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Hepatitis

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CONDITIONS

Who Is At Risk in Hepatitis?

Hepatitis A

It can affect anyone. In the U. S., hepatitis A can occur in situations ranging from isolated cases of disease to widespread epidemics. Hepatitis A is one of the most frequently reported vaccine-preventable diseases in the U. S. Some of the higher-risk groups are: travelers to countries with high rates of hepatitis A, men who have sex with men, injecting-drug users, people with clotting-factor disorders, people with chronic liver disease, and children living in communities with high rates of disease.

Hepatitis B

One out of every 20 people in the U. S. will become infected with HBV sometime during their lives. Your risk is higher if you:

Have sex with someone infected with HBV.
Have sex with more than one partner.
Is a man and have sex with a man.
Live in the same house with someone who has chronic HBV infection.
Have a job that involves contact with human blood.
Inject illegal substances/drugs. Have hemophilia.
Travel to areas where HBV is common (this includes all countries except northern and western Europe, Japan, Australia, New Zealand, and North America except Mexico).

Hepatitis C

Since about four million Americans are infected with HCV and most don't know it, you should have a blood test for hepatitis C whether you feel sick or not. About one in ten people infected with HCV have had no identifiable exposure to HCV. That said, here are several obvious risk factors:

Intravenous (IV) drug users - even IV use in the distant past.
Those with multiple sex partners or sex with partners who have other sexually transmitted diseases.
Those with tattoos or body piercing done with unsterile instruments. Anyone who has had a blood transfusion prior to 1992 or clotting factors produced before 1987.
Hemodialysis (diabetes) patients.
The potential for transmission from an HCV-infected mother to her newborn appears to be about 5%.

Hepatitis types and the risk of getting Hepatitis

What is Hepatitis A?

Hepatitis A is one of many hepatitis viruses causing inflammation of the liver. Each year an estimated 80,000 new people are infected with the hepatitis A virus (HAV) in the United States.

What is Hepatitis B?

Hepatitis B is an inflammatory liver disease caused by the hepatitis B virus (HBV) that results in liver cell damage. This damage can lead to scarring of the liver (cirrhosis) and increased risk of liver cancer in some people. About 80,000 Americans were newly infected with HBV in 1999.

What is Hepatitis C?

Hepatitis C virus (HCV) causes inflammation of the liver. A national U. S. survey found that 1.8 percent of Americans - about 3.9 million - have been infected with HCV, of whom most about 2.7 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.

SYMPTOMS

How does Hepatitis Spread?

How Does HAV Spread?

Hepatitis A is most often spread from person to person through situations such as these:

Food preparers who are infected can pass the virus on if they do not wash their hands with soap and water after having a bowel movement, especially when they prepare uncooked foods.
Fecal contamination of food and water.
Anal/oral contact, by putting something in the mouth that had been contaminated with infected feces.

Diaper changing tables, if not cleaned properly or changed after each use, may facilitate the spread of HAV.
Fecal residue may remain on the hands of people changing soiled diapers.
Eating raw or partially cooked shellfish contaminated with HAV.

How Does HBV Spread?

HBV is found in blood, seminal fluid, and vaginal secretions. The risk of transmission is increased in these situations:

Sexual contact with an infected person.

Living in the same household with an infected individual.

Contact with infected blood or seminal fluid and contaminated needles, including tattoo/body piercing instruments.

HBV-infected mother to her newborn at time of delivery (prenatal blood tests for HBV should always be done if there is a suspicion of HBV).

How Does HCV Spread?

Injection drug use is the primary risk for HCV infection. 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. The hepatitis C virus is found mainly in blood.

HCV is not spread through kissing or casual contact.

In relationships where there is one steady partner, sexual transmission is low (under 5%). Transmission is estimated to be about 15% among those who have multiple sex partners or where there is a history of sexually transmitted diseases.

HCV may be transmitted by using razors, needles, toothbrushes, nail files, a barber's scissors, tattooing equipment, body piercing or acupuncture needles if these items are contaminated by blood of an infected person.

Healthcare workers have a 2% risk of acquiring HCV after a needle stick contaminated with HCV-positive blood.

There is no evidence indicating that HCV is transmitted through breast milk.

The current transmission rate through blood transfusions is estimated at less than 1 per 1,000,000 units transfused.

Diagnosis of Hepatitis

Hepatitis A Virus

Your doctor can't single out Hepatitis A from other types of viral hepatitis based upon your physical symptoms alone. The only way to diagnose HAV is to do a blood test seeking to find IgM antibodies. In most people, these antibodies become detectable 5-10 days before the onset of symptoms and can persist for up to 6 months after infection.

Hepatitis B Virus

There are three standard blood tests for HBV:

HBsAG (hepatitis B surface antigen):
When this test is positive or reactive, you are infected with HBV and can pass it on to others.
Anti-HBc (antibody to hepatitis B core antigen):
When you test positive, it means you are currently infected with HBV or have been infected at some point in the past.
Anti-HBs (antibody to HbsAg):
When this test is positive, it means that you are immune to hepatitis B either as a result of having had the disease or from having been given the vaccine.
Hepatitis C Virus

Test for HCV antibodies: HCV infection can be determined by a simple and specific blood test that detects antibodies against HCV. The current enzyme immunoassay test (EIA) that detects anti-HCV has a sensitivity of about 95% in chronic HCV. HCV infection may be identified by anti-HCV testing in approximately 80% of people as early as five weeks after exposure. This test is not a part of a routine physical examination, and people must ask their doctor for a hepatitis C antibody test. (Note: The antibody itself does not provide immunity, and the test does not distinguish between acute or chronic infection.) If the initial test is positive, it test should be repeated to confirm the diagnosis (and exclude possible laboratory error). If the initial test is negative, but the infection could have occurred within the last six months and HCV is suspected, antibody levels may not be high enough yet to be detectable (antibodies may not be present in the first 4 weeks of infection in about 30% of patients) or you may lack immune response. Under these circumstances, ask you doctor about repeating the test and about alternative test methods.
Test liver enzyme levels: If you may already have chronic infection, your doctor will test the levels of two liver enzymes. These are alanine aminotransferase (ALT) and aspartate aminotrasferase (AST). Both are released when liver cells are injured or die. Elevated ALT and AST levels may appear and disappear throughout the course of the HCV infection. If the liver enzyme levels are normal with chronic HCV, they should be re-checked several times over a 6 - 12 month period. If the liver enzyme levels remain normal, your doctor may check them less frequently, such as once a year.

Symptoms of HAV, HBV and HCV

HAV

Children with hepatitis A usually have no symptoms. Adults may become quite ill suddenly, experiencing jaundice, fatigue, nausea, vomiting, abdominal pain, dark urine/light stools, and fever. The incubation period averages 30 days. However, an infected individual can transmit the virus to others as early as two weeks before symptoms appear. Symptoms will disappear over a 6 -12-month period until complete recovery occurs.

HBV

Many people with newly acquired hepatitis B have no symptoms at all, or they may be very mild and flu-like - loss of appetite, nausea, fatigue, muscle or joint aches, mild fever, and possibly jaundice (yellowish tinge to the skin). The only way to know if you are currently infected with HBV - or if you still carry the virus - is to ask your doctor to do a specific blood test for hepatitis B (it may not be included in a routine blood test). The test may not show positive during the incubation period (45-180 days).

HCV

Most people who are infected with the HCV do not have symptoms and are leading normal lives. If symptoms are present, they 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.

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.

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