What
is hepatitis?
Hepatitis is an inflammation of the liver.
The condition can be self- limiting or can progress to fibrosis (scarring),
cirrhosis or liver cancer. Hepatitis viruses are the most common cause of
hepatitis in the world but other infections, toxic substances (e.g. alcohol,
certain drugs), and autoimmune diseases can also cause hepatitis.
Types
of Hepatitis.
There are 5 main hepatitis viruses, referred
to as types A, B, C, D and E. These 5 types are of greatest concern because of
the burden of illness and death they cause and the potential for outbreaks and
epidemic spread. In particular, types B and C lead to chronic disease in
hundreds of millions of people and, together, are the most common cause of
liver cirrhosis and cancer. Hepatitis A and E are typically caused by ingestion
of contaminated food or water. Hepatitis B, C and D usually occur as a result
of parenteral contact with infected body fluids. Common modes of transmission
for these viruses include receipt of contaminated blood or blood products,
invasive medical procedures using contaminated equipment and for hepatitis B
transmission from mother to baby at birth, from family member to child, and
also by sexual contact. Acute infection may occur with limited or no symptoms,
or may include symptoms such as jaundice (yellowing of the skin and eyes), dark
urine, extreme fatigue, nausea, vomiting and abdominal pain.
Q:
What are the different hepatitis viruses?
A: Scientists have
identified 5 unique hepatitis viruses, identified by the letters A, B, C, D,
and E. While all cause liver disease, they vary in important ways. Hepatitis A
virus (HAV) is present in the faeces of infected persons and is most often
transmitted through consumption of contaminated water or food. Certain sex
practices can also spread HAV. Infections are in many cases mild, with most
people making a full recovery and remaining immune from further HAV infections.
However, HAV infections can also be severe
and life threatening. Most people in areas of the world with poor sanitation
have been infected with this virus. Safe and effective vaccines are available
to prevent HAV.
What
is hepatitis A?
Hepatitis A is an illness caused by
the hepatitis A virus. The virus mainly causes inflammation of the liver.
Symptoms include:
Generally feeling unwell.
Yellowing of your skin and the whites
of your eyes (jaundice).
Sometimes, being sick (vomiting).
A raised temperature (fever).
However, some people who are infected
do not develop any symptoms (a subclinical illness). The illness is not usually
serious and full recovery is usual but the symptoms can be quite unpleasant for
a while. The hepatitis A virus is passed out in the stools (faeces) of infected
people and infection is usually spread by eating dirty (contaminated) food or
drink.
Who
should be immunised against hepatitis A?
Immunisation is generally recommended
for anyone over the age of 1 year.
Close contacts of someone found to
have hepatitis A infection (for example, family members or other members of the
institution) may be offered immunisation. This only happens rarely. The most
important measure for anybody with hepatitis A is good personal hygiene.
In particular, washing hands after
going to the toilet or before eating. People with chronic liver disease. If you
have a persistent (chronic) liver disease (for example, cirrhosis) it is
suggested that you have the hepatitis A vaccine. Hepatitis A infection is not
more common in those with chronic liver disease but, if infection does occur,
it can cause a more serious illness. People exposed to hepatitis A at work. For
example, laboratory workers who are exposed to hepatitis A during their work
and sewage workers are advised to be immunized against hepatitis A. Staff of
some large residential institutions. Outbreaks of hepatitis A have been associated
with large residential institutions for people with learning difficulties,
where standards of personal hygiene among clients or patients may be poor.
Therefore, immunisation of staff and residents of some institutions may be
recommended. Injecting drug users who share drug injecting equipment are also
thought to have an increased risk of hepatitis A infection and so should
consider immunisation. People with certain blood clotting problems (such as
haemophilia) who need to receive blood clotting factors, may have an increased
risk of hepatitis A infection. This is because the hepatitis A virus may not be
completely destroyed during the preparation of these blood products.
Immunisation is therefore suggested for these people. Men who have sex with men
, and other people whose sexual practices involve oral-anal contact, may also
like to consider immunisation against hepatitis A.
Note: if you have
been infected with hepatitis A in the past, you should be immune to further
infection and therefore not need immunisation. A blood test can detect
antibodies to check if you are already immune.
This may be worthwhile doing if you
have had a history of yellowing of your skin and the whites of your eyes
(jaundice) or come from an area where hepatitis A is common.
Hepatitis
A vaccine.
