhosis (scarring of the liver) and liver cancer. There is a vaccine to prevent hepatitis B.

Anyone who has chronic hepatitis B is also susceptible to infection with another strain of viral hepatitis known as hepatitis D (formerly called delta virus). Hepatitis D virus can only infect cells if the hepatitis B virus (HBV) is present. People who use IV drugs are at greatest risk. Being infected with both hepatitis B and D raises the risk of developing cirrhosis or liver cancer.

Hepatitis C is usually spread through contact with infected blood, as when IV drug users share needles. It can be either acute (a short term infection) or become chronic and even life threatening. There is no vaccine for hepatitis C.

Hepatitis E is rare in the United States. It is spread through ingesting food or water contaminated with feces. There is no vaccine for hepatitis E. The only way to prevent the disease is to reduce the risk of exposure to the virus.

Signs and Symptoms:

Acute Hepatitis

  • Flu like symptoms including fever, as well as aching or painful muscles and joints
  • Jaundice (yellow discoloration of both your skin and the whites of your eyes)
  • Abdominal pain
  • Fatigue
  • Weight loss
  • Loss of appetite
  • Nausea, vomiting
  • Dark urine, colorless stool
  • Diarrhea
  • Whole body itching (called pruritus)
  • Mild anemia
  • Enlarged, tender liver

Chronic Hepatitis

People with chronic hepatitis do not always have the symptoms of acute hepatitis. Some people with hepatitis C feel only mild ongoing fatigue and, perhaps, whole body itching. The virus is often discovered by a blood test.

Causes:

Hepatitis A is usually transmitted by someone touching feces and then not washing their hands before putting them in their mouth or touching food. It can be transmitted by ingesting contaminated food and water (for example, seafood from sewage contaminated water). It can also be transmitted through close contact with someone who has the virus.

Hepatitis B and C are transmitted through contact with infected blood. These viruses are usually transmitted by contaminated needles (in the case of IV drug users). Having unprotected sex with someone who is infected can also pass on the hepatitis B virus (it is more rare for hepatitis C to be transmitted through sexual activity). In as many as 40% of the cases of hepatitis C, the specific cause of transmission is unknown. Before better testing was developed, you could get hepatitis B or C from a blood transfusion. Now blood and blood products that are used for transmission can be tested for both hepatitis B and C.

Risk Factors:

Hepatitis A

  • Being in an institution (such as a nursing home or rehabilitation center)
  • Day care employees or children who attend daycare
  • Recent hepatitis A infection in a family member
  • Recent travel or immigration from Asia, South, or Central America
  • Food industry workers
  • Sewage workers

Hepatitis B

  • Contact with blood in work setting: health care providers are at particular risk
  • Unprotected sex with multiple partners
  • History of blood transfusion prior to the early 1990s
  • Receiving a tattoo with contaminated instruments
  • IV drug use with sharing of contaminated needles
  • Birth to a hepatitis B infected mother
  • Travel to underdeveloped nations and immigrants from areas where disease rates are high (the Asia Pacific and Mediterranean regions and southern Africa)
  • Having the human immunodeficiency virus (HIV) puts you at greater risk for chronic hepatitis and its potential complications

Hepatitis C

  • Blood transfusion prior to July 1992
  • Solid organ transplantation from a donor who has hepatitis C
  • IV drug use and sharing of contaminated needles
  • Long term kidney dialysis
  • Contact with blood in work setting: health care providers are at particular risk
  • Sex with a person who has hepatitis C
  • Birth to a hepatitis C infected mother, particularly if she has HIV
  • Having HIV or hepatitis B puts you at greater risk for chronic hepatitis C and its potential complications

Diagnosis:

First, your doctor will ask questions to assess your risk for the different types of viral hepatitis. Questions will include whether you:

  • Work in health care setting, including either a medical laboratory or a dialysis unit
  • Have a parent, sibling, or child infected with hepatitis
  • Engage in unprotected sex or have a sexual partner with either hepatitis B or C
  • Use IV drugs
  • Live in or are exposed to unsanitary conditions
  • Consume possibly contaminated food or water
  • Eat or handle raw shellfish

Next, your doctor will examine your abdomen carefully to see whether your liver or spleen are enlarged or tender. A blood test will check your liver function and test for antibodies against the specific hepatitis viruses. Your doctor will likely do a urine test as well. For chronic hepatitis, you may need a liver biopsy, which must be done under general anesthesia. A liver biopsy is important if you have chronic hepatitis C because this test checks the degree of liver damage, which can occur even if you don't have symptoms.

Prevention:

Hepatitis A

  • Avoid unclean food and water.
  • Wash hands thoroughly after using the toilet or changing a diaper, as well as before serving food.
  • Clean yourself thoroughly if you come into contact with any type of body fluid from an infected person (such as blood and feces).
  • Those with the virus should not prepare food for others.
  • People at risk should receive the hepatitis A vaccine (see below).

