The ABCs of Hepatitis

The ABCs of Hepatitis

What do Pamela Anderson, Naomi Judd, and Keith Richards all have in common?  You may recognize the names. The disease they share is more common than you may realize.  Millions of Americans are living with a version of the same disease. Over half don’t know that they are affected with this ailment because symptoms may not appear for years.

The disease is Hepatitis C.

Hepatitis is inflammation of the liver. Your liver is an essential organ, you can’t live without it. It produces bile that is important for digestion.  The liver breaks down carbohydrates, fats and proteins.  It stores glycogen, the energy you get from glucose so it’s ready when you need it, along with minerals and vitamins.  Your liver is also responsible for the synthesis of blood proteins and clotting factors.   When the liver is inflamed with the hepatitis virus, all of these functions are disrupted. While you might not feel the symptoms, once you contract the hepatitis virus, your liver function begins to diminish.

There are five similar but different types of hepatitis virus that attack the liver; A, B, C, D, and E.

Hepatitis A (HAV) is a short term infection that spreads through the fecal-oral route. It was first identified in 1979 but, like other hepatic viruses, it originated in the distant past with small animals.[1]  Eons before the small animals became carriers, insects gave the virus to the animals.  Insects, like our modern day fleas or mosquitos, transferred the virus to animals through a bite. The people got the virus from the animals by coming into contact with animal feces.

Most people overcome the virus on their own, without treatment, but it is very contagious. This is the virus that restaurant workers can easily spread to customers if they don’t wash after using the restroom. It’s a virus that can spread like wildfire in a child care setting where children often share toys, and little hands can carry the germs. Moreover, children typically carry the virus without showing symptoms. Hand washing is extremely important when it comes to stopping the spread.

While it’s possible and likely that hepatitis shows no symptoms in the early stages, often the symptoms can be attributed to any number of other causes.   Sudden nausea, vomiting, or abdominal pain and discomfort could be a stomach flu, but these are also signs of hepatitis.  Additional symptoms include a loss of appetite, low-grade fever, dark urine, and jaundice.

In 1997, there were over 30,000 cases in the United States. There is now a vaccine for HAV and less than 2000 cases are reported each year.[2]

Hepatitis B (HBV) is the second most common version of the virus and it is extremely contagious.  More than a third of the World’s population has been infected at one time or another.  Hepatitis B has been around since the Bronze Age, 3000 – 1200 BC.[3] The virus was first suspected in 1947 and identified in 1966.  Genetic studies have traced the origins back to ancient vertebrates.

The difference between HAV and HBV is that the latter is spread by blood, semen, or other bodily fluids.

“It is easily spread through sharing contaminated needles,” said Jennifer Sebes, GraceMed APRN. “Medical procedures, IV drug use, and unregulated tattoos are all culprits.  It could be spread by sharing razors, toothbrushes, or medical equipment like glucometers. Mothers can pass HBV on to their newborns during childbirth.  It is also sexually transmitted.”

The largest outbreak occurred during World War II when 330,000 soldiers who received a yellow fever immunization made from the live serum of a chronic HBV carrier.[4]  The vaccine caused jaundice in 50,000 of the troops.

Like hepatitis A, the symptoms of HBV include fatigue, abdominal pain, nausea, and vomiting.  There may also be joint pain, fever and jaundice.  But, here again, there may be no symptoms at all. Because people may not know they have the virus, it can be spread by members of the same household.

Since 1991, the first dose of the vaccine for HBV has been given to infants at birth.  This has substantially reduced the number of people who have the virus although it has not been eradicated.

Hepatitis C (HCV) is by far the most common version of the disease, it is also the most deadly.  The World Health Organization has estimated that 1% of the global population is living with hepatitis C.  About 2% of the people infected with HCV exhibit chronic symptoms.[5]

“Hepatitis C is the number one reason for liver transplants,” Jennifer said. “It carries with it a significant risk of liver cancer and cirrhosis – particularly if the individual has been infected for many years.”

The hepatitis C virus was officially identified in 1989. As early as the mid-1970s, the virus was identified as non-A and non-B, and it was known that about 30% of people who received blood transfusions were becoming ill with a hepatitis-like virus. While blood is now screened for hepatitis, that was not a standard practice prior to 1992.

