Hepatitis: the virus that attacks your liver

Canadians became acutely aware of a disease called hepatitis C in the early 1990s: an estimated 95 per cent of hemophiliacs who received blood transfusions before 1990 contracted hepatitis C from tainted blood.

Hepatitis means "inflammation of the liver." The most common cause is infection by one of five viruses: hepatitis A, B, C, D, and E. All of these viruses can cause an acute disease with symptoms lasting several weeks. Some will develop into chronic illnesses that can eventually kill you.

The most common forms are hepatitis B and hepatitis C. An estimated 600,000 Canadians have it. Globally, it's estimated that one in 12 people are infected with hepatitis B or C. That's far higher than the prevalence of HIV or any cancer.

May 19 is recognized as World Hepatitis Day, an event spearheaded by the World Hepatitis Alliance to raise public awareness about hepatitis B and C. The organization represents about 200 hepatitis B and C patient groups around the world.

What are the symptoms of hepatitis?

The symptoms of hepatitis include jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. But many people with some forms of hepatitis can go decades without showing any symptoms.

What are the differences between the strains of hepatitis?

Hepatitis A and E are usually caused by the consumption of contaminated food or water. They can be passed on by someone infected with the virus who doesn't wash his or her hands properly after a bowel movement and then touches something you eat. They are primarily food-borne illnesses but can also be passed through contact with an infected person.

Hepatitis B, C and D are caused by contact with infected bodily fluids often through blood transfusion. Hepatitis B can also be spread through sexual contact or sharing needles.

You'll usually know fairly quickly whether you have hepatitis A or E. You'll start showing symptoms within two to six weeks. Once symptoms start, they'll develop over a period of a few days. You can expect to show symptoms for two months, although some people can be sick for up to six months.

If you have acute hepatitis B or D, symptoms normally appear three months after exposure, but they can appear between six weeks and six months after exposure. Symptoms will last for a few weeks, but some people can be ill for up to six months.

If you have acute hepatitis, your condition could become chronic especially if you were infected before your fifth birthday.

People with chronic hepatitis B or D can remain symptom-free for up to 30 years. Some will have ongoing symptoms similar to acute hepatitis. About 15 to 25 per cent of people with chronic hepatitis B will develop serious liver conditions, such as cirrhosis or liver cancer.

You can only develop hepatitis D if you have hepatitis B. It is uncommon in North America.

Up to 80 per cent of people with acute hepatitis C will not have any symptoms. But those who do show symptoms normally develop them between two weeks and six months after exposure. The average is six to seven weeks. You can still pass on the virus even if you don't show any symptoms. Most people with acute hepatitis will develop chronic hepatitis.

Most people with chronic hepatitis C also will not show symptoms. However, up to 70 per cent will develop chronic liver disease, five to 20 per cent will develop cirrhosis of the liver, and one to five per cent will die from cirrhosis or liver cancer.

Hepatitis E is uncommon in North America and is normally associated with parts of the world where sanitation is poor especially in parts of South Asia, Africa and Central America. It usually takes four to six weeks for symptoms to appear. You can expect to be sick for a couple of weeks. It does not lead to chronic illness.

The disease is generally mild unless you have a pre-existing liver condition.

How can I protect myself from getting hepatitis?

The best defence against food-borne versions of the disease is through proper handwashing. The disease is spread when fecal matter even minute quantities enters your mouth.

There are sometimes outbreaks of hepatitis A. They're often caused by an infected person who handles food for a living. More than 45,000 Canadians lined up to be inoculated against hepatitis A between January 2001 and September 2002. There were four separate outbreaks across the country.

Currently there are vaccines only for hepatitis A and B. For hepatitis A, vaccination is recommended for children over the age of one, travellers to certain countries, and others at risk, including people who:

• Share drug paraphernalia.
• Have clotting-factor disorders, such as hemophilia.
• Live with someone who has hepatitis A.
• Have oral-anal sexual contact with someone who has hepatitis A.
• Travel to parts of the world where sanitation may be poor.

The hepatitis B vaccine which is usually a series of three or four shots over a six- month period is recommended for:

• Infants.
• Anyone under the age of 19 who has not been vaccinated.
• Sexually active people not in a monogamous relationship.
• People who share needles, syringes, or other drug-injection equipment.
• People who have close household contact with someone infected with the hepatitis B virus.
• Health care and public safety workers at risk for exposure to blood or blood-contaminated body fluids on the job.
• People with HIV.
• Travellers to parts of the world with moderate or high rates of hepatitis B.

How is hepatitis treated?

There's no treatment for hepatitis A. You will feel sick for a few months before you start to feel better. Similarly, there's not much your doctor can do if you come down with acute hepatitis B, C, D or E.

As with other viral diseases, your doctor will recommend rest, adequate nutrition and fluids.

Treatment for chronic hepatitis B and C will depend on your needs. You should be monitored for signs of liver disease.

Several drugs have been approved for hepatitis B treatment and new drugs are in development. But not everyone with hepatitis B will need to be on medication. Drugs can cause serious side effects in some people.

The treatment most often used for hepatitis C is a combination of two medicines, interferon and ribavirin. But again not everyone with chronic hepatitis C will need drug therapy.