Public Enemy Number One - Hepatitis

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The hepatitis A virus (HAV) is by far the most prevalent form of the disease. The Centers for Disease Control and Prevention (CDC) estimates that approximately 143,000 cases of HAV are reported in the United States annually, with about 1.4 million cases worldwide. The virus is most often transferred via the fecal-oral route (spread by ingesting something that has been tainted with the stool of a person or animal with hepatitis A). Areas with poor hygienic practices and substandard sewage disposal systems, such as Africa, Asia (except Japan), South America, Eastern Europe, and the Middle East, show high infection rates.

HAV is spread through close personal contact with a carrier, use of street drugs, ingestion of contaminated foods, raw or undercooked shell-fish from contaminated waters, or tainted blood transfusions.

Three of every four adults who contract HAV develop symptoms over a period of several days. Yellow eyes, darkening of the urine, and nausea are common. Children younger than age two often do not show symptoms, but they can still spread the disease to other children and adults if sanitary precautions are not taken. Unlike other forms of hepatitis, HAV does not cause any long-term liver damage and usually does not cause death. Because of this, doctors often suggest bed rest and prescribe medication to alleviate the symptoms.

As a rule, hepatitis epidemics are not common in the United States, but there are exceptions.

In 1997, a San Diego packaging company shipped containers of frozen strawberries to schools in six states (Michigan, Arizona, California, Georgia, Iowa, and Tennessee) to be part of a federal school lunch program. Some of the strawberries were also served at a Special Olympics event attended by about 1400 people in Grand Rapids, Michigan. Officials say that as many as 9,000 children in Los Angeles could have been exposed to the virus, but so far the only significant cases of hepatitis A were reported in Michigan, where approximately 150 students and teachers were infected.

Hepatitis B
In the early 1950's, Dr. Baruch Blumberg, curious about inherited traits disease susceptibility, and his team traveled the world, collecting different blood samples from native populations in remote areas. They did not have the technology to analyze these samples sufficiently, however, and turned their attentions toward hemophiliac patients. Dr. Blumberg surmised that hemophiliacs subjected to various blood transfusions would be exposed to diseases inherited from their donors. As a result, the patient's immune system would produce antibodies to attack the foreign antigens. Using the hemophiliac's blood samples to compare antibodies and antigens, Dr. Blumberg observed an unusual match between a New York patient's antibody and an Australian aborigine's antigen. A series of research and clinical observations led to the confirmation in 1967 that the Australian antigen caused hepatitis B. Dr. Blumberg won the Nobel Prize for his discovery.

Chronic hepatitis B virus (HBV) is far more dangerous than HAV. Some people infected with HBV never fully recover. About 1.25 million Americans currently suffer from chronic HBV, but not all of them show symptoms or are even aware that they carry the disease. Symptoms include jaundice, fatigue, abdominal and joint pain, nausea, and loss of appetite.

HBV can be spread through sexual contact, shared toothbrushes or razors, street drugs, contact with infected blood, or perinatally. It cannot be spread, however, through casual contact, kissing, sneezing, coughing, or food and water.

Hepatitis C
Hepatitis C virus (HCV) enters through the bloodstream, where it goes into the liver and begins to reproduce. The body attacks the infected cells, which inflames the liver. Some adults infected with hepatitis C suddenly begin to feel flu-like symptoms that do not go away completely; in others, the onset of the illness may appear gradually over a long period of time. Infants and children often show no signs of the illness at all.

Symptoms differ among patients. Fatigue, low-grade fever, slight sore throat, nausea, and stiff joints are common. Many people feel a pain in the right side, in the area of the liver; the urine becomes dark brown, and feces may become pale. Symptoms tend to come and go over time.

HCV is easily spread through contact with blood, such as minor cuts, nosebleeds, and even menstrual blood. People at the greatest risk of contracting HCV are those who received a blood transfusion before 1992, hemodialysis patients, health-care workers who handle blood, patients with body piercings and tattoos, and needle drug users.

Nearly four million Americans (2 percent of the adult population) have tested positive for HCV, considered the most serious form of hepatitis. Almost 85 percent of HCV infections become chronic. If HCV is left untreated, the chances of cirrhosis, liver failure, and liver cancer increase dramatically. HCV-induced liver failure is the leading cause of liver transplants in the United States. Without further advances in HCV research, the virus is expected to kill 30,000 Americans each year-more than HIV and acquired immunodeficiency syndrome (AIDS).

Treatment options are available, although the therapy is often long, unpleasant, and expensive and does not always work. The most effective therapy consists of three injections of interferon each week and ribavirin capsules twice daily for an average of 48 weeks. The virus is eliminated from the bloodstream and liver function returns to normal in only about 40 percent of treated patients. Side effects appear in 60 percent of patients and include fatigue, fever, muscle aches, anemia, and depression. The best candidates for HCV therapy are patients between ages 18 and 60 who have had abnormal liver function tests and positive HCV tests for at least six months.

