Viral Hepatitis Overview

What is hepatitis?

Hepatitis is the inflammation of the liver, resulting in liver cell damage and destruction.

Illustration of the  anatomy of the biliary system

Hepatitis can be categorized in two groups:

  • acute hepatitis
  • chronic hepatitis

There are six main types of the hepatitis virus that have been identified, including the following:

  • Hepatitis A
    This type of hepatitis is usually spread by fecal-oral contact, or fecal-infected food and water, and may also be spread by blood-borne infection (which is rare). The following is a list of modes of transmission for hepatitis A:
    • consuming food made by someone who touched infected feces
    • drinking water that is contaminated by infected feces (a problem in developing countries with poor sewage removal)
    • touching an infected person's feces, which may occur with poor handwashing
    • outbreaks may occur in large childcare centers, especially when there are children in diapers
    • residents of American Indian reservations or Native Alaskan villages where hepatitis A may be more common
    • sexual contact with an infected person
    A vaccine for hepatitis A has been developed and is now available.
  • Hepatitis B
    Hepatitis B has a wide range of clinical presentations. It can be mild, without symptoms, or it may cause chronic hepatitis and, in some cases, can lead to full-blown liver failure and death. Transmission of hepatitis B virus occurs through blood and body fluid exposure such as blood, semen, vaginal secretions, or saliva. Needle sticks, sharp instruments, sharing items (razors, toothbrushes) and sex with an infected person are primary modes of transmission. Infants may also develop the disease if they are born to a mother who has the virus. Infected children often spread the virus to other children if there is frequent contact or a child has many scrapes or cuts. The following describes persons who are at risk for developing hepatitis B:
    • children born to mothers who have hepatitis B (the illness may present up to five years after the child is born)
    • children who are born to mothers who have immigrated from a country where hepatitis B is widespread such as southeast Asia and China
    • persons who live in long-term care facilities or who are disabled
    • persons who live in households where another member is infected with the virus
    • persons who have a blood clotting disorder such as hemophilia
    • persons who require dialysis for kidney failure
    • persons who may participate in high-risk activities such as intravenous (IV) drug use and/or unprotected heterosexual or homosexual sexual contact
    • persons who have a job that involves contact with human blood
    • persons who received blood transfusions or blood products before the early 1990s 
    A vaccine for hepatitis B does exist and is now widely used for routine childhood immunization. The Centers for Disease Control and Prevention (CDC) now recommend that universal infant hepatitis B vaccination should begin at birth except in rare circumstances.
  • Hepatitis C
    The symptoms of hepatitis C are usually mild and gradual. Children often show no symptoms at all. Transmission of hepatitis C occurs primarily from contact with infected blood, but can also occur from sexual contact, or from an infected mother to her baby. Although hepatitis C has milder symptoms initially, it leads to chronic liver disease in a majority of people who are infected. According to the Centers for Disease Control and Prevention (CDC), hepatitis C is the leading indication for liver transplantation. With some cases of hepatitis C, no mode of transmission can be identified. In addition, people with alcoholic liver disease also tend to develop hepatitis C.

    The following describes persons who may be at risk for contracting hepatitis C:

    • children born to mothers who are infected with the virus
    • persons who have a blood clotting disorder such as hemophilia and received clotting factors before 1987
    • persons who require dialysis for kidney failure
    • individuals who received a blood transfusion before 1992
    • persons who may participate in high-risk activities such as intravenous drug use and/or unprotected heterosexual or homosexual sexual contact
    There is no vaccine for hepatitis C. Persons who are at risk should be checked regularly for hepatitis C. Persons who have hepatitis C should be monitored closely for signs of chronic hepatitis and liver failure.
  • Hepatitis D
    This form of hepatitis can only occur in the presence of hepatitis B. If an individual has hepatitis B and does not show symptoms, or shows very mild symptoms, infection with D can put that person at risk for full-blown liver failure that progresses rapidly. Hepatitis D can occur at the same time as the initial infection with B, or it may show up much later. Transmission of hepatitis D occurs the same way as hepatitis B, except the transmission from mother to baby is less common.
  • Hepatitis E
    This form of hepatitis is similar to hepatitis A. Transmission occurs through fecal-oral contamination. It is less common than hepatitis A. Hepatitis E is most common in poorly developed countries and rarely seen in the United States. There is no vaccine for hepatitis E at this time.
  • Hepatitis G
    This is the newest strain of hepatitis and very little is known about it. Transmission is believed to occur through blood and is most commonly seen in IV drug users, individuals with clotting disorders such as hemophilia, and individuals who require hemodialysis for renal failure. Often, hepatitis G shows no clinical symptoms and has not been found to be a cause of acute or chronic hepatitis.

