Hepatitis A, B and C

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Hepatitis A
Definition
Hepatitis A is an infection of the liver caused by the hepatitis A virus.
Hepatitis

Causes
Hepatitis A virus is usually found in the stool (bowel movement) of people who have the infection. Note: It's not found in everybody, only those who have the infection. It is spread by:
• Putting something in your mouth that has been infected with the hepatitis A virus
• Drinking water contaminated by raw sewage
• Eating food contaminated by the hepatitis A virus, especially if it has not been properly cooked
• Eating raw or partially cooked shellfish contaminated by raw sewage
• Sexual contact with a partner infected with the hepatitis A virus, particularly anal sex (Anal sex has an especially high risk, but all kinds of sexual intercourse can spread the disease.)
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
• Close contact with an infected person (Note: The virus is generally not spread by casual contact.)
• Using household items that were used by an infected person, but were not properly cleaned
• Sexual contact with multiple partners
• Sexual contact with a partner who has hepatitis A
• Traveling to or spending long periods of time in a country where hepatitis A is common or where sanitation is poor
• Injecting drugs, especially if you use shared needles
• Childcare workers who change diapers or toilet train children
• Children in daycare centers
• Institutionalized patients
• Hemophiliacs receiving plasma products
Symptoms
Hepatitis A does not always cause symptoms. Adults are more likely to have symptoms than children.
Symptoms include:
• Tiredness
• Loss of appetite
• Fever
• Nausea
• Abdominal pain or discomfort
• Jaundice (yellowing of the eyes and skin)
• Darker colored urine
• Light or chalky colored stools
• Rash
• Itching
• Muscle pain
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include:
• Blood test – to look for hepatitis A antibodies (These are proteins that your body has made to fight the hepatitis A virus.)
• Liver function studies
• Liver biopsy – removal of a sample of liver tissue to be examined (only in severe cases)
Treatment
There are no specific treatments for hepatitis A. The goals of hepatitis A treatment are to:
• Keep the patient as comfortable as possible
• Prevent the infection from being passed to others
• Prevent more liver damage by helping the patient avoid substances (eg, medications, alcohol) which might stress the liver while it's healing
The disease generally will go away without treatment within 2-5 weeks. However, about 15% of people who are infected by hepatitis A will have relapsing symptoms for up to 9 months. In almost all cases, once you recover, there are no aftereffects, and you are immune to the virus.
In rare cases, hepatitis A infection will be so severe that a liver transplant may be needed.
Prevention
Proper Sanitary Habits
• Wash your hands with soap and water after using the bathroom or changing a diaper.
• Wash your hands with soap and water before eating or preparing food.
• Carefully clean all household utensils after use by a person infected with hepatitis A virus.
• Avoid using household utensils that a person infected with hepatitis A may touch.
• Avoid sexual contact with a person infected with hepatitis A.
• Avoid injected drug use, especially with shared needles.
• If you travel to a high risk region, take the following precautions: drink bottled water, avoid ice chips, wash the fruits well, and eat well-cooked food.
Immune (gamma) Globulin
This is a preparation containing antibodies that provides temporary protection from hepatitis A (about 1-3 months). It must be given:
• Before exposure to the virus or
• Within two weeks after exposure to the virus
Hepatitis A Vaccine
This vaccine is made from inactive hepatitis A virus and is highly effective in preventing infection. It provides full protection four weeks after the first injection. (The hepatitis vaccine takes a month to become fully effective.) A second injection provides protection lasting up to 20 years.
The vaccine is recommended for:
• People who have a chronic liver disease or a clotting factor disorder
• People who have close physical contact with those who live in areas with poor sanitary conditions
• People traveling to countries where sanitary conditions are poor
• Children who live in areas that have repeated hepatitis A epidemics
• People who inject illicit drugs
• Men who have sex with men
Check with your doctor to see if you should receive the vaccine, and if so, when and how many injections you should have.


