The ABCs of hepatitis

San Diego has recently seen a growing number of cases of hepatitis A. Public health officials have responded by offering free vaccination and education clinics and hand-distributing hygiene kits.

“The local hepatitis A outbreak is primarily affecting homeless patients and those with a history of drug use,” says Dr. Fadi Haddad, an infectious disease specialist with Sharp Grossmont Hospital. “This patient population is also at high risk for alcoholism, hepatitis C and other conditions that can lead to liver disease. Unfortunately, hepatitis A mortality is higher in patients with underlying liver disease, which is likely why we have seen at least one death this year in San Diego County caused by hepatitis A.”

While the increase in numbers is concerning, understanding the differences between the various forms of viral hepatitis, or inflammation of the liver, can help decrease alarm and lead to increased prevention.

Three types of hepatitis

According to the World Health Organization (WHO), there are three main types of viral hepatitis common in the U.S. These types are known as hepatitis A, B and C and can be caused by heavy alcohol use, toxins, some medications and certain medical conditions.

Symptoms of all three types of hepatitis can take three or more weeks to appear. However, not everyone with hepatitis will exhibit symptoms, which can include:

• Jaundice

• Fever

• Loss of appetite

• Fatigue

• Joint pain

• Abdominal pain

• Diarrhea, nausea and vomiting

• Dark urine or light-colored stools

How hepatitis spreads

Hepatitis is commonly spread via person-to-person contact and eating contaminated food or drink. It is usually transmitted as follows:

Hepatitis A

Hepatitis A is found in the feces of people infected with the virus and is usually transmitted through consumption of contaminated water or food, shared drug paraphernalia and certain sexual practices. While most cases are mild, if left untreated, hepatitis A can lead to severe illness and death.

Hepatitis B

Hepatitis B is transmitted through infected bodily fluids, such as blood and semen. It can be shared between mother and infant during birth, as well as via blood transfusions, medical procedures, sexual contact and injected drug use. Chronic infection can occur in infants infected at birth, children infected under the age of 5 and, very rarely, in those infected after the age of 5.

Hepatitis C

Like hepatitis B, hepatitis C is usually transmitted through exposure to infected blood during transfusions, medical procedures and drug use. It can, on rare occasions, also be shared via sexual transmission. It can be either acute or chronic, meaning it becomes a serious, lifelong illness. The Centers for Disease Control and Prevention (CDC) reports that acute hepatitis C often leads to chronic hepatitis C.

Those at greatest risk for hepatitis include the following:

• Travelers to countries where hepatitis is common

• Members of the homeless population

• Those who have sexual encounters with someone infected with hepatitis

• People of all genders who have sexual encounters with men

• Recreational drug users

• Hemophiliacs (people with a blood-clotting disorder)

• People who live with or care for infected persons

• Care providers for the homeless and drug users

Preventing hepatitis

While there are safe and effective vaccines for types A and B there is no vaccine for hepatitis C. Along with being vaccinated, thoroughly washing hands with soap and running water — both before eating and after using the restroom — as well as avoiding the sharing of food, drinks and drug paraphernalia can help prevent the spread of the hepatitis virus.

“Hand hygiene and washing fresh fruits and vegetables are simple measures that prevent this virus from spreading,” Dr. Haddad says. “Vaccination for those who have not been vaccinated is strongly recommended.”

Once a hepatitis virus — whether A, B or C — is diagnosed, the infected person should always avoid alcohol consumption to prevent further liver damage. There is no medication to treat hepatitis A or acute hepatitis B and C, other than supportive care of the symptoms including rest, adequate nutrition, fluids and medical monitoring. However, some people with hepatitis may have to be hospitalized. Chronic hepatitis B and C can be treated with antiviral medications that have a 40% to 50% success rate in eliminating the virus.

Talk with your doctor if you are concerned about hepatitis or are at greater risk for developing hepatitis and may need to be tested. Vaccination is strongly recommended for people at risk, those with immunocompromised conditions and chronic liver disease, and for anyone traveling overseas to areas with hepatitis outbreaks.

According to San Diego County Public Health Services, the hepatitis A vaccination schedule is generally a two-dose series. The first dose is about 95% effective but will eventually begin to decrease. A second shot is recommended at 6 to 18 months later to provide immunity for up to 40 years.

Learn more about hepatitis and where you can receive a hepatitis A vaccine.