World Hepatitis Day

June 29, 2017
J. Davis Allan, MD
J. Davis Allan, MD

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July 28 each year is designated “World Hepatitis Day”.  The purpose of this to raise awareness and stimulate changes in behavior, both political and personal, to reduce the worldwide burden of viral hepatitis.

Hepatitis refers to any inflammation in the liver.  This inflammation can be caused by drugs, toxins (most typically alcohol) as well as infectious agents particularly viruses.  A number of viruses can affect the liver although their primary disease is manifested elsewhere such as infectious mononucleosis.  Of the viruses that primarily target the liver hepatitis A, B and C are the most common.  Hepatitis A is often referred to as “infectious hepatitis” because it is transmittable by contaminated food and water and is a very common cause of infections in travelers, particularly to underdeveloped countries.  While you can become very ill with Hepatitis A, it only rarely causes death and does not lead to chronic liver disease.  Hepatitis B and Hepatitis C are both transmitted by exposure to blood and body fluid as in intravenous drug use or sexual exposure but not through food and water.  There are highly effective vaccines to prevent both hepatitis A and B.  Hepatitis B vaccination has been part of universal childhood vaccination in the United States since approximately 1991.  Hepatitis A vaccine is also frequently administered now as part of childhood vaccination in the United States.  As yet there is no vaccination for the prevention of Hepatitis C but this is an area of intense research but problematic because of the large number of strain variations that exist in Hepatitis C.  Both H There are highly effective vaccines to prevent both hepatitis A and B.  Hepatitis B vaccination has been part of universal childhood vaccination in the United States since approximately 1991.  Hepatitis A vaccine is also frequently administered now as part of childhood vaccination in the United States.  As yet there is no vaccination for the prevention of Hepatitis C but this is an area of intense research but problematic because of the large number of stain variations that exist in Hepatitis C.  Both Hepatitis B and C frequently lead to chronic hepatitis and chronic liver disease.  It is this aspect and the burden of chronic hepatitis that is the focus of World Hepatitis Day.

It is estimated that worldwide there are approximately 350-400 million people chronically infected with Hepatitis B and 185 million with chronic Hepatitis C.  In the United States, estimates are .8-2.2 million for Hepatitis B and 2.7-3.9 million for Hepatitis C.  The remainder of this article will focus on Hepatitis C.  As noted, hepatitis C can be transmitted by exposure to infected blood or body fluids.  While it may be transmitted sexually, it is primarily transmitted in the United States by IV drug abuse.  After an acute infection which is usually without or with minimal symptoms often goes unnoticed and undiagnosed.  Acute infection with Hepatitis C will result in chronic ongoing infection 75% of the time.  Chronic infection with Hepatitis C often has no symptoms or findings for many years but eventually can lead to the development of cirrhosis of the liver, metabolic abnormalities and hepatocellular carcinoma (liver cancer).  Chronic Hepatitis C infection that results in cirrhosis is now one of the most common reasons for liver transplantation in the United States.  Approximately 1/2 of individuals infected with hepatitis C are not aware that they are infected.  For this reason, the CDC (Centers for Disease Control) and other agencies recommend that all individuals born between 1945 and 1965 be tested one time to make sure they are not infected.  This recommendation is based on the fact that at present this age group has the highest incidence of undiagnosed Hepatitis C infection.  Individuals who may perceive themselves to be at increased risks such as current or former IV drug users, hemodialysis patients, persons who received blood transfusion, clotting factors or organ transplantation before 1991 should consider one-time testing if this has not already been done.  There are now highly effective therapies for hepatitis C that are frequently curative.  You should discuss with your physician whether it is appropriate for you to be screened for hepatitis C.