Topic Tuesday: Hepatitis

The word hepatitis means an inflammation of the liver. It can be caused by one of many things — including a bacterial infection, liver injury caused by a toxin (poison), and even an attack on the liver by the body’s own immune system. However, hepatitis usually is caused by a virus. The three most common hepatitis viruses are hepatitis A, hepatitis B, or hepatitis C. Two other types of hepatitis virus, D and E, are rare in the United States.

Hepatitis A is usually the least serious of the three main types of hepatitis, but can make you very ill. Unlike some other hepatitis viruses, hepatitis A rarely leads to permanent liver damage. Within a few weeks, the symptoms will have gone away on their own and the virus will no longer be in your system. Once someone has recovered from a hepatitis A infection, that person has immunity to the virus, meaning he or she will probably never get it again. People are also protected against hepatitis A if they’ve been vaccinated against it.

Hepatitis A is found in fecal matter, even in microscopic amounts. Infected individuals shed large amounts of the virus in their stool, starting about two weeks before symptoms present, and continue shedding the virus in their stool for one to three months.

So how exactly does a person get microscopic amounts of fecal matter in their system during sex? One obvious answer is anal sex without a condom. But here are some less obvious things to consider:

• Rimming: the act of using one’s tongue on the anal rim of another person in order to gain and/or give sexual pleasure.
• Anal fingering: the act of sticking one’s finger (or, in some cases, the fist) in the anus and start to move in and out like people do during sex.
• Handling used condoms and dildos.

And here are the non-sexual routes of transmission:

• The hepatitis A virus also may be spread by ingestion of food or water that is contaminated by infected individuals;
• or by eating food or drinking water that’s been contaminated with feces. As disgusting as that sounds, though, hepatitis A is actually considered less destructive than some other hepatitis viruses.
• People traveling in countries with poor hygiene risk getting it too.

Here’s the thing about the symptoms of Hepatitis A: you are most infectious before your symptoms appear. Once those symptoms do appear, they can be so mild that you may not realize you have it. In addition, people with hepatitis A may not show any symptoms, so the infection can go undiagnosed.

Any hepatitis infection causes inflammation of the liver, which means that the liver becomes swollen and damaged and begins losing its ability to function. People with hepatitis often get symptoms similar to those caused by other virus infections, such as weakness, fatugue, and nausea. Because the symptoms of hepatitis are similar to those from other conditions, it’s easy for someone who has it to confuse it with another illness.

Even when infected people don’t have any symptoms, they can still pass the disease on to others.

The incubation period for hepatitis (how long it takes from when someone is infected to when symptoms first appear) varies — some people might not feel any different, while others may notice symptoms anywhere from 15 days to 4 months after getting the disease, depending on the type of hepatitis.

Symptoms of hepatitis A include:

• yellowing of the skin and eyes, known as jaundice
• mild flu-like symptoms
• fever
• diarrhea
• fatigue
• nausea, vomiting, and lack of appetite
• abdominal pain (on the upper right side)
• light-colored bowel movements
• dark-colored urine
• weight loss
• may feel sick around tobacco smoke, alcohol and fatty foods.

The illness can last many weeks and take many months before you get your strength back.

There is a vaccine for Hepatitis A. Hepatitis A does not cause chronic or persistent infection of the liver. Once a person has recovered from hepatitis A, he or she is immune to reinfection with hepatitis A for life. This is true because effective antibodies are developed against the hepatitis A virus. After infection with hepatitis A, these antibodies provide life-long protection against the virus. The ability of the body to make protective antibodies after infection with hepatitis A led researchers to develop vaccines against the disease.

The hepatitis A vaccine is made of killed hepatitis A viruses and causes the body’s immune system to produce antibodies against the hepatitis A virus. In most vaccine recipients, antibodies start to develop immediately after the first dose but do not reach protective levels for 2 to 4 weeks. A second dose of the vaccine is recommended at least six months after the first dose to provide prolonged protection.