There are a number of different
hepatitis A vaccines available. There are also some combined vaccines for both
hepatitis A and hepatitis B and also hepatitis A and typhoid fever. A combined
vaccine may be useful if you require protection against both diseases. The
hepatitis A single vaccine is given as two doses. The first dose of the vaccine
protects against hepatitis A for about one year. The vaccine causes your body
to make antibodies against the virus. These antibodies protect you from illness
should you become infected with this virus. Ideally, you should have an
injection at least two weeks before travel to allow immunity to develop.
However, the vaccine may still be advised even if there is less than two weeks
before you travel.
A second dose of the vaccine, 6-12
months after the first gives protection for about 20 years. If you are late
with this second dose, you should have it as soon as possible but you don't
need to start with the first dose again. Another booster dose of hepatitis A
vaccine after 20 years can be given to those people still at risk of infection.
The doses of the combined vaccines against both hepatitis A and hepatitis B or
hepatitis A and typhoid may need to be given at slightly different time
intervals.
Are
there any side-effects from the vaccine?
Some people develop a temporary
soreness and redness at the injection site. Much less common are:
ü A mild raised
temperature (fever).
ü Tiredness.
ü Headaches.
ü Feeling sick
(nauseated).
ü Feeling off your
food for a few days.
Severe
reactions are extremely rare.
Who should not receive hepatitis A
vaccine?
There are a very few situations where
the hepatitis A vaccine is not recommended. They include:
If you have an illness causing a high
temperature. In this situation, it is best to postpone immunisation until after
you have fully recovered from the illness. If you have had an allergic reaction
to the vaccine or to any of its components in the past. One type of vaccine
(Epaxal®) should not be given to anyone who is known to be allergic to eggs.
Children under the age of 1 year. However, the risk of hepatitis A in children
under the age of 1 year is very low. The hepatitis A vaccine is not licensed
for this age group. The vaccine may be given if you are pregnant or
breast-feeding and immunisation against hepatitis A is thought to be necessary.
Other points Remember; immunisation
for travellers is only one aspect of preventing illness. No immunization is
100% effective. So when travelling to at-risk areas, you should have very good
personal hygiene and also be careful about what you eat and drink. You should
avoid eating and drinking the following when travelling to areas where the risk
of hepatitis A is higher:
Raw or inadequately cooked shellfish,
Raw salads and vegetables that may have been washed in unclean (contaminated)
water. (Wash fruit and vegetables in safe water and peel them yourself.) Other
foods that may have been grown close to the ground, such as strawberries.
Untreated drinking water, including ice cubes made from untreated water.
(Remember also to use only treated or bottled water when brushing your teeth.)
Unpasteurised milk, cheese, ice cream and other dairy products.
Also, be careful when buying food
from street traders. Make sure that food has been recently prepared and that it
is served hot and on clean serving plates. Food that has been left out at room
temperature (for example, for a buffet) or food that may have been exposed to
flies could also pose a risk.
Hepatitis
B
Hepatitis B is a serious disease that
affects the liver. It is caused by the hepatitis B virus. Hepatitis B can cause
mild illness lasting a few weeks, or it can lead to a serious, lifelong
illness. Hepatitis B virus infection can be either acute or chronic. Acute
hepatitis B virus infection is ashort-term illness that occurs within the first
6 months after someone is exposed to the hepatitis B virus. This can lead to:
fever, fatigue, loss of appetite, nausea, and/or vomiting jaundice (yellow skin
or eyes, dark urine, clay-colored bowel movements) pain in muscles, joints, and
stomach Chronic hepatitis B virus infection is a long-term illness that occurs
when the hepatitis B virus remains in a person's body. Most people who go on to
develop chronic hepatitis B do not have symptoms, but it is still very serious
and can lead to: liver damage (cirrhosis) liver cancer death
Chronically-infected people can spread hepatitis B virus to others, even if
they do not feel or look sick themselves.
How Hepatitis B is been spread
Hepatitis B is spread when blood,
semen, or other body fluid infected with the Hepatitis B virus enters the body
of a person who is not infected. People can become infected with the virus
through Sharing items such as razors or toothbrushes with an infected person, Contact
with the blood or open sores of an infected person, Sex with an infected
partner.
Hepatitis B virus (HBV) can also be
transmitted through exposure to infective blood, semen, and other body fluids.
