Two "New" Forms of Viral Hepatitis

Hepatitis A, B, and C infect nearly 500,000,000 people worldwide, but they are not the only known strains of the disease. There are also hepatitis D and hepatitis E.

Hepatitis D is a virus that has a structure unlike hepatitis A, B, or C. It is a unique infection that requires the help of the hepatitis B virus to make copies of itself and infect liver cells. In about 1% of cases, hepatitis D infection results in rapid destruction of the liver and death unless there is a successful liver transplant. In 99% of cases there is minimal effect on health.

Only people who are already infected with hepatitis B get infections with hepatitis D, but hepatitis D infections are uncommon where hepatitis B infections are most common, in China, Japan, and Taiwan. Most of the 15 million people who have chronic hepatitis D infections live in Italy, North Africa, the Amazon Basin, and the Pacific islands of Samoa, Hiue, and Hauru. It is most commonly spread to children through contact with infected people who have cracks in the skin (especially cracks in the skin of the nipples when the breastfeeding mother has the disease) or by multiple blood transfusions.

Hepatitis E is a virus that is spread in the same way as hepatitis A, although it is more likely to be spread through contaminated water supplies, particularly after storms, than through food. Like hepatitis A, the virus is transmitted from infected people before they develop any symptoms. Unlike hepatitis E, about 4% of people who get hepatitis E infections die of liver failure.

This strain of hepatitis is most likely to strike people aged 15 to 40, and pregnant women are especially prone to develop complications. The disease causes blood clots in the placenta that cause death in up to 40% of women who come down with hepatitis E during their second or third trimesters.

Over 100,000 people were infected with hepatitis E from contaminated water in northeastern China in 1988. About 2% of the population of the United States has been infected with hepatitis E, mostly during foreign travel. Once hepatitis E infection occurs, the virus may stay in the liver for life, although the virus is only infectious during the third week after exposure.

What can you do to avoid becoming one of the two billion people in the world who has been infected with hepatitis A, B, C, D, or E? Here are some simple suggestions:

1. Wash your hands before and after you use the toilet, and before you eat.
2. When traveling to destinations where food safety is questionable, eat cooked food and avoid iced drinks.
3. Avoid raw shellfish that may have been harvested from contaminated waters.
4. Boil water when contamination is suspected. Chlorination alone may not kill hepatitis viruses.
5. And, although most public health authorities are hesitant to put it quite so explicitly, avoid any sexual practice that involves bleeding. Sexual transmission of the virus is most likely when heterosexual couples have sex during the female partner's menstrual period and when homosexual couples involve in practices that induce anal bleeding, or when couples use devices that cut or cause abrasion to the sex organs.

Immune boosters to prevent hepatitis A and vaccinations to prevent hepatitis B are controversial but effective, at least for preventing infection with the virus.