Topic: Final Paper
Sarah Rund
December 16, 2004
Professor Timothy Weiskel
SC280b
Hepatitis A, B, and C
Hepatitis is a general term for inflammation of the liver (hepa meaning liver in Greek). This may be caused by chemical substances, such as alcohol or Tylenol. Or, as in the cases of Hepatitis A, B, and C, can be caused virally. Until 1955, all non-chemical forms of hepatitis were called infectious hepatitis or yellow jaundice (jaundice, a yellowing of the skin and eyes caused by bilirubin which the liver usually eliminates, is a symptom of all viral hepatitis).
In 1955, scientists discovered the virus that causes hepatitis A (HAV). At this point, they assumed that all infectious hepatitis was HAV. HAV is transmitted through fecal-oral contact, including through contaminated plates, glasses and utensils, or through unclean water due to sewage. Prevention in the United States was therefore quite simple; proper hand-washing techniques and keeping sewage separate from drinking water prevented HAV in the general population. It is not unusual, however, for children to be infected with HAV, especially in daycare and school settings, where not everyone knows how to wash their hands properly and care givers cannot always supervise every trip to the bathroom. However, childhood infection with HAV is actually a good thing; HAV in children is generally mild, and most of the time they do not exhibit any symptoms at all. After becoming infected with HAV once, you cannot get it again. Like many childhood diseases, HAV is much more serious when contracted later in life. Adults with the HAV can have severe, and sometimes deadly, symptoms, including high fever, loss of appetite, fatigue, dark urine, pale stool, nausea, vomiting, and jaundice (Hepatitis Foundation International). A safe, effective vaccine has been developed to prevent HAV infection. Unfortunately, among neglected communities, in this country and around the world, HAV is still quite common. Access to clean water and food is essential to HAV prevention. Thus, the reality is that Hepatitis A is an infection of the poor and marginalized.
In 1965, another hepatitis virus was discovered in the blood of infected persons. This ?serum hepatitis,? so called because of its blood borne properties, was called hepatitis B (HBV). HBV can be spread through bodily fluids; semen and vaginal fluid, breast milk, mother-to-child during birth, and blood (needles, tattooing, piercing, and blood products). Most people with HBV don?t even know that they have it, but if symptoms occur, they are the same as for HAV. Also like hepatitis A, HBV can only be contracted once. Close to 90% of those infected with HBV get better on their own, but 10% of fail to rid themselves of the virus and develop chronic hepatitis B. Chronic infection increases the chance of cirrhosis, or scarring, of the liver, which may lead to liver cancer and can be fatal. Now there is a vaccine to prevent hepatitis B that is very effective and very safe. Besides the vaccine, safe sex practices and the use of clean needles are ways to prevent transmission of HBV.
In the early 1970s, tests were developed to identify both HAV and HBV. As the result of this testing, in the mid ? late 1970s, doctors and scientists began to notice people with non-chemical hepatitis that tested negative for HAV and HBV. They called this unknown virus Non A Non B Hepatitis, or NANB hepatitis. In 1988, researchers discovered the virus that caused NANB hepatitis and called it Hepatitis C (HCV). This strain of hepatitis is, like HBV, carried in blood.
There was no way of testing for HCV, and many blood donors unknowingly gave contaminated blood. Because of contaminated transfusions, before 1992, there were approximately 350,000 new cases of HCV in the United States per year. In July of 1992, a test was developed to detect HCV in the blood supply. After this test was widely implemented, the number of cases of HCV dropped by 90% to 35,000. Symptoms of HCV are similar to those of HAV and HBV. Hepatitis C can only be contracted through blood or via mucosal membranes. Sexual transmission, while possible, is very rare, constituting around 15% of cases (CDC).
Almost all cases of HCV since 1992 are in intravenous drug users (IDUs). Astoundingly, most (50-80%) IDUs contract the virus in the first year of beginning to inject (Carter, et al 1254). Upon contemplation, this statistic begins to make sense; when heroin is first tried, the user is less likely to have their own ?kit? for drug injection, and is more likely to be in the company of others who inject on a more regular basis. HIV, which is contracted in similar ways, is much less hardy than hepatitis C. HIV can only be transmitted through needle sharing because it cannot survive in the air. HCV, however, can be transmitted through the sharing of the ?cookers,? or spoons that are used to heat the heroin, the sharing of ?cottons,? or the filters used to draw up the drug from the cooker to block any particular matter from entering the syringe, as well as through the syringe itself. Dr. Lina Thompson, of the University of Illinois at Chicago, found that among young injection drug users, the risk of hepatitis C was highest among those who shared cookers and cottons. After taking into account the sharing of syringes, the sharing of cookers quadrupled the risk of infection, the sharing of cottons more than doubled the risk, and the sharing of rinse water only marginally increased the risk of contracting the virus.
Because of the high rate of infection among IDUs, hepatitis C infection is extremely stigmatized in the United States. Since there is no vaccination against HCV, and the drug regimen is very difficult and works only sixty percent of the time, many people who are infected with HCV have it for the rest of their lives. Often HCV exists in the infected person?s system for years without ever exhibiting symptoms, before diagnosis, and continuing after treatment. Hepatitis C, is, however, the only virus that currently has a cure. No other virus has ever had a cure for those who are already infected. Many have had vaccines for pre-infection protection against the virus, but none have a cure. In an age when science claims to have conquered disease, this is truly amazing.
Hepatitis remains largely ignored by the general public. Hepatitis B is ?one of the most common, serious infectious diseases in the world. It is 100 times more infectious than the AIDS virus (HIV)? states the American Liver Foundation on their website. ?More than four million people have hepatitis C in the United States, five times as many as are infected with HIV? (Bain 1). Steps need to be taken immediately to prevent the spread of hepatitis infection among IDUs and other marginalized groups. With the proper public health action, these diseases could be transformed from potentially life altering infections to minor health risks.
Works Cited
Bain, Julie. ?More Are Finding Permanent Cures for Hepatitis C,? The
New York Times. May 14, 2002.
Carter, Rosalind; Layton, Marcelle; Paone, Denise; Udeagu Pratt, Chi-
Chi. ?Hepatitis C Screening and Management Practices: A
Survey of Drug Treatment and Syringe Exchange Programs in
New York City,? The American Journal of Public Health.
(08/02) Vol.92; No. 8: pp 1254-1256
Center For Disease Control and Prevention. http://www.cdc.org
Lindor, Keith. The American Liver Foundation Liver Health
Information Hepatitis B Fact Sheet.
http://www.liverfoundation.org/db/articles/1062