Two hepatitis A vaccines are currently available in the United States; these vaccines are hepatitis A vaccine injections of Havrix or Vaqta. The vaccine is given as an injection into the deltoid muscle of the arm. Both Havrix and Vaqta provide high-level protection against hepatitis A. There is also a combination vaccine called hepatitis-b-hepatitis-a-vaccine injection (Twinrix) that protects against both hepatitis A and hepatitis B. The dosing schedule for Twinrix is different from the other hepatitis A vaccines and requires three doses over six months.

In the United States, hepatitis A vaccination is recommended for all children at one year of age. Vaccination also is recommended for individuals in high-risk settings. Examples include:

• travelers to developing countries,
• men who have sex with men,
• users of intravenous drugs,
• persons needing frequent blood products, and
• people who have chronic liver disease.

Side effects of the hepatitis A vaccine usually are mild. Soreness at the site of injection is common. Less commonly, recipients may complain of a headache or fatigue. Serious allergic reactions are possible, but are rare.

A blood test before being vaccinated shows if you’ve picked up the virus already. If you have, you already are immune and don’t need the vaccine. Hepatitis vaccines are safe if you have HIV, but can briefly affect your viral load.
After 10 years, a booster is needed.

Hepatitis B (HBV) is a more serious infection that also attacks the liver. It may lead to a condition called cirrhosis (permanent scarring of the liver) or liver cancer, both of which cause severe illness and even death.

There’s no effective cure for hepatitis B, although people who have had the hepatitis B vaccine are protected against it. In most cases, teens who get hepatitis B will recover from the disease and may develop a natural immunity to future hepatitis B infections. But some people will have the condition forever. Medicines can help some people with hepatitis B get rid of the virus.

Hepatitis B is extremely contagious. Listen up, here’s what you need to know:

Hepatitis B virus (HBV) is transmitted from person to person through five body fluids: semen (including pre-cum), vaginal fluid, urine and saliva.

In the United States, the most common way people get infected with HBV is through unprotected sex with someone who has the disease. In other words, contact of mucous membranes with an infected person’s fluids: as you read above – semen (including pre-cum), vaginal fluid, urine and saliva.

Another way to explain it is:

• Kissing, anal, oral and vaginal intercourse, rimming and watersports.
• People who share infected needles are also at risk of becoming infected because it’s likely that the needles they use will not have been sterilized.
• Inadvertent exposure to infected blood or body fluids may also occur during tattooing, body piercing, or when sharing razors or toothbrushes (blood particles) with an infected person.

At first, people are usually asymptomatic; they can have the virus for between one and six months before showing any symptoms. In some cases, symptoms can appear within 4 weeks. It’s a flu-like illness characterized by:

• extreme fatigue
• headache
• fever
• nausea and vomiting
• loss of appetite
• yellowing of skin and whites of eyes (jaundice)
• clay-colored stool
• very dark urine
• abdominal pain

The majority of people infected with Hepatitis B recover from their symptoms, suffer no lasting damage and stop being infectious. In most cases, the infection clears in 4-8 weeks. However some people (1 in 10) remain contagious (carriers) for life, which means they feel fine but stay infectious to others. Carriers run a small risk of getting cirrhosis, liver cancer or liver failure. One in 100 die from it.

Vaccination has reduced the number of new cases of hepatitis B by more than 75% in the United States. The hepatitis B vaccine contains a protein (antigen) that stimulates the body to make protective antibodies. Examples of hepatitis B vaccines available in the United States include hepatitis B vaccine-injection Engerix-B and Recombivax-HB. Three doses (given at 0, 1, and 6 months) are necessary to assure protection.
There are also combination vaccines on the market that provide protection against hepatitis B and other diseases. For example:

• Hepatitis-b-hepatitis-a-vaccine injection (Twinrix), which provides protection against both hepatitis A and hepatitis B;
• Haemophilus B/hepatitis B vaccine – injection (Comvax) provides protection against hepatitis B and Haemophilus influenzae type b (a cause of meningitis; and
• Pediarix provides protection against hepatitis B, tetanus, pertussis and polio.
  Hepatitis B vaccines are effective and safe. Most vaccinated individuals develop protective antibodies when they get the vaccine and are protected from infection with hepatitis B.

