What is Hepatitis A?

Hepatitis is a general term that means inflammation of the liver. Inflammation of the liver can result from infection, from exposure to alcohol, certain medications, chemicals, or poisons, or from a disorder of the immune system.

Hepatitis A refers to liver inflammation caused by infection with the hepatitis A virus (HAV). HAV is one of several viruses that can cause hepatitis and is one of the 3 most common hepatitis viruses in the United States. The other 2 are hepatitis B and hepatitis C.

Unlike hepatitis B and hepatitis C, hepatitis A does not cause chronic (ongoing, long-term) disease. Although the liver does become inflamed and swollen, it heals completely in most people without any long-term damage. Once you have had hepatitis A, you develop lifelong immunity and cannot get the disease again.

Because of the way it is spread, the hepatitis A virus tends to occur in epidemics and outbreaks. As many as 1 in 3 people in the United States have antibody to HAV, meaning they have been exposed to the virus, but most do not become ill. The number of cases of hepatitis A in the United States varies among different communities and has not been affected significantly by the introduction of the hepatitis A vaccine since the early 1990s.

Hepatitis A Causes

• The hepatitis A virus is found in the stools (feces) of people with hepatitis A. It is transmitted when a person puts something in his or her mouth that has been contaminated with the feces of an affected person. This is referred to as fecal-oral transmission.
  
  • If food or drinking water becomes contaminated with stool from an infected person (usually because of inadequate hand washing or poor sanitary conditions), the virus can quickly spread to anyone who drinks or swallows the contaminated food or water.
    
  • The virus can also be spread by eating raw or undercooked shellfish collected from water that has been contaminated by sewage.
    
  • The hepatitis A virus can be transmitted through blood transfusions, although this is extremely rare.
  
  
• People who are infected can start spreading the infection about 1 week after their own exposure. People who do not have symptoms can still spread the virus. Infection with HAV is known to occur throughout the world.
  
  • The risk of infection is greatest in developing countries with poor sanitation or poor personal hygiene standards.
    
  • Infection rates are also higher in areas where direct fecal-oral transmission is likely to occur, such as daycare centers, prisons, and mental institutions.
  
  
• People at increased risk for hepatitis A infection
  
  • Household contacts of people infected with HAV
    
  • Sexual partners of people infected with HAV
    
  • International travelers, especially to developing countries
    
  • Military personnel stationed abroad, especially in developing countries
    
  • Men who have sex with other men
    
  • Users of illegal drugs (injected or non-injected)
    
  • People who may come into contact with HAV at work
  
  
• Workers in professions such as health care, food preparation, and sewage and waste water management are not at greater risk of infection than the general public.
  

• People who live or work in close quarters, such as dormitories, prisons, and residential facilities, or work in or attend daycare facilities are at increased risk only if strict personal hygiene measures are not observed.
  

Hepatitis A Symptoms

Many people with HAV infection have no symptoms at all. Sometimes symptoms are so mild that they go unnoticed. Older people are more likely to have symptoms than children. People who do not have symptoms can still spread the virus.

• Symptoms of hepatitis A usually develop between 2 and 6 weeks after infection. The symptoms are usually not too severe and go away on their own, over time. The most common symptoms are as follows:
  
  • Nausea
    
  • Vomiting
    
  • Diarrhea, especially in children
    
  • Low-grade fever
    
  • Loss of appetite
    
  • Rash
    
  • Tiredness, fatigue
    
  • Jaundice - A yellow discoloration of the skin and the whites of the eyes
    
  • Urine is dark brownish in color, like cola or strong tea.
    
  • Pain in area of liver - On the right side of the abdomen, just under the rib cage
  
  
• If the vomiting is severe, dehydration may occur. The symptoms of dehydration include the following:
  
  • Feeling weak, tired, or "blah"
    
  • Feeling confused or unable to concentrate
    
  • Rapid heartbeat
    
  • Headache
    
  • Urinating less frequently than usual
    
  • Irritability
  
  
• Symptoms usually last less than two months, although they may last as long as nine months. About 15% of people infected with hepatitis A have symptoms that come and go for 6-9 months.

• Hepatitis does not occur simply from being near someone who has the disease at work or at school.
  

Hepatitis A Treatment

There are no specific medicines to cure infection with hepatitis A. Most people require no treatment except to relieve symptoms.

If you have been exposed to someone who is infected with HAV, there is a treatment that may prevent you from becoming infected. It is called immune globulin and is more likely to be effective when given within 2 weeks of exposure.

