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Dr Miriam: The bug that bides its time.

Byline: Miriam Stoppard

ABOUT one in every 1,000 people in the UK - about 600,000 in all - carry the virus for hepatitis, although not all of them will go on to develop the disease.

In fact, nine out of 10 people with hepatitis don't

even know they're carrying it.

Hepatitis has many causes, as Dr Miriam explains.

VIRUS TYPES

A

THIS is the commonest cause of acute

viral hepatitis in the West.

Often, the hepatitis A virus doesn't cause symptoms, or symptoms are so mild the infection passes unrecognised.

The virus can be detected in the urine and faeces of infected people, and it can be transmitted to other people in contaminated food or water.

THE most common cause of acute hepatitis, worldwide, is a viral infection.

Until the late 1980s, there were only two known hepatitis viruses, hepatitis A and B.

More have now been identified, including C, D and E. Others are almost certainly yet to be discovered.

The known viruses can all cause acute hepatitis. Most people with this condition recover within a month or two.

However, in some cases, inflammation of the liver persists for many months, or can even last for years (chronic hepatitis) and may progress to liver failure.

Other infectious causes

ACUTE hepatitis may also result from other viral infections, such as cytomegalovirus and the Epstein-Barr virus (the cause of glandular fever).

Some bacterial infections, such as Legionnaries' disease, can cause hepatitis, as can malaria. Certain drugs and toxins, including alcohol, can also be responsible.

What can I do?

IMMUNISATIONS to protect against hepatitis A and B are available.

This year the National Institute of Clinical Excellence) recommended a new and effective treatment, pegylated interferon for people with hepatitis C.

B

IT'S estimated that each year about one million people in Europe become

infected with the hepatitis B virus.

The virus is spread by contact with an infected person's body fluids. For example, the virus can be spread by sexual intercourse or by sharing contaminated needless used for taking drugs intravenously.

In developing countries, the infection is most commonly transmitted from mother to baby at birth.

Before blood banks routinely screened blood for the virus, blood transfusions used to be a source of hepatitis infection, and many people with haemophilia contracted hepatitis.

All blood used for transfusions is now screened for the hepatitis B virus.

C

ABOUT 3 per cent of people worldwide are infected with the hepatitis C virus each

year, and they can live with the virus for 20 years before showing signs of hepatitis.

The virus is most commonly transmitted by blood, often by sharing contaminated needles used for taking drugs intravenously, and through sex.

It can cause cirrhosis, liver cancer and liver failure. All blood used for transfusions in the UK is now screened for the hepatitis C virus.

DE

INFECTION with hepatitis D occurs only in people who already have hepatitis B infection. It is spread by contact with infected body fluids.

The hepatitis E virus is a rare cause of hepatitis in the developed world.

CHECK OUT THE SYMPTOMS

SOME people infected with a hepatitis virus have no symptoms. In other cases, the disorder may be life-threatening.

If hepatitis is due to a viral infection, the time from infection to appearance of symptoms - if there are any - varies from up to six weeks for hepatitis A to six months for hepatitis B.

Some people who have no symptoms may become carriers of the virus.

If symptoms do develop, they may initially include:

Fatigue and a feeling of ill health.

Poor appetite.

Fever, nausea and vomiting.

Discomfort in the upper right side of the abdomen.

Several days after the first symptoms develop, the whites of the eyes and the skin may take on a yellow tinge (jaundice).

Often, initial symptoms improve once jaundice appears. At this time, faeces may become paler than usual,

and widespread itching is distressing.

Acute hepatitis caused by the hepatitis B virus may also cause joint pains.

Severe acute hepatitis may cause liver failure, mental confusion, seizures and sometimes coma.

In the blood

IF your doctor suspects you have hepatitis, you'll have blood tests to evaluate your liver function and to look for possible causes.

Blood tests will be repeated to monitor your recovery.

If the doctor still has doubts whether you have the condition, you may also have an ultrasound scan and in some cases a liver biopsy, in which a small piece of liver is removed and examined under a microscope.

IT PAYS TO REST

THERE is no specific treatment for most cases of acute hepatitis, and people are usually advised to rest.

Consult your doctor before taking any medicines, such as painkillers, because of a risk of side effects.

If you have viral hepatitis, you'll need to take precautions to prevent the spread of the disease, including practising safe sex.

Avoid drinking alcohol during the illness and for a minimum of three months after you recover. However, if the cause was alcohol-related, you'll be advised to give up drinking alcohol permanently.

The outlook

Most people with acute hepatitis feel better after four to six weeks and recover after three months.

However, for some people with hepatitis C, recovery is followed by a series of relapses over several months.

About three out of four people with hepatitis C, and one out of 20 with hepatitis B and D, develop chronic hepatitis.

People with acute hepatitis caused by an infection other than the hepatitis viruses usually recover completely once the infection clears up.

Recovery from acute hepatitis due to excessive alcohol consumption, drugs or other toxins depends on the extent of liver damage. Avoid the substances causing acute hepatitis in future.

In rare cases where hepatitis progresses to liver failure, a liver transplant may be necessary.

FOR further reading, Family Health Guide, by Dr Miriam Stoppard is available from Mirror Direct on 0870 07 03 200, price pounds 22.50 including postage and packing.

CAPTION(S):

FEVER: One of the symptoms; ALCOHOL: Avoid it
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Title Annotation:Features
Publication:The Mirror (London, England)
Date:Sep 9, 2004
Words:1002
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