Hepatitis B

Definition
Hepatitis B is a liver disease caused by the hepatitis B virus. Most hepatitis B infections clear up within 1-2 months without treatment. When the infection lasts more than six months, it can develop into chronic hepatitis B, which can lead to:
• Chronic inflammation of the liver
• Cirrhosis (scarring of the liver)
• Liver cancer
• Liver failure
• Death
Hepatitis

Causes
Hepatitis B is caused by the hepatitis B virus. This virus is spread through contact with body fluids of an infected person, such as blood, semen, vaginal fluids, and saliva. A woman infected with hepatitis can pass the virus on to her baby during childbirth.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Coming in contact with the blood or other body fluids of someone infected with hepatitis B increases your risk for infection. Unlike hepatitis A virus, hepatitis B virus is not spread through contaminated food or water.
The following situations may increase your risk of getting hepatitis B:
• Having sex with someone infected with hepatitis B or who is a carrier of hepatitis B
• Injecting illicit drugs, especially with shared needles
• Having more than one sexual partner
• Being a man who has sex with men
• Living in the same house with someone who is infected with hepatitis B
• Having a job that involves contact with body fluids, such as:
o First aid or emergency workers
o Funeral directors
o Medical personnel
o Dentists
o Dental assistants
o Firefighters
o Police personnel
• Having a sexually transmitted disease at the time you come in contact with hepatitis B
• Traveling to areas where hepatitis B is common, such as China, southeast Asia, and sub-Saharan Africa
• Receiving a blood transfusion prior to 1992 (the year a more reliable test to screen blood was developed)
• Receiving multiple transfusions of blood or blood products, as hemophiliacs do (risk is greatly reduced with modern blood screening techniques)
• Working or being a patient in a hospital or long-term care facility
• Working or being incarcerated in a prison
• Being bitten so that the skin is broken by someone whose saliva contains the virus
• Being a hemodialysis patient
Symptoms
Symptoms usually appear within 25 to 180 days following exposure to the virus. The most common symptoms are:
• Yellowing skin and eyes (jaundice)
• Fatigue that lasts for weeks or even months
• Abdominal pain in the area of the liver (upper right side)
• Loss of appetite
• Nausea
• Vomiting
• Joint pain
• Low-grade fever
• Dark urine and light-colored stool
• Widespread itching
• Rash
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Hepatitis B is diagnosed with blood tests, which are also used to monitor its effects on the liver. For chronic cases, a liver biopsy may be needed. A biopsy is the removal of a sample of liver tissue for testing.
Treatment
The symptoms of hepatitis B can be treated with medication. Patients with uncomplicated cases can expect to recover completely. Patients with chronic hepatitis B are sometimes treated with medication to reduce the activity of the virus and prevent liver failure.
Medications include:
• Interferon alfa-2b (Intron A) injection
• Lamivudine (Epivir-HBV) oral medication
Chronic hepatitis B patients should avoid anything that can further injure the liver. These include:
• Alcohol
• Certain medications, dietary supplements, and herbs (Discuss these substances with your doctor before taking them.)
Chronic hepatitis B patients should prevent the spread of their infection by:
• Telling their doctors, dentists, and sexual partner(s) that they have hepatitis B
• Never donating blood, organs, or tissue
• Discussing their hepatitis B status with their doctor during pregnancy or before becoming pregnant to insure the baby receives treatment
Prevention
Hepatitis B can be prevented through vaccination, which consists of three injections over a six-month period. Protection is not complete without all three injections. Anyone at increased risk for hepatitis B should be vaccinated.
In addition, to prevent the transmission of hepatitis B:
• Use condoms or abstain from sex.
• Limit your number of sexual partners.
• Do not inject drugs. If you use IV drugs, get treatment to help you stop. Never share needles or syringes.
• Do not share personal items that might have blood on them, such as:
o Razors
o Toothbrushes
o Manicuring tools
o Pierced earrings
• If you get a tattoo or body piercing, make sure the artist or piercer properly sterilizes the equipment. You might get infected if the tools have someone else's blood on them.
• If you are a healthcare or public safety worker:
o Get vaccinated against hepatitis B.
o Always follow routine barrier precautions and safely handle needles and other sharp instruments.
• Wear gloves when touching or cleaning up body fluids on personal items, such as:
o Bandages
o Band-aids
o Tampons
o Linens
• Cover open cuts or wounds.
• Use only sterilized needles for drug injections, blood testing, ear piercing, and tattooing.
• If you are pregnant, have a blood test for hepatitis B. Infants born to mothers with hepatitis B should be treated within 12 hours after birth.