Self-Care at Home

The following measures can help you feel better while you are having symptoms.

• Take it easy; curtail your normal activities and spend time resting at home.
  
• Drink plenty of clear fluids to prevent dehydration.
  
• Avoid medicines and substances that can cause harm to the liver such as acetaminophen (Tylenol) and preparations that contain acetaminophen.
  
• Avoid alcoholic beverages, as these can worsen the effects of HAV on the liver.
  
• Avoid prolonged, vigorous exercise until symptoms start to improve.

Call your health care provider if symptoms worsen or a new symptom appears.

Be very careful about personal hygiene to avoid fecal-oral transmission to other members of the household.

Prevention

If you have hepatitis A, strict personal hygiene and hand washing help prevent transmission of HAV to others.

• Wash your hands thoroughly every time you use the bathroom, before touching or preparing food, and before touching others. Wash carefully with soap and warm water and dry thoroughly.
  
• Contaminated surfaces should be cleaned with household bleach to kill the virus.
  
• Heat food or water to 185°F or 85°C to kill the virus.
  

If you are not infected with HAV, you can protect yourself from becoming infected.

• Wash your hands carefully with soap and warm water several times a day, including every time you use the bathroom, every time you change a diaper, and before preparing food.
  
• Do not eat raw or undercooked seafood or shellfish such as oysters from areas of questionable sanitation (just about everywhere).
  
• Travelers to developing countries should not drink untreated water or beverages with ice in them. Fruits and vegetables should not be eaten unless cooked or peeled.
  

There are vaccines that work to prevent infection with HAV.

• The vaccines, Havrix and VAQTA, contain no live virus and are very safe. No serious adverse effects have been reported. Some people have some soreness at the injection site for a few days.
  
• The vaccines are given in a series of 2 shots. The second is given 6-18 months after the first. The shots can be given at the same time as other vaccines.
  
• Your protection starts about 2-4 weeks after the first shot. The second dose is necessary to ensure long-term protection.
  
• The vaccines are thought to protect from infection for at least 20 years.
  
• The vaccines must be given before exposure to the virus. They do not work after exposure.
  

Not everyone needs to have the hepatitis A vaccines. However, the vaccines are recommended for the following groups:

• All children older than 2 years who live in communities where the number of HAV infections is unusually high or where there are periodic outbreaks of hepatitis A (The vaccines are not recommended for children younger than 2 years because they are not as effective.)
  
• People who are likely to be exposed to HAV at work - The only group of workers shown to be at higher risk than the general population is people who work in research laboratories where HAV is stored and handled. Routine vaccination is not recommended for health care workers, food service workers, daycare personnel, and sewage and waste-water workers.
  
• Travelers to developing countries (it must be given at least 4 weeks before travel)
  
• Men who have sex with men
  
• People who use illegal drugs - This group has higher-than-average rates of HAV infection.
  
• People who are likely to become seriously ill if they are infected with HAV - This includes people with impaired immune systems or chronic liver disease.
  
• People with blood-clotting disorders who receive clotting factors
  

If you have never had hepatitis A and are exposed to the virus, call your health care provider immediately. There is a treatment that may prevent you from becoming infected. It is called hepatitis B immune globulin (BayHep B, Nabi-HB).

• Immune globulin is a preparation of antibodies that can fight the virus in the body.
  
• It is given as a one-time shot (injection).
  
• It must be given within 2 weeks after exposure for maximum protection.
  
• Immune globulin can be safely given to children younger than 2 years.
  
• Immune globulin can be given during pregnancy and breastfeeding.
  
• Immune globulin can provide short-term protection against infection if given before exposure. This protection lasts no longer than 3 months.
  

If you have had hepatitis A confirmed by a blood test, you cannot get it again. You should continue to practice preventive measures, however, to prevent transmission of other infections.

What is Hepatitis B ?

Hepatitis is a general term that means inflammation of the liver. The liver can become inflamed as a result of infection, a disorder of the immune system, or exposure to alcohol, certain medications, toxins, or poisons.

• Hepatitis B is caused by infection with the hepatitis B virus (HBV). This infection has 2 phases: acute and chronic.
  
  • Acute (new, short-term) hepatitis B occurs shortly after exposure to the virus. A small number of people develop a very severe, life-threatening form of acute hepatitis called fulminant hepatitis.
    
  • Chronic (ongoing, long-term) hepatitis B is an infection with HBV that lasts longer than 6 months. Once the infection becomes chronic, it may never go away completely.
    
