BACKGROUND MEDIA INFORMATION VIRAL HEPATITIS

BACKGROUND MEDIA INFORMATION
VIRAL HEPATITIS
What is viral hepatitis 1
Hepatitis is inflammation of the liver and can have multiple causes.
The term viral hepatitis is generally used to describe hepatitis caused by a few specific viruses that
mainly attack the liver. These are named hepatitis virus A, B, C, D and E. The most common
hepatitis viruses are types A, B, and C.
What are the risk factors 2
Anyone who has not been previously infected or vaccinated (vaccines are available for hepatitis A
and B) can become infected. Risk factors include:
Unprotected sexual intercourse with someone who is infected
Sharing contaminated needles in drug users
Sharing a contaminated person‟s razor
An infected mother giving birth to her child
Tattooing or body piercing if using equipment that is not properly sterilised
Blood transfusions before screening was introduced
Being subjected to medical or dental interventions in countries where equipment is not
adequately sterilised
What are the symptoms 1
The period of time between contact with the hepatitis virus and the onset of illness is called the
incubation period. The incubation period varies depending on the type of hepatitis virus. Hepatitis A
has an incubation period of 15-45 days, hepatitis B between 45-160 days, and hepatitis C from 2
weeks to 6 months.
Many patients infected with hepatitis A, B, and C have few or no symptoms of illness and, as a
result, may not realise they have been infected. For those who do develop symptoms, the most
common include loss of appetite, nausea/vomiting, fever, weakness or fatigue and aching in the
abdomen.
Less common symptoms can include dark urine, light-coloured stools, fever and jaundice (a yellow
colouring of the skin and eyes).

What are the most common types of hepatitis
Hepatitis A
Hepatitis A is the most common type of viral hepatitis, with an estimated 1.4 million infections
occurring annually. 3 It is present worldwide but is more common in developing countries where
sanitation and hygiene are poor. Most infections occur in early childhood. 2
The virus is spread when food or drink contaminated with the faeces of an infected person is
ingested. The virus usually causes a short term infection (acute) and is rarely serious, although
symptoms can be unpleasant (fever, loss of appetite, abdominal pains or jaundice). 2
Older people suffer more severe symptoms and have a higher risk of death. Jaundice is seen in
more than 70% of older children and adults, compared to only 10% of children under six. 2
Most people recover without complications in a few weeks, or sometimes a couple of months. 2
Key hepatitis B & C facts
About one fifth of patients with chronic hepatitis B and C are at-risk of developing liver-cirrhosis or
liver cancer 4 – one of the top three causes of cancer death in men, and a major cause of death in
women. 2
Most patients are currently undiagnosed. Many people with hepatitis B and C do not know they‟re
infected until the late stages of these diseases, as the symptoms are not obvious for many years.
By this time, many patients have already developed complications and treatment becomes more
difficult and costly.
A European survey suggested that only 21.5% of patients knew they were infected at the
time of diagnosis 5
Sixty-three per cent of patients were unaware that they were at risk 5
Very limited data are available to show how many people are actually infected by either hepatitis B
or C. This is one of the key challenges that experts face in understanding the true scale and
burden of these diseases.
Hepatitis B
Hepatitis B is the most serious type of viral hepatitis and a major global health problem. Infection
can cause chronic liver disease with a high risk of death from cirrhosis (scarring of the liver) and
liver cancer. 2
The World Health Organization (WHO) has estimated that 2 billion people are infected worldwide
and 350 million are living with chronic (life-long) infection. 6 The virus is endemic in China and other
parts of Asia where most people become infected during childhood. 2
The hepatitis B virus is 100 times more infectious than HIV and is present in, and usually
transmitted through, bodily fluids such as blood, saliva, semen and vaginal fluid. 7

Infection with the hepatitis B virus can cause an acute illness that resolves itself quickly without
causing long-term liver damage. However, hepatitis B causes long-term (chronic) illness in 90% of
infected infants and five to 10% of adults. 7 Approximately 25% of those with a chronic infection will
later die from liver cancer, liver disease or cirrhosis. 2
Hepatitis C
Worldwide, approximately 170 million people are chronically infected with the hepatitis C virus and
the WHO estimates that 3-4 million people are newly infected each year. 3
Hepatitis C virus is present in the blood and, to a much lesser extent, the saliva, semen or vaginal
fluid of an infected person. As such, it is most commonly spread through direct contact with
infected blood. 3
Hepatitis C is regarded as a silent killer because patients often experience no symptoms for years.
Frequently, when symptoms do present themselves, they are commonly mistaken for signs of cold
or „flu. The course of hepatitis C is unpredictable: about one in five people eliminate the infection
while others may develop mild to moderate liver damage. 8 Alcohol consumption and co-infection
with the HIV virus are known to accelerate liver damage. 9
Hepatitis C infection can be categorised into two stages – firstly an acute stage (following initial
infection, sometimes with no symptoms) and secondly a chronic stage. Approximately 20% of
people will naturally clear the virus from their body and experience no long-term effects. However,
for the remaining 80%, a chronic (long-term) infection will develop. Confusingly, there seems to be
no clear relationship between the degree of liver damage and the experience of symptoms. 10
What are the rarer types of hepatitis
Hepatitis D
The hepatitis D virus can only survive within the body if hepatitis B virus is also present, and so
only affects those who are also infected with hepatitis B. 2
The combination of hepatitis viruses D and B can be more serious than the B virus alone and is
more likely to cause chronic hepatitis and cirrhosis. 4 Vaccination against hepatitis B virus will
prevent hepatitis D infection. 11
Hepatitis E
Hepatitis E is generally a mild and acute (short-term) infection. Person-to-person transmission is
rare and the virus is most commonly spread by the consumption of food or drink infected with
faeces contaminated with the virus. 2
How is viral hepatitis diagnosed
Diagnosis of viral hepatitis is based on symptoms and blood tests that detect liver enzymes, virus
particles, or antibodies against viral components. 1

