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The ABC's of hepatitis

By: Ken Ripp, M.D.

When we think of the ABC's, what comes to mind for most of us is the group of 26 letters that we memorized before kindergarten. And, while the alphabet is well known, there is another ABC group that deserves our attention: the ABC's of hepatitis.

Hepatitis is a liver disease that is often caused a viral infection. There are actually five different types of viral hepatitis – A, B, C, D, and E, with the first three being the most common.

There are a number of similarities between hepatitis A, B, and C, as well as some significant differences between the strains.

Hepatitis may manifest with similar symptoms. These can include fatigue, fever, muscle ache, joint pain, headache, pain on the right side of the abdomen (near the liver), nausea, vomiting, loss of appetite, skin rash, diarrhea, constipation, itchy skin, and jaundice.

All types of hepatitis damage liver cells and can cause the liver to become swollen and tender. They are all diagnosed through a blood test.

Treatment for all includes some of the same tactics. People with hepatitis are advised to slow down to reduce fatigue, eat healthy foods, drink plenty of fluids, and avoid alcohol and drugs.

Hepatitis A
Hepatitis A is the most common type of viral hepatitis. It is spread mainly by oral contact with feces containing the virus. This typically happens when a person with the disease doesn't wash his or her hands after using the restroom, and then prepares food. It is very rare for hepatitis A to be spread by infected blood or blood products. It is not known to be spread through saliva or urine. Hepatitis A is not related to the human immunodeficiency virus (HIV), which causes AIDS, and does not increase the risk of HIV infection.

The incubation period is about 30 days, but can vary from two to seven weeks. Symptoms do not develop until after the incubation period is over, but a person can spread the disease to others from at least two weeks before symptoms develop until the time that symptoms disappear.

Symptoms of hepatitis A usually last less than two months. In about 15 percent of cases, people with hepatitis A experience a relapse or prolonged symptoms that last up to nine months.

Most people (99 percent) recover fully on their own with at-home treatment and over-the-counter medication. Once you have had hepatitis A, your body develops lifetime immunity to the disease, so you will never get it again.

While there are no prescription medications used to treat hepatitis A, there is a vaccine to prevent the disease. It is comprised of a series of two shots received six months apart. Immunization is recommended for all children one year of age or older.

Hepatitis B
Hepatitis B is one of the most contagious forms of viral hepatitis. It is spread through body fluids, including blood, semen, and vaginal fluids. This most often happens during sexual contact or when people share needles during drug use, however the hepatitis B virus can remain contagious for at least a week and possible much longer, even if dried. Hepatitis B is not spread through kissing. In the past, blood transfusions were a common means of spreading hepatitis B. This is no longer the case. In the United States, blood is routinely screened for the virus, so it is very unlikely that a person would become infected from a blood transfusion.

The incubation period ranges from 60 to 90 days. People are infectious during this time as well as throughout the course of the disease.

Hepatitis B can be acute (short-term), or chronic (long-term). People with the more common acute form of the disease typically recover on their own without treatment. Some people have no symptoms. Others, who do develop symptoms, usually feel better within two to three weeks and recover fully within four to eight weeks. Once an acute infection is over, you are no longer contagious, and your body has permanent antibodies against the illness.

Chronic hepatitis B develops when the virus continues to be present in your liver and blood for six months or more. The chronic form of the disease puts you at risk for developing serious liver diseases such as cirrhosis and liver cancer. Most people with chronic hepatitis B have no symptoms. Treatment may include ongoing monitoring and frequent medical checkups to assess for liver damage. An antiviral medication may be used to halt the virus and prevent liver damage.

Vaccination to prevent hepatitis B is comprised of three injections that provide life-long immunity. The Centers of Disease Control recommends that all healthy babies weighing over 4.4 pounds receive their first dose of the vaccine at birth.

Hepatitis C
Hepatitis C can be silent, but serious. Many people do not know that they have the disease until they have had it for years, and after permanent liver damage has occurred.

The virus is spread through blood-to-blood contact. You cannot get hepatitis C through casual contact such as hugging, kissing, sneezing, coughing or sharing food or water. As is the case with hepatitis B, hepatitis C is no longer spread through blood transfusions, because all donated blood is screened for the disease.

The incubation period varies from two weeks, to six months. A person can spread the disease any time after the virus enters his or her body, and throughout the duration of the disease.

Immediately after a person is infected with hepatitis C, he or she enters into an acute state of the illness. At this point, some people fight off the virus and never encounter further liver problems. For about 85 percent of people, however, hepatitis C develops into a chronic disease, which can last for years and years before being detected.

Because hepatitis C is often not detected during the early stages of the disease, many people do not know they have it before they already have some permanent liver damage. In fact, in the worst-case scenario, hepatitis C can develop into cirrhosis, liver cancer, and liver failure. There are six different types of chronic hepatitis C known as genotypes. Genotype 1 is the most common type in the United States. It is also one of the hardest genotypes to treat.

Home treatment for acute and chronic hepatitis C may be all that is needed in many cases. Medication is available to treat more severe cases of the disease, however it has significant side-effects. Currently there is no vaccination available for hepatitis C. The best way to avoid the disease is to stay away from the behaviors that are likely to precede it.

Hepatitis – in whichever form – A, B, or C, is nothing to take lightly. It can cause liver damage and requires life changes such as slowing down and dietary changes in order to get the disease under control. In some cases, prescription medications and ongoing medical monitoring are required. But, in most cases, people recover fully from hepatitis and are able to return to a normal life and normal activities.

A vaccination for the A and B strains is available and is very successful in preventing the illness. If you think vaccination may be beneficial for you, talk to your health care professional about it during your next regular visit.

Dr. Ripp is a board certified family practice physician at Raiter Clinic.