A blood test for hepatitis B antibodies is recommended after vaccination is completed to ensure that antibodies have been produced. For the few who do not form antibodies, revaccination may improve the response, especially in infants. The vaccine works for about 95% of people. However, a small proportion of individuals will never respond to hepatitis B vaccination. The older you are, or if you have HIV, the less effective it can be. (If you’ve read this far, I’m one of those people.)

Side effects from the vaccine usually are mild, primarily soreness at the site of injection. The risk of serious allergic reaction is less than one per million doses.
In the United States, hepatitis B vaccination is recommended for all infants at birth. Older children and adolescents should receive the vaccine if they did not receive it at birth. Adults in high-risk situations also are advised to receive hepatitis B vaccine.
Some countries have a high prevalence of hepatitis B in their population. Travelers who visit these countries for a prolonged period of time (usually 6 months or longer) and those who may be exposed to blood or semen should consider vaccination.

After five years, you’ll need a booster injection.

Hepatitis C is the most serious type of hepatitis. Like hepatitis B, hepatitis C can lead to cirrhosis or liver cancer. An estimated 4.1 million Americans are currently infected with the virus. It’s now one of the most common reasons for liver transplants in adults. Every year, thousands of people in the United States die from HCV. And there’s no cure and no vaccine.

The hepatitis C virus (HCV) is transmitted from person to person through blood.

• The most common way people become infected is through sharing drug paraphernalia such as needles.
• People also get hepatitis C after having unprotected sex with an infected partner.
• Also anal sex without a condom if there is blood.
• A lesser known fact is that you can Hepatitis C from fisting, if blood is present.
• Inadvertent exposure to infected blood or body fluids may also occur during tattooing, body piercing, or when sharing razors or toothbrushes (blood particles) with an infected person.
• Before July 1992, many people got HCV through blood transfusions, but better blood screening and handling procedures now mean that this rarely happens.
• Or if you were treated for clotting problems with a blood product made before 1987.
• Sometimes, mothers with hepatitis C pass the virus along to their babies during birth.
  

A doctor will test for antibodies, which can take up to 6 months to appear in the blood. Sometimes, a doctor will take a liver biopsy.

The medicines currently used to treat hepatitis C (6 – 12 months of Alpha Interferon and Ribavirin) are effective in controlling the disease in some people. However, hepatitis C treatments are not very easy to take, especially because some require frequent injections.There is no vaccine for Hepatitis C.

The hepatitis A virus (HAV) is transmitted through the feces (poop) of infected individuals. Unlike some other hepatitis viruses, hepatitis A rarely leads to permanent liver damage.

The hepatitis B virus (HBV) is transmitted from person to person through five body fluids: semen (including pre-cum), vaginal fluid, urine and saliva.

The hepatitis C virus (HCV) is transmitted through blood and sharing infected needles. It is not as easy to get through sex as A and B.

Even when infected people don’t have any symptoms, they can still pass the disease on to others.

Get Vaccinated. Vaccinations can protect you from A and B. Today, all kids in the United States are routinely vaccinated against hepatitis B at birth and against hepatitis A when they’re between 1 and 2 years old.

A blood test for hepatitis B antibodies is recommended after vaccination to ensure that antibodies have been produced.

In addition to getting vaccinations against hepatitis A and B, here’s how to protect yourself against hepatitis virus infection:

• Don’t have unprotected sex.
• Avoid intravenous drug use and sharing of drug paraphernalia.
• Wash your hands before handling food and after using the bathroom.
• Be sure tattoo or piercing shops sterilize needles and other equipment properly.
• Don’t share toothbrushes or razors. Hepatitis can be transmitted through sores or cuts.
• Avoid eating raw shellfish (such as clams or oysters). You could put yourself at risk for hepatitis A if the shellfish was harvested from contaminated water.

1. KidsHealth.org – Hepatitis
2. MedicineNet.com – Hepatitis Immunizations
3. “Sexually Transmitted Infections – The Facts” by David Barlow

DISCLAIMER: The information contained in this post is intended to inform readers and is not intended to replace specific advice from a health care professional.