BACKGROUND MEDIA INFORMATION VIRAL HEPATITIS
BACKGROUND MEDIA INFORMATION VIRAL HEPATITIS
BACKGROUND MEDIA INFORMATION VIRAL HEPATITIS
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<strong>BACKGROUND</strong> <strong>MEDIA</strong> <strong>INFORMATION</strong><br />
<strong>VIRAL</strong> <strong>HEPATITIS</strong><br />
What is viral hepatitis 1<br />
Hepatitis is inflammation of the liver and can have multiple causes.<br />
The term viral hepatitis is generally used to describe hepatitis caused by a few specific viruses that<br />
mainly attack the liver. These are named hepatitis virus A, B, C, D and E. The most common<br />
hepatitis viruses are types A, B, and C.<br />
What are the risk factors 2<br />
Anyone who has not been previously infected or vaccinated (vaccines are available for hepatitis A<br />
and B) can become infected. Risk factors include:<br />
Unprotected sexual intercourse with someone who is infected<br />
Sharing contaminated needles in drug users<br />
Sharing a contaminated person‟s razor<br />
An infected mother giving birth to her child<br />
Tattooing or body piercing if using equipment that is not properly sterilised<br />
<br />
<br />
Blood transfusions before screening was introduced<br />
Being subjected to medical or dental interventions in countries where equipment is not<br />
adequately sterilised<br />
What are the symptoms 1<br />
The period of time between contact with the hepatitis virus and the onset of illness is called the<br />
incubation period. The incubation period varies depending on the type of hepatitis virus. Hepatitis A<br />
has an incubation period of 15-45 days, hepatitis B between 45-160 days, and hepatitis C from 2<br />
weeks to 6 months.<br />
Many patients infected with hepatitis A, B, and C have few or no symptoms of illness and, as a<br />
result, may not realise they have been infected. For those who do develop symptoms, the most<br />
common include loss of appetite, nausea/vomiting, fever, weakness or fatigue and aching in the<br />
abdomen.<br />
Less common symptoms can include dark urine, light-coloured stools, fever and jaundice (a yellow<br />
colouring of the skin and eyes).
What are the most common types of hepatitis<br />
Hepatitis A<br />
Hepatitis A is the most common type of viral hepatitis, with an estimated 1.4 million infections<br />
occurring annually. 3 It is present worldwide but is more common in developing countries where<br />
sanitation and hygiene are poor. Most infections occur in early childhood. 2<br />
The virus is spread when food or drink contaminated with the faeces of an infected person is<br />
ingested. The virus usually causes a short term infection (acute) and is rarely serious, although<br />
symptoms can be unpleasant (fever, loss of appetite, abdominal pains or jaundice). 2<br />
Older people suffer more severe symptoms and have a higher risk of death. Jaundice is seen in<br />
more than 70% of older children and adults, compared to only 10% of children under six. 2<br />
Most people recover without complications in a few weeks, or sometimes a couple of months. 2<br />
Key hepatitis B & C facts<br />
About one fifth of patients with chronic hepatitis B and C are at-risk of developing liver-cirrhosis or<br />
liver cancer 4 – one of the top three causes of cancer death in men, and a major cause of death in<br />
women. 2<br />
Most patients are currently undiagnosed. Many people with hepatitis B and C do not know they‟re<br />
infected until the late stages of these diseases, as the symptoms are not obvious for many years.<br />
By this time, many patients have already developed complications and treatment becomes more<br />
difficult and costly.<br />
A European survey suggested that only 21.5% of patients knew they were infected at the<br />
time of diagnosis 5<br />
Sixty-three per cent of patients were unaware that they were at risk 5<br />
Very limited data are available to show how many people are actually infected by either hepatitis B<br />
or C. This is one of the key challenges that experts face in understanding the true scale and<br />
burden of these diseases.<br />
Hepatitis B<br />
Hepatitis B is the most serious type of viral hepatitis and a major global health problem. Infection<br />
can cause chronic liver disease with a high risk of death from cirrhosis (scarring of the liver) and<br />
liver cancer. 2<br />