Acute viral hepatitis is usually much easier to diagnose than chronic hepatitis. Symptoms of
fatigue, nausea, abdominal pain, darkening of urine and jaundice indicate acute hepatitis and the
diagnosis can be confirmed with blood tests. 1
However, patients with chronic hepatitis often have no symptoms or only mild nonspecific
symptoms such as fatigue. As a result, these patients can remain undiagnosed for years or even
decades, with undetected liver damage progressing all the while. 1
How is viral hepatitis treated
No medical treatment is available for acute viral hepatitis. Care is aimed at maintaining comfort and
replacing fluids that are lost from vomiting and diarrhoea. 1 In a few very severe cases (fulminant
hepatitis) liver transplantation may be necessary. 12
Current treatment for chronic hepatitis B & C involves injections that stimulate the immune system
against the virus and therapeutic drugs that stop the virus from replicating - which, used in
combination, cure approximately half of all hepatitis C patients. 13
Treatment does not cure hepatitis B, but may turn an „aggressive‟ hepatitis B into a mild infection,
which can stop the liver from being damaged. The majority of patients require long-term, in some
cases life-long, treatment to stop the disease from progressing.
Several new hepatitis C treatments are in development – the first generation of these will be used
in combination with current treatments and hopefully lead to even greater cure rates. 14
Treatment helps to prevent progressive liver damage, cirrhosis, liver failure and liver cancer 1 ;
however, the drugs used can be very costly and are not available to most patients in developing
countries. 2

What is the long-term prognosis
About one-fifth of patients with chronic hepatitis B and C are at risk of developing cirrhosis or liver
cancer. 4
Liver cancer is one of the top three causes of cancer death in men, and a major cause of cancer
death in women. 2
How can viral hepatitis be prevented
Improved sanitation and vaccination are the most effective ways to combat hepatitis A and B. 2
Vaccination is the most effective way to prevent infection with the hepatitis B virus. 2
The hepatitis B vaccine is 95% effective in preventing infection and its chronic
consequences, and is the first vaccine to be developed against a major human cancer.
However, the vaccine is not readily available in many poorer regions due to its high cost.
There is currently no vaccine to prevent hepatitis C. Treatment with drugs can clear the infection in
approximately half of those who are infected, but side effects may be a problem and treatment is
often not available in areas of the world where infection and subsequent disease is widespread. 2
Taking precautions to prevent exposure to another individual's blood (e.g. contaminated needles),
semen (e.g. in unprotected sex), and other biologic materials (e.g. stools) will also help prevent the
spread of these viruses. 1
Many people with hepatitis B and C do not know they are infected until the late stages of the
diseases, as the symptoms are not obvious for many years. By this time, many patients have
already developed complications relative to their infections and treatment becomes more difficult
and costly.
Screening programmes can allow patients who have been infected by either hepatitis B or C to be
diagnosed earlier in the development of the disease, therefore allowing for them to be monitored
and treated accordingly.

References
1 Viral Hepatitis. Medicine Net. Available at http://www.medicinenet.com/viral_hepatitis/article.htm
accessed 19.03.10
2 Hepatitis. NHS Choices. Available at http://www.nhs.uk/Conditions/Hepatitis/Pages/Introduction.aspx
accessed 19.03.10
3 World Health Organization factsheet. Available at
http://www.who.int/mediacentre/factsheets/fs328/en/index.html accessed 19.03.10
4 Hepatitis. Net Doctor. http://www.netdoctor.co.uk/diseases/facts/hepatitis.htm. Accessed 19.03.10
5 Piorkowsky N Y. Europe‟s hepatitis challenge: defusing the “viral timebomb”. Journal of Hepatology 51
(2009) 1068-1073
6 The Hepatitis Alliance. Available at http://www.aminumber12.org/HepatitisBandC.aspx accessed
29.03.10
7 World Health Organization factsheet. Available at
http://www.who.int/mediacentre/factsheets/fs328/en/index.html accessed 19.03.10
8 Hepatitis C patient information leaflet. NHS Clinical Knowledge Summaries. Available at
http://www.cks.nhs.uk/patient_information_leaflet/hepatitis_c. Accessed 10.03.11
9 Essential Information for Professionals and guidance on testing. NHS.
http://www.nhs.uk/hepatitisc/SiteCollectionDocuments/pdf/essential-information-for-professionals-andguidance-on-testing.pdf
Accessed 02.09.10
10 Hepatitis C Trust. Available at http://www.hepctrust.org.uk/hepatitis-c accessed 19.03.10
11 Mele A, Mariano A, Tosti ME, et al. Acute hepatitis delta virus infection in Italy: incidence and risk factors
after the introduction of the universal anti-hepatitis B vaccination campaign. Clin Infect Dis 2007; 44: e17-24.
12 Fulminant Hepatic Failure: Treatment & Medication. Nazer, H.
http://emedicine.medscape.com/article/929028-treatment
13 NHS Treatments. NHS. http://www.nhs.uk/Conditions/Hepatitis-B/Pages/Treatment.aspX. Accessed
02.09.10
14 Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of chronic hepatitis C. Nice
Guidelines. http://www.nice.org.uk/nicemedia/live/11524/32809/32809.pdf. Accessed 02.09.10