Viral hepatitis

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What is it about ?

Hepatitis literally refers to inflammation of the liver and can have different causes. This patient guide deals exclusively with viral hepatitis. To date, 7 hepatitis viruses are known, namely: A, B, C, D, E, F and G. Each virus has its specific characteristics, but all have one thing in common: they affect the liver. Viruses A, B and C are the most common hepatitis viruses in our regions.

Contamination
Contamination occurs in different ways. Hepatitis A and E are spread mainly through contact with contaminated food and water or with infected blood. In areas where sewage systems are in poor condition, resulting in direct contact between wastewater and drinking water, the water can become contaminated with stool. Food is in turn contaminated during rinsing and water preparation of vegetables and food. Poor hygienic conditions contribute in all cases to contamination.

Hepatitis B is usually the result of contact with infected blood. The virus can thus be transmitted during a blood transfusion and by the use of contaminated needles (sharing of needles between drug users, accidental injections, etc.).
Hepatitis B and C can be spread through sexual contact. A newborn baby may have contracted the virus through the placenta.

Evolution
Infection with a hepatitis virus can vary widely. You may have an “acute” infection, which means you have the infection, develop symptoms, but can be cured (on its own or with treatment). It is also possible that you are a “carrier” of the virus, that is, the virus is present in your body and you can infect others, but you have no symptoms. After a while (it may take a few years) you will be cured of the virus. In some cases, the infection becomes “chronic” and progresses to hepatic cirrhosis (scarring of the liver), or even liver cancer.

What is its frequency?

Since the introduction of the vaccine against hepatitis A and B, the number of patients has fallen sharply. In the United States, the figure is between 1 and 2 per 100,000 population, compared to 20 or more before vaccination. In some countries, up to 20% of people have antibodies to hepatitis in their blood. This presence of antibodies indicates that they have been in contact with the disease or that they have had it.

Hepatitis affects twice as many men as women. Globally, 1.5 million new cases of hepatitis A are diagnosed each year. In Belgium, this number is estimated at 1,460 cases per year, mainly in children under 12 years of age. Since hepatitis B was included in the basic childhood immunization program, the disease has become rare among us, especially among young people. Hepatitis C mainly affects drug users who use contaminated needles. Other groups at risk are HIV positive men, children whose mothers are infected with hepatitis C and first generation migrants from countries where the disease is widespread. There are around 2,000 cases per year.

Five percent of people with hepatitis B and 80% of people with hepatitis C develop a chronic form of the disease. They become carriers. The virus therefore remains active in their body and they can continue to infect other people. It is estimated that 500 million people are carriers of the hepatitis C virus around the world.

How to recognize it?

The course of the disease can vary considerably. Sometimes the disease progresses without you realizing it. This is especially the case with hepatitis C.

The interval between infection and the appearance of the first symptoms is quite long, ranging from a few weeks up to sometimes 6 months. Symptoms usually appear suddenly and include fever, fatigue, pain in the right side of the abdomen (upper part), nausea, and sometimes diarrhea. The most obvious sign is the jaundice (jaundice). Jaundice can be recognized by the yellowing of the skin and the whites of the eyes. At the same time, the urine turns a dark brown color and the stool turns pale (resembling putty). With the exception of hepatitis C, the disease often resolves on its own. However, in some cases the disease progresses to hepatic cirrhosis and in liver cancer.

How is the diagnosis made?

The doctor makes the diagnosis on the basis of a blood test. Indeed, jaundice and enlarged liver are not enough to conclude that hepatitis, because these symptoms are also manifested in other conditions. The blood test can detect the presence of antibodies against the different types of the virus. It can also measure inflammatory factors and estimate the severity of liver damage. In the event of an accidental needle stick or injection drug use, the blood work will also include screening for other infections, such as HIV.

People infected with B and C viruses will be followed for longer because the disease can become chronic in 5% and 80% of cases, respectively. You are a carrier of hepatitis B virus when the virus is still in your blood after 12 months. Chronic hepatitis C progresses very slowly. Progression in chronic form lasts between 13 and 18 years. The progression to hepatic cirrhosis and liver cancer (hepatoma or hepatocellular carcinoma) is monitored regularly.

What can you do ?

Prevention is extremely important. Do not consume raw food and drink only bottled water when traveling to areas with poor sanitary conditions. Get vaccinated before traveling to a sensitive area. Always use condoms during sexual contact. Buy them preferably before you go, as their quality often leaves something to be desired in developing countries.

After an accidental bite, always contact your doctor.

If you yourself are infected with a hepatitis virus, it is very important to realize that you have a communicable disease. The good news is that you are not contagious until the end of your life, unless you develop the chronic form of the disease. Limit your consumption of alcohol and drugs, because it is the liver that is in charge of their degradation, while it no longer works optimally in the case of hepatitis. If you inject drugs, always use sterile single-use needles. Never share needles with other consumers.

What can your doctor do?

Processing
Usually, hepatitis resolves on its own. It therefore does not require treatment. For the chronic forms progressing to cirrhosis, there are long-term, expensive and highly specialized treatments. If necessary, you will be referred to a specialized center. The objective of these treatments is above all to prevent complications (cirrhosis, liver cancer).

There are some very effective drugs for hepatitis C, but they are also very expensive and are reimbursed only under certain conditions.

Vaccination
You can be vaccinated against hepatitis A and B. The hepatitis A vaccine consists of 2 injections, given 6 months apart. It is recommended for everyone traveling to a country where hepatitis A is prevalent. Children of first and second generation migrants whose (grand-) parents come from a country where hepatitis A is very common should also be vaccinated.

The hepatitis B vaccine is now included in the basic immunization program for all children. People belonging to a risk group should be vaccinated. This applies to all people living with someone who has hepatitis B or who carries the virus, their sexual partners, patients who regularly receive blood transfusions (due to bleeding disorders), injecting drug users and their partners, people involved in prostitution and health professionals who work in areas where the disease is widespread.

Healthcare providers are vaccinated after an accidental needle stick and contact with infected blood.

Vaccines protect you for up to 20 years, or even for life. There is a blood test to see if you are still protected by the vaccine. If not, a vaccine booster is required.

There is also a combined vaccine against hepatitis A and B, which is given to people who were not vaccinated in their childhood. This vaccination requires 3 injections, at months 0, 1 and 6. The vaccine is not effective in about 10% of individuals, who do not produce antibodies after vaccination (non-responders).

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