The World Health Organization (WHO) has estimated that 2 billion people are infected worldwide<br />
and 350 million are living with chronic (life-long) infection. 6 The virus is endemic in China and other<br />
parts of Asia where most people become infected during childhood. 2<br />
The hepatitis B virus is 100 times more infectious than HIV and is present in, and usually<br />
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<br />
causing long-term liver damage. However, hepatitis B causes long-term (chronic) illness in 90% of<br />
infected infants and five to 10% of adults. 7 Approximately 25% of those with a chronic infection will<br />
later die from liver cancer, liver disease or cirrhosis. 2<br />
Hepatitis C<br />
Worldwide, approximately 170 million people are chronically infected with the hepatitis C virus and<br />
the WHO estimates that 3-4 million people are newly infected each year. 3<br />
Hepatitis C virus is present in the blood and, to a much lesser extent, the saliva, semen or vaginal<br />
fluid of an infected person. As such, it is most commonly spread through direct contact with<br />
infected blood. 3<br />
Hepatitis C is regarded as a silent killer because patients often experience no symptoms for years.<br />
Frequently, when symptoms do present themselves, they are commonly mistaken for signs of cold<br />
or „flu. The course of hepatitis C is unpredictable: about one in five people eliminate the infection<br />
while others may develop mild to moderate liver damage. 8 Alcohol consumption and co-infection<br />
with the HIV virus are known to accelerate liver damage. 9<br />
Hepatitis C infection can be categorised into two stages – firstly an acute stage (following initial<br />
infection, sometimes with no symptoms) and secondly a chronic stage. Approximately 20% of<br />
people will naturally clear the virus from their body and experience no long-term effects. However,<br />
for the remaining 80%, a chronic (long-term) infection will develop. Confusingly, there seems to be<br />
no clear relationship between the degree of liver damage and the experience of symptoms. 10<br />
What are the rarer types of hepatitis<br />
Hepatitis D<br />
The hepatitis D virus can only survive within the body if hepatitis B virus is also present, and so<br />
only affects those who are also infected with hepatitis B. 2<br />
The combination of hepatitis viruses D and B can be more serious than the B virus alone and is<br />
more likely to cause chronic hepatitis and cirrhosis. 4 Vaccination against hepatitis B virus will<br />
prevent hepatitis D infection. 11<br />
Hepatitis E<br />
Hepatitis E is generally a mild and acute (short-term) infection. Person-to-person transmission is<br />
rare and the virus is most commonly spread by the consumption of food or drink infected with<br />
faeces contaminated with the virus. 2<br />
How is viral hepatitis diagnosed<br />
Diagnosis of viral hepatitis is based on symptoms and blood tests that detect liver enzymes, virus<br />
particles, or antibodies against viral components. 1
Acute viral hepatitis is usually much easier to diagnose than chronic hepatitis. Symptoms of<br />
fatigue, nausea, abdominal pain, darkening of urine and jaundice indicate acute hepatitis and the<br />
diagnosis can be confirmed with blood tests. 1<br />
However, patients with chronic hepatitis often have no symptoms or only mild nonspecific<br />
symptoms such as fatigue. As a result, these patients can remain undiagnosed for years or even<br />
decades, with undetected liver damage progressing all the while. 1<br />
How is viral hepatitis treated<br />
No medical treatment is available for acute viral hepatitis. Care is aimed at maintaining comfort and<br />
replacing fluids that are lost from vomiting and diarrhoea. 1 In a few very severe cases (fulminant<br />
hepatitis) liver transplantation may be necessary. 12<br />
Current treatment for chronic hepatitis B & C involves injections that stimulate the immune system<br />
against the virus and therapeutic drugs that stop the virus from replicating - which, used in<br />
combination, cure approximately half of all hepatitis C patients. 13<br />
Treatment does not cure hepatitis B, but may turn an „aggressive‟ hepatitis B into a mild infection,<br />
which can stop the liver from being damaged. The majority of patients require long-term, in some<br />
cases life-long, treatment to stop the disease from progressing.<br />
