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Hepatitis is an inflammation of the liver. The inflammation can be triggered by a number of causes such as toxins, heavy alcohol use, and autoimmune diseases with viruses being the most common cause worldwide.

The liver has a lot of functions. It helps us digest food, produces hormones, stores vitamins and filters out the toxins from our blood. Although it has a great capacity for recovery, it can also be greatly affected by different causes, with symptoms ranging from mild or practically non-existent, to severe and potentially deadly. Viruses are the leading cause of infectious hepatitis.

Causes of viral hepatitis

Viral hepatitis is caused by many different viruses, with five of them being the most common: hepatitis A, B, C, D and E. Other viruses, such as the Epstein-Barr virus, can also cause viral hepatitis but to a smaller extent. Out of the five hepatitis viruses, in the United States, the most common types are hepatitis A, hepatitis B and hepatitis C.

Hepatitis A

Hepatitis A is caused by HEPATOVIRUS A (HAV). The virus is transmitted via food or water contaminated with feces. There about 4000 new infections in the US each year, though it is more common in countries without modern sanitation. Recently, an outbreak of food-borne infections with HAV has been reported, linked to imported food.

Also, certain groups of the population are at a higher risk than others, including:

  • Drug users
  • Homeless people
  • Men who have sex with men
Most patients recover without any permanent liver damage, but, rarely, death can occur.

Hepatitis B

Hepatitis B is caused by HEPATOVIRUS B (HBV). Unlike HAV, HBV is not spread via contaminated food or water, but by bodily fluids such as blood or semen. Common ways of infection include being born to an infected mother, having sex with an infected person, and sharing needles and syringes, razors or toothbrushes etc. However, this disease is not spread by breastfeeding, kissing, coughing or sneezing. Oftentimes, the virus remains unnoticed, while destroying the liver little by little. This makes HBV the leading cause of liver cancer. It is estimated that there are around 850 000 people in the US living with HBV, with 21000 new infections each year.

People who are at risk of contracting this disease include:

  • Infants born to infected mothers
  • IV drug users
  • Sex partners of people who have hepatitis B
  • Men who have sexual contact with men
  • People who live with a person who has hepatitis B
  • Hemodialysis patients

Hepatitis B is also an occupational disease, meaning that professionals who come in contact with infected blood are at higher risk of contracting the disease than others.

If the disease becomes chronic, it can result in cirrhosis, liver failure and liver cancer.

Hepatitis C

Hepatitis C is caused by HEPATOVIRUS C (HCV). Like HBV, HCV is also spread by blood, so the most important ways of infection include sharing needles and syringes, by needle stick injuries in health institutions, or again being born to an infected mother. Less commonly, hepatitis C can also be contracted by having sex with a person who has the disease. It is important to say that one of the ways a person can get infected is by getting a tattoo or a body piercing in an unregulated setting.

It is estimated that there are 2.4 million people living with hepatitis C in the US. About 41000 people get infected each year. About 50 percent of the infected aren’t aware of the infection. Hepatitis C is the leading cause of liver transplants and liver cancer.

Risk groups include:

  • Current or former IV drug users
  • People born from 1945 through 1965
  • People who received clotting factor concentrates made before 1987 and people who received blood transfusions or organ transplants before July 1992.
  • Hemodialysis patients
  • People with known exposure to the HCV, such as health care workers after needle stick injuries containing blood of a person who tested positive to HCV, or a transfusion/transplant recipients from a donor who tested positive
  • HIV positive people
  • Children born to mothers with the hepatitis C virus
  • Prison inmates
  • People who use intranasal drugs
  • People who received body piercings or tattoos done with non-sterile instruments

Up to 85 percent of people infected with HCV develop a chronic infection, five to 20 percent get cirrhosis, and one to five percent die from liver cancer.

What are the symptoms of infectious hepatitis?

Regardless of the type of virus which caused the infection, the symptoms of acute viral hepatitis are the same. The symptoms vary from very mild to severe, and include:

  • Fever
  • Fatigue
  • Muscle and joint pain
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain, especially in the upper-right quadrant
  • Jaundice
  • People who smoke usually develop a distaste for tobacco

Later on, other symptoms such as hives, dark urine, light colored stool and itchy skin may occur.

How is infectious hepatitis diagnosed?

If some of the symptoms listed above occur, your doctor will usually order some blood tests. The tests include levels of liver enzymes (AST, ALT, ALP, GGT) which are elevated in the case of hepatitis. Bilirubin, which is a waste product, is what colors the white of the eye yellow, if jaundice is present. The levels of bilirubin should also be higher than normal.

Some imaging tests, such as X-rays or ultrasound, may be used to evaluate the structure of the liver. If needed, a biopsy could be done, so a pathologist could help with the diagnosis, and determine the level of the liver tissue destruction.

There is also a possibility to test the blood for specific proteins that indicate the presence of the virus. Also, genetic tests for HBV and HCV are available.

Infectious hepatitis: Treatment and prevention

Unfortunately, there is no treatment for acute viral hepatitis other than supportive treatment for symptoms. As with other diseases caused by viruses, prevention is the key. While there are vaccines available for hepatitis A, B and E (hepatitis D is linked to hepatitis B, and cannot cause the infection on its own), unfortunately, there is no vaccine for hepatitis C. In the US, it is recommended that all children under the age of one should be vaccinated for hepatitis A and B. The vaccine for hepatitis E is available only in China.

Other than vaccines, other measures can help reduce spreading of the disease. These include regular testing if you’re in a risk group, safe sex measures, including limiting your number of sex partners and using condoms, thus protecting against HBV and possibly HCV infection, and using clean needles if you’re an IV drug user. Safe food and water protect against the spreading of HAV and HEV infection.

In conclusion

Since many people are infected with some of the hepatitis viruses without experiencing any symptoms, it is possible for a seemingly healthy person to be the carrier of the disease. If possible, vaccination is encouraged for infants and people in risk groups. Get tested. Practice safe sex. Check where your food and water comes from. If traveling to a foreign land, drink only bottled water. Viral hepatitis can easily be avoided, but can also be deadly if left untreated.

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