Hepatitis
Hepatitis
inflammation of the liver
• Can have many causes
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drugs
toxins
alcohol
viral infections (A, B, C, D, E)
other infections (parasites, bacteria)
physical damage
Liver
• Functions
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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
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
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Nausea
Loss of appetite
Vomiting
Fatigue
Fever
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Dark urine
Pale stool
Jaundice
Stomach pain
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?
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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
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Nausea
Loss of appetite
Vomiting
Fatigue
Fever
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Dark urine
Pale stool
Jaundice
Stomach pain
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
100,000 (50%)
Symptomatic Cases
100,000 (50%)
Clear Virus; Healthy
170 - 182,000 (90-94%)
Hepatitis B Chronic Carriers
12-20,000 (6-10%)
Death
100 (0.05%)
Chronic Liver Disease
Death from Cirrhosis
3400 (1.7%)
Death-Primary Liver Cancer
800 (0.4%)
Hepatitis B
• Who is at highest risk?
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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
• 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
• 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
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Nausea
Loss of appetite
Vomiting
Fatigue
Fever
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Dark urine
Pale stool
Jaundice
Stomach pain
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
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 (HCW, tattoo, piercing …)
– Sex? (HCV in semen and vf but only 1.5% rate of
transmission for long-term partners)
– 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
– 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)
HEPATITIS C
15%
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
• A damaged liver may not be able to
metabolize certain vitamins and minerals
properly. Iron supplements should not be
used, and intake of iron-rich foods may be
limited. People with chronic hepatitis
should not take large doses of vitamin A,
which can be toxic to the liver.
Hepatitis C
• What should a person do who has Hep C?
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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
Symptoms
of
Initial
Infection
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Chronic
Infection
No chronic disease 10% Chronic
85% Chronic
How is it
Spread?
Can cause:
Liver cell damage
Cirrhosis
Liver cancer
 Fecal/ oral
 Blood and body
fluid contact
 Contaminated
food and water  Sex
 Oral/Anal sexual  Needles
contact
 Mother to baby
 Human bite
Can cause:
Liver cell damage
Cirrhosis
Liver cancer
 Blood and body fluid
contact
 Needles
 Mother to baby
 Sex (minimal)
Vaccine
Yes
No
(Infection for
life)
B Virus
C Virus
Some people have no symptoms (especially HCV)
Eyes or skin may turn yellow (jaundice)
Loss of appetite
Nausea, vomiting, fever, stomach or joint pain
Fatigue (can last weeks or months)
Dark urine & pale bowel movements
Yes
Questions