If you were to take a quiz about the risk factors for various forms of hepatitis or how the illness affects people, would you earn a passing grade? For many the answer is a resounding no — and that’s unfortunate because when it comes to hepatitis, what you don’t know could end up seriously harming your health.
A study in the July-August 2016 issue of the Journal of Infection and Public Health found that 137 participants responded correctly only 49 percent of the time to nine statements about how hepatitis C can be transmitted, which organs are affected and what the long-term effects are. Meanwhile, a study in a 2015 issue of the Journal of Immigrant and Minority Health found that of the 329 people surveyed, fewer than 40 percent were knowledgeable about how the hepatitis B virus can be spread, and only 33 percent knew that the majority of people with chronic hepatitis B are asymptomatic.
On the most basic level, “there are more types of viral hepatitis than most people realize,” says Dr. Ira Jacobson, a professor of medicine and director of hepatology at the NYU School of Medicine. Hepatitis refers to inflammation of the liver, and while various illnesses and conditions can cause liver inflammation, viruses are responsible for the majority of hepatitis cases in the U.S., according to the Centers for Disease Control and Prevention. Symptoms of acute viral hepatitis can include fever, fatigue, nausea, vomiting, diarrhea, abdominal pain, dark urine, joint pain and jaundice (yellowing of the skin and eyes). But in some cases people don’t develop noticeable symptoms.
Some types — such as hepatitis B, C and D — can cause chronic infection, while others — such as hepatitis A — cause only acute infections that people recover from. Though it’s usually an acute infection, hepatitis E can become chronic in immune-suppressed people such as those who’ve received organ transplants, Jacobson notes. Vaccines are available to prevent hepatitis A and B but not the others. (These days, all children are advised to get these vaccines and some adults should, too; your best bet is to talk to your doctor to find out if you should.)
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While doctors don’t routinely test for hepatitis, there are guidelines for who should be screened, particularly for hepatitis B and C. In patients who have symptoms suggestive of hepatitis, a physician will take a medical history to glean which type of hepatitis the person may have been exposed to, then do blood tests to diagnose the specific type of hepatitis the person has, Jacobson explains. Chronic viral hepatitis is often diagnosed when elevated liver enzymes are detected on routine blood tests in asymptomatic patients.
Here’s how the different types of hepatitis stack up against each other:
Hepatitis A: People can become infected with the hepatitis A virus when they consume contaminated food or water. In the U.S., the most common route of transmission is the fecal-to-oral route: Someone who’s infected with the virus will shed microscopic particles in their stool, and if the infected person doesn’t wash his or her hands properly, the virus can be spread when other people come in contact with food or objects the infected person has touched. The virus is highly contagious and can be spread among people. In October, an outbreak of hepatitis A in California — mostly among the homeless community — led the governor to declare a state of emergency.
“It’s a miserable thing to catch because it can make you quite ill, but many people, especially in the younger age groups, don’t get symptoms,” Jacobson says. “Many adults have antibodies to hepatitis A, signifying past infection, but don’t remember ever having symptoms of it.” Among those who do develop symptoms, plenty of rest and fluids usually can help them recover fully within days or weeks, without lasting damage to the liver.
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Hepatitis B: Spread primarily through infected blood, semen or other body fluids, hepatitis B can be transmitted through sex, shared IV drug needles, transfusions with infected blood and during childbirth from infected mothers to their newborns. Sometimes the virus can also be spread through tattooing, body piercing or sharing razors or toothbrushes with someone who’s infected. “People who are exposed to hepatitis B as adults have an approximately 80 percent chance of clearing the virus through an immune response,” says Dr. Sean G. Kelly, an assistant clinical professor in the division of gastroenterology, hepatology and nutrition at The Ohio State University Wexner Medical Center in Columbus. “If a person is infected with hepatitis B for over six months, they are diagnosed with chronic hepatitis B and require life-long treatment.”
Chronic hepatitis B can be treated with drugs called nucleotide analogues, and while it can’t be cured, replication of the virus can be suppressed in the body so that it no longer damages the liver, Jacobson explains. New treatment approaches for hepatitis B that have the potential to cure it are being investigated.
Hepatitis C: It often sits silently in older adults, which is why it’s taking a major toll on baby boomers. The transmission of hepatitis C occurs primarily when people share contaminated drug needles and syringes or if they received a blood transfusion before 1992, when widespread screening of the blood supply for hepatitis C began. “The risk of transmission for hepatitis C is much lower between [sexual] partners than it is for hepatitis B,” notes Dr. K.V. Narayanan Menon, medical director of liver transplantation at the Cleveland Clinic.
Approximately 80 percent of people who get infected with the hepatitis C virus develop a chronic infection. The good news? New antiviral medications, though quite expensive (most insurance plans will cover them), can eradicate the hepatitis C virus in more than 95 percent of people after a 12-week course of treatment. “If it can’t be detected in the blood, it’s rare to see it reappear,” Jacobson says. “The story of our ability to cure hepatitis C with well-tolerated medications is a miracle of modern medicine.”
[See: How to Disinfect Germ Hotspots.]
Hepatitis D: Spread through IV drug use, other forms of blood exposure or sexual contact, hepatitis D only infects people with hepatitis B. But the piggyback effect doesn’t occur the other way — meaning, people can get hepatitis B on its own. “Hepatitis D cannot survive on its own — it’s a co-infection with B,” Menon explains. People can catch the two viruses at the same time, or they can acquire the hepatitis D infection after hepatitis B.
Either way, hepatitis D infection is chronic and incurable, and at this point, it’s challenging to treat. “Interferon is the only medicine available, and it has limited efficacy and lots of unpleasant side effects,” such as body aches, chills, headache, nausea, poor appetite, fatigue and weakness, Jacobson says. Fortunately, new treatments are currently being investigated.
Hepatitis E: Rare in the U.S., hepatitis E is transmitted through contaminated food or water, especially in developing countries. Being exposed to pigs that carry the virus is another risk factor, Kelly notes, just as certain animals can carry swine flu or bird flu. “Hepatitis E is a major concern for pregnant women in developing countries [because they] are especially prone to severe cases,” Kelly adds. “For other people, it usually resolves on its own.”
Liver cancer and liver failure are associated with chronic hepatitis B, C and D infection, Jacobson notes. “For patients with advanced scarring from chronic viral hepatitis or any other liver disease, it is essential to undergo regular screening for liver cancer.” But when hepatitis B and C are treated effectively, liver inflammation and the progression of scarring come to a halt, he explains, and “scar tissue in the liver can actually reverse itself.” That’s one of the amazing things about the liver: It has the remarkable ability to rebuild itself — but only if the damage is caught early enough.
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The ABCs (D’s and E’s) of Hepatitis originally appeared on usnews.com