  • About 90-95% of people who are infected are able to fight off the virus so their infection never becomes chronic. Only about 5-10 percent of adults infected with HBV go on to develop chronic infection.
  • HBV infection is one of the most important causes of infectious hepatitis.
  
  
• People with chronic HBV infection are called chronic carriers. About two-thirds of these people do not themselves get sick or die of the virus, but they can transmit it to other people. The remaining one third develop chronic hepatitis B, a disease of the liver that can be very serious.
  
  • The liver is an essential organ that the body needs to stay alive. Its most important functions are filtering many drugs and toxins out of the blood, storing energy for later use, helping with the absorption of certain nutrients from food, and producing substances that fight infections and control bleeding.
    
  • The liver has an incredible ability to heal itself, but it can only heal itself if nothing is damaging it.
    
  • Liver damage in chronic hepatitis B, if not stopped, continues until the liver becomes hardened and scarlike. This is called cirrhosis, a condition traditionally associated with alcoholism. When this happens, the liver can no longer carry out its normal functions, a condition called liver failure. The only treatment for liver failure is liver transplant.
    
  • Chronic hepatitis B also can lead to a type of liver cancer known as hepatocellular carcinoma.
    
  • Any of these conditions can be fatal. About 15-25 percent of people with chronic hepatitis B die of liver disease.
  
  
• Hepatitis B is the most common serious liver infection in the world. Worldwide, about 350 million people are chronic carriers of HBV, of whom, more than 250,000 die from liver-related disease each year.

• In the United States, hepatitis B is largely a disease of young adults aged 20-50 years. About 1.25 million people are chronic carriers, and the disease causes about 5000 deaths each year.

• The good news is that infection with HBV is almost always preventable. You can protect yourself and your loved ones from hepatitis B.
  
  

Hepatitis B Causes

• The hepatitis B virus is known as a blood-borne virus because it is transmitted from one person to another via blood.
  
  • Semen and saliva, which contain small amounts of blood, also carry the virus.
    
  • The virus can be transmitted whenever any of these bodily fluids come in contact with the broken skin or a mucous membrane (in the mouth, genital organs, or rectum) of an uninfected person.
  
  
• People who are at increased risk of being infected with the hepatitis B virus include the following:
  
  • Men or women who have multiple sex partners, especially if they don't use a condom
    
  • Men who have sex with men
    
  • Men or women who have sex with a person infected with HBV
    
  • People with other sexually transmitted diseases
    
  • People who inject drugs with shared needles
    
  • People who receive transfusions of blood or blood products
    
  • People who undergo dialysis for kidney disease
    
  • Institutionalized mentally handicapped people and their attendants and family members
    
  • Health care workers who are stuck with needles or other sharp instruments contaminated with infected blood
    
  • Infants born to infected mothers
  
  
• In some cases, the source of transmission is never known.

• The younger you are when you become infected with the hepatitis B virus, the more likely you are to develop chronic hepatitis B. The rates of progression to chronic hepatitis B are as follows:
  
  • 90% of infants infected at birth
    
  • 30% of children infected at age 1-5 years
    
  • 6% of people infected after age 5 years
    
  • 5-10% of infected adults
  
  
• You cannot get hepatitis B from the following activities:
  
  • Being sneezed or coughed on
    
  • Hugging
    
  • Handshaking
    
  • Breastfeeding
    
  • Eating food or drinking water
    
  • Casual contact (such as an office or social setting)
    
    

Hepatitis B Symptoms

• Half of all people infected with the hepatitis B virus have no symptoms.

• Symptoms develop within 30-180 days of exposure to the virus. The symptoms are often compared to flu. Most people think they have flu and never think about having HBV infection.
  
  • Appetite loss
    
  • Feeling tired (fatigue)
    
  • Nausea and vomiting
    
  • Itching all over the body
    
  • Pain over the liver (on the right side of the abdomen, under the lower rib cage)
    
  • Jaundice - A condition in which the skin and the whites of the eyes turn yellow in color
    
  • Urine becomes dark in color (like cola or tea).
    
  • Stools are pale in color (grayish or clay colored).
  
  
• Many types of acute viral hepatitis have similar symptoms (hepatitis A, hepatitis C).

• Fulminant hepatitis is an unusual illness. It is a severe form of acute hepatitis that can be life threatening if not treated right away. The symptoms develop very suddenly.
  