Because there have been multitudes of people who received blood transfusions as part of medical treatment prior to the discovery of hepatitis C, many people have HCV without symptoms.  The virus remains present in the liver in about 75% to 85% of those infected without any symptoms.  Over time however, the virus advances to become life threatening.  This is why it is so important to be screened at least once between the ages of 18 and 79.

Sharing contaminated needles, unclean medical procedures, unregulated tattoos and homosexual interactions are also ways the virus is transmitted. Moreover, it can be passed to a child from the mother during the birthing process.

People who show symptoms of HCV may notice that they bleed or bruise more easily.  They may experience itchy skin, leg swelling or spider-like blood vessels.  Symptoms also include poor appetite, fatigue, dark urine and jaundice.

About 15% to 30% of the people who contract hepatitis C will be able to clear the infection on their own, without treatment.  There have been some impressive advances in the treatment for HCV.  New direct-acting antiviral medications are giving better results without the side effects of previous treatments in a shorter time frame. The new antivirals are better than 90% effective at completely clearing the infection.

Hepatitis D (HDV) was first seen in 1977.[6]  It’s unusual because the virus requires the presence of HBV to reproduce.  This is known as a “co-infection” or “super-infection.” When someone tests positive for HDV, the D virus is dominant over the B virus. And, because the person affected is fighting two hepatitis viruses, the complications are severe, including the highest fatality rate of all hepatitis infections.

The hepatitis D virus is not seen frequently in developed countries and is mainly linked to drug use. It is more common in the Mediterranean regions, some African countries and parts of South America.

The vaccine for hepatitis B also protects against hepatitis D because HDV needs the HBV to become active and grow.

Hepatitis E (HEV) is similar to HAV but is not related.  The origin of the virus has been traced to ancestors about 1300 years ago.  It may have been related to the domestication of pigs over 6000 years ago.[7]  HEV is transmitted via the fecal-oral route, so having access to good sanitation and regular hand washing is important.

The virus was isolated and identified in 1983 but evidence shows an epidemic of HEV in New Dehli in 1955.  Most people who get this virus will recover on their own, and the death rate is low in developed countries.  However, in people with compromised immune systems or pregnant women, hepatitis E can be fatal.

Hepatitis E is not common in the United States, it is seen more frequently in Central America and the Middle East. More recently, there have been more than 800 cases reported in Wales and England.

With the five different types of hepatitis, there are several ways you can come into contact with the virus.  If you are in a group that puts you at a higher risk, be sure to ask your health care provider about screening.   A short list of risk factors includes:

  • Intravenous drug use
  • Being the child of a mother who had HVC
  • Working in healthcare where you may be exposed to blood products and needles
  • Having an HIV infection or AIDS
  • Having had a blood transfusion prior to 1992
  • Having tattoos or body piercings

You can find more risk factors and information about hepatitis here. If you would like to find out about treatment at GraceMed, please contact us.


[1] Drexler, J. F., Corman, V. M., & Lukashev, A. N. (2015, December 8). Evolutionary origins of hepatitis A virus in small mammals. Proceedings of the National Academy of Sciences. https://www.pnas.org/content/112/49/15190.

[2] Centers for Disease Control and Prevention. (2020, June 22). Hepatitis a – FAQs, STATISTICS, data, & guidelines. Centers for Disease Control and Prevention. https://www.cdc.gov/hepatitis/hav/index.htm.

[3] Ben Guarino. (2018, May 9). New strains of hepatitis B virus discovered in ancient human remains. The Washington Post.
https://www.washingtonpost.com/news/speaking-of-science/wp/2018/05/09/new-strains-of-hepatitis-b-virus-discovered-in-ancient-human-remains/

[4] Seeff, L. B. (1991, January 1). Yellow fever Vaccine-Associated Hepatitis epidemic During World War Ii: Follow-up more than 40 years later. Epidemiology in Military and Veteran Populations: Proceedings of the Second Biennial Conference March 7, 1990. https://www.ncbi.nlm.nih.gov/books/NBK234464/.

[5] World Health Organization. (n.d.). Hepatitis c. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c.

[6] Mentha, N., Clement, S., & Negro, F. (2019). A review on hepatitis D: from virology to new therapies. Journal of Advanced Research, 17(May 2019), 3–15. https://doi.org/10.1016/s2090-1232(19)30113-4

[7] Aggarwal, R. (2011, January 26). Hepatitis e: Historical, contemporary and future perspectives. Journal of gastroenterology and hepatology. https://pubmed.ncbi.nlm.nih.gov/21199517/.