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    The ABCs of Hepatitis

    Rubin Bahuva, MD, Gastroenterologist, Deaconess Clinic Gastroenterologist, Deaconess Clinic 07/08/2020

    You’ve likely heard of hepatitis, and you may’ve even heard that some types of hepatitis are identified by letters A, B, & C. I’m glad to be writing about this, as so many people don’t know enough about hepatitis. It’s a serious issue, as hepatitis can cause serious illness and severe liver damage. Hepatitis C in particular is of concern, as more than 3 million Americans are infected—mostly “Baby Boomers.” Hepatitis C is actually the most common reason people need a liver transplant.

    What is Hepatitis?
    Hepatitis is swelling and inflammation of the liver, and can have several causes:

    • Immune cells in the body attacking the liver
    • Infections from viruses (such as hepatitis A, hepatitis B, or hepatitis C), bacteria, or parasites
    • Liver damage from alcohol or poison
    • Medicines, such as an overdose of acetaminophen
    • Fatty liver

    The symptoms of hepatitis include:

    • Nausea and vomiting
    • Pain or bloating in the belly area
    • Dark urine and pale or clay-colored stools
    • Fatigue
    • Low fever
    • Itching
    • Jaundice (yellowing of the skin or eyes)
    • Loss of appetite
    • Weight loss
    • Confusion, changes in mental state, even coma.

    Hepatitis may start and get better quickly. It may also become a long-term condition. In some cases, hepatitis may lead to liver damage, liver failure or even liver cancer. You may not have symptoms when first infected with hepatitis B or C. You can still develop liver failure later.

    Hepatitis A
    Hepatitis A is a short-term (acute) illness. You can get very sick, but most get well with no long-term or lasting effects. Fortunately, people develop immunity to it and will never get it again.

    The hepatitis A virus is found mostly in the stool and blood of an infected person. You can catch hepatitis A if:

    • You eat or drink food or water that has been contaminated by stools (feces) containing the hepatitis A virus. Unpeeled and uncooked fruits and vegetables, shellfish, ice, and water are common sources of the disease.
    • You come in contact with the stool or blood of a person who currently has the disease
    • A person with hepatitis A passes the virus to an object or food due to poor hand-washing after using the toilet.
    • You take part in sexual practices that involve oral-anal contact.

    Risk factors include:

    • Overseas travel, especially to Asia, South or Central America, Africa and the Middle East
    • Living in a nursing home center
    • Working in a health care, food, or sewage industry

    Hepatitis A&B vaccines have become a standard immunization for children in the U.S. If you don’t know if you’ve been vaccinated, a blood test can check for antibodies.
    Vaccination is recommended for people who meet these criteria:

    • Those who intend to travel to an area of high risk
    • Healthcare workers
    • Anyone with liver issues for any reasons should get a vaccine to avoid further injury from hepatitis A or B

    Hepatitis B
    Hepatitis B is also a viral infection, and is very serious. It’s a chronic condition, and unlike hepatitis A, it doesn’t go away. Those who get hepatitis B experience serious liver damage over time. Treatment is needed for those with a high viral count in the blood that is affecting liver function. It’s a lifelong process with oral medications, and includes careful ongoing monitoring of liver function.

    Hepatitis B often leads to cirrhosis, liver cancer and other serious complications. You can catch hepatitis B through contact with the blood or body fluids (semen, vaginal fluids, and saliva) of a person who has the virus.

    Exposure may occur:

    • After a needlestick or sharps injury
    • If any blood or other body fluid touches your eyes or mouth, or open sores or cuts in the skin

    People who may be at risk of hepatitis B are those who:

    • Have unprotected sex with an infected partner
    • Have contact with blood at work (such as health care workers)
    • Have been on long-term kidney dialysis
    • Get a tattoo or acupuncture with unclean needles
    • Share needles during drug use
    • Share personal items (such as toothbrush, razor, and nail clippers) with a person who has the virus
    • Were born to a hepatitis-B infected mother
    • Receive blood transfusions (note: All blood used for blood transfusions is screened, so the chance of getting the virus in this way is very small

    The vaccine for hepatitis B (in combination the A vaccination) is now standard for children in the U.S. Again, if you don’t know if you’ve been vaccinated, a blood test can check for antibodies.

    Hepatitis C
    Hepatitis C gets a lot of attention because it’s so important to diagnose. Also, we have excellent treatments available for it now, but someone has to know they have it to begin treatment.
    Hepatitis C is a blood-borne virus. Today, most people become infected by sharing needles or other equipment to inject drugs. There is no vaccine for hepatitis C. The best way to prevent hepatitis C is by avoiding behaviors that can spread the disease, especially injecting drugs.

    One percent of the American population is infected with hepatitis C. Most of those infections are among those of “Baby Boomer” age. The CDC recommends that everyone born from 1945 to 1965 should get a one-time test for hepatitis C. There are several reasons:

    • Some behaviors that were common in that generation’s “young and wild years”
    • Needle safety wasn’t a focus during their younger years, even in medical settings.
    • Blood transfusions were not screened for hepatitis C prior to 1990.
    • Pregnant mothers with hepatitis C can transmit the infection to their babies (about 5% of the time).

    Basically, if you’re of the age to need a colon cancer screening, you should also be screened for hepatitis C. Both are conversations to have with your primary care doctor.

    For some people, hepatitis C is a short-term illness but for 70%–85% of people who become infected with hepatitis C, it becomes a long-term, chronic infection. Chronic hepatitis C is a serious disease than can result in long-term health problems, even death. The majority of infected persons might not be aware of their infection because they are not clinically ill. However, once someone is diagnosed, hepatitis C is very treatable.

    Treatment for hepatitis C is dependent upon a few factors.

    • First, genetic testing is done to check for the type of hepatitis C (genotype). There are six types of the virus (genotypes 1 through 6). Test results can help your doctor choose treatment that is best for you.
    • We also look at the amount of scarring in the liver, either by a blood test, imaging or a liver biopsy. Insurance coverage is more likely if there is significant scarring of the liver.
    • All treatments are oral medications, and the goal is to help eliminate the virus the body completely—to cure the infection. Most people (95-100%) are cured after a 12 week treatment.
    • Also, liver function is monitored closely during a hepatitis C treatment process.

    I also want to note that hepatitis B & C increase your risk of cirrhosis of the liver, and increase risk for liver cancer. Patients with cirrhosis will have regular checks (imaging, endoscopy exams) to check for complications.

    This is a helpful site with great information about hepatitis C. (Note—it is from a pharmaceutical company.) It mentions that 1 in 30 Baby Boomers is infected with hepatitis C—and most don’t know.

    I encourage parents to take advantage of hepatitis vaccines for their children and those who are 50 and over should talk with their doctor about hepatitis C screening.

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