As noted here last week, May is National Hepatitis awareness month, and it is appropriate to look at this topic because it is a common problem and often one that is life-long.

As noted here last week, May is National Hepatitis awareness month, and it is appropriate to look at this topic because it is a common problem and often one that is life-long. Usually when people think of hepatitis they think of viral hepatitis, but there are other types. The word hepatitis simply means inflammation (itis) of the liver (hepat, Greek). Just as a rash is an inflammation of the skin that can come from an allergic reaction, result from exposure to a chemical or be due to other causes, so also there is autoimmune hepatitis and also toxic or chemical hepatitis, such as is caused by an overdose of Tylenol, and many other causes of inflammation of the liver. We shall limit the rest of this article to a discussion of viral hepatitis. The types of viral hepatitis were named A, B, C, D and E in the order in which they were characterized, and they are abbreviated HAV for Hepatitis A Virus, etc. I am going to take them out of order, however, because Hepatitis C (HCV) is special for several reasons. The first reason is that it is a life-long disease.

Most people who catch it don't know they have it, and it almost never goes away by itself. Also, it is especially common among people of my generation (1 in 30 baby boomers has it). HCV is spread by sharing bodily fluids, and it may be no coincidence that people born in 1945 were becoming sexually active at the height of the sexual revolution, and the people born after 1965 were becoming sexually active in the age of HIV with a heightened awareness of diseases. HCV can be cured, it causes liver failure if not treated in time and HCV is the leading cause of liver cancer (hepatocellular carcinoma or HCC). HCC is the third leading cause of cancer death. If you were born between 1945 and 1965 you should be screened, and your insurance should pay for that screening. If your test is positive, you should be seen by a liver specialist and learn about treatment options. It is a complex, somewhat inconvenient and expensive process… but so is liver cancer.

HAV used to be the most common type of viral hepatitis, at least in the US, but the number of cases per year is now about 2500 and is about a tenth of what it was before vaccination became available in 1996. HAV is spread by the fecal-oral route, either person to person or in contaminated food. The incubation period is 15 to 50 days (Avg. 28), then there is abrupt onset of symptoms: fever, nausea, malaise and then jaundice as yellow bile discolors the skin and the whites of the eyes. Most people with the disease are fully recovered in 2 to 3 months. In some cases recovery takes up to six months, and some people (<1%) have fatal liver failure. Hepatitis B (HBV), on the other hand, is a virus that is passed by sharing bodily fluids, such as mother to fetus or sexual contact or blood products and accidental needle sticks or needle sharing.

Vaccination is available and effective, it consists of a series of two shots and is recommended for anyone who is at risk for accidental exposure, such as dental or medical workers. Only about a third of people infected with HBV develop clinical infection at the time of exposure, but almost all of them will continue to have the virus active in their body for life. Thus, they can pass the virus in the ways mentioned above, and they can also develop chronic HBV which affects the other organs, especially the kidney, skin and joints. The worst problems, however, are chronic scarring of the liver (cirrhosis) and liver cancer (hepatocellular carcinoma). Some people do get over their infection, probably 2% of people with infection become disease free each year. In the US less than 3 people in 1000 have been infected with HBV, but 2 billion people world-wide have been. The prevalence in some groups in the US is also quite high, such as among IV drug abusers. Hepatitis D (HDV) is a virus that is uncommon and relies on the HBV for replication. It is like a bonus illness that only people with HBV can get. Hepatitis E (HEV) is spread in the same fashion as HAV, and it is actually quite common, though infrequently diagnosed. The vast majority of people who are infected have no symptoms or minimal symptoms, and for these the incubation period is a little longer than HAV (15 to 60 days). The symptoms are similar in most cases, but some people with pre-existing conditions do go on to have chronic disease, unlike HAV which never causes chronic disease.

This article is intended to provide general information only, and is not to be taken as medical advice. For advice about a particular case or situation, consult your own physician or other trusted health professional.

This column is a service of The Health and Wellness Coalition of Runnels County which now meets every second Thursday at 7 pm. The next meeting will be June 14 at 7 pm in the Conference Room at Keel Drug in Ballinger, and it will be devoted to Emergency Planning and Preparation for Healthcare Services and Facilities.