Are you or one of your family members suffering from hepatitis? Here is everything you need to know about it, including the symptoms, prevention, and treatments.
What is Hepatitis – An Overview
Hepatitis in general terms is the inflammation of the liver. The condition can be self-limiting when in acute phase, or can progress to fibrosis (scarring of liver), cirrhosis or liver cancer if enters the chronic phase.
Viral infections are the most common causes of hepatitis, but there can be other causes which include autoimmune hepatitis where body’s immune system attacks liver cells causing the liver to be inflamed, and hepatitis that occurs as a secondary result of medication, drugs, toxins, and alcohols. In any case, hepatitis kills hepatocytes (the liver cells) that are responsible for important body functions which are:
- Metabolizing or processing of nutrients
- Producing bile for digestion
- Filtering of toxins from the body
- Breakdown of carbohydrates, fats, and proteins
- Excretion of bilirubin, cholesterol, hormones, and drugs
- Synthesis of blood proteins, such as albumin, and clotting factors
- Activation of specialized proteins called enzymes
- Storage of glycogen (a form of sugar), minerals, and vitamins
Global and US Based Research on Hepatitis
According to WHO Global Hepatitis Report, viral hepatitis caused 1.34 million deaths globally in 2015 which levels to tuberculosis in numbers and is higher than those caused by HIV.
- A huge 720,000 deaths were caused by cirrhosis, a chronic liver disease
- And, 470,000 were due to hepatocellular carcinoma, a primary liver cancer disease.
The report focuses more on hepatitis B and C, which are responsible for 96% of all hepatitis mortality. It says that globally, in 2015:
- 257 million people were having chronic HBV infection
- While 71 million were living with chronic HCV infection.
In US, Centers for Disease Control and Prevention (CDC) estimates approximately 4.4 million Americans who are currently living with chronic hepatitis B and C. And there may be others who have it but don’t even know about it.
How it Happens?
Hepatitis virus enters your liver to invade your liver cells (called hepatocytes). During invasion, it starts making copies of itself. This prompts the immune cells to launch a counter attack on both the viruses and the infected liver cells. As a result, these liver cells get inflamed, and then die.
Over time, scar tissue forms around dead and infected cells which prevents your liver from working properly. In case of chronic hepatitis B infection, the liver will contain large amount of scar tissues called cirrhosis which will limit the blood flow and result in permanent shrinking and hardening of your liver.
If you have chronic hepatitis B or C, it may not show any sign or symptoms in the beginning. That’s because chronic hepatitis develops slowly, and the signs are difficult to be noticed. Symptoms will start appearing only when liver function is interrupted due to damage.
However, signs and symptoms of acute hepatitis appear quickly, which are:
- Loss of appetite
- Unexplained weight loss
- Muscle or joint pain
- Mild fever
- Nausea and vomiting
- Slight abdominal pain
The acute phase isn’t usually dangerous unless it develops into a rapidly progressing form, which can lead to death.
As the patient gets worse, these symptoms may follow:
- Dark urine
- Pale stool, feces may contain pus
- Yellowing of skin, and whites of eyes and tongue (signs of jaundice)
- Itchy skin
- Bleeding inside your body
- Circulation problem, drowsiness, and dizziness (for only toxic/drug-induced hepatitis)
- Enlarged spleen (for only alcohol hepatitis)
Types of Hepatitis
There are mainly 5 types of hepatitis viruses namely A, B, C, D, and E. These 5 are the most common and bears the burden of illness and deaths they cause and the potential for outbreak and epidemic spread.
Let’s have a look at each one of them:
- Hepatitis A:
- Hepatitis B:
- Hepatitis C:
- Hepatitis D:
- Hepatitis E:
This can be called as the least serious form of hepatitis because nearly everyone who develops hepatitis A makes a full recovery. It is caused by infected food or water and in some cases through anal-oral contact during sex. California, Florida, New York, Oregon, Texas, and Washington reported increased cases of hepatitis A in 2015.
The liver swells and the patient can suffer serious liver damage, resulting in cancer. This is spread by contact through infected blood, semen, and some other body fluids. The contact may occur through unprotected sexual intercourse, biting, breast feeding, use of infected syringe, or by having skin perforated with non-sterilized needles.
