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Hepatitis is the pathological swelling or inflammation of the liver. This swelling and the damage done by it can affect the functioning of the liver. Hepatitis can be an acute (short-term) infection or a chronic (long-term) infection. Few types of hepatitis cause only acute infections. Other types of hepatitis can cause both acute and chronic conditions. Generally, hepatitis is the primary symptom of many illnesses like autoimmune diseases, toxicity, alcohol, or it can be due to a viral infection.

There are five primary strains of the hepatitis virus: types A, B, C, D, and E. While they all cause liver disease, they differ in important ways, including modes of transmission, the severity of the illness, geographical distribution, and prevention methods. An estimated 300 to 325 million people worldwide live with hepatitis B or C, and for most, testing and treatment remain beyond reach. (Terrault et al., 2021) In particular, type B leads to chronic disease in millions of people and, together, is the most common cause of liver cirrhosis, malignancies, and viral hepatitis-related deaths. However, some types of hepatitis can be easily prevented through vaccination and access to clean food and water. A WHO study found that an estimated 4.5 million premature deaths could be prevented in low-and middle-income countries by 2030 through vaccination, diagnostic tests, medicines, and education campaigns. (Hepatitis B, 2020) Their global hepatitis strategy aims to reduce new hepatitis infections by 90% and deaths by 65% between 2016 and 2030.

What Causes Hepatitis?

Common causes of hepatitis include:

• Hepatitis virus (Strains A, B, C, D, and E)
• Alcohol
• Non-alcoholic fatty liver disease
• Toxins and drugs (E.g. Isoniazid used to treat tuberculosis)

Other relatively uncommon causes of hepatitis include: 

• Autoimmune disorders
• Genetic liver disorders 
• Rare viral infections (E.g. infectious mononucleosis, yellow fever, cytomegalovirus infection) and leptospirosis
• Bacterial and parasitic infections (Kumar, 2020)

Hepatitis A and E are acute (short-term) viral infections usually transmitted through food or water contaminated by fecal matter. The primary sources of hepatitis viruses A and E are:

• Raw or undercooked food
• Food handled by personnel with unwashed hands
• Water contaminated with human or animal waste

What Are the Symptoms of Hepatitis?

As reported by the NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases), hepatitis may be asymptomatic. However, when symptoms occur, they can include:

• Jaundice (yellow discoloration seen in the sclera of eyes and the skin)
• Abdominal pain
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Fever
• Dark urine
• Clay-colored stool
• Joint pain

Chronic infection and inflammation can also result in extensive scarring of the liver (cirrhosis) and impaired liver functions. In addition, while the estimated number of new conditions has been declining, hepatitis B and C viruses can persist as chronic infections. Both of which are leading causes of chronic liver disease and liver cancer in the United States. (“Hepatitis,” n.d.)(“Toxic Hepatitis,” 2018)

Hepatitis A:

Hepatitis A symptoms include fatigue, nausea, abdominal pain, loss of appetite, and low-grade fever. The infection typically clears up on its own in one or two months. Hepatitis A treatment includes rest and adequate hydration. Hepatitis E is common in the tropical, developing parts of the world. 

Hepatitis B:

Hepatitis B, a vaccine-preventable liver infection caused by the hepatitis B virus (HBV), is transmitted when blood, semen, or other body fluids from an infected individual enters the body of a healthy person. It can happen through sexual contact, sharing needles, syringes, or drug-injection equipment, or from mother to baby at childbirth. Newly infected people may not have hepatitis B symptoms, but for those that do, symptoms can include fatigue, nausea, poor appetite, stomach pain, and jaundice. For many people, hepatitis B is a short-term illness. However, in other cases, it can become a long-term, chronic infection that can lead to serious, even life-threatening health issues like cirrhosis or liver cancer. The risk for chronic disease is linked to age at infection: about 90% of infants with hepatitis B develop chronic illness, whereas only 2% to 6% of people who get hepatitis B as adults become chronically infected. (Hepatitis B, 2020) Currently, there is no evidence that hepatitis B is curable, but it is manageable. Active and extensive research is being conducted to search for a hepatitis B cure; until then, the best way to prevent this is to get the hepatitis B vaccine.

Hepatitis C:

Hepatitis C is mainly transmitted through contact with the blood of an infected person. For example, such communication can occur when people share needles for drug injections. Less frequently, the hepatitis C virus can also spread through sexual contact or childbirth. Most people have no hepatitis C symptoms, but those who develop symptoms may have fatigue, nausea, loss of appetite, and yellow discoloration seen in the eyes and skin. (Nierenberg, 2017)

Hepatitis D:

Hepatitis D also spreads through contact with blood. Still, infections with this virus only occur when someone is already infected with hepatitis B. Injection drug users are at the most significant risk for this type of hepatitis.

What Happens if You Have Hepatitis and You’re Pregnant?

