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Viral hepatitis, everybody's problem?

What is viral hepatitis?

Viral hepatitis is the most common of the serious contagious diseases caused by several viruses that attack the liver. About 70,000 cases are reported to the Centers for Disease Control each year but this represents only a fraction of the cases occurring in this country.

Hepatitis means inflammation of the liver, usually producing swelling and tenderness and sometimes permanent damage to the liver. Hepatitis may also be caused by non-viral substances such as alcohol, chemicals and drugs. These types of the hepatitis are known respectively as alcoholic, toxic and drug-induced hepatitis.

Are there different types of viral hepatitis?

At least five types of viral hepatitis are currently known, each caused by a different identified virus.

* Hepatitis A-formerly called infectious hepatitis, is most common in children in developing countries, but is being seen more frequently in adults in the western world.

* Hepatitis B-formerly called serum hepatitis, is the most serious form of hepatitis, with over 200 million carriers in the world and an estimated one million in the United States.

* Hepatitis C-formerly called non-A, non-B hepatitis, is now the most common cause of hepatitis after blood transfusion. More than one percent of Americans are carriers of the virus.

* Hepatitis D-formerly called delta hepatitis, is found mainly in intravenous drug users who are carriers of the hepatitis B virus which is necessary for the hepatitis D virus to spread.

* Hepatitis E-formerly called enteric or epidemic non-A, non-B hepatitis, resembles hepatitis A, but is caused by a different virus commonly found in the Indian Ocean area.

* Other viruses, especially members of the herpes virus family, including the cold sore virus, chicken pox virus, infectious mononucleosis virus and others can affect the liver as well as other organs they infect. This is particularly true when the immune system is impaired.

How is the infection spread?

Hepatitis A and E viruses are excreted or shed in feces. Direct contact with an infected person's feces or indirect fecal contamination of food, the water supply, raw shellfish, hands and utensils may result in sufficient amounts of virus entering the mouth to cause infections.

Hepatitis B is spread from mother-to-child at birth or soon after birth, through sexual contact, blood transfusions or contaminated needless. Almost a quarter of the cases may result from unknown sources in the general population. In families the virus can be spread from adults to children.

Hepatitis C is spread directly from one person to another via blood or needles. While sexual transmission and mother-to-child spread may occur, the transmission of this disease is not clearly understood.

Hepatitis D is spread mainly by needles and blood. Hepatitis D infects only individuals infected with hepatitis B and may be transmitted by carriers of hepatitis D and B.

What are the symptoms of viral hepatitis?

The most common symptoms are fatigue, mild fever, muscle or joint aches, nausea, vomiting, loss of appetite, vague abdominal pain, and sometimes diarrhea.

Many cases go undiagnosed because the symptoms are suggestive of a flu-like illness or may be very mild or absent.

A minority of patients notice dark urine and light colored stools, followed by jaundice in which the skin and whites of the eyes appear yellow. Itching of the skin may be present. With the onset of jaundice, other symptoms tend to subside. Some people may lose 5 to 10 pounds during the illness.

Do you always turn yellow when you have hepatitis?

No, most individuals with viral hepatitis do not develop jaundice.

Can I get hepatitis again?

Yes, because there are five or more hepatitis viruses, you can acquire different ones at different times. You will not be infected by the same virus as each produces its own immunity after the virus disappears. However, sometimes the viruses of B, C and D hepatitis remain in the body forever. They can cause flare-ups of hepatitis that look like new disease.

What is a carrier and how can I tell if I am one?

A carrier is a person who has hepatitis B, C or D in his or her blood even after all symptoms (except fatigue) have disappeared. Because the virus is present in the blood, it can be transmitted to others. Hepatitis A does not have a carrier state. The hepatitis B carrier can be recognized by a simple and specific blood test. Some of the carriers are contagious and others are not; this too can be determined by a simple blood test. A test for the hepatitis C carrier is being developed but is not yet available. Prior to transfusion, all blood is now tested for abnormality of the liver function and for the hepatitis B virus. These tests have reduced the rate of the post-transfusion hepatitis C by about 50%. Blood banks notify donors if they have found such abnormalities. Hepatitis D can be detected by a simple blood test for antibody to the virus and by a positive test for hepatitis B; both must be positive to be sure that the hepatitis D virus is present. Testing for hepatitis E is being developed but is not yet available.

If I am pregnant and develop hepatitis, is there a risk for my baby?

Hepatitis does not increase the risk of still births and malformations. Miscarriages, however, occur more frequently and conception may be more difficult in those with chronic hepatitis.

When hepatitis B occurs during pregnancy of a mother who is a carrier of the virus, the chances are very high that the baby will become infected at birth. Infection of the baby in the uterus is rare. Most of the infected babies become carriers. A few become very sick and some seem to escape infection. All pregnant women should be tested for hepatitis B so that the infants of those who test positive can be immunized at birth. Some of the countries with a high incidence of hepatitis B carriers are beginning to vaccine all newborn babies.

