Hepatitis
Hepatitis
inflammation of the liver
• Can have many causes
– drugs
– toxins
– alcohol
– viral infections (A, B, C, D, E)
– other infections (parasites, bacteria)
– physical damage
Liver
• Functions
– Stores sugar needed for energy
– Absorbs good nutrients
– Breaks down poisons (toxins) and drugs
– Makes important proteins that help build new
tissue and repair broken tissue
– Produces bile, which helps remove waste from
the body
• Store vitamins A, D, K and B12 (also
mineral)
• Produce 80% of your body’s cholesterol
• Decomposing red blood cell
Healthy Liver Cirrhosis Liver
Hepatitis Terms
• Acute Hepatitis: Short-term hepatitis.
– Body’s immune system clears the virus from
the body within 6 months
• Chronic Hepatitis: Long-term hepatitis.
– Infection lasts longer than 6 months because
the body’s immune system cannot clear the
virus from the body
Hepatitis A
• What is it?
– Infection of the liver caused by Hepatitis A
virus
Geographic Distribution of HAV Infection
Anti-HAV Prevalence
High
Intermediate
Low
Very Low
Hepatitis A
• Incubation period
– 30 days on average (range 15-50 days)
– infectious latter half of incubation period while
asymptomatic through 1 week after having
jaundice.
Hepatitis A
• Symptoms
– Nausea – Dark urine
– Loss of appetite – Pale stool
– Vomiting – Jaundice
– Fatigue – Stomach pain
– Fever – Side pain
A person may have all, some or none of these
Hepatitis A
• How do you get it?
– Feces (stool) on hands that gets on food or in
water
– Contaminated shellfish
– Sex
• A person is most contagious 2 weeks before
they feel sick
• Not spread by kissing, sneezing, saliva
Hepatitis A
• Diagnosis and Treatment
– Blood test
– No medicine or treatment to make it go away
– Rest, fluids, treatment of symptoms
– Most people recover completely and become
immune to reinfection
Hepatitis A
• Prevention
– Shot of immune globulin up to 2 weeks after
exposure
– Good hand washing
– Cook food well
– Good diaper hygiene
– Only drink clean water
– VACCINE!!!
Hepatitis A
• Who needs immune globulin?
– Living with someone with Hep A
– Eaten food handled by someone with Hep A
– Sexual contact with person with Hep A
– Traveling to an area where Hep A is common
– Child or employee at a child care program
where someone else has Hep A
Hepatitis B
• What is it?
– Hep B is a serious disease caused by a virus
that infects the liver
– Can cause lifelong infection, cirrhosis (liver
scarring), liver cancer, liver failure and death
Geographic Distribution of Chronic HBV
Infection
HBsAg Prevalence
8% - High
2-7% - Intermediate
<2% - Low
Hepatitis B
• Incubation period
– 60-90 days on average (range 45-180 days)
– infectious weeks before getting ill and for
variable period after acute infection
– chronic carriers remain infectious
Hepatitis B
• Symptoms
– Nausea – Dark urine
– Loss of appetite – Pale stool
– Vomiting – Jaundice
– Fatigue – Stomach pain
– Fever – Side pain
A person may have all, some or none of these
Hepatitis B
• Who is at risk?
– Anyone can get it
– In the USA, 200,000 people get Hep B every
year
– 5,000 people die every year of Hep B
– If you have had other kinds of Hepatitis, you
can still get Hep B
Hepatitis B Infections
200,000 per year
Asymptomatic Cases Symptomatic Cases
100,000 (50%) 100,000 (50%)
Clear Virus; Healthy
170 - 182,000 (90-94%) Death
Hepatitis B Chronic Carriers 100 (0.05%)
12-20,000 (6-10%)
Chronic Liver Disease
Death from Cirrhosis Death-Primary Liver Cancer
3400 (1.7%) 800 (0.4%)
Hepatitis B
• Who is at highest risk?
– Injection drug users
– Sex partners of those with Hep B
– Sex with more than one partner
– Men who have sex with men
– Living with someone with chronic Hep B
– Contact with blood
– Transfusions, travel, dialysis
Hepatitis B
• How do you get it?
– Direct contact with blood or body fluids of an
infected person
• sharing injection equipment
• sex
• baby from infected mother during childbirth
• Hepatitis B is not spread by food, water or
casual contact
Hepatitis B
• Who is a carrier of Hep B virus?
– Some people with Hep B never fully recover
from the infection (chronic infection)
– They still carry the virus and can infect others
for the rest of their lives
– There are about 1 million carriers of Hep B in
the USA
HEPATITIS B
10%
Chronically infected
Clear the infection
90%
Hepatitis B
• Diagnosis and Treatment
– Blood test
– There is no cure
– Interferon/Ribaviron
Hepatitis B
• What about Hep B and pregnancy?
