Viral Hepatitis     

Hepatitis means inflammation of the liver. Hepatitis has many causes, including autoimmune disease, toxins, alcohol, medications and parasites, but most hepatitis is caused by viruses. Viral hepatitis is given a letter designation. Currently, these designations run from A to G (with the exception of F). The most important are A, B and C.

Causes

The viruses responsible for each type of hepatitis are named like the disease they cause.  For instance, hepatitis A is caused by hepatitis A virus, or HAV; hepatitis B is cause by HBV, hepatitis C by HCV. 

Symptoms

Symptoms of viral hepatitis can vary tremendously. For instance, most people infected with hepatitis C are unaware of infection until a late stage of the disease, when cirrhosis, liver failure or liver cancer develops. Hepatitis A in young children frequently has no symptoms, but in adolescents and adults, it may produce sever disease with jaundice, fatigue, nausea and vomiting. As a rule, viral hepatitis often begins with flu-like symptoms: fatigue, headache, loss of appetite, nausea or vomiting, and a low-grade fever (below 101 F). As symptoms get worse, other signs may be present, such as jaundice (yellow color to skin and whites of eyes), brown urine and pale stools, and pain or pressure on the right side below the ribs.

Types of Hepatitis

There are three main types of viral hepatitis: hepatitis A, B and C.

Hepatitis A

The incidence of hepatitis A has rapidly decreased in the United States since the introduction of hepatitis A vaccine; this vaccine is now given routinely as a part of childhood immunizations. Widespread vaccination does not mean, however, that people should not practice good hygiene and sanitation.

The hepatitis A virus is spread through food, water, eating utensils, toys and other objects that have been contaminated by feces, usually from dirty hands. Prevention of hepatitis A is one of the main reasons restaurant employees and child-care workers are required to wash their hands after using the restroom or changing babies' diapers.

Symptoms usually do not appear until two to six weeks after infection. During this time, the virus is contagious, so a person must take care not to spread the virus to others. Symptoms vary in intensity and may include fatigue, abdominal pain, nausea, pale stool, dark urine, jaundice and diarrhea. Most people get over the infection in two months, but symptoms may persist for up to six months. Children younger than 6 and particularly those young enough to be in diapers may not have any symptoms or only very mild symptoms. Hepatitis A usually does not permanently damage the liver, but serious and sometimes fatal complications can occur.

All close family members or close contacts of someone with hepatitis A who have not been immunized should get a shot of gamma globulin to prevent or reduce the symptoms of hepatitis A.

If you are traveling abroad or are in one of the following high-risk groups, you can receive a vaccine:

• Men who have sex with men

• Users of injecting and non-injecting drugs

• People who have clotting factor disorders

• People who work with primates

• People with chronic liver disease

• Food handlers

• Day care workers

• Health care workers

• People with developmental disabilities who live in institutions

• Children not yet immunized who are entering school

• Workers exposed to sewage

For best protection from hepatitis A, you should have two shots six months apart. Travelers can be considered protected, however, if they travel four weeks after the initial shot. If your trip is less than four weeks away, you can receive a shot of immune globulin.

Hepatitis B

Like hepatitis A, the incidence of hepatitis B has declined because of routine immunization. It will be several generations, however, before universal immunization against hepatitis B is achieved. Until then, it is important to understand the disease and how it is spread.

Hepatitis B is a more serious form of viral hepatitis. About 10 percent of people with hepatitis B will develop chronic hepatitis, a long-term inflammation that in some cases causes worsening liver damage, cirrhosis and liver cancer.

Hepatitis B spreads mainly through blood and body fluids, sexual contact and contaminated needles used with intravenous drugs. It can also be spread if needles used for tattooing, acupuncture or ear piercing are contaminated. In years past, contaminated blood transfusions were another cause of hepatitis B. Since 1972, screening of donated blood has almost wiped out the risk of getting hepatitis B from transfusions and blood products.

Risk factors for hepatitis B include being sexually active and not in a mutually monogamous relationship, being infected with the human immunodeficiency virus (HIV), being an intravenous drug user, having anal sex, being a health care or dental provider, or being a dialysis patient. Pregnant women should be tested for hepatitis B; if they are infected, their babies should be given the immune globulin at birth along with hepatitis B vaccine.

Symptoms of hepatitis B are basically the same as those of other forms of hepatitis, but they appear later, may last longer and may be worse. Symptoms can take up to two to three months to develop. During this time, hepatitis B is most contagious. A hepatitis B vaccination series before exposure can prevent the illness. Hepatitis B immune globulin, a special type of gamma globulin that is given shortly before possible exposure or immediately after exposure, may prevent or reduce symptoms of hepatitis B.

Children are now vaccinated routinely. It is recommended that everyone receive a hepatitis B vaccine. Talk with your doctor about having a hepatitis B vaccination.

Hepatitis C

Hepatitis C spreads mainly through blood transfusions and through contaminated needles used for intravenous drugs. It can also be spread by sexual contact and through contaminated needles used for tattooing. Many people with hepatitis C have no symptoms. When symptoms are present, they are similar to those of hepatitis B.  Symptoms, when present, usually appear one to 10 weeks after exposure. Unlike hepatitis B, hepatitis C leads to chronic hepatitis 80 to 90 percent of the time. Treatment is available for chronic hepatitis B and C, but it may not work for everyone.

Until recently, about 2 percent of those who received blood transfusions got hepatitis C. A screening test is now available to detect hepatitis C in donated blood.

Self-Care

Acute viral hepatitis has no specific treatment. You can do several things to help maintain your health and avoid spreading the disease to others:

• Get plenty of rest.

• Eat well. Hepatitis interferes with the liver's ability to metabolize nutrients. Therefore, it is very important to eat easily digestible food to get enough calories. Fatty food is often poorly tolerated. Try eating mostly carbohydrates (grains and fruits).

• Check in with your doctor regularly. He or she may run blood tests for several months to check for recovery or continuing inflammation of the liver.

• Avoid alcohol and medications that irritate the liver, including birth-control pills, tranquilizers, some antibiotics, antidepressants and acetaminophen. Until you are fully recovered, do not use any medications without checking with your doctor.

• Wash your hands after using the bathroom and before handling food.

• If you have hepatitis A, do not prepare food for others until two weeks after symptoms begin. This is especially important for those in the food-handling business.

Decision Guide for Viral Hepatitis
Symptoms/Signs	Action
Suspected exposure to hepatitis	Call provider's office
Symptoms that worsen or persist despite rest and self-care	See provider
Headache, low-grade fever, loss of appetite, nausea or vomiting, fatigue for more than 3 to 5 days	See provider
Yellow color to skin or whites of eyes	See provider
Dark urine and light, clay-colored stools	See provider
Pain or tenderness in right upper abdomen	See provider
Known exposure to hepatitis	See provider