  • Mental disturbances such as confusion, lethargy, extreme sleepiness or hallucinations (hepatic encephalopathy)
    
  • Sudden collapse with fatigue
    
  • Jaundice
    
  • Swelling of the abdomen
  
  
• Prolonged nausea and vomiting can cause dehydration. If you have been vomiting repeatedly, you may notice these symptoms:
  
  • Feeling tired or weak
    
  • Feeling confused or having difficulty concentrating
    
  • Headache
    
  • Not urinating
    
  • Irritability
  
  
• Symptoms of liver failure may include the following:
  
  • Fluid retention causing swelling of the belly (ascites) and sometimes the legs
    
  • Weight gain due to ascites
    
  • Persistent jaundice
    
  • Loss of appetite, weight loss, wasting
    
  • Vomiting with blood in the vomit
    
  • Bleeding from the nose, mouth, or rectum or blood in the stool
    
  • Hepatic encephalopathy (excessive sleepiness, mental confusion, and in advanced stages, development of coma)
    

Hepatitis B Treatment

Acute hepatitis B usually goes away by itself and does not require medical treatment. If very severe, symptoms such as vomiting or diarrhea may require treatment to restore fluids and electrolytes. There are no medications that can prevent acute hepatitis B from becoming chronic.

If you have chronic hepatitis B, you should see your health care provider regularly.

Prevention

There is a vaccine against the hepatitis B virus (Engerix-B, Recombivax HB). It is safe and works well to prevent the disease. A total of 3 doses of the vaccine are given over several months.

• This vaccine has successfully prevented infection in people exposed to the virus.
  
• The vaccine is recommended for all children younger than 19 years. It can be given as part of their normal vaccination series.

The following groups should be vaccinated for hepatitis B:

• All children younger than 18 years, including newborns--especially those born to mothers who are infected with HBV
  
• All health care and public safety workers who may be exposed to blood
  
• People who have hemophilia or other blood clotting disorders and receive transfusions of human clotting factors
  
• People who require hemodialysis for kidney disease
  
• Travelers to countries where HBV infection is common - This includes most areas of Africa, Southeast Asia, China and central Asia, Eastern Europe, the Middle East, the Pacific Islands, and the Amazon River basin of South America.
  
• People who are in prison
  
• People who live in residential facilities for developmentally disabled persons
  
• People who inject illegal drugs
  
• People with chronic liver disease such as hepatitis C
• People who have multiple sex partners or have ever had a sexually transmitted disease
  
• Men who have sex with men

Hepatitis B immune globulin (BayHep B, Nabi-HB) is given along with the hepatitis B vaccine to unvaccinated people who have been exposed to hepatitis B.

• These include close contacts of people with HBV infection, health care workers who are exposed to HBV-contaminated blood, and infants born to mothers infected with HBV.
  
• It also includes people who have finished only part of the 3-shot vaccination series.
  
• Giving the immune globulin and the vaccine together in these situations prevents transmission of the disease in 80–90 percent of cases.

Other ways to protect yourself from HBV infection:

• If you are sexually active, practice safe sex. Correct use of latex condoms can help prevent transmission of HBV, but even when used correctly, condoms are not 100% effective at preventing transmission. Men who have sex with men should be vaccinated against both hepatitis A and hepatitis B.
  
• If you inject drugs, don't share needles or other equipment.
  
• Don't share anything that might have blood on it, such as a razor or toothbrush.
  
• Think about the health risks if you are planning to get a tattoo or body piercing. You can become infected if the artist or piercer does not sterilize needles and equipment, use disposable gloves, or wash hands properly.
  
• Health care workers should follow standard precautions and handle needles and sharps safely.
  
• If you are pregnant or think you might be pregnant, tell your health care provider if you have any of the risk factors for HBV infection.
  

What is Hepatitis C ?

Hepatitis is a general term that means inflammation of the liver. This inflammation can be caused by infection. Hepatitis can also be caused by exposure to alcohol, certain medications, chemicals, poisons, and other toxins, or by other diseases. Hepatitis C virus (HCV) is one of the many viruses that can cause inflammation of the liver.

Inflammation of the liver caused by infection with HCV is referred to as hepatitis C.

• If the inflammation is not reversed, it becomes chronic (ongoing, long term) and can cause chronic liver disease, which can be serious or even fatal.
  
• At least 75% of people infected with hepatitis C develop chronic hepatitis C.
  
• If the disease progresses to the point at which the liver begins to fail (end stage liver disease), the only treatment is liver transplantation.

Hepatitis C is an increasing public health concern in the United States and throughout the world.

• HCV is one of the most common causes of chronic liver disease in the United States and the most common cause of chronic viral hepatitis.
  
