Hepatitis: an overview
Hepatitis (inflammation of the liver) is an illness that can cause permanent and life-threatening damage.
Why your liver is important
The liver is the largest organ in the body, weighing between 1.5 and 2 kg. It is situated in the upper right side of the abdomen where it is tucked under the ribs. It is a sort of miniature chemical processing laboratory.
One of the liver's chief roles is to get rid of poisonous waste products contained in the food we eat. After it has been digested in the intestine, food is absorbed into the bloodstream and taken directly to the liver via the portal vein. The liver gets rid of the unwanted products of digestion and modifies others, before returning the blood to the general circulation.
In hepatitis these vital activities are interrupted, producing symptoms that can range from mild to very serious.
Types of hepatitis
There are several forms of hepatitis, both infectious, such as hepatitis A, B and C, and non-infectious, such as autoimmune hepatitis, alcoholic hepatitis, hepatatis associated with iron overload and the increasingly common hepatitis caused by fatty infiltration of the liver. This article focuses on infectious hepatitis.
Hepatitis A is usually the mildest form of hepatitis. It is due to a virus that gets into the bowel and then into the liver. It is spread from person to person by direct contact and through contaminated food, eating utensils and the like.
People with hepatitis A may have a mild flu-like illness with loss of appetite and nausea followed by the appearance of jaundice — a yellow discoloration of the skin and whites of the eyes. The urine may be very dark in colour. A full recovery can be expected.
Protection from hepatitis A is now available through vaccination. A single injection is assumed to give immunity within 2 weeks. A booster 6 months later can give protection for at least 5 or 6 years. Hepatitis A vaccination should be considered by people who may come into close contact with those with the infection and by travellers to parts of the world where hygiene standards are poor. Hepatitis A can be an extremely severe, even fatal infection for people who already have chronic liver disease, so if you are in this group you must consider vaccination.
Hepatitis B is a more serious illness. It is common in many parts of the world. The virus that causes this form of hepatitis is found in all body fluids, including blood, breast milk, saliva, semen, vaginal secretions and sweat. It spreads very easily and can be caught through direct contact with any of the body fluids of an infected person. Sexual intercourse and needle sharing with a carrier are 2 obviously risky activities but other seemingly harmless things such as sharing a razor or toothbrush can also spread the infection. Also at risk are hospital workers and those who play contact sports.
Many people with hepatitis B show no obvious signs of the illness. Most infected adults will recover, but in more than 10 per cent the virus will persist in their bodies. These people become permanent 'carriers' of the infection and can spread the disease for the rest of their lives. Those infected in childhood have a higher chance of developing chronic (long-term) infection.
The Australian National Immunisation Program Schedule now recommends vaccination for all children at birth, followed by 3 doses at 2, 4 and 6 to 12 months, with a catch-up dose at 10 to 13 years for those children who have missed being vaccinated.
For adults and children who have not been vaccinated as part of the schedule, a simple course of 3 injections, the second and third given one and 6 months after the first, will give protection for several years. The vaccine is readily available and relatively inexpensive. Combination vaccines offering protection against hepatitis A and B are also available.
Hepatitis C is becoming more common and represents a major problem for the future. In some ways it is similar to hepatitis B, but is thought to be harder to catch. There is lower transmission of the virus from body fluids other than blood, meaning that it is rarely caught from sexual contact, and the risk of mother to baby transmission is low.
Often there are no symptoms. Most of those infected with hepatitis C do become carriers. While the rate of new hepatitis C infection in Australia is falling, the prevalence in some groups, such as intravenous drug users, remains very high. Some people have acquired the infection from blood transfusions given before the virus was known about. At present there is no vaccine to prevent this form of hepatitis.
The B and C forms of hepatitis can both produce a chronic low-grade infection of the liver. In some people this can after many years lead to chronic scarring of the organ (cirrhosis) and, ultimately, liver failure. In these cases a liver transplant may be considered. In these people liver cancers may also develop. There are now effective antiviral treatments against hepatitis B and C which can eliminate or greatly slow down the infection in many carriers. Newer hepatitis C treatments available on the PBS have a cure rate of 95%.
Hepatitis can be a very serious illness. However, most cases are preventable by careful personal habits and avoiding dangerous practices such as needle sharing and casual sex without condoms. Vaccination against hepatitis B and hepatitis A will protect most people at risk of these infections. Currently there is no vaccine against hepatitis C.
2. Hepatitis NSW. Hep C treatment. Updated Aug 2018.
3. CDC Centers for Disease Control and Prevention. Viral hepatitis [Website]. [Updated Jul 2018] https://www.cdc.gov/hepatitis/index.htm