Hepatitis

Hi! There is a lot of information on this page, so we have coloured each section but you can also use the jump menu below. Even if you don't have hepatitis you will still need to read this section. It will show you how to protect yourself in the future.

THIS MAY BE DIRECTLY RELATED TO YOU IN THE FUTURE.
So know you stuff and check this section thoroughly.

What is Hepatitis? Jump to
The function of the liver Jump to
What happens in the body? Jump to
What is the incubation period? Jump to
Diagnosis Jump to
Following infection / symptoms Jump to
How is it transmitted & how it isn’t? Jump to
How long is a person able to spread the hepc virus? Jump to
Tests & pre test counselling Jump to
Can you catch it more than once? Jump to
Treatments Jump to
Combination therapy Jump to
Liver transplants Jump to
Prevention Jump to

“Hepato” comes from the Greek and means to do with the liver. “-itis” at the end of the word means inflammation. So Hepatitis basically means inflammation of the liver.

Your liver can become inflamed for a number of reasons; it may because you drink too much, some drugs can cause it to happen as a side effect. It can also occur as result from viral infection. This is known as viral hepatitis.

Viral Hepatitis
There are several types of hepatitis viruses - -these include hepatitis A,B,C,D,E and G. There are differences in the way you can catch these viruses, and they cause damage to the liver in varying ways.
Unlike hepatitis A and B, there is no vaccine to protect against hepatitis C.

The different types of viral hepatitis
Hepatitis A Virus
Hepatitis B Virus
Hepatitis C Virus
Hepatitis D Virus
Hepatitis E Virus

A brief summary of the liver’s functions follows, but remember there are more than 500 functions:

· Processing digested food from the intestine
· Controlling levels of fats, amino acids and glucose in the blood
· Combating infections in the body
· Clearing the blood of particles like bacteria
· Neutralising and destroying drugs and toxins
· Manufacturing bile, an important substance for digestion of fats
· Storing iron, vitamins and other essential chemicals
· Breaking down food and turning it into energy
· Manufacturing, breaking down and regulating numerous hormones including sex hormones
· Making enzymes and proteins, which are responsible for most chemical reactions in the body, for example those involved in blood clotting and repair of damaged tissues.

Some of the most important functions include:

Producing quick energy
One of the liver’s most important functions is to break down food and convert it into energy when needed. When energy is required in an emergency the liver quickly converts its store of glycogen back into glucose ready for the body to use. Carbohydrates such as bread and potatoes from our diet are broken down to glucose and stored mostly in the liver and muscles as glycogen.

The liver also helps the body to get rid of waste products. Waste products, which are not excreted by the kidneys, are removed from the blood by the liver.

People with liver damage often lose the ability to control glucose concentration in the blood and need a regular supply of sugar.

Fighting infections
The liver plays a vital role in fighting infections, particularly infections arising in the bowel. It does so by mobilising part of the body’s defence mechanism. The liver contains over half of the body’s supply of macrophages (known as Kuppfer cells) which literally destroy any bacteria that they come into contact with.

If the liver is damaged in any way its ability to fight infections is impaired.

The hepatitis A & E viruses first enter the gut and begin reproducing. They then spread to the liver and multiply there.

Hepatitis B & C enters through the blood stream; when they pass through the liver it then becomes infected and the virus begins to reproduce. The body then attacks the infected cells, and that causes the liver to become inflamed.

The incubation period means the length of time that passes between getting infected and when you start to show symptoms.

Hepatitis A 2 to 4 weeks after exposure.
Hepatitis B Average period is 2 to 3 MONTHS, but may take 6.
Hepatitis C Average 6 to 9 weeks but may take up to 6 MONTHS.

Firstly you should only consider getting tested for Hepatitis after you have thouroughly thought it through. You should also consider talking it over with a counsellor, and discussing the consequences of the tests. Its also important that people know that GP records may be shared with other people in your life. GUM records are confidential and never shared. Again you need to be careful about confidentiality.

If you think you could have been in contact with the hepatitis virus at any time in the past, you can have a simple blood test to find out if you may have been infected.

Where can I get a test?
Your doctor will be able to carry out tests for hepatitis. Local drug agencies and sexual health/ GUM (genito urinary medicine) clinics may also offer testing.

What’s involved?
There are a number of tests and procedures that can be performed to check if you have the virus. The most basic is a series of tests on a sample of your blood. These are known as "Liver Function Tests”.

The procedure requires a sample of blood to be taken, quite often for a number of different tests including liver function tests. You may see a number of bottles or containers lined up for a sample of your blood or just one for the liver function test alone.

It is quite important to remember that no test is completely accurate and one test is a snapshot of your health at the time it was taken. It is good practice to do a number or series of tests over time to allow the doctor, nurse or specialist to examine a trend in your results, especially if the tests detect anything abnormal.

Look at Tests & Pre tests counselling

A hepatitis C positive mother to her baby, before or during birth.
Unprotected sex (without a condom) with someone who has the virus.
Medical and dental treatment abroad where un-sterile equipment may be used. Tattooing, ear piercing, body piercing or acupuncture with un-sterile equipment sharing.
Razors or toothbrushes contaminated with blood from someone who has the virus.

