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hepatitis virus
Hepatitis is a viral disease that affects the liver. There are at least six known kinds of hepatitis (hepatitises A, B, C, D, E and F). Hepatitis A, hepatitis B and Hepatitis C (which wasn't even identified until 1989) are relatively common in some places. Hepatitis D and hepatitis E are very rare. Hepatitis may be infectious or noninfectious. Six or seven virus are usually responsible for the infectious versions although other viruses, parasites, fungi may cause it.

Hepatitis is debilitating disease that can last for months. It often creeps up slowly (between 15 to 50 days, usually around 25 days), peaks, sometimes with pronounced symptoms, and fades away slowly. leaving victims feeling weak and tired for a long time.

Hepatitis A is contacted from contaminated water and hepatitis B is contacted from infected blood or bodily fluids. Both diseases can be very serious and debilitating and often include jaundice (yellowing of the skin and the whites of the eyes). Immunizations, consisting of a series of shots given over several weeks, are available for both diseases. If you are getting these shots for traveling make sure you get them well advance of your departure date.

Hepatitis generally begins with mild symptoms that may or may not become severe. Hepatitis can go on a long time and cause considerable damage before people realize they have it. Early symptoms include a slight fever, achy joints, abdominal pain, lethargy and aversion to cigarette smoke. One telltale sign of hepatitis is urine that is deep orange in color regardless of how much liquid has been consumed (if you think you may have hepatitis drink a lot of water, if you urine is still really orange or yellow see a doctor).

Websites and Resources Centers for Disease Control and Prevention (CDC) cdc.gov/DiseasesConditions ; World Health Organization (WHO) fact sheets who.int/news-room/fact-sheets ; National Institute of Health (NIH) Library Medline Plus medlineplus/healthtopics ; Merck Manuals (detailed info many diseases) merckmanuals.com/professional/index

Hepatitis A

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person with jaundice
Hepatitis A is a viral disease common in the developing world but less common in the developed world. It is caused by an intestinal virus that is found in fecal matter and is usually transmitted by exposure to contaminated food or water. The incubation period is an average of 28 days.

Hepatitis A is contacted by something, usually food or water, contaminated by the feces of an infected person. Symptoms include jaundice (yellowing of the skin and eyes), flu-like fatigue, loss of appetite, nausea, and dark urine. Symptoms range from mild and transient to severe and prolonged. Sometimes the symptoms are so slight people don't even know they have the disease. Children under two years of age may have no symptoms.

Hepatitis A is very common in the developing world. In some areas in Third World countries 95 percent of local populations has it. There is no cure for hepatitis A. Treatment includes bed rest, increased intake of fluids. Infection can often be limited if and immune gamma globulin shot is given within two weeks of exposure to the virus. Otherwise there are no known medicines for the disease. People with hepatitis often have spend several weeks or months in bed.

There is a vaccine for hepatitis A that is widely available. It consists of a series of shots; two shots two weeks apart. In the old days, people used to get an immune gamma globulin shot (a preparation of antibodies) as a preventative measure against hepatitis but these days most people get the vaccine. There is now a vaccine for Hepatitis A and B. Called Twinrix, it is produced by Glaxo-SmithKline. Most places don’t offer it. The Hepatitis A vaccine provide protection for at least 15 years.

The Hepatitis A vaccine consists of a single dosage given two weeks prior to exposure. A booster is recommended anytime between six and 12 months later to assure the best protection. The side affects are generally mild.

Hepatitis B

Hepatitis B is an infection of the liver caused by the hepatitis B virus. The term “viral hepatitis” is often used for and may include hepatitis B and other similar diseases which affect the liver but are caused by different viruses. Hepatitis B can be a wasting disease that causes victims to slowly waste away or unpredictable disease which lies dormant for years and suddenly and painfully strike with vomiting, yellowing of the skin and eyes, fatigue and join pain. One victim told Bloomberg News, “When it first flared up, I felt like I would rather die than live with this disease.”

Hepatitis B kills or contributes to the death of at least 600,000 and maybe as many a million adults every year. It is transmitted by body fluids, primarily blood and semen but occasionally saliva, and is contacted by direct contact with an infected person’s blood or contact with the infected person’s bodily fluids, such as through sharing needles or having sex. Transmission is mainly through blood contact, such as a blood transfusion, or to a lesser extent from infected unsterilized needles, acupuncture and tattooing. Transmission through sex is rare. It can not be contacted through casual contact such as shaking hands.

Symptoms for hepatitis B include, jaundice, fatigue, abdominal and joint pain, loss of appetite, vague feeling of oncoming illness, extreme tiredness, stomach pain, dark urine, nausea and vomiting and jaundice (yellow eyes and skin). Skin rashes and joint pain can also occur. Sometimes people never get symptoms. Unlike hepatitis A, hepatitis B can cause cirrhosis of the liver (a disease which kills liver cells and impairs the ability of the liver to perform vital functions), liver cancer and permanent liver damage.

