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The Five Faces of Hepatitis
Click here to view original press release.
Accession Number
A00475
Author
US Department of Health and Human Services (HHS), Food and Drug Administration (FDA)
Source
FDA Consumer Magazine
Release Date
March 1, 1999
Major Descriptors
Hepatitis C virus (HCV)
Prevention
Transmission
Cirrhosis, Liver Cancer
Ribavirin
Liver Transplant, Interferon
Rebetron
Topic
Hepatitis
Text
Scientists have currently identified five different hepatitis viruses. All are serious infections that can attack and damage the liver.
Hepatitis A How It Is Spread: By drinking water or eating food contaminated with fecal material that contains the virus. Symptoms: Flu-like symptoms such as fatigue, nausea, vomiting, abdominal discomfort, dark urine, and jaundice (yellowing of the skin and eyes). Liver tests may be elevated. Treatment: Bed rest and avoidance of intimate contact. Can last between three weeks and six months. Two approved vaccines: immune globulin for short-term protection and for patients already exposed, and hepatitis A vaccine for long-term protection.
Hepatitis B How It Is Spread: Exposure to infected blood, unprotected sex with an infected person, sharing contaminated needles, and travel to countries with a high rate of infection. Infected mothers also may infect newborns. Symptoms: Loss of appetite, nausea, vomiting, fever, fatigue, abdominal pain, dark urine, or jaundice. No symptoms in some people. Treatment: Interferon alpha. A vaccine--recommended for newborns, infants, and teenagers--provides immunity for at least five years.
Hepatitis C How It Is Spread: Direct contact with human blood, which can occur from being pricked accidentally by a contaminated needle, injecting illegal drugs, and sharing razors or toothbrushes with an infected person. Symptoms: More than half have no symptoms. Others have appetite loss, fatigue, nausea, fever, dark-yellow urine, and jaundice. Liver tests may be elevated. Treatment: Interferon or a combination of interferon and the drug ribavirin. No vaccine.
Hepatitis D How It Is Spread: Contact with infected blood. Requires the hepatitis B virus to replicate, so it infects either at the same time as hepatitis B or those who already have hepatitis B. Symptoms: Same as for hepatitis B but typically more severe: appetite loss, fatigue, nausea, vomiting, abdominal pain. Treatment: Interferon alpha for hepatitis B may have some effect.
Hepatitis E How It Is Spread: Water contaminated with fecal material, especially in developing countries, and contaminated uncooked shellfish, fruits and vegetables. Symptoms: Abdominal pain, dark urine, fever, jaundice, nausea, and vomiting. Treatment: Bed rest. No drug treatment or vaccine.
Identifying Recipients of Contaminated Blood Before 1992, tests to detect antibodies to the hepatitis C virus in the nation's blood supply were unreliable or nonexistent. As a result, many patients who received blood then may have contracted the virus unknowingly. To identify them so they can receive treatment, the Department of Health and Human Services is sponsoring a "lookback" program that is tracking down and informing about 300,000 people who received suspected HCV-contaminated blood before 1992. HHS agencies, including FDA and the Health Care Financing Administration, will ensure that recipients of blood that initially tested negative for antibodies to HCV, but was collected from donors who later tested positive for the antibodies, are informed by letter that they may have received blood containing HCV. As part of the lookback program, the national Centers for Disease Control and Prevention is leading educational programs for health-care professionals and the public to bring greater awareness of the disease.
Hepatitis C: Types and Symptoms Infection with hepatitis C may cause symptoms right away, not for years, or sometimes not at all. With the acute form of the disease, symptoms such as fatigue, nausea, and dark urine typically show up within six months. About one-fourth of patients with acute hepatitis C recover completely with treatment. But according to the National Institute of Diabetes and Digestive and Kidney Diseases, the other estimated 75 percent of these patients will progress eventually to the long-term, or chronic, form of the disease, with detectable HCV in their blood.
Chronic hepatitis C, however, varies widely in its severity and outcome. It can lie dormant for 10 years or more before symptoms appear. Some patients will have no symptoms of liver damage, and their liver enzymes will stay at normal levels (elevated enzymes are one indication of liver disease). A liver biopsy, in which the doctor removes a tiny piece of liver with a needle, may show some degree of chronic hepatitis, but it may be mild.
Other patients, however, will have severe hepatitis C, with detectable HCV in their blood, liver enzymes elevated as much as 20 times more than normal, and a prognosis of ultimately developing cirrhosis and end-stage liver disease. Another group of patients falls somewhere in the middle, with few or no symptoms, mild- to- moderate elevation of liver enzymes, but with an uncertain prognosis.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, at least 20 percent of chronic hepatitis C patients develop cirrhosis, but this process can take 10 to 20 years from the onset of infection. As many as 5 percent of chronic patients, after 20 to 40 years, develop liver cancer. Other studies show that those with cirrhosis develop liver cancer within 17 years.
Patients with no symptoms sometimes learn they have the disease when a routine physical or blood donation shows elevated levels of liver enzymes, which can indicate hepatitis C, as well as other liver disorders.
Other patients, however, have symptoms that prompt them to seek medical attention, including: - yellowish eyes or skin (jaundice) - fatigue, or an extreme feeling of being tired all the time - pain or tenderness in the right upper quadrant of the body - persistent nausea or pains in the stomach - lingering fever - loss of appetite diarrhea - dark yellow urine or light-colored stools If you have any of these symptoms, see a doctor right away.
For More Information
Contact any of the following organizations for more on hepatitis C, its treatment, support groups, and Internet mailing lists.
American Liver Foundation 1425 Pomptom Ave. Cedar Grove, NJ 07009 1-800-GO LIVER (1-800-465-4837) http://gi.ucsf.edu/alf/alffinal/homepagealf.html
Hepatitis C Foundation 1502 Russett Drive Warminster, PA 18974 (215) 672-2606 http://www.hepcfoundation.org/
Hepatitis Foundation International 30 Sunrise Terrace Cedar Grove, NJ 07009-1423 1-800-891-0707 http://www.hepfi.org/
National Digestive Diseases Information Clearinghouse 2 Information Way Bethesda, MD 20892-3570 301-654-3810 http://www.niddk.nih.gov/
In addition, two helpful publications are available on-line from the National Centers for Disease Control and Prevention or by calling CDC at (404) 332-4555.
Hepatitis C Fact Sheet: http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm Hepatitis C Questions and Answers: http://www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm
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