See your doctor or nurse if you think you could have been in contact with the virus in any of these ways.

For some patients, the illness begins suddenly as though you have come down with the flu.

For others there is no obvious onset of the illness.

For many other patients the onset appears to be gradual and over a long period of time.

Infants and young children have no symptoms at all.

Many other symptoms may also be present; these will be different amongst different patients.

These include:

FATIGUE
LOW-GRADE FEVER
HEADACHES
SLIGHT SORE THROAT
LOSS OF APPATITE
NAUSEA
VOMITING
STIFF & ACHEING JOINTS
PAIN IN THE RIGHT SIDE, OVER THE LIVER AREA
URINE (WEE) MAY BECOME DARK BROWN
FEACES (POO) MAY BECOME PALE
JAUNDICE – When the skin & whites of the eyes become yellowish.

Symptoms differ from patient to patient, and vary over time for the same patient.
How severe also varies from being fatigued after a stressful event to being totally bed ridden and completely disabled.

15% - 20% of those infected clear the disease completely
80% will have chronic infection
40% of those infected (half of the chronic infected) will remain symptom free – although they may have changes to their liver and & evidence of chronic infection
40% of those infected (the other half of the chronic infected) will have non-specific symptoms. Lethargy, anxiety, depression, joint pains, low concentration.
20% of the chronically infected will develop cirrhosis after 10 – 30 years. (may die or require a transplant)
5% of those that developed cirrhosis will develop primary liver cancer.

Hepatitis A

Fecal – oral (Saliva)

Hepatitis A is passed from person to person by eating food or drinking water contaminated (infected) with the virus.
The illness can spread easily within families and where people live closely together.
The virus is passed out in the bowel motions of an infected person, which is why it is important to wash your hands after going to the toilet.

You can prevent illness by having a vaccination that will give you protection from the virus.

Hepatitis B

Percutaneous – Permucosal (Blood, sex, mother to child)

The virus is present in body fluids such as blood, saliva, semen and vaginal fluid.
In the UK, Europe and North America, hepatitis B is mainly passed from person to person by having unprotected sex.
In the rest of the world the most common way of getting infected is from infected mothers to their children, or from child to child.

You can prevent illness by having a vaccination that will give you protection from the virus.

Hepatitis C

Contact with blood

A tiny amount of blood - too small to be visible to the naked eye - from someone who has the virus, will transmit the infection if it gets into someone else’s bloodstream, for example, through an open wound, cut or scratch.

Blood donations in the United Kingdom have been screened for hepatitis C since September 1991.
Some people who received blood or blood products before then may be infected,
e.g. haemophiliacs.

Blood and blood products may not be screened for the virus in some overseas countries.

Sex
Sexual transmission of hepatitis C is thought to be unusual, but probably does occasionally occur. Doctors are unsure whether the infection that occurs between partners is because of sexual exposure or because of other reasons, for example, sharing a personal item such as a toothbrush or razor.
People with more than one sexual partner are advised to use condoms, as there is some evidence that those with many sexual partners have an increased risk of being infected.

Naturally, couples are often worried about infecting each other, but when one partner is positive and the other negative after many years, it seems reasonable to advise that it is unnecessary to change to using condoms for protection.

Penetrative sex during a period is best avoided when a woman is hepatitis C positive.


Normal social contact
Infection is not acquired through normal social contact, for example, from a cup or by touching an infected person.
However, it is a sensible precaution if you are HCV positive to use your own personal items such as a nailbrush, scissors or razor and to be meticulous about cleaning up any blood, for example from cuts or scratches.
Undiluted household bleach should be used to clean up blood from floors and work surfaces.
Scratches, cuts and wounds should be carefully cleaned and covered with a waterproof dressing or plaster.


Injecting drug use
Current evidence suggests that 50% - 80% of past and present users may be infected with hepatitis C. They become infected by sharing any equipment used in the process of injecting because it is likely to have invisible contamination with blood.

Only one occasion of sharing injecting equipment is needed to be exposed to the virus - and that may have been years previously. An increasing number of people who injected a few times many years ago, are now being diagnosed as having hepatitis C.

Recently there has been some concern about sharing straws for snorting cocaine because the practice may be a route of infection through the mucus membrane .


Acupuncture, tattoos, body piercing
A few people have become infected by un-sterile needles being used for ear and body piercing, acupuncture and tattooing.
The best way to protect yourself is to ensure disposable needles are used and that they come straight out of a sterile packet.


Saliva
The virus has been detected in saliva, but it is unlikely that it can be transmitted by kissing. It is advisable to reduce the possibility of infection by not using someone else’s toothbrush and by maintaining good oral hygiene.


