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Understanding Hepatitis Part 2

World Hepatitis Day was July 28th and we wanted to continue share with you some more information about this very misunderstood disease.

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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