Viral hepatitis tends to run its course and is no more severe than in the non-pregnant individual as long as the pregnant woman is receiving good prenatal care. However, hepatitis E does have an unexplained high mortality rate during pregnancy. When jaundice occurs with viral hepatitis, especially in the last half of pregnancy, it may persist with itching until after delivery.

What should I do if I have been exposed to or suspect that I have hepatitis?

Consult your physician who will examine you and order blood tests to confirm the diagnosis, identify the specific type of hepatitis and advise you about diet and activity. Your contacts should be notified about your infection and the need for gamma (immune) globulin and vaccination.

Should I see a specialist if I have hepatitis?

Most physicians can care for a patient with an ordinary case of viral hepatitis. However, referral to a specialist in diseases of the liver (hepatologist, gastroenterologist) may be necessary if the disease appears to be unusually severe or complications are recognized.

IS hospitalization necessary?

In most cases, no. Some patients are hospitalized if neither liquids nor food can be tolerated or if the disease is unusually severe or complications arise.

Are there medications for viral hepatitis?

No medicine now available alters the course of acute viral hepatitis. Prevention is the only effective treatment. Several antiviral drugs are being tested and studies are underway to determine whether interferon, a natural substance in the human body but now synthetically produced, will rid the chronically infected patient of hepatitis B and C viruses. Whether interferon has any role in acute hepatitis has yet to be determined.

If I take medicine for other purposes, can I continue to do so?

Medications taken regularly should be reviewed by a physician and a decision made regarding their continuation. Because the liver plays a key role in processing drugs and this function may be impaired in the patient with hepatitis, medications are usually withheld unless they are essential for the treatment of other problems.

Can I take birth control pills if I have hepatitis?

Although the pill itself occasionally produces abnormalities in the liver, continuation during and after viral hepatitis appears to be harmless. However, if jaundice with itching is present, the pill should be discontinued until the symptoms disappear.

Can I exercise while I have hepatitis?

Vigorous exercise during the acute stage of the disease should be discouraged. Light or moderate exercise may be undertaken as symptoms subside.

Must I stay in bed?

Restriction to bed is not necessary for patients with viral hepatitis. A good general rule is "if you feel well, get up, but if you do not, take it easy."

How great is the risk of hepatitis to me and my family?

Spread within the family can occur with hepatitis A, B or E. Prompt diagnosis and appropriate precautions with gamma globulin or vaccination are important for those who are exposed.

Do I need a special diet or vitamins?

A nutritious, well balanced diet with additional calorie-rich fluids (soft drinks, fruit juices) is normally sufficient during the illness. Since many patients describe a reduction in appetite and an increase in nausea as the day progresses, a hearty breakfast is often the best tolerated meal of the day. Multiple small snacks between meals are encouraged if large meals cause problems. Vitamin supplements have no clear value if a balanced diet can be eaten.

Must I give up alcohol?

All alcoholic beverages should be avoided during the acute phase of the disease since metabolism of the alcohol stresses the already sick liver.

(Modest alcohol consumption later in the convalescent phase or after recovery is not harmful.)

Should I avoid sexual activity?

Sexual activity does not seem to affect the disease or recovery. However, your partner may be at risk for acquiring the infection, especially of hepatitis B.

Do dishes and clothing of the patient need special care?

Hot water and soap or detergent is sufficient for cleaning dishes or clothing of patients with hepatitis A or E. Special care must be taken if anything has blood on it when the patient has hepatitis B or C. Dishes, utensils and clothing do not harbor the hepatitis B or C virus.

Can I prepare meals?

If you have hepatitis A or E, you should not prepare meals or handle food to be eaten by others. However, you were especially contagious before the symptoms of hepatitis were recognized and you may have already transmitted the infection or exposed others unknowingly.

If you have hepatitis B, C or D, limitations on food handling are not necessary.

How long does the illness last?

The onset is often abrupt and recovery occurs in a few weeks to a month or two. The contagious period lasts 2 to 3 weeks. With hepatitis B, the onset is more gradual and the course is longer. Over 80% of patients recover within 6 months, another 10% after 2 years, while 5 to 10% either develop chronic hepatitis or become carriers. The onset of hepatitis C is often not recognized and the disease becomes apparent months to years after infection. More than half of the patients who are infected by blood transfusion will develop chronic hepatitis with fluctuating symptoms and laboratory test results. Hepatitis D coinfection with hepatitis B acts as though it were very serious hepatitis B but recovery after a few months is usual. Hepatitis D concurrent infection in a hepatitis B carrier looks like a flare-up of hepatitis B and symptoms may become lifelong. The symptoms of hepatitis E are like those of hepatitis A, although the period of illness may be as long as several months.

How long should I continue to see a doctor?

You should continue to see your doctor until blood tests indicate the illness is clearly over. Abnormalities in the blood tests that persist beyond six months must be carefully evaluated since they may indicate the development of chronic infections.

What are the complications of hepatitis?