According to Center for Disease Control & Prevention (CDC) estimates, approximately 850,000 persons in US are infected with this virus. Other studies estimate this number to be as high as 2.2 million.
It usually spreads through direct contact with the blood of a person already infected with the same. The liver can swell and get damaged, but probability of developing liver cancer is low as only 20% of hepatitis C patients get cirrhosis. In 2015, a total of 2,436 cases of acute hepatitis C were reported to CDC from 41 states in US.
It doesn’t get developed on its own. It means that hepatitis D can only be developed into a person who is already infected with hepatitis B. it also spreads through infected blood, unprotected sex, and perforation of the skin through infected needles.
It’s a water borne disease and is mainly found in areas with poor sanitation and typically result from ingesting fecal matter that contaminates the water supply. In the US, this is an uncommon disease and is more reported in the Middle East, Asia, Central America, and Africa, according to CDC.
How to Prevent Hepatitis?
Maintaining a good hygiene, taking proper vaccination at proper times, and avoiding unprotected contacts with persons and objects (like a unsterilized blade, or a used syringe) can prevent you from developing hepatitis.
For Hepatitis A and E:
As both types spread mainly through poor sanitation, or infected food or water, both can be prevented by:
- Keeping your hands clean at any time
- Consuming food that has just been cooked
- Avoiding tap water in areas with unsure local sanitation
- Avoiding raw fruits, or under-cooked shellfish & oysters
- Getting a vaccination of Hepatitis A if you are traveling to places where hepatitis may be endemic
For Hepatitis B and D:
As hepatitis D develops in only who already has Hepatitis B, both can be prevented by:
- Practicing safe sex
- Using clean and unused syringes only, for any purpose
- Avoid sharing of toothbrushes, razors, or manicure instruments
- Allowing only well-sterilized skin perforating equipment (tattoo, acupuncture, etc.)
- Having a Hepatitis B series of shots if you are at risk
For Hepatitis C:
Globally, an estimated 1.75 million new cases of HCV infection were reported in 2015, as a result of unsafe injections. To being prevented from hepatitis C, you should:
- Make sure to use only unused syringes
- Avoid sharing of toothbrushes, razors, or manicure instruments
- Cover open wounds if you are infected
- Make use of only sterilized equipment while having tattoo, etc.
- Go easy on alcohol
Treatment for Hepatitis
Treatment depends on the type of hepatitis you are having, and whether the infection is acute or chronic:
It’s a short-term illness and usually doesn’t require any treatment. However, if you are experiencing vomiting or diarrhea, see your doctor for hydration and nutrition advice.
Hepatitis A vaccine is available that is given to children of ages between 12 and 18 months. Adult vaccination is also available that can be combined with Hepatitis B vaccine.
Acute hepatitis B doesn’t require any medical attention as it has a short span and your liver’s immune cells will find a way to destroy all of them. However, antiviral medication is necessary for chronic hepatitis B. The treatment is costly as it takes months or years and it needs regular monitoring to determine if the medication is working or not.
Newborns should be given the three-dose hepatitis B vaccination over the first 6 months of their childhood, as recommended by CDC. This three-dose vaccination’s global coverage in 2015 was at 84% that helped in reducing HBV prevalence among children to an all-time low of 1.3%.
As there is no available vaccine for hepatitis C currently, it is treated with a combination of antiviral drug therapy, in both acute as well as chronic hepatitis C. Patients are continuously taken through further testing to determine the best form of treatment. People who develop cirrhosis as a result of the hepatitis C, may be candidates for a liver transplant.
No guaranteed antiviral medication is available yet for this type, but people should take vaccination of hepatitis B to prevent them from developing hepatitis D. That’s because hepatitis D develops only in persons who already have hepatitis B.
No special medical therapy available for this type also. The infection is more often acute and typically resolves on its own. However, pregnant ladies need to be kept under close monitoring and care.
That’s all about hepatitis, going through which you must have understood how you can keep you and your family safe from the disease, and in what cases you should consult your medical practitioner for better prevention and treatment.
Newport Family Medicine, located in Newport Beach, CA, offers full-service family practice from pregnancy through childhood and adulthood to maturity. We provide comprehensive health care for people of all age groups.