What is viral hepatitis?

Definition

Viral hepatitis is an infection of the liver caused by a virus. Viral hepatitis leads to liver inflammation and can also lead to liver cancer. There are five types of viral hepatitis infection: A, B, C, D, and E.

Causes

Progressive and chronic viral hepatitis is caused by toxins and by heavy drinking of alcohol.

Risk Factors

It is possible to develop viral hepatitis with or without the common risk
factors listed here. However, the more risk factors, the greater the likelihood
that a person will develop viral hepatitis. The risk factors for hepatitis
vary, depending on the type of hepatitis.

Persons at a greater risk include infants born to women with hepatitis B
or C and children in day-care centers. Also at greater risk are
child-care workers (especially if one changes diapers or toilet-trains
toddlers), first aid and emergency workers, funeral home staff, health care
workers, dentists and dental assistants, firefighters, and police personnel.

The following behaviors are risk factors for developing hepatitis: close
contact with someone who has the disease; using household items that were used by
an infected person and were not properly cleaned; anal sex; sexual contact with
multiple partners; sexual contact with someone who has hepatitis or a
sexually
transmitted disease (STD); injecting drugs, especially with
shared needles; using intranasal cocaine; and getting a tattoo or body piercing
(because the needles may not be properly sterilized). For hepatitis A
or E, risk factors include traveling to (or spending long
periods of time in) a country where hepatitis A or E are common or where there is
poor sanitation.

Health conditions and procedures that increase the risk of hepatitis include
hemophilia or other disorders of blood clotting, kidney
disease requiring hemodialysis, receiving a blood
transfusion, receiving multiple transfusions of blood or
blood products, receiving a solid-organ transplant, persistent elevation of
certain liver function tests (found in people with undiagnosed liver problems),
and having an STD.

Screening and Diagnosis

The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms but who may be at high risk for certain diseases or conditions.

The Centers
for Disease Control and Prevention recommends screening for
hepatitis in pregnant women at their first prenatal visit and in people at high
risk for the disease. Screening for hepatitis is a method of finding out if a
person has hepatitis before he or she begins to have symptoms. Screening involves
assessing the person’s medical history and behaviors that may increase or decrease
the risk of hepatitis and undergoing tests to identify early signs of hepatitis,
including blood tests for hepatitis antigens and antibodies.

Treatment and Therapy

Treatment for hepatitis involves behavioral changes, medications, and alternative and complementary therapies. There are no surgical procedures to treat viral hepatitis.

Prevention and Outcomes

Hepatitis is a contagious disease that is preventable. Basic preventive principles include avoiding contact with other people’s blood or bodily fluids and practicing good sanitation. In addition, vaccines are available to prevent some types of hepatitis. They are given to people at high risk of contracting the disease.

Infected blood and bodily fluids can spread hepatitis. To avoid contact, one should avoid sharing drug needles, avoid sex with partners who have hepatitis or other STDs, practice safer sex (such as using latex condoms) or abstain from sex, limit one’s number of sexual partners, avoid sharing personal hygiene products (such as toothbrushes and razors), and avoid handling items that may be contaminated with hepatitis-infected blood. Also, one should donate his or her own blood before elective surgery so it can be used if a blood transfusion is necessary.

Health care professionals should always follow routine barrier precautions and safely handle needles and other sharp instruments and dispose of them properly. One should wear gloves when touching or cleaning up bodily fluids on personal items, such as bandages, tampons, sanitary pads, diapers, and linens and towels. One should cover open cuts or wounds and use only sterile needles for drug injections, blood draws, ear piercing, and tattooing.

Women who are pregnant should have a blood test for hepatitis B. Infants born to women with hepatitis B should be treated within twelve hours of birth.

When traveling to countries where the risk of hepatitis is higher, one should follow proper precautions, such as drinking bottled water only, avoiding ice cubes, and avoiding certain foods, such as shellfish, unpasteurized milk products, and fresh fruits and vegetables. Good sanitation too can prevent the transmission of some forms of hepatitis.

Vaccines are available for hepatitis A and B. Hepatitis A vaccine is recommended for all children age twelve months and older. The following people also should be vaccinated: persons traveling to areas where hepatitis A is prevalent, persons who engage in anal sex, drug users, people with chronic liver disease or blood-clotting disorders (such as hemophilia), children who live in areas where hepatitis A is prevalent, and people who will have close contact with an adopted child from a medium- or high-risk area. Hepatitis B vaccine is recommended for all children and for adults who are at risk.

An immunoglobulin injection, if recommended, is available for hepatitis A and B. Immunoglobulin contains antibodies that help provide protection. This shot is usually given before exposure to the virus or as soon as possible after exposure to the virus.

Bibliography

Boyer, Thomas D., Teresa L. Wright, and Michael P. Manns, eds. Zakim and Boyer’s Hepatology: A Textbook of Liver Disease. 5th ed. Philadelphia: Saunders/Elsevier, 2006. A thorough compendium on most aspects of liver disease. The section on hepatitis contains a complete clinical description of the disease and of the biology of the hepatitis viruses.

Feldman, Mark, Lawrence S. Friedman, and Lawrence J. Brandt, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. New ed. 2 vols. Philadelphia: Saunders/Elsevier, 2010. A clinical text that covers basic liver anatomy, disorders and diseases of the liver (including hepatitis), and related topics.

Humes, H. David, et al., eds. Kelley’s Textbook of Internal Medicine. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2000. A medical textbook that contains an extensive section on liver diseases, including a concise description of viral hepatitis. The discussion of hepatitis viruses is thorough and clear.

Plotkin, Stanley A., and Walter A. Orenstein, eds. Vaccines. 5th ed. Philadelphia: Saunders/Elsevier, 2008. An excellent description of the role of vaccines in the prevention of disease. The book begins with a history of immunization practices. Chapters deal with specific diseases and the role and history of vaccine production in its prevention.

Specter, Steven, ed. Viral Hepatitis: Diagnosis, Therapy, and Prevention. Totowa, N.J.: Humana Press, 1999. This clearly written and readable review of viral hepatitis provides useful information for family physicians and general readers. Each chapter is divided into sections for quick access to desired information.