Hepatitis is an infection of the liver, which is the large organ that lies high up in the abdomen under the ribs on the right side. It is concerned with the build-up, breakdown and storage of foodstuffs.
It also breaks down used red blood cells, and breaks down and removes most drugs that we may take. Recently there has been a lot of interest in hepatitis because the infection is caused by two separate viruses and we are now aware of the methods of spread of the more recently discovered one.
Type A, short-incubation or infectious hepatitis is the more common. This has an incubation time of between 15 and 40 days. The virus is passed into the feces. It may then be spread from contamination, being transferred to the hands and then to the mouth, or by means of food. Flies may play a part in spreading the virus and also water contaminated by sewage. It is important to wash hands thoroughly after using the toilet.
There is no evidence that there are chronic carriers of this type A virus.
Though it can occur at any age, young children are the ones most likely to get it. The main symptom, jaundice, a yellow discoloration of the skin, may only occur in about a fifth of cases.
Type B, long-incubation or serum hepatitis is less common but is increasing. This has an incubation time of from one to six months.
The virus which causes type B can persist in the body and the person becomes a carrier. It is mainly spread by contamination from the blood and has not been shown to spread like hepatitis A from the feces.
Mothers who are carriers may pass on the virus to their babies, either during pregnancy by the spread across the placenta, during birth or even by breastfeeding.
Those who have close and frequent contact with blood such as laboratory workers, medical and nursing staff in renal or kidney units and kidney patients undergoing dialysis are particularly at risk.
Recently it has been shown that the B virus may be present in other body fluids such as the urine, saliva, breast milk, semen and vaginal fluids. By these means, it is thought that the infection can be spread other than by the blood. It may be spread by sexual contact and is common in prostitutes.
People whose immunity is low due to immune deficiency states, or where it is lowered by drugs such as in kidney transplant cases, are also at risk.
Dentists as a group have a tendency to infection with the B virus, thought to spread by means of saliva.
Drug addicts who “share the needle around” and whose standard of hygiene is poor have a high rate of infection and the spreading of B hepatitis by infected blood has occurred through tattooing, ear-piercing and acupuncture. The virus is easily and rapidly destroyed by heating but may be immune to chemical disinfectants.
The symptoms in both forms of hepatitis are similar, but in type B may come on more slowly and maybe more variable.
In type A the illness usually starts suddenly with nausea, vomiting, sometimes diarrhea and abdominal pain. There is often fever and aches and pains.
The sign that points to the nature of the infection is jaundice or the yellow discoloration of the skin and the whites of the eyes (though many cases of hepatitis are not diagnosed because jaundice does not become obvious so no tests are done to establish a diagnosis), and bile pigments may overflow into the urine which develops a dark color, like strong tea.
Blood tests to show liver function may reveal the diagnosis. Discovery of the specific antigen (a protein that provokes an antibody response) determines that it is type B hepatitis.
The illness may last only a week or two, three to six weeks is common, or it may be prolonged for months.
In type B there may be mild arthritis and the person may feel depressed and off-color for several weeks before jaundice is noted.
There is no specific treatment for hepatitis. Bed rest is usually necessary. Sometimes, hospitalization is necessary to isolate the patient and prevent the spread of the condition. Diet is not all that important but simple carbohydrates and proteins should be taken and are better tolerated than fats.
There are no drugs necessary in treatment.
Cortisone has been used to reduce the inflammation but is only necessary in those cases with prolonged jaundice.
One attack usually gives lifetime immunity, but having developed one type of hepatitis it is still possible to develop the other.
Gamma globulin prepared from blood and containing many antibodies will protect from type A for about four months. This does not protect against type B, but temporary immunity may be obtained by a specially concentrated immune globulin.
Only those in frequent and close contact such as the immediate family living in the same house as a type A sufferer need be given gamma globulin. It is unnecessary for workmates or casual visitors to the house to have an injection. No vaccine for either type is yet available, although this may not be far away.
Although most cases settle down and many are so mild as to go unnoticed, sometimes hepatitis is a serious disorder and the inflammation persists for months or years and leads to scarring or cirrhosis of the liver. Occasionally the liver fails and death may result.
Blood taken for transfusion is routinely tested for hepatitis associated antigen and if this is found the blood is not used for transfusion.