Thursday, May 26, 2016

The ABCs of Hepatitis: What It Is; How to Prevent It

By Janice Stachowiak, MD
Lubbock Internist
Member, TMA Be Wise ― ImmunizeSM Physician Advisory Panel

May is Hepatitis Awareness Month. While May is almost over, you can benefit anytime by knowing how to prevent hepatitis, inflammation of the liver. Liver inflammation can have several causes, including alcohol, medications, and viral infections. I will focus on viral causes of hepatitis, especially those that can be prevented by vaccines. In the United States, the most frequent types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C.

Hepatitis A:

Hepatitis A usually is caused by consuming contaminated food or water or through person-to-person contact, such as when an infected person does not wash his or her hands properly after using the bathroom and touches other objects. Some people with hepatitis A have no signs of illness, some have a mild illness, and others are severely ill. Symptoms of Hepatitis A can include fever, fatigue, loss of appetite, nausea, vomiting, stomach pain, dark urine, light or clay-colored stools, and jaundice (yellowing of the skin and eyes). These symptoms can last a few weeks to several months.

The older a person and the more medical problems they have — especially prior liver disease — the more severe symptoms are likely to be. In rare cases, hepatitis A can be life-threatening. Once someone recovers from hepatitis A, he or she has antibodies to protect from further episodes of hepatitis A for life. Hepatitis A also does not cause a long-term infection that can lead to cirrhosis (scarring of the liver).

The best way to prevent hepatitis A is through vaccination. Vaccination is recommended for children 1 year of age or older, travelers to certain countries, and other adults at high risk for severe illness should they have contracted hepatitis A, such as people with chronic liver disease. The hepatitis A vaccine is given as two shots, six months apart. Adults 18 years of age or older can get a combination vaccine that protects against both hepatitis A and B; this is given as three shots over six months. Protection begins approximately two to four weeks after getting the hepatitis A vaccine. If you are traveling outside of the United States this summer, you can check if the hepatitis A vaccine is recommended for your destination. Getting vaccinated two or more weeks before departure is best but even getting the shot a few days before you leave will offer some protection.

Hepatitis B:

Hepatitis B can be transmitted several ways: Through sexual contact; the sharing of needles, syringes, or other drug-injection equipment; the exposure to blood from needle sticks or other sharp instruments; or from mother to baby at birth. People living with diabetes or on hemodialysis (a procedure to treat kidney failure that filters waste and removes extra fluid from the blood) can be at increased risk. In some Asian countries hepatitis B is so prevalent, mother-to-child transmission is common. For some people, hepatitis B is a short-term illness. For others, it can be a long-term, chronic infection. The younger a person is when he or she contracts hepatitis B, the greater the risk of long-lasting infection. Chronic hepatitis B (a long-term condition) can lead to cirrhosis or liver cancer.

Most adults will develop symptoms with an acute hepatitis B infection (a shorter-term severe case), while most children will not. Symptoms of acute hepatitis B infection are similar to hepatitis A: fever, nausea, vomiting, dark urine, and jaundice. An acute infection can last a few weeks to several months. People who develop chronic hepatitis B can remain symptom-free for as long as 20 to 30 years after the initial infection. Acute and chronic hepatitis B can be diagnosed with blood tests. Treatment is available for people with complications from chronic hepatitis B, but it doesn’t work in all cases.

Again, the best way to prevent hepatitis B is through vaccination. All children should get their first hepatitis B shot at birth and complete the series by 6-18 months of age. All children and adolescents younger than 19 years of age who were never vaccinated should get the shots. Any adult at increased risk or who wants to be protected against hepatitis B can be vaccinated. I received my hepatitis B shots while I was in medical school.

Hepatitis C:

Hepatitis C usually is spread when blood from an infected person enters the body of someone else who is not infected. The most common form of transmission is sharing needles or equipment to inject drugs. Less commonly, a person can get hepatitis C through sexual contact.

Approximately 70 to 80 percent of people with acute hepatitis C do not have symptoms. Many people with acute hepatitis C will develop chronic hepatitis C that can lead to cirrhosis and liver cancer.

Testing for Hepatitis C is recommended for:

  • Anyone born between 1945 and 1965;
  • Anyone who received a blood transfusion or organ donation before 1992;
  • Anyone treated for a blood clotting disorder before 1987;
  • Anyone who has injected drugs — even only once; and
  • Anyone infected with HIV.  

The treatment options for people with chronic hepatitis C have greatly improved during the past several years. However, no vaccine currently is available for hepatitis C. The best prevention is to avoid the behaviors that can spread the virus, such as sharing needles.

Dr. Stachowiak, an internist from Lubbock, teaches at Texas Tech University Health Sciences Center in Lubbock. She is a member of TMA’s Be Wise – ImmunizeSM Physician Advisory Panel and is a member of the South Plains Immunization Network.

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