About Hepatitis

The word hepatitis simply means an inflammation of the liver without pinpointing a specific cause. Someone with hepatitis may:

• have one of several disorders, including a viral or bacterial infection of the liver
• have a liver injury caused by a toxin (poison)
• have liver damage caused by interruption of the organ's normal blood supply
• be experiencing an attack by his or her own immune system through an autoimmune disorder
• have experienced abdominal trauma in the area of the liver

Hepatitis is most commonly caused by one of three viruses:

1. the hepatitis A virus
2. the hepatitis B virus
3. the hepatitis C virus

In some rare cases, the Epstein Barr virus (which causes mononucleosis) also can result in hepatitis because it can cause liver inflammation. Other viruses and bacteria can cause hepatitis, including hepatitis D and E, chickenpox, and cytomegalovirus (CMV).

Hepatitis A

Hepatitis A (also called infectious hepatitis) is a common form of hepatitis in children. It's caused by the hepatitis A virus (HAV), which is present in the stool (feces or poop) of infected people. Infected stool might be found in small amounts in food and on objects (such as doorknobs and diapers). Hepatitis A can remain in the stool for several months after the initial illness, especially in younger babies and children.

HAV is spread:

• when someone ingests anything contaminated with HAV-infected stool (making it easy for the virus to spread in overcrowded, unsanitary living conditions)
• in water, milk, and foods (especially shellfish)

Because hepatitis A can be a mild infection, particularly in children, some people might not know that they've had it. HAV can cause prolonged illness for up to 6 months, but usually only causes short-lived, mild illness. It does not cause chronic liver disease. In milder cases, symptoms may be similar to a stomach virus (with vomiting and diarrhea).

Hepatitis B

Hepatitis B (also called serum hepatitis) is caused by the hepatitis B virus (HBV). HBV can cause a wide range of symptoms, from a mild illness and general feeling of being unwell to more serious chronic liver disease that can lead to liver cancer.

HBV spreads through:

• infected body fluids, such as blood, saliva, semen, vaginal fluids, tears, and urine
• a contaminated blood transfusion (this is uncommon in the United States)
• shared contaminated needles or syringes for injecting drugs
• sexual activity with an HBV-infected person
• transmission from HBV-infected mothers to their newborn babies

Hepatitis C

The hepatitis C virus (HCV) is spread by direct contact with an infected person's blood. Symptoms can be very similar to those of hepatitis A and B. However, infection with HCV can lead to chronic liver disease and is a leading reason for liver transplantation in the United States. Chronic HCV infection is also associated with liver cancer.

HCV is more common in adults than in children. In kids, it's often acquired through transmission from a mother to her newborn. It also can be spread by:

• sharing drug needles and intranasal drug use (snorting drugs)
• getting a tattoo or body piercing with unsterilized tools
• blood transfusions or organ transplants (especially before 1992; since then the U.S. blood supply and donated organs have been routinely screened for hepatitis C)
• sexual contact (although this is less common)
• hemodialysis (especially before 1990)

Rarely, people living with an infected person can contract HCV by sharing items that might contain that person's blood, such as razors, toothbrushes, or scissors.

Diagnosis

All of these viral hepatitis conditions can be diagnosed through blood tests.

Liver function tests might be used to determine how well the liver is working or if it is damaged. Sometimes, a liver biopsy (the removal of a small liver tissue sample for examination) is done to further check for organ damage. A liver biopsy also can help doctors choose the best treatment.

Ultrasounds or CAT scans can check for any progression to cancer, particularly in chronic HBV and HCV infection.

Signs and Symptoms

Hepatitis, in its early stages, may cause flu-like symptoms, including:

• malaise (a general ill feeling)
• fever
• muscle aches
• abdominal pain
• loss of appetite
• nausea
• vomiting
• diarrhea
• jaundice (a yellowing of the skin and whites of the eyes)

But some people with hepatitis have no symptoms and might not know they're infected. Children with hepatitis A, for example, usually have mild symptoms or none at all.

If hepatitis progresses, its symptoms begin to point to the liver as the source of illness. Chemicals normally secreted by the liver begin to build up in the blood, which causes:

• jaundice
• foul breath
• a bitter taste in the mouth
• dark or "tea-colored" urine
• white, light, or "clay-colored" stools

Abdominal pain also can occur, which may be centered below the right ribs (over a tender, swollen liver) or below the left ribs (over a tender spleen).

Contagiousness

Hepatitis A, hepatitis B, and hepatitis C are all contagious.

The hepatitis A virus spreads through contaminated food or water, as well as unsanitary conditions in childcare facilities or schools. Toilets and sinks used by an infected person should be cleaned with antiseptic cleansers. People who live with or care for someone with HAV should wash their hands after contact with the infected person. In addition, before traveling to countries where HAV is common, kids should receive at least two doses of the hepatitis A vaccine.

The hepatitis B virus can be found in virtually all body fluids, though its main routes of infection are through sexual contact, contaminated blood transfusions, and shared needles for drug injections. Household contact with adults with HBV can put people at risk for contracting hepatitis. But frequent hand washing and good hygiene practices can reduce this risk.

All kids in the United States are routinely vaccinated against hepatitis B at birth and use of the hepatitis B vaccine can greatly decrease the risk of infection. Ask your doctor about this vaccine. Even adults can be vaccinated if they feel they're at risk.

The hepatitis C virus can spread through shared drug needles, contaminated blood products, and less commonly through sexual contact. It can spread from a mother to her fetus during pregnancy, but this risk is about 5%. If you're pregnant, contact your doctor if you think you may have been exposed to hepatitis C.

Over the past several years, improved medical technology has almost eliminated the risk of catching hepatitis from contaminated blood products and blood transfusions. But as tattoos and acupuncture have become more popular, the risk of developing hepatitis from improperly sterilized equipment has increased. Shared needles in drug use and shared straws in intranasal drug use (snorting) are two very common ways for hepatitis C to spread.

Duration

For viral hepatitis, the incubation period (the time it takes for a person to become infected after being exposed) varies depending on which hepatitis virus causes the disease:

• hepatitis A: 2 to 6 weeks
• hepatitis B: 4 to 20 weeks
• hepatitis C: 2 to 26 weeks

Hepatitis A is usually active for a short period of time and, once recovered, a person can no longer pass the virus to others. It's very rare for someone to become a chronic carrier of hepatitis A. Almost all previously healthy people who develop hepatitis A will completely recover from it in a few weeks or months without long-term complications.

With hepatitis B, 85% to 90% of patients recover from their illness completely within 6 months without long-term complications.

However, 75% to 85% of those who are infected with hepatitis C do not recover completely and are more likely to continue to have a long-term infection. People with hepatitis B (the percentage who don't recover completely) or hepatitis C who continue to be infected can go on to develop chronic hepatitis and cirrhosis of the liver (the chronic degeneration and disruption of the structure of the liver). Some people with hepatitis B or C also may become lifelong carriers of these viruses and can spread them to others.

Prevention

In general, to prevent viral hepatitis you should:

• Follow good hygiene and avoid crowded, unhealthy living conditions.
• Take extra care, particularly when drinking and swimming, if you travel to areas of the world where sanitation is poor and water quality is uncertain.
• Never eat shellfish from waters contaminated by sewage.
• Remind everyone in your family to wash their hands thoroughly after using the toilet and before eating.
  
• Use antiseptic cleansers to clean any toilet, sink, potty chair, or bedpan used by someone in the family who develops hepatitis.

Because contaminated needles and syringes are a major source of hepatitis infection, it's wise to encourage drug awareness programs in your community and schools. At home, speak to your kids frankly and often about the dangers of drug use. It's also important to encourage abstinence and safe sex for teens to protect them from hepatitis infection through sexual contact.

A hepatitis A vaccine is available for anyone 12 months of age or older. In the past, it was recommended only for those at high risk for infection (such as those who lived in or traveled to areas with high rates of HAV), but is now available to anyone seeking immunity to HAV. If you plan to travel, consult your doctor in advance so you and your family have time to complete any required immunizations. The HAV vaccine also is useful for staff of childcare facilities or schools where they may be at risk of exposure.

The hepatitis B vaccine is given to both children and adults as part of routine immunization.

Unfortunately, there's no vaccine for hepatitis C — studies indicate that it may not be possible because the virus doesn't cause the kind of response needed for a vaccine to be successful.

Treatment

Hospitalization might be necessary when symptoms are severe or laboratory tests show liver damage. Here's a quick look at the treatments available for the various hepatitis viruses:

• No medications are used to treat hepatitis A because it's a short-term infection that goes away on its own.
• Chronic hepatitis B can sometimes be treated using medications. Several drugs are approved for use in adults. Most are not approved for use in children but some are used in select circumstances. Not all patients with hepatitis B require medication.
• The treatment of chronic hepatitis C has improved significantly with the use of two medications, interferon and ribavirin, often used in combination.
  
  Other treatments and medications are approved for use in adults, which are sometimes used in children on a research basis or if a child is nearing adulthood. Not every patient will benefit from treatment, and the treatments also have side effects. It's best to discuss all options with your doctor.

Children with mild hepatitis may be treated at home. Except for using the bathroom, they should rest in bed until the fever and jaundice are gone and their appetite is normal. Kids with a lack of appetite should try smaller, more frequent meals and fluids that are high in calories (like milkshakes). They should also eat healthy foods rich in protein and carbohydrates and drink plenty of water.

When to Call the Doctor

Call the doctor if your child:

• has symptoms of hepatitis
• attends a school or childcare facility where someone has hepatitis
• has been exposed to a friend or relative with the illness

If you have an older child who volunteers at a first-aid station, hospital, or nursing home, be sure that he or she is aware of proper safety procedures for preventing contact with blood or body fluids. You may also want to have your child immunized against hepatitis A and B. Call your doctor if you believe your child may have been exposed to a patient with hepatitis.

If you already know your child has hepatitis, call your doctor if you notice any of the following symptoms, which may be signs of liver condition problems:

• confusion or extreme drowsiness
• skin rash
• itching

Also, monitor your child's appetite and digestive functions, and call the doctor if your child's appetite decreases, or if nausea, vomiting, diarrhea, or jaundice increase. Be sure to talk to your doctor before giving your child any over-the-counter medications or herbal remedies because some can make the condition worse.

Reviewed by: Yamini Durani, MD
Date reviewed: July 2012