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Hepatitis
Hepatitis is an inflammation of the liver that occurs when the liver is
injured or infected. It can range from being asymptomatic to becoming a
life-threatening condition. Symptoms may include fatigue, nausea, vomiting,
muscle and joint aches, liver tenderness and enlargement and/or weight loss.
Hepatitis can be acute (lasting less than six months) or chronic. It occurs
commonly throughout the world.
Hepatitis can be caused by any substance that damages the liver, including
alcohol, drugs, chemicals, viruses or a combination of any of these. Hepatitis
caused by viruses is called viral hepatitis and can be transmitted through
blood and blood products.
Six different viruses are now known to cause hepatitis—hepatitis A,
B, C, D, E and G. Hepatitis A, B and C account for almost 95% of all cases
of viral hepatitis. The other strains are uncommon.
Today's factor products are much safer than those of the past, though there
is still some risk of getting hepatitis from clotting factor. Screening
methods to identify donors with hepatitis have become more sensitive, greatly
lowering the chances of transmitting one of the hepatitis viruses. Also,
new viral inactivation methods now are being used on clotting factor products
that make them much safer to use. As of 1997, there have been no reports
of hepatitis C transmission through clotting factor that has been treated
with these new processes. Hepatitis B and D are also killed by these methods.
There is no known case of hepatitis E transmission through blood products.
Small numbers of people with hemophilia have been exposed to hepatitis G,
probably through blood products. Hepatitis A has been found in solvent detergent-treated
clotting factor, in part because hepatitis A can resist the viral-killing
methods now being used. Transmission of hepatitis A remains a risk for people
with bleeding disorders who use plasma-derived products. However, hepatitis
A may be prevented by immunization with a vaccine.
Today's blood safety measures, though highly advanced, are not perfect.
Whole blood and blood components, including packed red blood cells, platelets
and cryoprecipitate cannot be treated with currently available virus-killing
methods. Plasma may now be created with the same virus-killing methods (solvent-detergent
plasma) used for hemophilia products. This is because these methods would
damage or inactivate important blood components, making these blood products
useless. According to recent figures, for each unit of blood the risk of
getting hepatitis C is less than one in 103,000, while the risk of getting
hepatitis B is one in 63,000. As a health precaution, it is advised that
persons with bleeding disorders get vaccines against both hepatitis A and
hepatitis B. They should also be tested for hepatitis C on a yearly basis.
There is, however, no vaccine for hepatitis C.
Prevention
High-risk activity that may lead to the transmission of hepatitis includes
direct sexual contact with an infected person, sharing needles and coming
into contact with infected blood. In some cases of hepatitis, little is
known about how the infection is acquired.
Good hygiene helps prevent the spread of hepatitis A. Because the stool
of people with hepatitis A is infectious, stool samples must be handled
with special care. The same is true for the blood of people with any type
of acute hepatitis. On the other hand, infected people don't require isolation—it
does little to prevent the transmission of hepatitis A, and it won't prevent
the transmission of hepatitis B or C.
Vaccinations are available against hepatitis A and B. Vaccination is especially
important for people at risk for contracting hepatitis B, though it isn't
effective once the disease is established. For these various reasons, universal
vaccination of all people against hepatitis B is being increasingly recommended.
A hepatitis B vaccine is recommended for all children by the American Academy
of Pediatrics. A hepatitis A vaccine is recommended for all individuals
two years of age and older with hemophilia and other congenital bleeding
disorders.
Hepatitis A vaccines are given to people who are at a high risk of acquiring
the infection, such as travelers to parts of the world where the disease
is widespread. No vaccines are available against the hepatitis C, D and
E viruses.
People who haven't been vaccinated and are exposed to hepatitis may receive
an antibody preparation (immune serum globulin) for protection.
The infection can be detected by simple, routine blood tests performed by
doctors who suspect infection. Unfortunately, many people with hepatitis
are never tested because they have no symptoms; by the time their infection
is discovered, serious liver damage may have occurred. If someone thinks
he or she may be infected, a doctor should be seen as soon as possible.
Treatment
People with unusually severe acute hepatitis may require hospitalization,
but in most cases treatment isn't necessary. After the first several days,
a person's appetite usually returns and they don't need to stay in bed.
Severe restriction of diet or activity are unnecessary, and vitamin supplements
are not required. Most people can safely return to work after the jaundice
clears, even if their liver function test results aren't quite normal.
Acute viral hepatitis symptoms can range from minor flu-like illness to
liver failure. Hepatitis B is usually more serious than hepatitis A and
is occasionally fatal, especially in elderly people. The course of hepatitis
C is unpredictable. The acute illness is usually mild, but liver function
may improve, stay the same or worsen over months to years. Fifteen percent
of persons will spontaneously clear the virus and only 15% will develop
severe liver failure.
A person with acute viral hepatitis usually recovers after four to eight
weeks, even without treatment.
• Hepatitis A rarely if
ever becomes chronic.
• Hepatitis B becomes
chronic in 5 to 10 percent of the infected people and can be mild or full-blown.
• Hepatitis C has the
greatest likelihood of becoming chronic—about a 70% chance. About
one-third of chronic carriers have normal liver enzymes, and 70% will persist
with
elevated liver enzymes.
Though usually mild and often without symptoms, hepatitis C is a serious
problem because about 20% of the infected people may eventually develop
cirrhosis of the liver.
A person with acute viral hepatitis can become a chronic carrier of the
virus. In the carrier state, the person has no symptoms but is still infected.
This situation occurs only with hepatitis B and C, not hepatitis A. A chronic
carrier has a higher chance (about six times the risk) of developing liver
cancer.
New advances and developments in the field of hepatitis are constantly being
made. Contact HANDI, the information center of the National Hemophilia Foundation,
at 800-42-HANDI for current updates and news briefs.
Disclaimer
The information contained on the NHF web site is provided for your general
information only. NHF does not give medical advice or engage in the practice
of medicine. NHF under no circumstances recommends particular treatment
for specific individuals and in all cases recommends that you consult your
physician or local treatment center before pursuing any course of treatment.
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