• It is believed to be the cause of about 15-20% of all cases of acute (new, short term) viral hepatitis and half of all cases of cirrhosis, end-stage liver disease, and liver cancer.

About 4 million people in the United States have antibodies to HCV, meaning they have been infected with the virus at some point; as many as half of them do not know they have the infection.

Hepatitis C Causes

• HCV is not related to the other viruses that cause hepatitis. Like the other hepatitis viruses, however, it is contagious. The hepatitis C virus is transmitted mainly by contact with blood or blood products.
  
  • Sharing of contaminated needles among IV drug users is the most common mode of transmission. Using a needle to inject recreational drugs, even once several years ago, is a risk factor for hepatitis C.
    
  • Transfusion with infected blood or blood products, hemodialysis, or transplantation of organs from infected donors was once a common mode of transmission but is now rare.
  
  
• In 1992, a test became available for checking blood for HCV. Blood and blood products are now tested to ensure that they are not contaminated. As a result, cases of hepatitis C related to transfusion, hemodialysis, or transplantation have dropped to almost zero since then. Transfusion of blood or blood products before 1992 is a risk factor for hepatitis C.

• Less common causes of HCV transmission include the following:
  
  • From mother to infant at the time of childbirth
    
  • Through sexual intercourse with an infected person: Having multiple sex partners is a risk factor.
    
  • Needle sticks with HCV-contaminated blood: This is mostly seen in health care workers. The risk of developing HCV infection after a needle stick is about 5-10%.
  
  
• You cannot get hepatitis C by living with, being near, or touching someone with the disease. You can get the disease by sharing a razor, nail clippers, or other such items with an infected person.

• The source of transmission is unknown in about 10% of people with acute hepatitis C and in about 30% of people with chronic hepatitis C.
  

Hepatitis C Symptoms

Although hepatitis C damages the liver, 80% of people with the disease do not have symptoms. In those who do, symptoms may not appear for 10-20 years, or even longer. Even then, the symptoms usually come and go and are mild and vague. Unfortunately, by the time symptoms appear, the damage may be very serious.

• A minority of people have symptoms during the early acute phase of the infection. These symptoms typically develop 5-12 weeks after exposure to HCV. Some people describe the symptoms as being flulike. The symptoms may last a few weeks or months.
  
  • Nausea
    
  • Vomiting
    
  • Diarrhea
    
  • Loss of appetite
    
  • Fatigue
  • Pain over the liver (on the right side of the abdomen, just under the rib cage)
    
  • Jaundice - A condition in which the skin and the whites of the eyes turn yellow
    
  • Dark-colored urine (may look like cola or tea)
    
  • Stools become pale in color (grayish or clay colored)
  
  
• Prolonged nausea and vomiting can cause dehydration. If you have been vomiting repeatedly, you may notice the following symptoms:
  
  • Fatigue or weakness
    
  • Confusion or difficulty concentrating
    
  • Headache
    
  • Not urinating
    
  • Irritability
  
  
• Chronic hepatitis C can lead to cirrhosis of the liver in many people, a condition traditionally associated with alcoholism. Cirrhosis is a condition in which healthy liver tissue is replaced by fibrous tissue, followed by scarlike hardening. As this happens, the liver gradually begins to fail, or lose its ability to carry out its normal functions. Eventually, symptoms develop. Symptoms of cirrhosis include the following:
  
  • Fluid retention causing swelling of the belly (ascites), legs, or whole body
    
  • Persistent jaundice
    
  • Fatigue
    
  • Disturbances in sleeping
    
  • Itchy skin
    
  • Loss of appetite, weight loss, wasting
    
  • Vomiting with blood in the vomit
    
  • Mental disturbances such as confusion, lethargy, extreme sleepiness, or hallucinations (hepatic encephalopathy)
    

Hepatitis C Treatment

Self-Care at Home

If you have symptoms, these measures will help you feel better faster.

• Take it easy; get plenty of rest.
• Drink plenty of fluids to prevent dehydration.
  
• Do not drink alcohol of any kind, including beer, wine, and hard liquor.
  
• Avoid medicines and substances that can cause harm to the liver such as acetaminophen (Tylenol) and other preparations that contain acetaminophen.
  
• Avoid prolonged, vigorous exercise until symptoms start to improve.
  

Prevention

Right now, there is no vaccine for the prevention of HCV transmission. The best means of preventing transmission of HCV is to prevent contact with infected blood and organs and to avoid high-risk sexual behavior such as multiple partners and anal contact.

Avoiding alcohol and drugs that can damage the liver may help slow the rate of progression of the disease.