Hepatitis alert: The lowdown from A to E

Viral hepatitis is just as baffling, silent and deadly as AIDs in the United States – and far more rampant. Learn what you can do to help stop its spread.

Hepatitis is spreading, and its death toll is rising. More than five million Americans are living with hepatitis – 10 times more than those living with AIDs. The debilitating liver infection causes approximately 15,000 deaths every year in America, and the US Centers for Disease Control and Prevention (CDC) predicts that number may double or triple over the next 20 years. Most often caused by one of five hepatitis viruses (A through E), the infection results in inflammation of the liver that can become severe enough to cause cirrhosis (scarring) of the liver, liver cancer, liver failure or death. All five viruses may cause acute viral hepatitis, which may resolve; but the hepatitis B.C. and D viruses also can cause chronic hepatitis, prolonged infection that typically lasts for a lifetime. The symptoms of viral hepatitis, may resemble the flu, and include jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, diarrhea, low-grade fever and headache. The standard way to distinguish among the types of hepatitis is through a blood test for specific antibodies to the virus. Here’s all the latest information on this complex infection.

Hepatitis A. In October through November 2003, the rarest and least serious form of hepatitis, hepatitis A virus (HAV) infection, took more than 900 restaurant patrons by surprise in Georgia, Tennessee, Pennsylvania and North Carolina. Three people died as a result. The Food and Drug Administration (FDA) and the CDC linked the outbreaks to the ingestion of raw or undercooked green onions imported from Mexico. According to the CDC, the virus was probably spread during handling of the green onions prior to shipment from Mexico, or through contaminated water during irrigation, rinsing, cooling or icing. That’s not to say you should steer clear of all raw vegetables. (Though, if you’re concerned, you may want to avoid freshly made salsa and ask that uncooked scallions be omitted from your meals.) Such outbreaks are rare, and you have a far higher chance of contracting the virus while traveling to another country. Still, to nix your risk, ask your doctor about vaccination.

Transmission. HAV is spread primarily through food or water contaminated by feces from an infected person. Transmission through contact with infected blood is possible but rate.

Toll on America. According to the Hepatitis Foundation International, approximately 100 of 180,000 Americans infected each year with HAV die.

Vaccinate. Vaccination is available to anyone after age two.

Protect Yourself and Others. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends always washing your hands after using the toilet and before preparing a meal or eating; wearing gloves if you will be in contact with other people’s stool and washing your hands afterward; and avoiding tap water when visiting another country.

Treatment. No treatment is yet available for hepatitis A. The infection usually resolves on its own within a six-week to three-month period.

Hepatitis B. One is 20 people in the United States will develop hepatitis B virus (HBV) infection at some point in their lives, according to the CDC. The risk increases if an individual’s parent were born in Southeast Asia, Africa, the Amazon Basin in South America, the Pacific Islands or the Middle East. A recent study by colleagues at the Stanford University Medical Center estimates that 1.2 million or one in 10 Asian Americans are chronically infected with HBV. The NIDDK estimates that about a third of people infected with HBV were infected as children or infants before the hepatitis B vaccine became available in 1982.

Transmission. HBV spreads through contact with infected blood, injection drug use, sex with an infected person or form mother to child during childbirth.

Toll on America. According to the NIDDK, every year 200,000 Americans become infected with hepatitis B, which is 100 times more infectious than HIV. Ninety percent eventually recover and clear the virus, but more than 20,000 yearly will become permanently infected. More than 4,000 people die each year from hepatitis B-related liver disease.

Vaccinate. All infants, children and adolescents should vaccinated. Doctor also recommends vaccination to household members and sexual partners of HBV-infected people, healthcare workers, dialysis patients, recipients of clotting factor concentrates, people institutionalized in correctional facilities for the developmentally disabled and travelers to endemic areas who stay for six months or longer.

Protect Yourself and Others. Do not share drug needles. Make sure that tools used for tattooing or body piercing are new and sterilized. Wear gloves when smoking with other people’s blood or blood products. Don’t share toothbrushes, razors or other personal items.

Treatment. There is no treatment for acute hepatitis B, which usually resolves on its own. For chronic hepatitis B, less than 40% of patients are candidates for treatment that includes interferon (given through shots for about four months) or one of the two oral treatments (taken orally once a day for one year or longer).

Hepatitis C. A 50-year-old registered nurse living in Arkansas, was diagnosed with chronic hepatitis C last summer. Doctors believe she may have contracted the disease 15 to 20 years age. "Hepatitis C is most often asymptomatic," The majority of patients with hepatitis C were infected when they were young but then diagnosed much later in life. It is a very slowly progressive disease. It is so slow and silent that was unaware she had a serious disease until she experienced a prolonged bout of fatigue, weight loss and nausea. After many tests, her doctor finally determined she had chronic hepatitis C. Patient said she’s bee in the health-care field all may adult life, so the have a long history of exposure [to infected blood] prior to when gloves were in use. They drew blood; they stuck themselves; they didn’t think of anything of it. Now, it’s all she can think about. Liver shows signs of early cirrhosis and portal hypertension (high pressure in the vein that filters blood to the liver).

Transmission. Spreads primarily through contact with infected blood, injection drug use and, less commonly, through sexual contact and childbirth.

Toll on America. Almost 4 million Americans – 1.8% - are persistently infected with hepatitis C virus, according to the NIDDK. Chronic hepatitis C is on leading causes of chronic lever disease in the United States, accounting for up to 50% of cirrhosis, end-stage liver disease and liver cancer, and it causes 10,000 to 12,000 deaths every year in the United States.

Vaccinate. Currently, no vaccine is available for hepatitis C.

Protect Yourself and Others. Avoid behaviors like sharing drug needles or personal items like toothbrushes, razors and clippers.

Treatments. Approximately 50% of patients will experience sustained benefit from treatment, and few options exist for patients who either do not respond to therapy or who respond and later relapse.

Hepatitis D and E Hepatitis D and E are much less common than the first three types of hepatitis. Hepatitis D is only seen in patients who also have hepatitis B. And hepatitis E is rare in the United States, but common in countries like India. We only see hepatitis E in people who travel and come back to America from these countries. Hepatitis D spreads through contact with infected blood. For those not already infected with hepatitis B, vaccination will prevent hepatitis D as well. Hepatitis e, like hepatitis A, is spread through food or water that has been contaminated by feces form an infected person. According to the NIDDK, this form of hepatitis usually resolves on its own over the course of several weeks.

Prevention is the Key. All types of hepatitis are preventable, Hepatitis A. B and D can be avoided through the vaccine, which was recently approved by the FDA for people over age 18. Young children and infant may receive other vaccines that will immunize them against both diseases. Vaccination against hepatitis C is not yet available, but you can protect yourself by practicing safe sex and not sharing needles or personal hygiene items. The provision of clean water supplies and prudent hygienic practices when traveling to other countries can protect you against you against hepatitis E. In addition to practicing these protective measures, ask you doctor to test your blood for hepatitis if you have any of the risk factors mentioned in this article. You’ll be taking one more step toward stopping the spread of this infection.