After about seven years with the disease victims they become very weak and the cost of medicines eat up a significant portion of their income. Victims often die of cirrhosis, liver cancer or some other liver disease. In the United States, about 300,000 people, mostly young adults, catch hepatitis B. About one quarter develop jaundice, about 10,000 require hospitalization, and 350 to 400 die.

Between 6 and 10 of every 100 people who catch hepatitis B become chronic carriers. Infants who catch hepatitis B are more likely to become carriers than adults. About one forth of these carriers go on to develop a disease called “chronic active hepatitis” that often causes cirrhosis of the liver and death due to liver failure. Chronic carriers are also more likely to develop cancer of the liver. In the United States, about 4,000 people die of hepatitis-B-related cirrhosis each year and more than 1,000 die of hepatitis-B-related liver cancer.

Vaccines and Treatment for Hepatitis B

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Hepatitis B is incurable but it can be prevented with a vaccine. The Hepatitis B vaccine is made two ways: 1) the plasma-derived vaccine is made with hepatitis B virus particles taken from the blood of carriers, with all viruses in the vaccine being killed; and 2) the recombinant vaccine made from common bakers yeast through genetic engineering.

The Hepatitis B vaccine is 85 percent to 95 percent effective in preventing the disease. A Hepatitis B vaccine given to children within seven days of birth can protect them from infections of the disease carried by their mothers. A 2012 study in Taiwan indicated Hepatitis B protects for 25 years, suggesting that booster is not necessary

For those that get it, full recovery is likely but 10 percent of hepatitis B sufferers become chronic carriers and are at greater risk for cirrhosis and liver cancer. The drug interferon reduces the chance of a return of the disease. It is effective in about 30 to 40 percent of patients.

Hepatitis B is difficult to bring under control because many carriers are symptomless yet the can still transmit the disease. One of the main reasons you should avoid blood transfusions is the risk of getting hepatitis B. One of the main reasons you should get a hepatitis B inoculation is in the event that you have an accident while traveling abroad and are given blood infected with hepatitis B in a transfusion.

The vaccine for hepatitis B that is widely available. First offered in the United States in 1991, it consists of a series of three shots (an initial dose, a second dose one or two months later and a third dose 4 to 12 months after the first). After the second dose you can consider yourself inoculated for the short term. The third shot is a booster. The Hepatitis B vaccine provide protection for at least 15 years.

Hepatitis C

Hepatitis C is a very serious illness and is currently the leading reason for liver transplants. Millions of people with the disease don’t know they have it. By 2010 it may kill more American than AIDS. Many of those who don't know they have it live long, healthy lives with the disease. Those that experience symptoms suffer from jaundice, fatigue, abdominal and joint pain, loss of appetite, nausea and vomiting. Often they don't realize they have the disease until 20 years after they have been infected and have come down with cirrhosis, liver cancer or permanent liver damage. One study in Japan found that if left untreated 30 percent of hepatitis C sufferers develop cirrhosis of the liver in 10 years and of these two thirds later develop liver cancer.

Hepatitis C is contacted by direct contact with an infected person’s blood or contact with the infected person’s bodily fluids, such as through sharing needles or having sex, before 1992. Transmission is mainly through blood contact, such as a blood transfusion, or to a lesser extent from infected unsterilized needles, tainted blood products, acupuncture and tattooing. Transmission through sex is rare because a carrier can only infect someone if his or her blood enters a vein. It can not be contacted through casual contact such as shaking hands.

There is no vaccine for hepatitis C. It is treated with interferon or rebetron (a combination of drugs made with interferon and ribavirin). These drugs are unpleasant to take and often ineffective. Interferon works with 60 to 70 percent of patients, with disease being eliminated in about 30 percent of cases. Experiments using interferon with ribavirin show promise of being more effective. The disease is detected with a blood tests that measures the increase of certain liver enzymes.

Hepatitis D, E and F

Hepatitis D is rare and similar to hepatitis B only the symptoms are more severe. It can be contacted from intravenous drug use and sex with in an infected partner and is sometimes contacted by people with hepatitis B. There is no vaccine.

Hepatitis E and F are rare and similar to hepatitis A but more deadly, particularly among pregnant women. They can be contacted from contaminated water and many people have no symptoms. There is no vaccine. Patients are advised to get lots of rest and drink lots of fluids.

Hepatitis E is very rare in the United States and western Europe but does occur in epidemics in Asia, Africa and Mexico. Hepatitis F is still under investigation and is not universally regarded as a type of hepatitis. . Hepatitis G and Hepatitis TT are two other virus also being investigated.

Image Source: Centers for Disease Control and Prevention cdc.gov/DiseasesConditions

Text Sources: Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services; World Health Organization (WHO) fact sheets; National Geographic, New York Times, Washington Post, Los Angeles Times, The New Yorker, Time, Reuters, Associated Press, AFP, Lonely Planet Guides and various websites books and other publications.

Last updated May 2022

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