Hepatitis Overview

This online Hepatitis Risk Assessment is designed to determine an individual’s risk for viral hepatitis and asks questions based upon CDC’s guidelines for testing and vaccination. The Hepatitis Risk Assessment allows individuals to answer questions privately and print their recommendations to discuss with their doctor. Take this 5 minute assessment developed by the CDC and get a personalized report.

What is hepatitis?

Hepatitis is an inflammation of the liver caused by a hepatitis virus.

An estimated 4.4 million Americans are living with chronic hepatitis; most do not know they are infected. Most do not know HOW they were infected. About 80,000 new infections occur each year.

There are several types of viral hepatitis infections. The most common types of viral hepatitis in the U. S. are hepatitis A, B, and C. In recent years, hepatitis D and E viruses also have been identified. Related health issues affecting the liver are cirrhosis and liver cancer.

How do you get hepatitis?

Hepatitis A is transmitted through fecal contaminated food or water and anal/oral contact. Transmission of hepatitis B (HBV) and C (HCV) involves contact with infected blood and body fluids. HBV is transmitted by infected body fluid. HCV is a blood born virus and is transmitted blood to blood. In some cases it is impossible to trace the source of a hepatitis infection. ??

Can someone visit me if they have hepatitis?

It is perfectly safe to visit someone with hepatitis. Hepatitis is not transmitted through casual contact. It is OK to shake hands with, hug, or kiss someone who is infected with viral hepatitis.

Can hepatitis be sexually transmitted?

Yes, hepatitis B is often sexually transmitted. HBV is found in blood, semen, and vaginal fluids. The virus is 100 times more infectious than the HIV virus. Sexual partners of an infected person should practice safe sex. Partners not infected should get vaccinated for hepatitis B. (Those who have recovered from HBV are immune.)

Hepatitis C is not easily transmitted through sexual contact; researchers are uncertain how often transmission occurs through sex.

Hepatitis A may be spread through anal/oral contact during sex.

Is treatment available for hepatitis patients?

  • Hepatitis A: no treatment for hepatitis A (HAV), however 99% of the time HAV will clear up over a period of a few weeks to months.
  • Hepatitis B: treatment for chronic hepatitis B usually consists of Alpha interferon and lamivudine. These drugs are effective in up to 40% of patients.
  • Hepatitis C: treatment for HCV will be interferon, ribavirin, and teleprevir or boceprevir. Currently these are the recommended drugs. Interferon can be taken alone or in combination with Ribavirin. Combination therapy is currently the treatment of choice.
  • Chronic hepatitis D is usually treated with pegylated interferon, although other potential treatments are under study.
  • Hepatitis E usually resolves on its own over several weeks to months.

Hepatitis A (HAV)

Hepatitis A is the most common of the two enterically (relating to, or being within the intestine) transmitted hepatitis viruses (hepatitis A virus and hepatitis E virus) in the U.S. and is one of the two vaccine-preventable hepatitis infections (hepatitis A and B). In children the infection is usually mild and without symptoms. However, in adults the severity generally increases with increasing age. Nonetheless, full recovery is expected in about 99% of all infections. HAV infection usually resolves on its own over several weeks, but occasionally relapses occur. Hepatitis A does not lead to chronic hepatitis.

Hepatitis A is spread primarily through person-to-person contact, or via food or water contaminated by feces from an infected person. In rare cases, it can be spread through contact with infected blood. Basic precautions like washing hands with soap and water following bowel movements and before food preparation can reduce the incidence. Hepatitis A is prevented through vaccination. The Centers for Disease Control and Prevention (CDC) recommend hepatitis A vaccination for children aged 12 to 23 months and for adults who are at high risk for infection. Following the initial dose, a booster dose is given 6-12 months later. Treatment with immune globulin can provide short-term immunity to hepatitis A when given before exposure or within 2 weeks of exposure to the virus but vaccination is preferred since it provides long-term immunity lasting at least 20 years.

If you are traveling to any countries with poor sanitary conditions then you should get vaccinated at least one month before departure. You should also avoid tap water when traveling internationally and practice good hygiene and sanitation. People who should be vaccinated against hepatitis A include:

  • Travelers (tourists, business, missionaries, military, peace-keepers)
  • Users of illegal injected drugs
  • Native peoples of America
  • Restaurant workers and food handlers
  • Children living in communities that have high rates of hepatitis
  • Children and workers in day care centers
  • People engaging in anal/oral sex or with STDs or HIV
  • People with chronic liver disease
  • If you eat raw shellfish frequently, ask your physician about being vaccinated.
  • Laboratory workers who handle live hepatitis A virus.

Hepatitis B (HBV)

Hepatitis B is a vaccine-preventable bloodborne infection. It is a serious viral disease that infects the liver. While the hepatitis B virus (HBV) doesn’t directly damage the liver, it is the body’s immune response to the virus that results in liver injury. Among adults with acute hepatitis B less than 2% fail to clear the virus within six months after infection and develop chronic Hepatitis B infection. To offer a comparison, about 80% of infected newborns and as many as 20% of children under the age of 5 develop persistent infection. Patients with acute hepatitis B must be followed carefully to identify those who have recovered spontaneously and those in whom chronic infection may require specific antiviral drug treatment. Treatment is reserved for those patients in whom viral levels are increased above a specific level and liver enzymes elevations are present. Other patients, for example, so-called inactive carriers with low levels of virus and normal liver enzymes are not currently treated.

In the U.S. the disease is spread predominantly through sex with an infected person, from mother to child during childbirth, (regardless if the delivery is vaginal or through Caesarean section), and through contact with infected blood or body secretions among injection drug users, health care workers, first-responders, and others at risk of exposure. Screening of Asian-Americans for evidence of HBV is recommended because mother to child transmission was common in Asia and other parts of the world prior to the development of immunization programs.

Vaccination provides the safest and most effective protection against hepatitis B for at least 15 years and possibly much longer. Currently, the Centers for Disease Control and Prevention (CDC) recommend that all newborns and individuals up to 18 years of age as well as adults at a high risk of infection (see below) be vaccinated. They also recommend that previously unvaccinated patients with diabetes, age 19 to 59 years, should be vaccinated since such individuals appear to be at increased risk.

Everyone who handles blood or blood products in their daily work should be vaccinated. Three injections over a 6-12 month period are required to provide full protection.

Infants born to infected mothers should receive hepatitis B immune globulin and the hepatitis B vaccine within 12 hours of birth to help prevent infection. Two additional doses of vaccine should be administered at 1 and then at 6-12 months of age. There is increasing evidence that for pregnant women with high levels of HBV, treatment with an oral antiviral at the end of the second or beginning of the third trimester until delivery will reduce the risk that the immunized baby will be infected.

People who develop acute hepatitis B are generally not treated with antiviral drugs because the disease often resolves on its own.

Infected newborns are most likely to progress to chronic hepatitis B, but by young adulthood, most people with acute infection recover spontaneously. Severe acute hepatitis B can be treated with an oral antiviral drug but available data on effectiveness are conflicting and those with acute liver failure are candidates for liver transplantation.

For the treatment of chronic hepatitis B two oral drugs – tenofovir and entecavir – and an injected drug, pegylated interferon are available and considered first-line options. Older drugs, such as lamivudine, telbivudine, and adefovir, are no longer favored. These treatments suppress HBV and improve outcomes. However, treatment is not a cure and small amounts of HBV may persist in the liver for decades.

Hepatitis C (HCV)

Hepatitis C causes inflammation of the liver, with an estimated 80% of those infected developing chronic hepatitis. Many people infected with hepatitis C also can develop cirrhosis (scarring of the liver), and some may also develop liver cancer.

Hepatitis C is spread primarily through contact with infected blood. Less commonly, it can spread through sexual contact and childbirth. There is NO vaccine to prevent HCV. The source of HCV infection remains a mystery in about 10% of the cases. That means preventive measures are your first line of defense against HCV.

The only way to prevent the disease is to reduce the risk of exposure to the virus. Reducing exposure means avoiding behaviors like sharing drug needles or personal items such as toothbrushes, razors, and nail clippers with an infected person.

People most likely to be exposed to the hepatitis C virus include: injection drug users; people with tattoos or piercings done with unsterile instruments; people who have sex with an infected person; people who have multiple sex partners; health care workers; infants born to infected women; hemodialysis patients; people who received a transfusion of blood or blood products before July 1992, when sensitive tests to screen blood donors for hepatitis C were introduced; and people who received clotting factors made before 1987, when methods to manufacture these products were improved.

The hepatitis C virus is found mainly in blood. Injection drug use accounts for about 60% of all new cases of hepatitis C and is a major risk factor for infection with hepatitis B virus. Among frequent drug users, 50-80% are infected by HCV within the first 12 months of beginning injecting. Straws shared in snorting drugs are also a potential source of infection of HCV. HCV is not spread through kissing or casual contact.

Most people infected with HCV don’t have symptoms and lead normal lives. Symptoms may be very mild and flu-like: nausea, fatigue, loss of appetite, fever, headaches, and abdominal pain. Most people do not have jaundice although jaundice can sometimes occur along with dark urine. Those infected with hepatitis C should not drink alcohol, as it accelerates the liver damage.

The incubation period varies from 2-26 weeks. Liver enzyme tests may range from being elevated to being normal for weeks to as long as a year. The virus is in the blood and may be causing liver cell damage, and the infected person can transmit the disease to others.

About 3.2 million are chronically infected with HCV, with many showing no signs or symptoms. The good news is that, in 1995, a reliable antibody test for HCV was finally implemented nationwide. About 41,000 new cases occurred in 1998 with 15-25% recovering spontaneously. Hepatitis C is a slow-progressing disease that may take 10-40 years to cause serious liver damage in some people.

Hepatitis D (HDV)

Hepatitis D (HDV) is spread through contact with infected blood. This disease only occurs as a co-infection with hepatitis B, or in anyone who are already infected with hepatitis B.

Not everyone infected with the hepatitis D virus will develop symptoms. You may develop a sudden fever, extreme tiredness, nausea, lack of appetite, abdominal or stomach pain, and yellowing of the skin or whites of the eyes.

Those at risk are injection drug users, people who live with or have sex with a person infected with HDV and people who received a transfusion of blood or blood products before 1987.

Vaccination against HBV will prevent HDV. Other preventive measures include avoiding exposure to infected blood, contaminated needles, and an infected person’s personal items such as toothbrushes, razors, and nail clippers.

Interferon alfa-2b treatments may be beneficial to a small proportion of patients.

Hepatitis E (HEV)

Hepatitis E was not recognized as a distinct human disease until 1980. It is caused by infection with the hepatitis E virus, a non-enveloped, positive-sense, single-stranded RNA virus.

Acute hepatitis E is uncommon in the United States and very rarely results in chronic hepatitis, particularly in solid organ transplant recipients, patients with cirrhosis, and those on immunosuppressive therapies. Currently there is no FDA-approved treatment for HEV infection. It usually resolves on its own over several weeks to months. For those rare instances in which the infection becomes chronic, treatment with ribavirin has been reported to be effective. Hepatitis E is spread through food or water contaminated by feces from an infected person. There is considerable evidence that because swine may carry the infection, ingestion of pork or pork products may transmit infection. Person-to-person transmission is uncommon. There is no evidence for sexual transmission or for transmission by transfusion in the United States.

People most likely to be exposed to the hepatitis E virus include international travelers, particularly those traveling to developing countries where hepatitis E is endemic, those who come in contact with swine, and those who ingest pork products and venison.

Typical signs and symptoms of hepatitis include jaundice (yellow discoloration of the skin and sclera of the eyes, dark urine and pale stools), anorexia (loss of appetite), an enlarged, tender liver (hepatomegaly), abdominal pain and tenderness, nausea and vomiting, and fever, although the disease may range in severity from subclinical to fulminant. The disease is especially severe in pregnant women in whom the case fatality rate may be as high as 10%.

Outbreaks of hepatitis E have been reported in Central and South-East Asia, North and West Africa, and in Mexico, especially where fecal contamination of drinking water occurs.

Testing for anti-HEV is usually reserved for individuals with hepatitis in whom the other more common hepatitis viruses cannot be detected.

Prevention is based on consumption of clean drinking water, avoidance of contaminated foods, and good sanitation. At present, no commercially available vaccines exist for the prevention of hepatitis E.

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