How often does hepatitis occur?

According to the CDC, in the US:

  • hepatitis A rates have declined by 92 percent since the hepatitis A vaccine first became available in 1995.
  • an estimated 800,000 to 1.4 million people have hepatitis B infections.
  • an estimated 3.2 million people have hepatitis C infections.
What is acute hepatitis?
What is chronic hepatitis?
Acute hepatitis is quite common in the US.

Causes:
Common causes of acute hepatitis may include:

  • infection with a virus (viral hepatitis A, B, C, D, or E)
  • overdose of drugs (such as acetaminophen)
  • chemical exposure (such as dry cleaning chemicals)

Symptoms:
Acute hepatitis usually starts with flu-like symptoms. The following are the most common symptoms of acute hepatitis. However, each individual may experience symptoms differently. Symptoms may include:

  • jaundice (yellow color in the skin and/or eyes)
  • nausea
  • vomiting
  • loss of appetite
  • fever
  • tenderness in the right, upper abdomen
  • sore muscles
  • joint pain
  • clay-colored bowel movements
  • itchy red hives on skin

The symptoms of acute hepatitis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Diagnosis:
In addition to a complete medical history and medical examination, diagnostic procedures for acute hepatitis may include the following:

  • specific laboratory tests
  • liver function tests

Treatment:
Specific treatment for acute hepatitis will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Treatment varies, depending on the type of acute hepatitis (viral versus non-viral). Severe, acute hepatitis may require hospitalization.

People who have had acute viral hepatitis may become chronic carriers of the disease. Proper precautions need to be taken to prevent the spread of the disease.

Some people do not recover fully from acute hepatitis and develop chronic hepatitis, as the liver continues to sustain more damage and inflammation. Hepatitis is considered chronic if symptoms persist longer than six months. Chronic hepatitis can last years.

Type of chronic hepatitis:

  • alcohol-induced chronic hepatitis - continued liver damage throughout the liver from heavy alcohol consumption.
  • chronic active hepatitis - an aggressive inflammation and destroyer of liver cells, which usually leads to cirrhosis.
  • chronic persistent hepatitis - a milder inflammation of the liver, which usually does not lead to cirrhosis.

Causes:
Certain viruses and drugs may cause chronic hepatitis in some people, but not in others. Some common causes include the following:

  • viral hepatitis
  • heavy alcohol consumption
  • autoimmune disorder (when the body attacks its own tissues)
  • reaction to certain medications
  • metabolic disorder (such as hemochromatosis or Wilson's Disease)

Symptoms:
Symptoms for chronic hepatitis are usually mild. Although the liver damage continues, its progression is usually slow. The following are the most common symptoms of chronic hepatitis. However, each individual may experience symptoms differently. Some individuals may experience no symptoms, while others may experience the following:

  • feeling ill
  • poor appetite
  • fatigue
  • low fever
  • upper abdominal pain
  • jaundice
  • symptoms of chronic liver disease (such as enlarged spleen, spider-like blood vessels in the skin, and fluid retention)

The symptoms of chronic hepatitis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Diagnosis:
In addition to a complete medical history and medical examination, diagnostic procedures for chronic hepatitis may include the following:

  • specific laboratory tests
  • liver function tests
  • liver biopsy (to determine severity of inflammation, scarring, cirrhosis, and underlying cause)

Treatment:
Specific treatment for chronic hepatitis will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • cause of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

The goal of treatment is to stop damage to the liver and alleviate symptoms. Treatment may include:

  • antiviral agent
    When caused by hepatitis B or C, inflammation of the liver may be stopped with the antiviral agent interferon-alpha.
  • corticosteroids
    Corticosteroids may be used to treat chronic liver disease caused by an autoimmune disorder. Inflammation is suppressed, but scarring of the liver may continue.
  • discontinuation of certain drugs
    When chronic hepatitis is caused by certain drugs, discontinuing those drugs usually clears up any symptoms.

Preventing the spread of viral hepatitis:

Proper hygiene is the key to preventing the spread of many diseases, including hepatitis. Other preventive measures include the following:

  • vaccinations
    A hepatitis B vaccine is routinely given to toddlers as part of their immunization schedule. A hepatitis A vaccine is available for people at risk. (There are no vaccines for hepatitis C, D, E, or G at this time.)
  • blood transfusion
    Blood transfusions are routinely screened for hepatitis B and C to reduce the risk of infection.
  • antibody preparation
    If a person has been exposed to hepatitis, an antibody preparation can be administered to help protect them from contracting the disease.

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