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There are five strains of viral hepatitis – A, B, C, D & E. If you fish around on the internet, you’ll also see mention of F (unsubstantiated, may not exist at all) and G (aka GBV-C), still under study. We’ll stick with forms A-E here with a brief description of each form followed by infection symptoms to watch for and a summary of risk factors for exposure. So, for the first time, but certainly not the last, remember your ABC’s and go get tested!
All forms of viral hepatitis can produce acute illness. BE VERY CAREFUL! Both Hepatitis B (HBV) and C (HCV) can go from exposure to chronic illness without EVER going through an acute phase! Roughly 5-10% of adults exposed to HBV will go on to have a chronic infection. Approximately 60-75% of adults exposed to HCV will go on to develop a chronic infection. Many will not go through an acute phase and/or their symptoms while acute are often mild to barely noticeable. This is why HBV and HCV are so scary and why you need to specifically test for them. I hear from people almost every day who tell me, “I was just diagnosed with Hep C! I don’t remember ever being sick. I’ve been trying to figure this out and I think maybe I’ve had it for….”, and then they give me a number,“….20 (or 30, or 40)…..years! How could I have this and not know it? Why hasn’t anyone ever tested me for this?!?”.
Hepatitis A (HAV) – (seven genotypes – four human, three primate) primarily spread through contaminated food or water (or other poorly sanitized items). Does not go on to become a chronic viral infection, but can still make you really sick. The very young, very old and others who are already health compromised may require hospitalization. Vaccine available (a must for anyone already infected with HBV or HCV). Very hardy – can live for weeks outside the body.
Hepatitis B (HBV) – (eight genotypes, A-H, and subtypes) spread through contact with contaminated blood, sex, and other body fluids and transmission from mother to child (known as vertical transmission) and even relatively casual household contact. Endemic in many parts of the world. Vaccine available. Treatment available, no cure. Chronic illness determined through antibody/antigen testing followed by a viral load test (if needed). Can survive for up to a week outside the body.
Hepatitis C (HVC) – (six genotypes, 1-6, and subtypes) spread through contact with contaminated blood, rarely through sex and rarely from mother to child, not spread through breastfeeding, not spread through casual contact. Not fully removed from the blood supply until 1992. NO VACCINE available. Treatment available, cure rates increasing. Chronic illness determined through an antibody test followed by a viral load test (if needed). Can survive for 3-5 days outside the body.
Hepatitis D (HDV) – HBV dependent (cannot survive without the presence of HBV) – you never have HDV by itself. If you have D, you definitely already have B. Spread through contaminated blood, sex. No vaccine.
Hepatitis E (HEV) – (four genotypes) – spread through contaminated food and water (also, zoonotic). Has become a chronic infection in those with immune system problems and transplant recipients, but usually not chronic. Currently no vaccine available.
Symptoms of acute viral hepatitis infection, as mentioned before: jaundice, fatigue, nausea, abdominal pain, diarrhea, vomiting, fever, weakness, dark urine or stool. Symptoms and illness can persist for months.
Remember, though – many people go from exposure to chronic illness without ever experiencing any symptoms.
Next time, we’ll go over the risk factors for exposure, testing and treatment.
Learn the risk factors and how to protect yourself.
Since we’re talking about lab tests, let me pass along a valuable online resource: labtestsonline.org This is a wonderful site where you can type in the name of any test your doctor has ordered (remember all those things that are only identified by initials, like ALT or AST or TIBC?) and the site will tell you what that is, why someone might order a test for that, other tests that may be run at the same time, what the results mean, what normal ranges are, what it means if you’re high or low, etc. I also strongly advocate that you request to be cc’d on all your labs and procedure reports. Take charge of your own health – don’t rely on anyone else to monitor your well-being. Start a medical file on yourself. Remember your ABC’s and go get tested!
Hollis Pickett, in partnership with Toni Donovan, runs a Redding area non-profit – Local Area Support For Hepatitis, also known as LASH. Hollis has been involved with hepatitis advocacy since 2002 and is a steering committee member with CalHEP Alliance. She has been the bookkeeper and office manager for the law firm of Carr, Kennedy, Peterson & Frost for the past 25 years. Toni has just completed a Masters in Public Health (MPH) and is currently employed by Planned Parenthood and Acaria Health (a specialty pharmacy). LASH provides community education and patient/caregiver support for those infected with chronic viral hepatitis. A support group meets once a month for patients and their families. LASH offers group presentations, individual counseling and clinical education for patients entering treatment. You can contact them via e-mail at email@example.com or call Toni (945-7853) or Hollis (524-5601).