Hepatitis

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 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 trauma to the abdomen 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) can also result in hepatitis because it can cause inflammation of the liver. Other viruses and bacteria that also can cause hepatitis include hepatitis D and E, chickenpox, and cytomegalovirus (CMV).

Hepatitis A
In children, the most common form of hepatitis is hepatitis A (also called infectious hepatitis). This form is caused by the hepatitis A virus (HAV), which lives in the stools (feces or poop) of infected individuals. Infected stool can be present in small amounts in food and on objects (from doorknobs to diapers).

HAV is spread:

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

Because hepatitis A can be a mild infection, particularly in children, it's possible for some people to be unaware that they have had the illness. In fact, although medical tests show that about 40% of urban Americans have had hepatitis A, only about 5% recall being sick. Although the hepatitis A virus can cause prolonged illness up to 6 months, it typically only causes short-lived illnesses and it does not cause chronic liver disease.

Hepatitis B
Hepatitis B (also called serum hepatitis) is caused by the hepatitis B virus (HBV). HBV can cause a wide spectrum of symptoms ranging from general malaise to 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 (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. The symptoms of the hepatitis C virus can be very similar to those of the hepatitis A and B viruses. However, infection with HCV can lead to chronic liver disease and is the leading reason for liver transplant in the United States.

The hepatitis C virus can be spread by:

• sharing drug needles
• getting a tattoo or body piercing with unsterilized tools
• blood transfusions (especially ones that occurred before 1992; since then the U.S. blood supply has been routinely screened for the disease)
• transmission from mother to newborn
• sexual contact (although this is less common)

Hepatitis C is also a common threat in kidney dialysis centers. Rarely, people living with an infected person can contract the disease by sharing items that might contain that person's blood, such as razors or toothbrushes.

Diagnosis

All of these viral hepatitis conditions can be diagnosed and followed through the use of readily available blood tests.

Signs and Symptoms

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

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

But some people with hepatitis may have no symptoms at all and may not even know they're infected. Children with hepatitis A, for example, usually have mild symptoms or have no symptoms.

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

There can also be abdominal pain, 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 can be spread in contaminated food or water, as well as in unsanitary conditions in child-care 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 hepatitis should wash their hands after contact with the infected person. In addition, when traveling to countries where hepatitis A is prevalent, your child should be vaccinated with 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 hepatitis B 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 incidence of this infection. Ask your doctor about this vaccine. Even adults can be vaccinated if they feel they're at risk.

The hepatitis C virus can be spread through shared drug needles, contaminated blood products, and, less commonly, through sexual contact. Although hepatitis C can be spread from a mother to her fetus during pregnancy, the risk of passing hepatitis C to the fetus isn't very high (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 used in these procedures has increased. Shared needles in drug use and shared straws in cocaine use are two very common ways for hepatitis C to spread.

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 a good idea to encourage drug awareness programs in your community and schools. At home, speak to your child frankly and frequently about the dangers of drug use. It's also important to encourage abstinence and safe sex for teens, in order to eliminate their risk of hepatitis infection through sexual contact.

A hepatitis A vaccine is available, and is especially recommended for those who:

• travel abroad
• have other forms of liver disease
• have many sexual partners
• are in high-risk occupations, such as health-care and child-care personnel

If you're planning to travel abroad, consult your doctor in advance so you and your family have enough time to complete the required immunizations. The vaccine is especially useful for staff of child-care facilities or schools where they may be at risk of exposure.

There's also a hepatitis B vaccine, which should be given to both children and adults as part of routine immunization.

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

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:

• For hepatitis A, the incubation period is 2 to 6 weeks.
• For hepatitis B, the incubation period is between 4 and 20 weeks.
• For hepatitis C, it's estimated that the incubation period is 2 to 26 weeks.

Hepatitis A is usually active for a short period of time and once a person recovers, he or she can no longer pass the virus to other people. It's practically unheard for people to become chronic carriers of hepatitis A. Almost all previously healthy persons who develop hepatitis A will completely recover from their illness 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 may also become lifelong carriers of these viruses and can spread them to other people.

Treatment

When symptoms are severe or laboratory tests show liver damage, it's sometimes necessary for hepatitis to be treated in the hospital. Here's a quick look at the treatments available for the various hepatitis viruses:

• There are no medications used to treat hepatitis A because it's a short-term infection that goes away on its own.
• Hepatitis B can sometimes be treated using medications. Four drugs are approved for use in adults with hepatitis B, but there hasn't been enough research yet on their use in children. However, you can talk to your child's doctor about a drug that may be available in some centers on a research basis for children.
• The treatment of hepatitis C has improved significantly with the use of two medications, only one of which is approved for use in children. Another more effective drug isn't approved for children yet but is available for kids in some centers on a research basis. In those adults who've just been infected with hepatitis C (by accidental needle injury, for example), combination therapy with the two drugs is the treatment of choice and can eliminate the virus in about 50% of the people infected.

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 child-care 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 the hepatitis B virus. 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 their liver condition worsening:

• 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.

Reviewed by: Joel Klein, MD
Date reviewed: April 2009