Hepatitis B and C

  • Avoid contact with blood or blood products whenever possible.
  • Do not use IV drugs, and do not share needles.
  • Avoid having multiple sexual partners.
  • Do not have unprotected sex.
  • Go to a reputable shop for tattoos and body piercing.
  • Health care workers should practice universal precautions when handling blood and bodily fluids. This includes wearing gloves when performing any procedure with blood exposure, disposing of needles properly, and other precautions.
  • Children should receive the hepatitis B vaccine (see below).
  • Avoid sharing personal items, such as razors and toothbrushes.

Immunization

Hepatitis A

People who should receive the hepatitis A vaccine include:

  • Anyone who lives or works in a community where outbreaks occur (such as a daycare center)
  • Those who travel frequently or have long overseas stays in high risk areas
  • Sexually active homosexual men
  • People who already have a chronic form of hepatitis should be vaccinated before the chronic form reaches late stages of liver disease.
  • Health care workers
  • People living in high risk U.S. states, which include Alaska, Arizona, Arkansas, California, Colorado, Idaho, Missouri, Montana, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Utah, Washington, and Wyoming
  • People with intimate exposure to someone with hepatitis A. In this case, your doctor will decide if the vaccine or immunoglobulin (an immunizing agent) is best for you.

Hepatitis B

Immunization provides the only true protection against hepatitis B. The hepatitis B vaccine is now part of routine pediatric care in the United States. Adults who are at higher risk should also be vaccinated:

  • Those who live with someone who has hepatitis B
  • Health care workers
  • Travelers to high risk areas
  • Sexually active people who have multiple partners
  • People on kidney dialysis
  • People who have suppressed immune systems (such as HIV)
  • High risk pregnant women
  • People who have inflammatory bowel disease (IBD)

Hepatitis C

There is no vaccine for hepatitis C, but immunoglobulin helps protect against it after blood transfusions. Receiving immunoglobulin in periodic doses may also help protect someone who has sex with an infected partner.

Treatment:

Acute Hepatitis

The goals for treating acute viral hepatitis include:

  • Supporting the person with nutrition and fluids
  • Preventing further damage to the liver
  • Avoiding transmission of the virus to others

There are no medications to treat acute hepatitis, although your doctor may recommend drugs to treat some of the symptoms. Most cases of acute hepatitis are mild. Only people who are at high risk for complications, such as pregnant women, the elderly, people with serious underlying medical conditions, or those who become dehydrated from nausea and vomiting need to be hospitalized. In very rare cases, acute hepatitis can lead to liver failure (called fulminant acute hepatitis) that requires liver transplantation.

Chronic Hepatitis

The goals for treatment of chronic viral hepatitis include:

  • Preserving liver function and preventing liver damage
  • Boosting the immune system to help fend off damage from the virus

There are several medications your doctor can choose to help treat chronic hepatitis. Many people also use CAM therapies that may help boost your immune function and help make you feel stronger and less tired while taking conventional medications, including herbal and vitamin supplements, homeopathy, acupuncture, and massage therapy. Make sure your health care providers know that you have hepatitis so that precautions can be taken to avoid spread of the virus.

Lifestyle

Your doctor will talk with you about steps you can take to avoid spreading the virus. For hepatitis A, these include:

  • Washing clothes thoroughly with hot water
  • Washing your hands after using the toilet
  • Heating contaminated articles for one minute, which should kill the virus
  • Using household bleach to disinfect hard surfaces
  • Keeping any eating and cooking utensils used by someone infected with the virus separate from other utensils
  • Abstaining from sex during an acute infection

For hepatitis B and C, these measures include:

  • Avoiding sharing personal items, such as toothbrushes and razors.
  • Abstaining from sexual activity, or taking strict precautions, such as always using a condom. Women should not have sex during menstruation.
  • Handling objects contaminated with blood with special care, like wearing gloves when drawing blood if you work in a hospital.
  • Not sharing drug needles if you use IV drugs and making sure that tattoo and piercing artists and acupuncturists use sterile needles. (Note: there have been no reports of hepatitis infection from acupuncture therapy in the United States.)

If you are traveling to a high risk country, take the following precautions:

  • Get vaccinated against hepatitis A and possibly hepatitis B.
  • Use bottled water for drinking and brushing teeth.
  • Eat heated food promptly. Heated food should be hot to the touch.
  • Do not buy food from street vendors.
  • Avoid sliced fruit. It may have been washed in contaminated water.
  • Do not eat raw or undercooked fish and shellfish.
  • Don't drink alcohol during the acute phase of hepatitis or if you become a carrier of types B or C.
  • Quit smoking. Evidence suggests that cigarette smoking is associated with more severe infection.

Medications

Interferons-- Interferon is produced by the body to fight viruses. Taking man made interferons may help stimulate your immune system against the hepatitis B and C viruses. Examples of interferon medications include Roferon-A, Intron-A, Rebetron, Alferon-N, and Peg-Intron. These drugs do not work for everyone who takes them, but the possible benefits include: