Viral Hepatitis (cont.)
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
In this Article
- Viral hepatitis facts
- Viral hepatitis definition and overview
- What are the common types of viral hepatitis?
- Who is at risk for viral hepatitis?
- What are the symptoms and signs of viral hepatitis?
- What is acute fulminant hepatitis?
- What is chronic viral hepatitis?
- How is viral hepatitis diagnosed?
- What is the treatment for viral hepatitis?
- How is viral hepatitis prevented?
- Hepatitis vaccinations
- What is the prognosis of viral hepatitis?
What are the common types of viral hepatitis?
Although the most common types of viral hepatitis are HAV, HBV and HCV, some clinicians have considered the acute and chronic phases of hepatic infections as "types" of viral hepatitis. HAV was considered to be acute viral hepatitis because the HAV infections seldom caused permanent liver damage with chronic or fulminant hepatic (liver) failure. HBV and HCV produced chronic viral hepatitis. However, these terms are not used as frequently because all of the viruses that cause hepatitis may have acute phase symptoms (see symptoms below). Prevention techniques and vaccinations have markedly reduced the current incidence of common viral hepatitis infections; however, there remains a population of about 800,000 to 1.4 million people in the U.S. with chronic HBV, and about 2.9 to 3.7 million with chronic HCV according to the U.S. Centers for Disease Control (CDC).
Hepatitis A (HAV)
HAV accounted for an estimated 17,000 infections in 2010 according to the newest CDC data. The hepatitis caused by HAV is an acute illness (acute viral hepatitis) that never becomes chronic. At one time, hepatitis A was referred to as "infectious hepatitis" because it could be spread from person to person like other viral infections. Infection with hepatitis A virus can be spread through the ingestion of food or water, especially where unsanitary conditions allow water or food to become contaminated by human waste containing hepatitis A (the fecal-oral mode of transmission). Hepatitis A typically is spread among household members and close contacts through the passage of oral secretions (intimate kissing) or stool (poor hand washing). It also is common to have infection spread to customers in restaurants and among children and workers in day care centers if hand washing and sanitary precautions are not observed.
Hepatitis B (HBV)
There were an estimated 38,000 new cases of HBV infection in 2010 in the United States according to the CDC. HBV hepatitis was at one time referred to as "serum hepatitis," because it was thought that the only way HBV could spread was through blood or serum (the liquid portion of blood) containing the virus. It is now known that HBV can spread by sexual contact, the transfer of blood or serum through shared needles in drug abusers, accidental needle sticks with needles contaminated with infected blood, blood transfusions, hemodialysis, and by infected mothers to their newborns. The infection also can be spread by tattooing, body piercing, and sharing razors and toothbrushes (if there is contamination with infected blood). About 6% to 10% of patients with HBV hepatitis develop chronic HBV infection (infection lasting at least six months and often years to decades) and can infect others as long as they remain infected. Patients with chronic HBV infection also are at risk of developing cirrhosis, liver failure, and liver cancer. It is estimated that there are 1.2 million people in the U.S. and 200 to 300 million people world-wide who suffer with chronic HBV infection.
Hepatitis C (HCV)
The CDC reported that there were about 17,0000 new cases of hepatitis C in 2010. HCV hepatitis was previously referred to as "non-A, non-B hepatitis," because the causative virus had not been identified, but it was known to be neither HAV nor HBV. HCV usually is spread by shared needles among drug abusers, blood transfusion, hemodialysis, and needle sticks. Approximately 90% of transfusion-associated hepatitis is caused by HCV. Transmission of the virus by sexual contact has been reported, but is considered rare. An estimated 50% to 70% of patients with acute HCV infection develop chronic infection. Patients with chronic HCV infection can continue to infect others. Patients with chronic HCV infection are at risk for developing cirrhosis, liver failure, and liver cancer. It is estimated that there are about 3.5 million people with chronic HCV infection in the U.S.
Types D, E, and G Hepatitis
There also are viral hepatitis types D, E, and G. The most important of these at present is the hepatitis D virus (HDV), also known as the delta virus or agent. It is a small virus that requires concomitant infection with HBV to survive. HDV cannot survive on its own because it requires a protein that the HBV makes (the envelope protein, also called surface antigen) to enable it to infect liver cells. The ways in which HDV is spread are by shared needles among drug abusers, contaminated blood, and by sexual contact; essentially the same ways as HBV.
Hepatitis E virus (HEV) is similar to HAV in terms of disease, and mainly occurs in Asia where it is transmitted by contaminated water.
Hepatitis G virus (HGV) was recently discovered and resembles HCV; the virus and its effects are under investigation but some investigators do not recognize it as a cause of hepatitis.
Patients who already have chronic HBV infection can acquire HDV infection at the same time as they acquire the HBV infection or, alternatively, on top of a chronic HBV infection. Patients with chronic hepatitis due to HBV and HDV develop cirrhosis (severe liver scarring) rapidly. Moreover, the combination of HDV and HBV virus infection is very difficult to treat.
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