HBV can be transmitted from infected mothers to infants at the time of birth or
from family member to infant in early childhood. Transmission may also occur
through transfusions of HBV-contaminated blood and blood products, contaminated
injections during medical procedures, and through injection drug use. HBV also
poses a risk to healthcare workers who sustain accidental needle stick injuries
while caring for infected-HBV patients. Safe and effective vaccines are
available to prevent HBV.
Hepatitis B vaccine.
What You Need to Know Why get
vaccinated?
Hepatitis B vaccine can prevent
hepatitis B and its consequences, including liver cancer and cirrhosis.
Hepatitis B vaccine is made from
parts of the hepatitis B virus. It cannot cause hepatitis B infection. The vaccine
is usually given as 3 or 4 shots over a 6-month period. Infants should get
their first dose of hepatitis B vaccine at birth and will usually complete the
series at 6 months of age. All children and adolescents younger than 19 years
of age who have not yet gotten the vaccine should also be vaccinated. Hepatitis
B vaccine is recommended for unvaccinated adults who are at risk for hepatitis
B virus infection, including:
People whose sex partners have
hepatitis B.
Sexually active persons who are not
in a long-term monogamous relationship Persons seeking evaluation or treatment
for a sexually transmitted disease Men who have sexual contact with other men
People who share needles, syringes, or other drug-injection equipment People
who have household contact with someone infected with the hepatitis B virus.
Health care and public safety workers
at risk for exposure to blood or body fluids Residents and staff of facilities
for developmentally disabled persons.
Persons in correctional facilities.
Victims of sexual assault or abuse Travelers to regions with increased rates of
hepatitis B People with chronic liver disease, kidney disease, HIV infection,
or diabetes Anyone who wants to be protected from hepatitis B There are no
known risks to getting hepatitis B vaccine at the same time as other vaccines.
Some people should not get this vaccine Tell the person who is giving the
vaccine:
If the person getting the vaccine has
any severe, life-threatening allergies. If you ever had a life-threatening
allergic reaction after a dose of hepatitis B vaccine, or have a severe allergy
to any part of this vaccine, you may be advised not to get vaccinated. Ask your
health care provider if you want information about vaccine components. If the
person getting the vaccine is not feeling well. If you have a mild illness,
such as a cold, you can probably get the vaccine today. If you are moderately
or severely ill, you should probably wait until you recover.
Risks of a vaccine reaction with any
medicine, including vaccines, there is a chance of side effects. These are
usually mild and go away on their own, but serious reactions are also possible.
Most people who get hepatitis B vaccine do not have any problems with it. Minor
problems following hepatitis B vaccine include:
Soreness where the shot was given
temperature of 99.9°F or higher If these problems occur, they usually begin
soon after the shot and last 1 or 2 days. Other problems that could happen
after this vaccine: People sometimes faint after a medical procedure, including
vaccination. Sitting or lying down for about 15 minutes can help prevent
fainting and injuries caused by a fall. Tell your provider if you feel dizzy,
or have vision changes or ringing in the ears.
Some people get shoulder pain that
can be more severe and longer-lasting than the more routine soreness that can
follow injections. This happens very rarely.
Any medication can cause a severe
allergic reaction. Suchm reactions from a vaccine are very rare, estimated at
about 1 in a million doses, and would happen within a few minutes to a few
hours after the vaccination. As with any medicine, there is a very remote
chance of a vaccine causing a serious injury or death. The safety of vaccines
is always being monitored. For more information, visit the vaccine safety site.
What if there is a serious problem?
What should I look for?
Look for anything that concerns you,
such as signs of a severe allergic reaction, very high fever, or unusual
behavior. Signs of a severe allergic reaction can include hives, swelling of
the face and throat, difficulty breathing, a fast heartbeat, dizziness, and
weakness. These would usually start a few minutes to a few hours after the vaccination.
Hepatitis
C
What
is hepatitis C?
One virus that causes hepatitis C is called
the hepatitis C virus (HCV).
Hepatitis C is also sometimes called
'hep C'. Hepatitis C was only discovered in the 1980s so it is still a
relatively new disease; some aspects of this disease are still not completely understood.
Hepatitis C is a virus which is carried in the bloodstream to the liver. It can
then affect and damage your liver. However, this virus can also affect other
parts of the body, including the digestive system, the immune system and the
brain.
People with persistent infection
remain free of symptoms, although others have symptoms. Persistent infection
can lead to 'scarring' of the liver (cirrhosis) and may lead to liver cancer.
What
does the liver do?