Hepatitis C (HCV)

Definition
Hepatitis C is an infection of the liver caused by the hepatitis C virus (HCV).
Hepatitis

Causes
Hepatitis C virus is carried in the blood of people infected with the virus. It is primarily spread through contact with infected blood, such as:
• Injecting illicit drugs with shared needles
• Receiving HCV-infected blood transfusions (before 1992) or blood clotting products (before 1987)
• Receiving an HCV-infected organ transplant
• Receiving long-term kidney dialysis treatment (The dialysis machine can be tainted with HCV-infected blood.)
• Sharing toothbrushes, razors, nail clippers, or other personal hygiene items that have HCV-infected blood on them
• Being accidentally stuck by an HCV-infected needle (a concern for healthcare workers)
• Frequent contact with HCV-infected people (a concern for healthcare workers)
• Receiving a tattoo, body piercing, or acupuncture with unsterilized or improperly sterilized equipment
Hepatitis C can also spread through:
• An HCV-infected mother to her baby at the time of birth
• Sexual contact with someone infected with HCV
• Sharing a straw (or inhalation tube) when inhaling drugs with someone infected by HCV
• Receiving a blood transfusion
HCV cannot spread through:
• The air
• Unbroken skin
• Casual social contact
• Breastfeeding
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
• Receiving a blood transfusion before 1992
• Receiving blood clotting products before 1987
• Long-term kidney dialysis treatment
• Tattooing
• Body piercing
• Injecting illicit drugs, especially with shared needles
• Having sex with partners who have hepatitis C or other sexually transmitted diseases
Symptoms
Eighty percent of people with hepatitis C have no symptoms. However, over time, the disease can cause serious liver damage.
Symptoms may include:
• Fatigue
• Loss of appetite
• Jaundice (yellowing of the eyes and skin)
• Darker colored urine
• Light or chalky colored stools
• Loose, light-colored stools
• Abdominal pain
• Aches and pains
• Itching
• Hives
• Joint pain
• Cigarette smokers may suddenly dislike the taste of cigarettes.
• Nausea
• Vomiting
Chronic hepatitis C infection may cause some of the above symptoms, as well as:
• Weakness
• Severe fatigue
• Loss of appetite
Serious complications of hepatitis C infection include:
• The possibility that the infection will become chronic, leading to cirrhosis (scarring) and progressive liver failure
• Increased risk of liver cancer
Diagnosis
Your healthcare provider will ask about your symptoms and medical history, and perform a physical exam. You will also discuss your risk factors for hepatitis C.
Tests may include:
Blood Tests – to look for hepatitis C antibodies or genetic material from the virus (The antibodies are proteins that your body has made to fight the hepatitis C virus.)
Liver Function Studies – to initially determine and follow how well your liver is functioning
Ultrasound of the Liver – to assess liver damage
Liver Biopsy – removal of a sample of liver tissue to be examined
Treatment
Hepatitis C is treated with medications, including:
• Interferon, given by injection
• Ribavirin, given orally
• A combination of interferon and ribavirin
These medications can cause difficult side effects and have limited success rates. In unsuccessful cases, chronic hepatitis C can cause cirrhosis (scarring) and serious liver damage. In rare cases, a liver transplant may be needed.
Prevention
To prevent becoming infected with hepatitis C:
• Do not inject illicit drugs, especially with shared needles. Seek help to stop using drugs.
• Do not have sex with partners who have sexually transmitted diseases.
• Practice safe sex (using latex condoms) or abstain from sex.
• Limit your number of sexual partners.
• Avoid sharing personal hygiene products, such as toothbrushes.
• Avoid handling items that may be contaminated by HCV-infected blood.
• Donate your own blood before elective surgery to be used if you need a blood transfusion.
To prevent spreading hepatitis C to others if you are infected:
• Tell your dentist and physician before receiving check-ups or treatment.
• Get both a hepatitis A and hepatitis B vaccination.
• Do not donate blood or organs for transplant.