Fortunately, most people recover completely from hepatitis A, B, D and E. Mild flare-ups may occur over a period of several months. Each flare-up is usually less severe than the initial attack and a relapse does not necessarily indicate that complete recovery will not take place.

About 1 patient in 1000 dies of hepatitis A, 1 in 100 of acute hepatitis B and somewhere in between for hepatitis C. The mortality rate of hepatitis D and B is higher than for hepatitis B alone. Not enough is yet known of hepatitis E.

About 5% of patients with hepatitis B and more than 50% of patients with hepatitis C develop chronic liver disease which may be mild and slowly progressive, or may be serious and rapidly lead to cirrhosis. The tersm "chronic persistent" and "chronic aggresive" have been used for these two varieties, but we now know that the degree of activity varies with time and in different places in the liver at the same time. Cirrhosis is the final state of scarring which develops in chronic hepatitis. To determine how much scarring is present or how rapidly it may be progressing, a liver biopsy is usually necessary. Predicting who will develop chronic liver disease is not possible at the time of acute hepatitis. Identification of those at risk and methods to prevent these consequences are the subjects of ongoing research.

How can the spread of hepatitis be prevented?

Adequate sanitation and good personal hygiene will reduce the spread of hepatitis A and E. Water should be boiled prior to its use if any question of safety exists. Similarly, in areas where sanitation is questionable, food should be cooked well and fruits peeled. Washing hands, cleaning utensils, bedding and clothing with soap and water is necessary for those involved in treating patients, especially in the first couple of weeks of illness. Those planning to travel to areas where hepatitis A is widespread are advised to take immune globulin before leaving. Its protection is effective 3-4 months. To prevent spread of hepatitis B, avoid exposure to infectious blood or body fluids. Do not have intimate contact, share razors, scissors, nail files, toothbrushes or needles. If any risk is present, you should receive immune globulin and vaccine as soon as possible.

Blood banks are hard at work to insure the safety of the blood supply. Hepatitis B from transfusion has been largely prevented and hepatitis C has been reduced, with prospects of even further reduction soon. Sharing needles with anyone should be avoided. Dentists, doctors, nurses, laboratory technicians and others who may draw blood, perform surgical procedures or handle sharp instruments used on hepatitis patients or carriers must be informed so that adequate precautions can be taken. Family members and other intimate contacts must be advised to seek medical advice about immune globulin shots or vaccination.

Are there vaccines and can the disease be prevented?

A vaccine for hepatitis A is currently under development but it will be many years before testing in humans begins. Several vaccines are being tested, but none is yet available.

Several vaccines are available to prevent hepatitis B. They are all safe and effective and they seem to prevent infection if started within a few days of exposure. The usual vaccination schedule used in the United States is two injections a month apart followed by a third injection 6 months after the first one. Hepatitis B immune globulin may also prevent infection after exposure but it must be given within 48 hours to be useful. Since both vaccination and immune globulin are expensive, rapid confirmation of the diagnosis of hepatitis B is needed. Hepatitis D is prevented by preventing hepatitis B. No vaccine or immune globulin is yet available for hepatitis C or E.

Does hepatitis cause cancer?

A high incidence of liver cancer is found in some African and Asian countries where there are many hepatitis B carriers and appears to be related to the chronic hepatitis B carrier state. Research on this relationship is being actively pursued.

The number of cases of liver cancer in patients with chronic hepatitis C is increasing, but whether the cancer rate will ever be as high as with hepatitis B is unknown. About 15% of hepatitis B carriers in the Orient are at risk of developing liver cancer, but the rate seems to be considerably less in the United States.

Is hepatitis related to AIDS?

Any relation between AIDS and hepatitis is coincidental. Male homosexuals and intravenous drug users who are at high risk for infection with the immunodeficiency virus (HIV), the cause of AIDS, are at equally high risk for infection with the hepatitis B virus.

Hope for the future through research!

Tremendous advances through research have been made in the field of viral hepatitis within the past decade. These all have followed identification on the specific viruses that cause diseases and will result in development of vaccines that eventually will prevent the one million new cases of viral hepatitis occurring in children and adults each year in the United States.

Vaccination eventually will lead to the prevention of liver cancer found in chronic carriers of some of the viruses.

Recent research has discovered a laboratory method of detecting hepatitis C. This will lead to further reductions in hepatitis after blood transfusions. It will also enable better monitoring of treatment.

Research is also being carried out on drugs that have the potential for eradicating some of these viruses and for improving treatment of chronic hepatitis.

BUT ... MORE RESEARCH IS NEEDED to help the millions of Americans suffering with liver diseases ... many of which are incurable at this time.

The AMERICAN LIVER FOUNDATION is a national voluntary health agency dedicated to attacking liver diseases.

Hope for the future depends on your help!
COPYRIGHT 1991 American Liver Foundation
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Publication:Pamphlet by: American Liver Foundation
Article Type:pamphlet
Date:Sep 23, 1991
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