The liver is in the upper right part
of the abdomen. It has many functions which include:
Storing fuel for the body (glycogen)
which is made from sugar. When required, glycogen is broken down into glucose
which is released into the bloodstream. Helping to process fats and proteins
from digested food. Making proteins that are essential for blood to clot
(clotting factors). Processing many medicines which you may take. Helping to
remove or process alcohol, poisons and toxins from the body. Making bile which
passes from the liver to the gut down the bile duct. Bile breaks down the fats
in food so that they can be absorbed from the bowel.
How can you get hepatitis C?
The main source of infection is from blood
from an infected person. Most cases are caused by using contaminated needles or
injecting equipment (spoons, syringes, filters, water for injection, etc) to inject
drugs ('sharing needles'). Even a tiny amount of an infected person's blood
left on a needle is enough to cause spread to others. There is also a risk of
contracting hepatitis C from needlestick accidents, or other injuries involving
blood spillage from infected people. There is a small risk of contracting the
virus from sharing toothbrushes, razors and other such items which may be contaminated
with infected blood. (The virus can live outside the body, possibly for up to
four days.) There is even a small risk from inhaling drugs like cocaine, as these
can make the inside of your nose bleed. If that happens, tiny spots of blood
can fall on to the note you are using and, if that is used by someone else,
your blood can travel up their nose and into their bloodstream.
There is also a small risk from re- used
equipment used for tattooing, body piercing, acupuncture, etc. There is a small
risk that an infected mother can pass on the infection to her baby. There is a
small risk that an infected person can pass on the virus whilst having sex. The
virus is not passed on during normal social contact, such as holding hands,
hugging, or sharing cups or crockery.
What are the symptoms and how does
hepatitis C progress?
Many people with hepatitis C feel entirely
well and have few or no symptoms. Any symptoms that may be present (see below)
are often initially thought to be due to another illness. This may mean that
hepatitis C may be diagnosed when you have had the virus for some time. Many people
have hepatitis C without knowing it. It is helpful to think of two phases of infection
with hepatitis C virus (HCV). An acute phase when you first become infected and
a chronic (persistent) phase in people where the virus remains long-term.
Acute phase of hepatitis C
Acute means 'new' or 'for a short time'.
This phase lasts for the first six months. When first infected with the virus,
most people have no symptoms, or only mild ones. If symptoms do occur, they
develop about 7-8 weeks after being exposed to the virus and may include
feeling sick (nausea), being sick (vomiting) and feeling generally unwell. Some
people go 'yellow' (become jaundiced). This is due to a build-up of the chemical
bilirubin which is made in the liver and spills into the blood in some liver
conditions. It is unusual to get severe symptoms. Following the initial
infection:
In about 1 in 5 cases the virus is cleared
from the body by the immune system within 2-6 months. If this happens then you will
have no long-term effects from the virus. Younger people and women are more
likely to clear the virus in this way. In about 4 in 5 cases, the virus remains
active in the liver and bloodstream long-term. This is called chronic infection
with hepatitis C.
Chronic hepatitis
C.
Chronic phase of hepatitis C When
infection with hepatitis C lasts for longer than six months, it is known as chronic hepatitis C infection. The
course of the chronic infection varies considerably between people and it is
very unpredictable. Of those people who develop chronic infection: Some people
have mild or no symptoms. However, even if you have no symptoms, you can still pass
on HCV to others who may develop problems. Some people develop some symptoms
due to persistent inflammation of the liver. For example, feeling sick, lack of
appetite, intolerance of alcohol, pains over the liver, jaundice and depression.
The most common symptoms of chronic hepatitis C are extreme tiredness, poor concentration
and memory problems, and muscle and joint aches. There is actually no relationship
between the severity of symptoms and the degree of liver damage. This means
that some people can have liver inflammation without having any symptoms. About
one third of people with chronic hepatitis C infection develop cirrhosis over a
period of about 20-30 years. Cirrhosis is like a 'scarring' of the liver, which
can cause serious problems and 'liver failure' when it is severe.
Some people with chronic hepatitis C
have no symptoms for many years until they develop cirrhosis. Only when the
liver starts to fail with cirrhosis do symptoms appear. A small number of
people who develop cirrhosis go on to develop liver cancer.
How is hepatitis C diagnosed?
