The name of the disease Hepatitis, can be broken up into the word root “hepat,” which means liver, and the suffix “itis,” which means inflammation. Therefore, its name literally means inflammation of the liver (Frucht). It has several causes, some viral and some non-viral, and I will be discussing the specific types of viral hepatitis, the symptoms, and the prognosis of each. Hepatitis A (HAV) is a virus that is transmitted through fecal-oral contamination. It can survive on a contaminated surface for up to four hours, and in feces for up to four weeks.
People who work with sewage are at high risk, since the virus is always found in sewer systems (Kennamer). It can survive temperatures of 140° F for up to 60 minutes so sewage treatment isn’t always effective. HAV from unsuccessfully treated sewage can survive in oysters for five days, so contaminated oyster beds have caused outbreaks. It is especially a risk for oysters that are consumed raw. Infected infants and young children are most likely to spread the disease, since it is spread through feces. In one epidemic, more than 15% of the people infected worked in daycares or cared for young children (Achord).
It is usually asymptomatic, especially in young children, but when symptoms occur they include abdominal pain, loss of appetite, nausea, fever, and general weakness. It never lasts longer than six months, and so it does not cause cirrhosis. Nausea usually goes away after 2-7 days, but if it doesn’t, anti-nausea medications are sometimes given to help prevent dehydration. There is no treatment that will shorten the course of the disease, and dehydration is the most common cause of hospitalization. The average mortality rate is around . 3%. It is much higher in adults over 40, and much lower in young children.
There are 140,000 cases in the U. S each year, and there are over 1,000,000 worldwide, even though there is an effective vaccine available (Achord). Three hundred fifty million people in the world are infected with Hepatitis B (HBV), and nearly one million die from it each year. Unlike HAV, HBV is only blood borne, since the virus is killed by stomach acid. It used to be common in people who had received blood transfusions, but that’s rare now that all donated blood is tested. Now, transmission is usually caused by sexual contact, sharing razors or toothbrushes, and drug related activity (Achord).
Transmission from household contact is rare, but possible since the virus can survive outside the body for several days, even on a dry surface (Kennamer). Usually treatment just involves treating the symptoms, which are similar to HAV. However, in the 5% of chronic cases, anti-viral courses are sometimes given. After 12 months, 30-40% of those treated with Interferon will no longer test positive. It is not always recommended because there is a 4-6 week period where the inflammation and liver cell death increases, which isn’t tolerated well by people with the acute phase, or in advanced stages.
Chronic HBV leads to scarring of the liver, which usually takes about 20 years to become severe enough to be classified as cirrhosis. Liver transplants have good long term results for these people. HBV can be passed from mother to child, and in 90% of cases the child becomes a lifetime, asymptomatic carrier, as opposed to 3% of people who are infected after birth. These people can pass the disease on to others, and may not know they are infected since they have no symptoms (Achord).
The HBV vaccine is helping bring down the number of new infections, and is recommended to anyone who is exposed to blood, or blood containing fluids on a regular basis (Kennamer). Hepatitis C (HCV) is one of the most common chronic diseases in the world. With no vaccine to help prevent the spread, there are more than four million people infected in the U. S. alone. It is only blood borne, like HBV, and since it is not easily transmitted sexually or through household contact, the testing of donated blood has reduced the rate of new infections tenfold. HCV is chronic in more than 85% of all cases, but when it is acute, it is very mild.
It is usually asymptomatic, but if symptoms present, they are flu-like. Because the symptoms are so mild, it often goes unnoticed until it is advanced, and has caused serious liver damage (Achord). The chronic inflammation caused by HCV does cause scarring over the years, but it only leads to cirrhosis in 20% of cases. Less than half of those who develop cirrhosis show any signs of liver disease, so less than 10% of chronic HCV patients are at risk for death from the disease. Any use of alcohol, even moderate, increases your risk of cirrhosis tenfold.
HCV sufferers also have a 5% chance of developing liver cancer, which is 250 times greater than the general population. Interferon can be used in the acute phase of HCV, unlike in HBV, because it does not have the 4-6 week worsening phase. In 39-40% of cases that are treated in the acute phase, the virus goes into complete remission. In the first 12-16 weeks, if the viral load isn’t down tenfold, the 48 week course can be discontinued, because it can be assumed the virus will not respond to treatment (Achord). Hepatitis D (HDV) requires HBV to be present to replicate, therefore the vaccine for HBV is also effective for HDV (Kennamer).
It is rare in the U. S. , but is common in some parts of Africa and the Mediterranean. It can occur simultaneously with HBV, or separately in someone with chronic HBV, and is usually suspected when HBV symptoms suddenly get worse for no apparent reason. HDV is blood borne, has similar symptoms as HBV, and is often mistaken for it. It is more likely to be chronic than in any of the other Hepatitis viruses, and also is the most likely to cause acute liver failure (Achord). Hepatitis E (HEV) is transmitted through fecal-oral contamination, and when symptoms occur they are similar to HAV.
It is highly infectious, and there is no vaccine. Unlike the other hepatitis viruses it has a high mortality rate in pregnant women and their fetuses, but mortality is low among men and women who are not pregnant. There have not been any cases of HEV in the U. S. yet, but it has been found in people who travelled here from India (Achord). Finally, there is Hepatitis G (HGV). HGV is common, and is usually transmitted through blood transfusions or plasma. It can be acute or chronic, but doesn’t cause significant changes in the liver in either form.
Because it is considered to be inconsequential, donated blood is not tested for HGV (Achord). Research is currently being done to find cures for chronic hepatitis sufferers, and for finding a vaccine for HCV. Until then, new infections of every type are on the decline due to education about the dangers of blood borne diseases. Information about AIDS specifically has helped reduce the spread of the blood borne viruses. Tattoo and body piercing shops that re-use needles are still being blamed for some new cases, so anyone interested in visiting such a place should make sure they are a reputable shop that uses disposable needles (Achord). To help prevent the spread of fecal borne varieties, people who come in contact with feces should practice proper hand washing at all times (Kennamer).
Achord, James L. Understanding Hepatitis. n. p. : University Press of Mississippi, 2002. eBook Collection (EBSCOhost). Web. 21 Nov. 2012. Frucht, Suzanne S. Medical Terminology. New Jersey, 2012. Kennamer, Mike. Basic Infection Control for Healthcare Providers. United States of America, 2007. 148-152