Several new hepatitis C treatments are in development – the first generation of these will be used<br />
in combination with current treatments and hopefully lead to even greater cure rates. 14<br />
Treatment helps to prevent progressive liver damage, cirrhosis, liver failure and liver cancer 1 ;<br />
however, the drugs used can be very costly and are not available to most patients in developing<br />
countries. 2
What is the long-term prognosis<br />
About one-fifth of patients with chronic hepatitis B and C are at risk of developing cirrhosis or liver<br />
cancer. 4<br />
Liver cancer is one of the top three causes of cancer death in men, and a major cause of cancer<br />
death in women. 2<br />
How can viral hepatitis be prevented<br />
Improved sanitation and vaccination are the most effective ways to combat hepatitis A and B. 2<br />
Vaccination is the most effective way to prevent infection with the hepatitis B virus. 2<br />
The hepatitis B vaccine is 95% effective in preventing infection and its chronic<br />
consequences, and is the first vaccine to be developed against a major human cancer.<br />
However, the vaccine is not readily available in many poorer regions due to its high cost.<br />
There is currently no vaccine to prevent hepatitis C. Treatment with drugs can clear the infection in<br />
approximately half of those who are infected, but side effects may be a problem and treatment is<br />
often not available in areas of the world where infection and subsequent disease is widespread. 2<br />
Taking precautions to prevent exposure to another individual's blood (e.g. contaminated needles),<br />
semen (e.g. in unprotected sex), and other biologic materials (e.g. stools) will also help prevent the<br />
spread of these viruses. 1<br />
Many people with hepatitis B and C do not know they are infected until the late stages of the<br />
diseases, as the symptoms are not obvious for many years. By this time, many patients have<br />
already developed complications relative to their infections and treatment becomes more difficult<br />
and costly.<br />
Screening programmes can allow patients who have been infected by either hepatitis B or C to be<br />
diagnosed earlier in the development of the disease, therefore allowing for them to be monitored<br />
and treated accordingly.
References<br />
1 Viral Hepatitis. Medicine Net. Available at http://www.medicinenet.com/viral_hepatitis/article.htm<br />
accessed 19.03.10<br />
2 Hepatitis. NHS Choices. Available at http://www.nhs.uk/Conditions/Hepatitis/Pages/Introduction.aspx<br />
accessed 19.03.10<br />
3 World Health Organization factsheet. Available at<br />
http://www.who.int/mediacentre/factsheets/fs328/en/index.html accessed 19.03.10<br />
4 Hepatitis. Net Doctor. http://www.netdoctor.co.uk/diseases/facts/hepatitis.htm. Accessed 19.03.10<br />
5 Piorkowsky N Y. Europe‟s hepatitis challenge: defusing the “viral timebomb”. Journal of Hepatology 51<br />
(2009) 1068-1073<br />
6 The Hepatitis Alliance. Available at http://www.aminumber12.org/HepatitisBandC.aspx accessed<br />
29.03.10<br />
7 World Health Organization factsheet. Available at<br />
http://www.who.int/mediacentre/factsheets/fs328/en/index.html accessed 19.03.10<br />
8 Hepatitis C patient information leaflet. NHS Clinical Knowledge Summaries. Available at<br />
http://www.cks.nhs.uk/patient_information_leaflet/hepatitis_c. Accessed 10.03.11<br />
9 Essential Information for Professionals and guidance on testing. NHS.<br />
http://www.nhs.uk/hepatitisc/SiteCollectionDocuments/pdf/essential-information-for-professionals-andguidance-on-testing.pdf<br />
Accessed 02.09.10<br />
10 Hepatitis C Trust. Available at http://www.hepctrust.org.uk/hepatitis-c accessed 19.03.10<br />
11 Mele A, Mariano A, Tosti ME, et al. Acute hepatitis delta virus infection in Italy: incidence and risk factors<br />
after the introduction of the universal anti-hepatitis B vaccination campaign. Clin Infect Dis 2007; 44: e17-24.<br />
12 Fulminant Hepatic Failure: Treatment & Medication. Nazer, H.<br />
http://emedicine.medscape.com/article/929028-treatment<br />
13 NHS Treatments. NHS. http://www.nhs.uk/Conditions/Hepatitis-B/Pages/Treatment.aspX. Accessed<br />
02.09.10<br />
14 Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of chronic hepatitis C. Nice<br />
Guidelines. http://www.nice.org.uk/nicemedia/live/11524/32809/32809.pdf. Accessed 02.09.10