Hepatitis D
In 1977, Dr. Mario Rizzetto and his associates in Italy discovered a new antigen that they named “delta,” which was slightly different than the hepatitis B antigen. Through tireless research and experiments, Dr. Rizzetto hypothesized that this was a new and unique virus, and it was named hepatitis D virus (HDV).

HDV is transmitted by blood. It is sometimes contracted at the same time as hepatitis B (co-infection), or infection may occur after a person is infected with HBV (superinfection). Fewer than 5 percent of co-infection cases become chronic; HDV seems to suppress HBV replication and does not have the ability to replicate itself. More than half of all patients with superinfection develop a severe form of acute hepatitis, and 90 percent of those patients become chronic carriers. This is because HDV attacks the liver cells that have already been damaged by HBV, providing and excellent environment for HDV replication.

HDV is considered the most severe of the seven types. It causes more fatalities and cirrhoses, even in children. It is not common to the United States and is most frequent and lethal in the Amazonian and Mediterranean basins. HDV is also prevalent in North Africa, the South Pacific, and certain parts of Asia. Approximately 15 million people worldwide are infected. Symptoms are typical of a hepatitis infection and include jaundice, dark urine, abdominal pain and, rarely, confusion, bruising, and bleeding.

Hepatitis E
Hepatitis E virus (HEV) is similar to HAV, in that it is spread mainly through contaminated food and water. Because of this, it is prevalent in developing and Third World countries. HEV is widespread in India, Asia, Africa, and Central America. Acute HEV does not lead to chronic HEV, but there is a 1 percent to 2 percent chance that sudden, severe liver damage will occur, necessitating transplantation.

The symptoms are similar to those of HBV, in that the patient tends to suffer from flu-like aches and pains, and jaundice. Testing for the disease is reserved for travelers returning from a country where HEV is endemic. Immune globulin prepared for HEV has not been shown to be an effective vaccine. It is suggested that travelers avoid potentially contaminated food and water.

Hepatitis F
Whether hepatitis F virus (HFV) exists is not clear. In 1994, reports of viral particles in stool samples of post-transfusion, non-A, non-B, non-C, non-E hepatitis cases piqued the curiosity of researchers. It is widely believed that the assumed viral findings were incidental and not significant.

Hepatitis G
Not much is known about hepatitis G virus (HGV). It is “clinically silent,” almost always chronic, and more common than hepatitis C. Dr. Harvey J. Alter, of the National Institutes of Heath in Bethesda, Maryland, said, “One cannot conclude that HGV causes acute or chronic hepatitis. HGV accounts for, at best, a minority of all cases of unexplained liver disease.”

Dialysis patients may be at a higher risk of contracting HGV. A study of 519 Japanese kidney dialysis patients showed that 3 percent were infected with HGV, compared to fewer than 1 percent of healthy blood donors. The virus may also be spread through intravenous drug use.

Development of cirrhosis is relatively low, but more studies must be done to understand thoroughly the seventh form of hepatitis.

Tips for Preventing Hepatitis B
Do:
Wash your hands after touching your blood or other bodily fluids.
Throw away personal items, such as tissues, menstrual pads, and tampons in a paper bag.
Cover all open cuts and sores.
See your doctor every 6 months to one year to be checked for liver abnormalities and to receive ongoing education about hepatitis B.
Do Not:
Share chewing gum, toothbrushes, razors, washcloths, or anything that may have come in contacts with your blood or body fluids.
Pre-chew food for babies.
Donate blood, plasma, body organs, tissue, or sperm.
Share syringes and needles.
Canadian Outbreak of Hepatitis B
In May 1999, several large boatloads of Chinese migrant workers began to arrive in British Columbia, Canada. According to the Canadian Medical Association Journal, 34 percent of the people who came in on the fourth boat were found to be carriers of chronic hepatitis B, which can leave a person constantly exhausted and can lead to cirrhosis of the liver.

“By the time the fourth boatload arrived in September, screenings for hepatitis B and syphilis had been introduced,” according to the Journal. It is unclear how many people from the first three boats were infected with the disease.

Although the rate of hepatitis B infection is only 1 percent in British Columbia, this is a high figure by Canadian standards. Dr. Mel Kajden, of the British Columbia Centre for Disease Control, said that “it's an issue, but it is not a catastrophic issue.”

A total of 599 men, women, and children traveled aboard rusting fishing trawlers to British Columbia from the Fujian province of China; most of them claimed refugee status in Canada. While determining the legitimacy of the workers' refugee claims, Canadian immigration officials released them into the community, where 80 immediately disappeared.

Immigration Department spokesman Jim Redmond acknowledged the high rate of hepatitis B infection among the workers but said that blood tests were not used until the third boatload arrived.

The workers, at first sight, were described as extremely malnourished. The smugglers were reportedly well nourished and in extremely good shape.

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