Hepatitis

Hepatitis and the liver

Hepatitis means inflammation (swelling and pain) of the liver.

The liver is important for a range of functions in the body. These include regulating metabolism, making proteins, storing vitamins and iron, removing toxins and producing bile.

If the liver doesn’t work properly, it can cause serious illness or sometimes even death.

Hepatitis may be caused by infection, viruses, chemicals, alcohol and other drug use, and other factors.

Chronic hepatitis means ongoing inflammation of the liver, irrespective of the underlying cause.

Types of hepatitis

The various forms of viral hepatitis are named after different letters of the alphabet. These include hepatitis A, B, C, D and E. They are also sometimes called hep A, hep B, hep C, and so on.

While all these viruses affect the liver, they are spread in different ways and have different treatments.

The most common types of viral hepatitis in Australia are hepatitis A, B and C.

Symptoms of hepatitis

It is very important to know that not everyone with hepatitis has symptoms.

The only way to know if you have hepatitis is by talking to your doctor and getting a blood test. Lots of people with hepatitis feel healthy even though their liver is being damaged.

When symptoms occur, they may include:

• fever
• nausea
• abdominal discomfort
• dark urine
• lethargy (tiredness)
• painful joints
• oedema (swelling)
• easy bruising
• jaundice (yellow skin and eyes).

Hepatitis A

Anyone can be at risk of hepatitis A transmission if they come in direct contact with the hepatitis A virus through food, drinks or objects contaminated by the faeces (poo) of an infected person.

Symptoms may last several weeks but the person usually recovers completely. Infection with hepatitis A will give lifelong immunity. However, this doesn’t offer immunity against the other types of hepatitis.

A vaccine is available to protect against hepatitis A.

Hepatitis B

Hepatitis B virus is spread when blood, semen, vaginal secretions or other body fluids from someone with hepatitis B enters the bloodstream of someone who does not have hepatitis B.

Activities that might enable the spread of hepatitis B include unsafe sex, or the use of shared injecting equipment.

Hepatitis B can also be transmitted from mother to child at birth or shortly after birth. On rare occasions, hepatitis B can also be transmitted through the womb.

People who are exposed to the hepatitis B virus may develop chronic hepatitis B, (where the virus stays in their body for their entire life). Babies and children who become infected are far more likely than adults to develop chronic hepatitis B.

A highly effective and safe vaccine is available to prevent hepatitis B infection. It is included in the standard immunisation schedule, beginning in infancy.

Screening the mother before birth can prevent infection of newborn infants. If a mother tests positive, hepatitis B immunoglobulin is given to the baby when it is born, as well as a hepatitis B vaccination.

Hepatitis C

Hepatitis C is a bloodborne virus that is spread when blood from a person with hepatitis C enters another person’s bloodstream. In Australia, the most common way it is transmitted is through sharing injecting drug equipment.

Around 30% of people who become infected with hepatitis C may clear the virus from their blood in a few months with no treatment. These people no longer have hepatitis C and cannot pass it on.

Around 70% of people with hepatitis C, if untreated, continue to have the virus in their blood and are likely to have chronic hepatitis C. Of these, about 10 to 20% will develop cirrhosis, which is serious scarring of the liver. This can take 20 years or more to develop. Cirrhosis increases the risk of developing liver cancer.

Treatment with direct-acting antiviral medicines has greatly improved the outcomes for people with hepatitis C. These treatments can help decrease inflammation in the liver and can clear the virus in up to 95% of people, and there are minimal side effects.

There is no vaccine available to prevent hepatitis C infection. If you have had hepatitis C in the past, it is possible to get it again. Treatment is available with no restrictions, if required.

Hepatitis D

Hepatitis D infection is uncommon in Australia, but is prevalent in countries that have a high incidence of hepatitis B.

Hepatitis D virus can be acquired either as a co-infection (occurs at the same time) with hepatitis B virus or as a super-infection in people who are hepatitis B positive.

You can get hepatitis D through unsafe sex, sharing injecting equipment and other activities where the blood of an infected person enters your bloodstream.

Hepatitis E

Hepatitis E is most common in low socioeconomic countries and regions. There is no chronic (long-term) infection associated with this virus.

Hepatitis E is more severe among pregnant women, especially in the third trimester.

The hepatitis E virus is found in the faeces of infected people and animals, and is spread by eating or drinking contaminated food or water. Transmission from person to person occurs less commonly than with hepatitis A virus.

Pregnant women from Australia are strongly advised not to travel to areas where there is a lot of hepatitis E, especially during the last 3 months of pregnancy.

Diagnosis of hepatitis

Tests used to diagnose hepatitis may include:

• blood tests
• liver ultrasound
• fibroscan – a quick and non-invasive test that uses ultrasound to measure the ‘stiffness’ of your liver.

Treatment for hepatitis

Treatment depends on the type of hepatitis. Talk to your doctor about the treatment that is recommended for you.

Chronic viral hepatitis, whether due to hepatitis B or C, can, after many years, lead to cirrhosis and primary cancer of the liver.

Where to get help

• Your GP (doctor)
• Local council immunisation service
• Infectious disease surveillance in Victoria, Victorian Government Tel. 1300 651 160
• LiverWELL Tel. 1800 703 003
• DirectLine Tel. 1800 888 236 – for 24-hour confidential drug and alcohol telephone counselling and referral (including information about where to get clean needles and syringes)
• National Immunisation Information Line Tel. 1800 671 811