A simple blood test can detect antibodies
to the hepatitis C virus (HCV) in your blood. (Antibodies are proteins made by
the immune system to attack germs such as viruses, bacteria, etc.) A positive
test means that you have at some stage been infected with hepatitis C. However,
this test remains positive even in people who have cleared the virus from their
body. (The antibodies remain even if the virus has gone.) Also, it can take up
to six months for the antibody test to become positive after a person has first
been infected, as the body may take a while to make these antibodies. So, a
negative test does not necessarily rule out a recently acquired infection. A
repeat test in a few months may be advised in some people who have recently
been at risk of catching hepatitis C. If the antibody test is positive then a further
blood test is needed to see if the virus is still present. This is called a PCR
test. This is a more specialised test which detects particles of the virus.
Tests may also be done to find exactly which type of HCV you are infected with.
Assessing the severity of the infection If you are found to have virus present
then other tests may be advised to check on the extent of inflammation or
damage to the liver. For example:
Blood tests called liver function
tests. These measures the activity of chemicals (enzymes) and other substances
made in the liver.
This gives a general guide as to
whether the liver is inflamed and how well it is working. See separate leaflet
called Liver function tests.
An ultrasound scans of the liver.
Other tests may be done if cirrhosis or other complications develop. There are
other specialised blood tests being developed which assess the development and
severity of cirrhosis. A small sample of the liver taken to look at under the
microscope (a liver biopsy) used to be recommended before considering
treatment. However, this is no longer routine prior to treatment.
How can I prevent passing on the
virus to others?
If you have a current hepatitis C
infection you should:
Not share any injecting equipment
such as needles, syringes, etc.
Not donate blood or carry a donor,
card.
Not share razors, toothbrushes or
anything else that may possibly be contaminated with blood.
Use condoms when having sex.
The risk of passing on hepatitis C
virus (HCV) during sex is small but risk is reduced even further by using
condoms. However, your partner in a regular faithful relationship may accept
the small risk of having sex without condoms. There is currently no vaccine
available to protect against hepatitis C.
What is the treatment of hepatitis C?
The treatment of hepatitis C has
advanced in recent years which has greatly improved the outlook for people with
hepatitis C. The mai aim of treatment is to clear the hepatitis C virus (HCV)
from the body and so prevent severe liver damage leading to cirrhosis. As the
damage caused by the hepatitis C is usually very gradual, the time at which
people with hepatitis C start treatment varies between cases. Your specialist
will be able to discuss with you in detail the most appropriate time for you to
start treatment. The usual treatment is a combination of two different
medicines called pegylated interferon and ribavirin. Overall, this treatment
can clear the virus ('cure') in over half of all cases.
However, the outlook does vary
depending on the type (genotype) of the virus. The treatment clears the virus
in almost half of those infected with genotype 1 but clears the virus in about
4 in 5 people infected with genotype 2 or 3. Pegylated interferon is also known
as peginterferon. It is a form of a medicine called interferon which is similar
to a substance produced in your body, also called interferon. It helps your
body get rid of HCV. This may stop the virus damaging your liver. This is
usually given as one injection each week. Ribavirin is a medicine that fights
viruses. It is given in combination with pegylated interferon and is taken each
day as a tablet or as a liquid. A course of treatment lasts 6-12 months,
depending upon your type of hepatitis C. It takes about 12 weeks to tell if
this treatment is working. You will usually have a blood test about 12 weeks
after you start the medicines, to see if the amount of virus in your body has reduced.
If so, then with the full course of treatment you have a good chance of
completely clearing the virus from your body.
Other medicines such as boceprevirand
telaprevir may be given in some cases. These are newer medicines that work by
preventing HCV from reproducing in the body. They are both given as tablets.
Side-effects from these treatments can occur which may include tiredness,
feeling sick (nausea), headaches, and depression. Some people need to change
their treatment, or take a lower strength, if they have troublesome
side-effects. Sofosbuvir, simeprevir and daclatasvir are also medicines that
may be used to treat some people with hepatitis C.
Liver transplant for some people with
advanced 'scarring' of the liver (cirrhosis), liver transplantation may be an
option. Although this is a major operation, the outlook following a liver
transplant can be very good.
Hepatitis
D
Hepatitis D virus (HDV) infections
occur only in those who are infected with HBV. The dual infection of HDV and
HBV can result in a more serious disease and worse outcome. Hepatitis B
vaccines provide protection from HDV infection.
Hepatitis
E
Hepatitis E virus (HEV) is mostly
transmitted through consumption of contaminated water or food. HEV is a common
cause of hepatitis outbreaks in developing parts of the world and is
increasingly recognized as an important cause of disease in developed
countries. Safe and effective vaccines to prevent HEV infection have been
developed but are not widely available.
