Hepatitis: Questions and Answers

What is Viral Hepatitis?

Hepatitis is an inflammation of the liver caused by medications, alcohol, poisonous mushrooms, or a variety of other agents including the viruses that cause mumps, measles, herpes and infectious mononucleosis. However, when health professionals talk about viral hepatitis, they usually mean hepatitis caused by the hepatitis A, hepatitis B, or hepatitis C virus. Although these viruses have similar names, they are quite different clinically and genetically.

How can I protect myself from infection?

Because the different viruses that cause hepatitis enter the body in different ways, there are several steps you can take to protect yourself from infection. Good hygiene, proper food preparation, and safe sex are good first steps. For more specific information, see the individual sections for hepatitis A, B and C.

What are the symptoms of Viral Hepatitis?

Early symptoms:

Later symptoms:

How is it diagnosed?

Although health providers use information about a person's symptoms, health history and behaviors to help make a diagnosis, only blood tests can confirm the diagnosis and determine which type of hepatitis a person has, and whether the infection is acute or chronic.

How is Viral Hepatitis treated?

Since there's no medication that can treat the initial (acute) infection of viral hepatitis, health professionals manage symptoms as they occur and try to help the body's immune system fight the infection. If you have viral hepatitis:

Your health professional may recommend hospitalization if you experience severe vomiting or do not feel better after several weeks.

HEPATITIS A

The Centers for Disease Control (CDC) estimates that 25,000 people were infected with Hepatitis A in 2007. Hepatitis A rates in the US have fallen 92% since the introduction of vaccine in 1995. In the United States, most infections result from close personal contact with an infected household member or sex partner. Less often, infection results from eating or drinking something that has been contaminated with the stool (feces) of an infected person. This type of transmission is called “fecal-oral”. The hepatitis A virus (HAV) can live outside the body for months. Heating the virus to 185 degrees F (85 degrees C) for one minute kills it. Chlorination kills HAV which enters the water supply.

Some facts about Hepatitis A

The CDC considers these groups to be at increased risk for acquiring Hepatitis A infection:

What behaviors could put me at risk for infection with the Hepatitis A virus?

What can be done to prevent Hepatitis A?

What if I've been exposed?

If you think you've been directly exposed to the hepatitis A virus, visit your health care provider immediately for treatment. Some treatments can help fight the infection if administered within two weeks (hepatitis A vaccine and Immune globulin G). All people who have close household or sexual contact with an infected person also need treatment.

If I'm infected, how do I keep from infecting others?

HEPATITIS B

Hepatitis B is a disease caused by the Hepatitis B Virus (HBV), which is transmitted through percutaneous (i.e. puncture through the skin) or mucosal (i.e. direct contact with mucous membranes) exposure to infectious blood or body fluids.

Although the rate of new Hepatitis B infections has fallen by an estimated 82% since 1991 (when routine vaccination of children began) it is still widespread. In 2007, an estimated 43,000 people in the United States were infected with HBV. Rates are particularly high among males aged 25-44 years. About 50% of adults with acute infection have no symptoms; most children with acute Hepatitis B are also asymptomatic. The mortality rate for acute Hepatitis B is 0.5-1.0%.

The CDC estimates that 800,000–1.4 million persons in the United States have chronic HBV infection and about 2,000-4,000 die each year from HBV-related cirrhosis or liver cancer. Worldwide, approximately 350 million people have chronic HBV: 620,000 die from HBV-related liver disease annually.

Some facts about hepatitis B

Modes of Transmission of Hepatitis B

HBV is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing, or sneezing.

Although HBsAg (an antibody to the HBV) has been detected in multiple body fluids, only (blood) serum, semen, and saliva have been demonstrated to be infectious.

The CDC considers the following groups to be at higher risk for HBV infection:

What can be done to prevent Hepatitis B?

If you are at risk of contracting hepatitis B, get vaccinated. The hepatitis B vaccine is an inactivated antigen (genetically engineered; not a live or killed virus). It is administered in a series of three injections over a six-month period. Approximately 95% of persons who receive the three injections develop full immunity after receiving the vaccine. (Persons who are allergic to yeast should not receive the HVB vaccine.)

Also, avoid high-risk behaviors and practice good personal hygiene when sharing food, kitchens, and bathrooms, especially if you live with someone who is infected with the hepatitis B virus. The virus can live outside the body for at least seven days. Wear gloves and use a 1:10 dilution of household bleach to clean up blood spills. Don't share razors, toothbrushes or pierced earrings with anyone.

What if I've been exposed?

If you have not been vaccinated against hepatitis B, but are exposed to the virus, your health professional can treat you with hepatitis B immune globulin (HBIG), combined with the hepatitis B vaccination. Studies have shown that HBIG, if given within one week of exposure, is about 75% effective at preventing HBV infection.

How is Chronic Hepatitis B treated?

HEPATITIS C

Some facts about Hepatitis C:

The CDC considers these groups to be at increased risk for Hepatitis C:

HCV can live outside the body for at least 16 hours, but not more than four days. Wear gloves and use a 1:10 dilution of household bleach to clean up blood spills. Additionally:

What can be done to prevent hepatitis C?

Since hepatitis C is transmitted in the same way as hepatitis B, you can help avoid infection by using the same precautions. Follow CDC guidelines regarding sexual practices. Practice good personal hygiene; and never share needles, razors, toothbrushes or pierced earrings with anyone. Currently, there is no vaccine available.

How is chronic HCV infection treated?

DELTA HEPATITIS

The delta virus (also known as hepatitis D) is an incomplete virus that may cause infection only in the presence of hepatitis B infection. The HDV may be acquired at the same time (co-infection) as HBV, or at a later time in a person with chronic HBV infection (super-infection). The symptoms and routes of transmission are similar to those of hepatitis B infection, but the risk of complications is higher. Acute liver failure is more likely with co-infection and cirrhosis is believed to be more common with chronic HBV/HDV infection (super-infection). Since Hepatitis D requires prior or concomitant infection with HBV, vaccination against Hepatitis B protects against HDV,

HEPATITIS E

Hepatitis E is a liver disease caused by the Hepatitis E virus (HEV). However, it occurs rarely in the United States. It is spread in the same way as Hepatitis A. It does not result in chronic infection. There is currently no vaccine.

Resources:

Hepatitis B Foundation web site: http://www.hepb.org/

Hep C Connection web site: http://www.hepc-connection.org/

Hepatitis Foundation International web site: http://www.hepfi.org/

Immunization Action Coalition’s Vaccine Information for the Public and Health Professionals web site: http://www.vaccineinformation.org/

CDC Vaccine & Immunization Recommendations and Guidelines: http://cdc.gov/vaccines/recs/default.htm

References

American Liver Foundation web site: http://www.liverfoundation.org/

Hepatitis Foundation International web site:  http://www.hepfi.org/

Family Doctor web site:  http://familydoctor.org/

Bonis P &Chopra, S. Patient information: Hepatitis C. UpToDate (18.1). January, 2010.

The Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services:
  1. Hepatitis C FAQs for Health Professionals. http://cdc.gov/hepatitis/HCV/HCVfaq.htm
  2. Hepatitis C FAQs for the Public. http://www.cdc.gov/hepatitis/C/cFAQ.htm
  3. Hepatitis B FAQs for Health Professionals. http://cdc.gov/hepatitis/HBV/HBVfaq.htm
  4. Hepatitis B, Chapter 8, Pinkbook, 11th Ed. http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/hepb.pdf