Hepatitis is a potentially fatal disease that affects 1 in 12 people worldwide, often without obvious symptoms. As one million people die each year from chronic hepatitis infection, viral hepatitis is among the top 10 infectious disease killers, according to the CDC.
The World Hepatitis Alliance and the World Health Organization (WHO) recognize July 28, 2012 as World Hepatitis Day in honor of Dr. Baruch Blumberg who won the 1976 Nobel Prize in Medicine for his discovery of the hepatitis B virus. Launched in 2008, World Hepatitis Day focuses on raising awareness of the different types of hepatitis, including their cause, treatment and prevention.
What is hepatitis?
Caused by a viral infection, hepatitis is an inflammation of the liver. Scientists have identified five unique hepatitis viruses which are referred to by type - A, B, C, D, and E - each causing serious liver disease. According to the World Health Organization, hepatitis types B and C “lead to chronic disease in hundreds of millions of people [and] are the most common cause of liver cirrhosis and cancer.”
People experiencing an acute hepatitis infection may have limited or no symptoms. Or, they may have symptoms such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, fever, loss of appetite, nausea, vomiting and abdominal pain.
Hepatitis A and E:
The hepatitis A virus is primarily contracted by eating food or drinking water which is contaminated with the feces of an infected person. It is a common food-born infection associated with inadequate sanitation, poor hygiene, and lack of safe water. An estimated 1.4 million cases of hepatitis A occur each year worldwide. The typical incubation period following exposure to the hepatitis A virus is 14-28 days. While hepatitis A does not cause chronic liver disease and is rarely fatal, it may take weeks or months for persons to recover enough from the illness to return to normal daily activities.
The hepatitis E virus is also spread through contaminated water. Every year, 20 million cases of hepatitis E infection occur worldwide with 70,000 related deaths. The incubation period for the virus ranges from 3 to 8 weeks and an infection typically resolves within 4 to 6 weeks. Children who become infected are mostly asymptomatic or have very mild symptoms, but without jaundice. Symptomatic infections are most common in young adults aged 15 to 40 years. Very rarely, hepatitis E can cause acute liver failure and death. Cases of chronic hepatitis E infection or reactivated infection have been reported in persons who are immunosuppressed.
Hepatitis B and D:
The hepatitis B virus is transmitted through contact with infected blood, blood products, or body fluids. Hepatitis B is the most serious type of viral hepatitis infection. It can cause chronic liver disease which increases the risk of death from cirrhosis of the liver and liver cancer. The hepatitis B virus can survive outside the body for over a week and is 50 to 100 times more infectious than HIV. The average incubation period is 90 days but can vary from 30 to 180 days.
Two billion people worldwide have been infected with hepatitis B causing about 600,000 deaths each year. During the acute infection phase, symptoms may be non-existent or they may last several weeks. High rates of chronic infection are found in the Amazon and southern parts of eastern and central Europe. About 8-10% of the adult population in Asia has a chronic hepatitis B infection as does 2-5% of the population in the Middle East and Indian subcontinent. However, less than 1% of the population in North American and Western Europe has chronic hepatitis B infection.
Hepatitis D, which can be chronic or acute, occurs only in persons who are infected with hepatitis B. It is uncommon in the United States. The hepatitis D virus is transmitted through contact with infectious blood. Vaccination for hepatitis B protects against contracting hepatitis D.
The hepatitis C virus is also transmitted through contact with infected blood. While hepatitis C can be a mild illness lasting just a few weeks, it can also be a lifelong condition which leads to cirrhosis of the liver or liver cancer. While 3–4 million people are infected with the hepatitis C virus each year, approximately 150 million people have chronic hepatitis C infection. Although hepatitis C is curable with antiviral medications, more than 350,000 people die from hepatitis C-related liver diseases every year. High rates of chronic infection are seen in the populations of Egypt (22%), Pakistan (4.8%), and China (3.2%). The incubation period for hepatitis C ranges from 2 weeks to 6 months. Hepatitis C is the underlying cause of cancer in 25% of liver cancer patients worldwide.
Vaccination and Treatment:
Effective vaccinations against hepatitis A and B are widely available. The hepatitis A vaccine can still be effective is given within two weeks after exposure to the virus. The hepatitis B vaccine is now given as part of routine childhood immunizations and unvaccinated adults who are at risk of contracting hepatitis B should be vaccinated. The first vaccine against hepatitis E was registered in China last year but it is not available globally. Vaccines against hepatitis C and D are not yet developed.
There is no specific treatment for hepatitis A, nor acute hepatitis B. Prevention is the most effective approach against the disease. Recovery may be slow and take several weeks or months. Self care is aimed at maintaining comfort and adequate nutritional balance, including the replacement of fluids depleted from vomiting and diarrhea.
Some people with chronic hepatitis B can be treated with drugs, including interferon and antiviral agents, however treatment can be very costly (thousands of dollars per year) and prohibitive. Combination antiviral and interferon therapy (not widely available globally and often not well tolerated) is considered the “standard” treatment for hepatitis C. But sometimes hepatitis C does not require treatment at all. The 6 genotypes of hepatitis C virus each respond differently to therapy, so it is important to test carefully before choosing treatment.
As many people contract hepatitis and do not know it, the value of testing is enormous. Get tested...for yourself and for those you love.
World Hepatitis Day, World Hepatitis Alliance, July 2012
Hepatitis A Fact Sheet No.328, World Health Organization, updated July 2012
Hepatitis B Fact Sheet No.204, World Health Organization, updated July 2012
Hepatitis C Fact Sheet No.164, World Health Organization, updated July 2012
Hepatitis E Fact Sheet No.280, World Health Organization, updated July 2012
Hepatitis D, Centers for Disease Control and Prevention, updated November 2009
World Hepatitis Day, Centers for Disease Control and Prevention, updated July 2012