ABC of hepatitis

[Doc Alan]

This can be a confusing topic, so for interested members here’s a short description :-


Hepatitis ( inflamed liver ) has several causes – usually a viral infection or excess alcohol. It may be more or less serious, depending on the cause(s) and each individual. It CAN cause jaundice ( yellow skin and eyes ), or symptoms like flu, feeling generally unwell, with fever, but often may have no symptoms, so people don’t know they have it.


• Hepatitis A - due to a virus ( HAV ), common where sanitation and sewage disposal are poor, spread by “ faecal – oral “ route. There is a vaccine, either for HAV alone ( recommended for travel to the Philippines ) or combined with hepatitis B / typhoid vaccine. Almost always there is complete recovery ( sometimes taking up to 6 months ).


• Hepatitis B – also due to a virus ( HBV ). Although most healthy adults infected CAN fight off the virus and fully recover, many infants and children infected DO progress eventually to serious chronic disease ( liver scarring / cirrhosis and possible cancer ).

HBV vaccine is very effective and safe – it should be given routinely ( starting as soon as possible after birth ) in countries like the Philippines ( around 1/10 adults are HBV “ carriers “ ) but not the UK ( only 1/400 “ carriers “ ; vaccinating all UK newborns might cost over £ 21 million to prevent a few hundred cases ).

Blood tests help diagnose and monitor HBV infection. There is no specific treatment. Drugs such as interferon and antivirals are expensive ; liver transplants are possible for a minority.

HBV is acquired by direct ( blood-blood ) contact, “ unprotected “ sex, or unsafe injection practices / blood transfusions. It may be spread from mother to baby, and in early childhood by close contact ( HBV can survive for days outside the body ). It is up to 100 X as infective as HIV ( AIDS virus ).



• Hepatitis C – due to another virus ( HCV ). Similar transmission ( but 10 X less infective ), with serious complications, to HBV. Donated UK blood is screened for HCV and HBV. Only ¼ can “ fight off “ the infection ; most do progress. There is antiviral drug treatment, but no vaccine.



• Hepatitis D - less common, needs HBV to survive in the body.



• Hepatitis E – also less common, similar to HAV.


• Hepatitis G – rare, may follow transfusion and cause liver failure.



• Alcoholic hepatitis – possible in ¼ heavy drinkers and detectable by blood test ( perhaps also liver sample / “ biopsy “ ). It’s a warning to cut down on alcohol consumption as continued heavy drinking may cause progression to cirrhosis or even cancer.


• Non-alcoholic hepatitis – similar features to alcoholic hepatitis but in NON-drinkers ( some diabetics or obese people ) – may progress to cirrhosis.



• Autoimmune hepatitis – very uncommon, where the person’s own white blood cells attack the liver – may result in cirrhosis and need transplantation.



• Other causes – various drugs, poisons, part of other infections like leptospirosis and malaria.



As always, this is accurate to the best of my knowledge and if members read this they may well know more than most politicians and newspaper editors !



http://www.nhs.uk/conditions/Hepatit...roduction.aspx

[cheekee]

Very informative.

I believe from a recent discussion I had with a consultant microbiologist, The risk of getting HIV from a needlestick injury at work is around 1.2% with the risk of getting hepatitis C being a little higher at around 1.8-2.5%.

He told me that some patients who contracted hepatitis C will clear the Virus with no trace. I believe some genotypes of the virus respond very well to treatment if not cleared.

I had my hepatitis A vaccination before I went to the Philippines in June and its worth noting if you go back and have a booster after six months, that you are protected for ten years.

[Doc Alan]

Thank you for your response, Cheekee ! The relative risks of HBV ; HBC ; HIV ( AIDS ) have been estimated at 30 ; 3 ; 0.3.


A booster dose of HAV vaccine may well last up to 20 years, following which a second booster can be given to those who continue to be at risk.


HBV is of particular importance because of its relatively high infectivity, and frequency in the Philippines. There was another thread on HBV six months ago (
http://filipinaroses.com/showthread....-HBV-infection ).



For members who might wonder WHY HBV varies so much in frequency between countries, the discoverer of HBV, which ultimately resulted in a vaccine ( 1982 ) was Baruch Bloomberg.



He was fascinated by inherited variations in illnesses, and collected thousands of blood samples from around the world. While investigating " yellow jaundice " he discovered a protein in the blood of an Australian aborigine. He called it " Australia antigen " – and later realised this was the surface antigen ( immune response trigger ) for Hepatitis B.



We owe Bloomberg a huge debt of gratitude for work which resulted in the first ever " cancer vaccine " – preventing not only liver cancer, but also the more common hepatitis, resulting from HB infection .



When I worked at Glasgow University, he visited us and we " took " him up Ben Lomond ( at his request ! ). Luckily he survived the climb , and received a Nobel Prize in 1976 .


Blumberg is in the foreground and I’m behind him, wearing shades !

[grahamw48]

Fascinating stuff.