– A woman with Hep B can give it to her baby at
birth
– Babies with Hep B can get very sick, can
develop chronic infection and spread Hep B,
can get cirrhosis or liver cancer
– Pregnant women should be tested for Hep B
– Babies should get Hep B vaccine at birth
Hepatitis B
• Who should get Hepatitis B vaccine?
– All babies, at birth
– All children 11-12 who have not had vaccine
– People at risk
• MSM
• Multiple sex partners
• Injection drug users
• People with jobs where exposure to blood might
happen
Hepatitis C
• What is it?
– Hep C is a liver infection caused by a virus
– Also known as non A, non B hepatitis
Hepatitis C
• Incubation period
– 6-7 weeks on average (range 2-6months)
– infectious one or more weeks before getting ill
– chronic carriers remain infectious
Hepatitis C
• Symptoms
– Nausea – Dark urine
– Loss of appetite – Pale stool
– Vomiting – Jaundice
– Fatigue – Stomach pain
– Fever – Side pain
3 out of 4 persons have no symptoms and can
infect others without knowing it
Hepatitis C
• Who is at risk?
– About 35,000 people get Hep C every year
• down from 180,000 in the 1980s
– About 3.9 million people in the USA are
infected with Hep C.
– It can cause liver failure, cirrhosis, liver cancer
– Responsible for 8,000 to 10,000 deaths/year.
Hepatitis C
• Who is at highest risk?
– Injection drug users
– Estimated that over 75% of injectors
nationwide have Hep C
– In Seattle/King County, 86%
Hepatitis C
• How do you get it?
– Shared injection equipment (60% of new infections)
– Blood transfusion before May, 1992 (now only 1 in
100,000 chance of transmission)
– Blood transfer (tattoo, piercing …)
– Sex?
– Mother to child (<5%)
– 10-20% of infections have no identifiable risk factors
Hepatitis C
• Diagnosis
– There is a blood test that screens for Hep C antibodies
(ELISA or RIBA)
– Antibodies usually develop within 3 months
– HIV+ persons may not develop detectable antibodies
– There is a PCR test (detects parts of actual virus) for Hep C
but it is not yet FDA approved
– If infected, liver enzyme tests or a liver biopsy can check
liver function
Hepatitis C
• What happens when you have Hepatitis C ?
– 85% of people develop chronic infection (infected for
the rest of their life)
– Rapid progression, slow progression, no progression
• HCV subtype
• Alcohol consumption (alcoholics 3 times more likely to
develop cirrhosis after 20 years)
• age (older at time of infection more rapid)
• gender (men faster progression than women)
15%
HEPATITIS C
Chronically infected
Clear the infection
85%
Hepatitis C
• Long term pathogenesis
– Over time progressive liver damage may occur
– 20 -30 % of those infected will develop cirrhosis over 10
- 30 years
– Of those with cirrhosis 25-30% (5% of overall) will
develop end-stage liver disease or liver cancer
– Many live without symptoms for decades
– Others experience mild symptoms --intermittent fatigue,
nausea, and muscle aches
Hepatitis C
• Treatment
– Interferon/Ribaviron (suggest 40% “cure” rate)
– Peginterferon Alfa-2a (still in studies - not yet
FDA approved)
Hepatitis C
• What should a person do who has Hep C?
– Get regular medical care--tell doctor about ALL drugs
(including herbs)!!!
– Have a healthy diet (no iron supplements, reduce salt
intake, no large doses of vitamin A)
– Get needed rest
– No alcohol or Tylenol, cut back on other drug use
– Avoid chemical fumes and other environmental toxins
– Get vaccinated for A and B!!!
Hepatitis C
• What should a person do who has Hep C?
– Do not share injection equipment.
– Do not donate blood or plasma, organs or sperm
– Do not share toothbrushes, razors
– Cover areas of open skin
– Use safer sex?
Hepatitis C and HIV
• 30 - 40% of HIV+ people in US also infected
with Hep C
• More rapid progression of Hep C (twice as fast)
• Little to no affect on HIV progression (still
inconclusive)
• Complications of medication regimens
• Increases risk of perinatal transmission
Hepatitis
A Virus B Virus C Virus
Symptoms Some people have no symptoms (especially HCV)
of Eyes or skin may turn yellow (jaundice)
Initial Loss of appetite
Infection Nausea, vomiting, fever, stomach or joint pain
Fatigue (can last weeks or months)
Dark urine & pale bowel movements
Chronic No chronic disease 10% Chronic 85% Chronic
Infection
Can cause: Can cause:
(Infection for Liver cell damage Liver cell damage
life) Cirrhosis Cirrhosis
Liver cancer Liver cancer
How is it Fecal/ oral Blood and body Blood and body fluid
Spread? Contaminated fluid contact contact
food and water Sex Needles
Oral/Anal sexual Needles Mother to baby
contact Mother to baby Sex (minimal)
Human bite
Vaccine Yes Yes No
Questions
