Aging Begins at 30

Preventing and Treating Hepatitis

The vaccine story in hepatitis is fascinating. At first, the virus could not be grown but, because of the presence of 10 trillion virus particles per milliliter and volunteers from the homosexual community, a heat-killed serum derived vaccine was tested and proved to be effective. Now the vaccine is made by inserting a piece of HBsAg into baker's yeast, which, on growing, produces more of it which can be harvested and purified. There is no live virus involved and no risk of hepatitis infection.

The shots are given at 0, 1 and 6 months and protection lasts for at least ten years and may be lifelong. It also protects against hepatitis D. Larger doses are needed in dialysis and immune compromised persons. A vaccine for hepatitis A has been developed and should be available in a year. Blood banks have done a wonderful job in making blood transfusion safer and almost eradicating hepatitis from this source. If you are traveling abroad, a 2 milliliter intramuscular shot of immune globulin will protect you against HAV for three months until the new vaccine is available.

In the 1970's, after commercial donors had been eliminated, approximately 10% of patient still got jaundice from screened donated blood and maybe 25% from blood products. Eliminating donors with abnormal liver function tests reduced the risk to 1% per patient. Now, non A, non B hepatitis, renamed HCV hepatitis, is prevented by screening with recently developed HCV tests.

Symptoms develop for hepatitis B in 2-6 months, for D in around 8 weeks; for E in 6 weeks, and for hepatitis C 7 weeks.

In some cases, the virus does not directly kill liver cells but immune complexes attached to liver cells making them susceptible to being killed by the body's own defenses. In other words, there is auto-immune destruction.

Virtually all previously healthy patients recover from HAV infection with no after effects. About 1 in 1000 patients die with hepatitis A, 1 in 100 of acute hepatitis B, and somewhere in between for hepatitis C. Hepatitis D infection makes hepatitis B more severe. About 5% of hepatitis B patients develop chronic liver disease and more than 50% of hepatitis C do the same. If a lot of liver tissue is destroyed, scarring occurs and is called cirrhosis. Alcohol can produce the same end result. Usually the illness will last a few weeks or months and you will be infectious to others for 3 weeks or longer, as long as the virus is present.

Supportive treatment is a high calorie diet, tolerated best in the morning. Avoidance of alcohol is important. Remember sexual activity can spread the disease for 3 to 5 weeks. If you have hepatitis A or E, you should not prepare food because the virus is in the stool and contaminates your hands. Specific treatment can be immunologic or by antiviral compounds. Interferon alpha-2b produces a sustained remission of hepatitis in 35% of those with chronic hepatitis B and 25% of those with chronic hepatitis C. Only 10% of hepatitis D cases are cleared of the virus. This is a beginning. About eight antiviral drugs have been tried in hepatitis, but, although they kill the virus in the test tube, they are unacceptable because of severe side effects. Stay in bed when you feel sick, but get up as you begin to feel well again and increase exercise as tolerated.

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See related Patient Topics Digestive System, Hepatitis or Infections.

See related Provider Topics Digestive System, Hepatitis or Infections.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

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