I haven't had any jabs since my original trip to the Phils more than 23 years ago (when I had all of the recommended ones).

Maybe I should review the situation.

[Rosie1958]

Thanks for the very interesting read Doc Alan, I always keep my inoculations up to date, Hep A included

[Doc Alan]

Vaccination is not compulsory in the UK or Philippines – although there is a good case for pre-entry screening of immigrants for hepatitis B where this is common, just as already exists for TB ; and encouraging universal vaccination from birth in such countries.


In the Philippines HB vaccine should be given at birth ( first dose ) ; around 1 – 2 months old ( second dose ) ; and around 6- 18 months old ( third dose ). A course is only recommended in the UK for neonates at risk ( with HBV positive mothers ).


Also in the Philippines HA vaccine should be given at 12 months ( first dose ) and around 18 – 24 months ( second dose ) ; but is not part of the usual UK vaccination schedule.


The purpose of this thread is to inform, to help members make their own value judgements about the various types of hepatitis.

Vaccination for HA is, however, usually recommended for travellers to the Philippines. It’s allowable ( free ) on the NHS.

Vaccination for HB is not normally recommended for travellers, except for healthcare workers and those likely to share needles for drugs and / or have unprotected sex with multiple partners. There is a charge for this vaccine ( and also the blood test 2 months afterwards to confirm a positive response ).


It might come as a surprise to know that primary liver cancer is relatively common in the Philippines, and rare in the UK – because of the differing frequency of HBV in the two countries. Of course there are other causes, such as Hepatitis C virus, and alcohol. Whatever the cause, most arise in livers which are scarred by cirrhosis. By far the commonest liver cancer is secondary spread ( often from lung, breast, or gut ). As the outlook is not good for most liver cancers, prevention is the best hope. HBV vaccination could prevent many of the primary cancers in this part of the body.

[Michael Parnham]

This can be a confusing topic, so for interested members here’s a short description :-


Hepatitis ( inflamed liver ) has several causes – usually a viral infection or excess alcohol. It may be more or less serious, depending on the cause(s) and each individual. It CAN cause jaundice ( yellow skin and eyes ), or symptoms like flu, feeling generally unwell, with fever, but often may have no symptoms, so people don’t know they have it.


• Hepatitis A - due to a virus ( HAV ), common where sanitation and sewage disposal are poor, spread by “ faecal – oral “ route. There is a vaccine, either for HAV alone ( recommended for travel to the Philippines ) or combined with hepatitis B / typhoid vaccine. Almost always there is complete recovery ( sometimes taking up to 6 months ).


• Hepatitis B – also due to a virus ( HBV ). Although most healthy adults infected CAN fight off the virus and fully recover, many infants and children infected DO progress eventually to serious chronic disease ( liver scarring / cirrhosis and possible cancer ).

HBV vaccine is very effective and safe – it should be given routinely ( starting as soon as possible after birth ) in countries like the Philippines ( around 1/10 adults are HBV “ carriers “ ) but not the UK ( only 1/400 “ carriers “ ; vaccinating all UK newborns might cost over £ 21 million to prevent a few hundred cases ).

Blood tests help diagnose and monitor HBV infection. There is no specific treatment. Drugs such as interferon and antivirals are expensive ; liver transplants are possible for a minority.

HBV is acquired by direct ( blood-blood ) contact, “ unprotected “ sex, or unsafe injection practices / blood transfusions. It may be spread from mother to baby, and in early childhood by close contact ( HBV can survive for days outside the body ). It is up to 100 X as infective as HIV ( AIDS virus ).



• Hepatitis C – due to another virus ( HCV ). Similar transmission ( but 10 X less infective ), with serious complications, to HBV. Donated UK blood is screened for HCV and HBV. Only ¼ can “ fight off “ the infection ; most do progress. There is antiviral drug treatment, but no vaccine.



• Hepatitis D - less common, needs HBV to survive in the body.



• Hepatitis E – also less common, similar to HAV.


• Hepatitis G – rare, may follow transfusion and cause liver failure.



• Alcoholic hepatitis – possible in ¼ heavy drinkers and detectable by blood test ( perhaps also liver sample / “ biopsy “ ). It’s a warning to cut down on alcohol consumption as continued heavy drinking may cause progression to cirrhosis or even cancer.


• Non-alcoholic hepatitis – similar features to alcoholic hepatitis but in NON-drinkers ( some diabetics or obese people ) – may progress to cirrhosis.



• Autoimmune hepatitis – very uncommon, where the person’s own white blood cells attack the liver – may result in cirrhosis and need transplantation.



• Other causes – various drugs, poisons, part of other infections like leptospirosis and malaria.



As always, this is accurate to the best of my knowledge and if members read this they may well know more than most politicians and newspaper editors !



http://www.nhs.uk/conditions/Hepatit...roduction.aspx

Another good one Alan!

[purple]

Very informative... makes me think to get jabs as precaution.