Mother to baby
The risk of a mother with hepatitis C infecting her baby during pregnancy or during the birth is about 6%. When it does occur, it is not known whether this is in the womb, during delivery or immediately after the birth, but it is not during conception.
Babies are sometimes found to have antibodies to the virus, but these usually disappear by the time the baby is 12 to 18 months old, which shows that the antibodies are acquired from the mother and that the baby has never been infected with the virus. Since the usual test is for antibodies, it may not be possible to determine if a baby is infected until it is over a year old, but there is a test for the virus itself (“PCR test”) that may detect it in the first few months. Doctors do not yet know if the disease that occurs when a baby is infected will go on to become serious in all cases.

Infected mothers are often concerned about passing the virus on to their other children. As long as all the precautions listed below are taken, household transmission is a low risk.
Kissing and cuddling a child is safe.


Breastfeeding
Most doctors consider breastfeeding to be safe if the mother has no symptoms. In theory infection could be possible if a mother has cracked nipples that bleed and the baby has a cut in the mouth.


Unknown
In some cases doctors don’t know how people became infected.

People who carry the virus in their bloodstream may remain contagious for the rest of their life.

Pre-test counselling

There should always be counselling pre & post any test
It should discuss:

Likelihood of positive result
Social & Financial implications
Medical Issues
Support issues
Treatments & their weaknesses
Negative results should give opportunity for prevention discussion
Posotive result should involve specific plan of referral etc.

Follow up tests

Liver function test – blood sample that can be tested against a base rate to see how
well the liver is working.

Ultra sound - Similar machine as used to view a baby, it will show the size, consistency and blood flow through the liver.

Liver Biopsy – Shows accurate picture of liver status. Normally don’t need to stay in hospital overnight. They deaden the right side of chest over liver, and get a small sample of the liver.
(Painless but can be uncomfortable)

You may catch another of the hepatitis viruses but not D if you are immune to B.

Avoid alcohol
Avoid other liver toxic drugs, foods and situations
General health care, stress avoidance, balanced diet, exercise

Immunisation against hep A & B

Complimentary treatments
May include milk thistle, vitamin E, other herbal remedies, TCM (tradition Chinese medicine is rumoured to work well with hepC), acupuncture, shiatsu etc

Medicine
Combination therapy with interferon & ribavirin
Combination therapy with pegylated interferon & ribavirin

Medicine
Combination therapy with interferon & ribavirin
Combination therapy with pegylated interferon & ribavirin

Interferon is natural protein that stops viral replication
(and is cause of viral symptoms)
Ribavirin is thought to enhance the immune system response

Guidelines from NICE (National Institute for Clinical Excellence)
State that any one over 18 with moderate to severe symptoms of Hepatitis C, and who is not currently injecting drugs or drinking should be offered combination therapy, provided they have not previously been treated.

A liver transplant for a Hep C patient shows success in the same way any other liver transplant would.
Although – Hep C is not solely contained in the liver, and part of the procedure requires the use of an immuno-suppresive drug to stop your immune system rejecting the new liver.
This drug enhances the replication of the virus and it is likely the new liver will become infected once more. This does not mean you will show symptoms immediately, but that the virus is still present.
Look at What is the incubation period?

Hepatitis B
Prevention

Protect yourself with vaccination

The vaccine is given by injection in the arm. The first dose is followed by one a month later and another five months after that.
It is important to have all three doses of the vaccine because you will not be fully protected until you have had the third injection.
(A booster injection is usually given 5 years after the initial injection).

A blood test is sometimes recommended up to two months after the final injection to find out whether the vaccine has worked. A few people will not respond to the vaccine and they may have to take another course, though some people may not respond to the vaccine at all. In exceptional circumstances, you may receive a quicker vaccination schedule of an injection at one month after your first, another injection a month later and a booster at one year.

Anyone who has been exposed to the virus should be given an injection of antibodies called immunoglobulin immediately as well as the vaccine, as there is not enough time to wait for the vaccine to work.

People who may be exposed to the virus during the course of their work include nurses, doctors, prison wardens and dentists. They may need an injection of antibodies as well as the vaccine if they accidentally injure themselves with a needle contaminated with blood.
Newborn babies of infected mothers

Babies born to infected mothers are given an immediate injection of immunoglobulin as soon as possible after they are born to help prevent the baby being infected.
At the same time a dose of the vaccine is given, followed by two doses, with a month in between each, with a booster dose 12 months later.

Family and friends

Partners, children and other household members of an infected person should be vaccinated. There is no risk of infection from normal social contact. For example, you cannot catch hepatitis B from a toilet seat or just by touching an infected person, so occasional visitors and friends do not need protection. The virus is thought to be killed by a hot wash in a washing machine and by using hot water and washing-up liquid on cutlery and plates.

Other people at risk

Doctors, dentists, nurses, prison officers and anyone else whose job may involve contact with infectious body fluids should be vaccinated.
To reduce the risk of infecting others:
· carefully clean and cover cuts, scratches and open wounds with a waterproof plaster
· clean up blood from floors and work surfaces with undiluted household bleach
· do not use anyone else’s toothbrush, razor, scissors or other personal items
· practise safer sex by using a condom in circumstances where you are likely to be infected
· do not donate blood or semen, or register as an organ donor.

Hep C

Preventing infection: