Healthy Travel and Hepatitis
Each year an estimated 30 million travelers visit destinations that are considered high-risk for hepatitis A and B. Hepatitis A and B are the most common vaccine-preventable diseases in travelers, affecting more than 280,000 Americans. Clearly, many thousands of travelers set out inadequately informed about the risks of getting hepatitis while outside the U. S.
The good news is that in addition to getting the two vaccines separately, there is a combination vaccine that safely and effectively prevents both of these potentially fatal diseases. This vaccine will reduce the number of shots needed to protect against both diseases from five to only three.
To find out more about your travel health risks visit www.cdc.gov/travel.
To find a travel medicine physician throughout the world visit the International Society of Travel Medicine.
Living with Hepatitis B
If you are a HBV carrier, it’s your responsibility to take important steps to care for yourself and prevent the spread of HBV. Here’s what to do:
Keep others healthy
- Hepatitis B is transmitted by contact with infected blood, serum, semen, and vaginal fluids. Wash your hands with soap after touching your own blood or body fluids. Throw personal items such as tissues, menstrual pads, tampons, or bandages away in a plastic bag.
- All cuts and open sores should be covered with a bandage. Wipe up your blood spills, then, re-clean the area with a solution of one part household bleach to ten parts water.
- Tell sexual partners you have hepatitis B. Partners should be tested for HBV, and if not immune to the virus, they should receive the vaccination series of three shots. Until protection from HBV has been guaranteed, use a condom.
- People living in the same household as a carrier should see their doctor for hepatitis B testing and vaccination. If anyone unvaccinated is exposed to the your blood or body fluids, hepatitis B immune globulin can be given within two days to two weeks can prevent the infection.
Keep yourself healthy
- Monitor the state of your liver at least once a year to determine if the disease is progressing and if cirrhosis or liver cancer is developing.
- Review all medications with your physician. Even some over-the-counter and alternative medicines can harm the liver and especially if taken with alcohol.
- Have periodic liver-imaging studies for liver cancer. The value of alpha-fetoprotein, a blood test for liver cancer, is uncertain.
- If pregnant, be sure to tell your physician you are an HBV carrier so your baby will receive appropriate management upon delivery.
- On routine visits, remind your doctor, dentist, and other healthcare providers that you are an HBV carrier.
Things NOT to do
- Avoid, or severely restrict, alcohol intake. Your liver may be further damaged by alcohol. If you do drink alcohol, NEVER do so with acetaminophen, found in Tylenol or other cold and headache remedies. Do not share with anyone toothbrushes, razors, needles, syringes, nail files, clippers, scissors, or any object that may come into contact with your blood or body fluids.
- Do not share food that has been in your mouth and do not pre-chew food for babies.
- Do not donate blood, plasma, body organs, tissue, or sperm.
Stay informed about research developments regarding treatments so you are able to make the best decisions. Research is now being planned and conducted to improve the treatment of chronic hepatitis C (HCV) and hepatitis B (HBV) infections.
Living With Hepatitis C
In past years, many individuals learned that they have HCV from a blood test during a routine physical or because they attempted to donate blood. Screening of baby boomers, recommended in 2012, is likely to identify many more. While testing positive for HCV isn’t good news, it’s not all doom, gloom, or a death sentence, either. Here are some important things to remember:
In most people the HCV infection does not disappear spontaneously, so you should be further tested and advised about treatment options. Think positively. The disease progresses over decades, silently killing liver cells and leading to scarring of the liver – called cirrhosis.
Get regular medical attention
A physician who knows about HCV, a gastroenterologist, hepatologist, or infectious disease specialist can watch for signs of trouble, identify problems and advise you about new treatments.
Avoid contact with blood
HCV can be transmitted through blood. Cover open cuts, and don’t share razors, toothbrushes, manicure tools, tattoo needles, body piercing instruments, or anything that might have even the smallest amount of blood on it. Be wary of menstrual blood, as well.
Protect your liver
Your liver is already stressed by the hepatitis virus. Omit or severely limit alcohol use. Alcohol should not be taken with other drugs – especially acetaminophen, the ingredient in Tylenol and a number of other headache and cold remedies. The combination may damage your liver that is already trying to fight off the virus. Check with your doctor before using any medications, including over-the-counter drugs or alternative (herbal) medicines.
Be concerned about sex partners
While studies have shown the risk of sexual transmission is low between long-term, monogamous couples, people with new or multiple sexual partners should use latex condoms. Inform potential partners that you have the virus. In addition, viral levels in the blood can vary widely or rise in response to immunosuppressive drugs, which would make HCV carriers more infectious at certain times. Virus levels increase when certain medications such as corticosteroids or cyclosporine are taken. People with HCV who take these drugs should discuss precautions needed with their doctor.
Keep yourself updated on current research, information, and treatment. Be aware of your own health status and what your various options are. Updates on current breakthroughs are sent through our email list server. Much additional valuable information can be found in our RESOURCESpage.
Living With Chronic Hepatitis
Chronic hepatitis can cause added stress to a busy life. The physical symptoms of hepatitis can increase the emotional toll of coping, so finding ways to minimize physical distress – and to ease the frustrations and complications caused by hepatitis – are critical. Here are the best ones:
Coping with stress
In addition to physical symptoms, hepatitis often causes emotional stress. It’s important to have people you can count on for support and encouragement. Talk to friends and loved ones about difficulties you experience and what you need from them. People are not mind-readers, and open discussions can help minimize problems and misunderstandings. Support from loved ones and friends makes coping easier. Try not to set unreasonable standards for yourself or anyone else. Regional and local support groups help with yours and your family’s understanding of your experiences while offering information on local resources. There are several online support options nowadays.
Good communication with your doctor
Be sure to tell your doctor about all the symptoms you’re experiencing. They may indicate changes in the way your liver is functioning. Your doctor may have suggestions or medications that can help you cope. In between visits to the doctor, write down the questions or the symptoms you have. It’s too easy to forget specifics until the problem reappears. With chronic liver disease your physician may suggest vaccinations against influenza, pneumonia, hepatitis A, and possibly hepatitis B for those not already infected or immune.
Coping with fatigue
Fatigue is a common problem so finding a happy balance between relaxation and activities is essential. Frequently, short naps between activities prevent overwhelming fatigue at the end of the day. Don’t plan too many activities for one day; instead, space them out over a full week. Separate the activities requiring a lot of energy from the less strenuous ones. Allow yourself time to regroup while still keeping busy. If your workday is simply too tiring, try arranging flexible hours, job-sharing, or telecommuting options.
Coping with nausea
Nausea can turn mealtime into a dreaded activity. Ask your doctor for medication to help fight that feeling. Eat and drink sensibly. A well-balanced diet is important to maintaining a healthy body. Try eating frequent, smaller meals (or snacks) instead of fewer, larger meals. Plan meals at times when the nausea is the least troublesome. Hepatitis patients must remember that alcohol is a toxin and can cause problems for your already compromised liver. Be careful not to take vitamins or nutritional supplements without discussing it with your doctor first. Some vitamins, Vitamin A in particular, can cause liver damage when taken in large doses.
Living With Cirrhosis
What is cirrhosis?
Cirrhosis is a condition in which normal, healthy liver cells are damaged and replaced by scar tissue. This reduces the number of healthy cells remaining to perform their many important functions. A cirrhosis-damaged liver can cause widespread disruption of many body functions. Patients with cirrhosis often lead full, healthy lives for many years. Most of the complications of the disease are treatable. Despite damage to the liver, the liver can still perform some of its functions.
What are the symptoms of cirrhosis?
- Fatigue (often the first and only sign)
- Loss of appetite
- Nausea and vomiting (accompanied by weight loss)
- Enlargement of the liver; Itching (caused by a buildup of bile products in the liver)
- Jaundice (yellowing of the skin and the whites of the eyes)
- Formation of gallstones (because of a lack of bile in the gallbladder)
- Accumulation of water in the abdomen (called “ascites”)
- Accumulation of water in the legs (called “edema”)
- Bruising or bleeding easily
- Vomiting of blood or black material; passage of black, tarry stools
- Changes in mental status and sleep disturbances
What causes cirrhosis?
Many things can cause cirrhosis including various liver diseases such as hemochromatosis, Wilson’s disease, alpha-1 antitrypsin deficiency, autoimmune hepatitis, and biliary atresia. The three most common causes of cirrhosis in the U.S are the excessive intake of alcohol, non-alcoholic fatty liver disease associated with obesity and diabetes, and chronic hepatitis C. Some people have a severe reaction to certain drugs and this can also cause cirrhosis. Chronic hepatitis B also causes inflammation of the liver leading to cirrhosis. Many of these disorders can go undiagnosed for long periods of time because the liver is a non-complaining organ. Blood tests that identify elevated liver enzymes are often the first indication of a problem.
Can cirrhosis be cured?
Currently, there is no cure for cirrhosis. However, successful treatment of the cause of the cirrhosis may delay its progress, minimize liver cell damage, and reduce the complications of the disease. In some patients it is possible to reverse the cirrhosis, thereby improving outcomes. Complications of cirrhosis can also be treated. One example is the use of a drug known as a beta-blocker, to reduce portal hypertension and the risk of bleeding from veins in the esophagus. Diuretics to remove excess fluid that has accumulated in the ankles or the abdomen are often used along with. reducing salt in the diet.
What are the treatment options?
If a person has cirrhosis as a result of hepatitis B or C, the doctor may administer anti-viral drugs to reduce liver cell injury. For hepatitis B, first-line options include the oral drugs tenofovir or entecavir and pegylated interferon which is given by injection. For hepatitis C, patients with genotype 1 may be treated with a protease inhibitor (telaprevir or boceprevir) plus pegylated interferon and ribavirin while those with genotypes 2 and 3 may be treated with pegylated interferon and ribavirin without a protease inhibitor. In the future, interferon-free oral combination therapy may be available for all HCV genotypes.
How does cirrhosis progress?
Over time the continuing or recurrent damage to the liver by the underlying cause increases fibrosis and reduces the number of functioning liver cells. This causes the liver’s filtering process to slow down, allowing toxins to remain in the blood stream. These toxins affect the brain causing mental confusion (“encephalopathy”). The buildup of toxins dulls an individual’s mental abilities, sometimes changing his/her personality. The liver’s ability to process medication is also affected. The liver does not remove drugs from the blood at the usual rate, so prescription drugs act longer than expected and can build up in the body. Be sure to report any drug reactions you may get to your doctor. Always keep your doctor current on all medications you are taking.
One serious result of cirrhosis is portal hypertension. Normally, blood from the intestines is pumped through the portal vein to the liver. Since the blood flow is slowed down by cirrhosis that constricts the blood flow in the smaller portal vein branches in the liver, these blood vessels, under pressure, expand and become greatly enlarged (called “varices” or “varicose veins”) causing a thinning of their blood vessel walls. As the cirrhosis increases so does the pressure in these vessels. If they burst, there will be serious bleeding in the esophagus or the stomach with vomiting of blood and black stools. Immediate medical attention is needed.