Acute hepatitis A virus infection during pregnancy might increase the rates of adverse pregnancy outcomes; cases leading to fetal liver injury and mother-to-child transmission of HAV have been reported. In addition, pregnant women with chronic hepatitis B or C infection might have an elevated risk of preterm delivery and gestational diabetes. (Terrault et al., 2021)

There is a risk of mother-to-child transmission of HBV, especially in mothers with high HBV DNA levels. Still, this risk is reduced using maternal antiviral therapy and prompt administration of infant immunoprophylaxis. According to the NIH, babies born to mothers infected with hepatitis B should receive hepatitis B immunoglobulin and the hepatitis B vaccine within 12 hours of birth to help prevent infection.

Acute hepatitis E virus infection in pregnancy is linked with an increased risk of maternal death and infant mortality, including higher rates of preterm delivery and stillbirths. 

How Is Hepatitis Diagnosed?

Acute liver infection is the usual suspect when patients have symptoms like fatigue and jaundice. Blood tests (comprehensive metabolic panel and liver panel, toxin screening) determine the type and quantity of hepatitis virus and antibodies in patient's bodies. The doctors may also suggest performing a liver biopsy if chronic hepatitis B and C are suspected and there's a chance of liver damage.

Since liver damage can occur before any severe signs and symptoms, routine screenings for hepatitis B and C are recommended for people at a high risk of contracting these viruses. In addition, intravenous drug users, multiple sexual partners, people who take immunosuppressive drugs, HIV-positive patients, and pregnant women should also be subjected to regular testing.

Suppose the blood tests do not show any viral presence. In that case, a detailed medical history and screening for toxins and alcohol will tell us about the other etiologies. Doctors might also do imaging tests, such as an ultrasound, CT scan, or MRI, for accurate diagnosis.

How Is Hepatitis Treated?

Treatment for hepatitis typically depends on the type and whether it is acute or chronic. Very often, acute viral hepatitis goes away on its own. You may need to rest, eat well and get enough fluids. However, in severe cases, hospitalization might be required.

There are several medicines used to treat hepatitis. Other than drug treatments, surgery and other medical procedures may be an option. People with alcoholic hepatitis need to stop their alcohol intake. If chronic hepatitis leads to liver failure or liver cancer, a liver transplant may be needed.

According to the NIH, most acute hepatitis infections brought on by the hepatitis A, B, C, and E virus will resolve on their own over several weeks or months. Severe cases of acute hepatitis B infections can be treated with antiviral drugs like lamivudine (Epivir).

Treatment for chronic hepatitis B and C infections are antiviral medications such as pegylated interferon (peginterferon) injections or oral antivirals such as lamivudine for hepatitis B or ribavirin (Copegus, Rebetol, Ribasphere) for hepatitis C. However, according to the NIH, ribavirin must be taken along with peginterferon to be an effective hepatitis C cure. In addition, liver transplants may be necessary if the liver is severely damaged. Even though there is no vaccine for Hepatitis C, treatments can reduce the viral load to undetectable levels, which is considered cured or in remission. Hepatitis C is considered cured when it is not detected in your blood 12 weeks after treatment is completed.

The most effective treatment for hepatitis caused by toxins or alcohol is to avoid further exposure to the chemicals, drugs, vitamins, minerals, or nutritional supplements causing toxic hepatitis. Patients must also avoid or limit workplace exposure to harmful chemicals. If it is confirmed that the patients developed toxic hepatitis after exposure to harmful chemicals, a change of jobs or duties must be done. Patients must not drink alcohol, use recreational drugs, or take prescription or over-the-counter medications other than as directed. It would help if you did not take more than the recommended dose.

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How Can Hepatitis Be Prevented?

There are various ways to prevent or lower the risk for hepatitis. For example, reducing the intake of too much alcohol can prevent alcoholic hepatitis. In addition, there are vaccines to prevent both hepatitis A and B. Unfortunately, autoimmune hepatitis cannot be prevented and must be routinely screened and monitored.

According to the CDC, routine childhood hepatitis A vaccination, which was implemented in many parts of the United States in the 1990s, has significantly reduced new cases of hepatitis A by 95 percent between 1995 (12 cases per 100,000 people ) to 2010 (less than 1 case per 100,000 people). (Hepatitis A, 2020)

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Hepatitis B Prophylaxis

Hepatitis B vaccination is readily available, and it is 95 percent effective in preventing viral infections and their chronic consequences, according to the WHO. Screening of donated blood, practicing safe sex, and disposal of contaminated needles are recommended. Also currently, there is no vaccine developed for hepatitis D. The disease can still be prevented by vaccinating against hepatitis B.

References:

1. Hepatitis. (n.d.). MedlinePlus.
2. Hepatitis A. (2020, July 27). WHO.
3. Hepatitis B. (2020, July 27). WHO.
4. Kumar, S. (2020, December). Causes of Hepatitis. MSD Manual.
5. Nierenberg, C. (2017). Hepatitis C Deaths Rising in U.S. Live Science.
6. Terrault, N. A., Levy, M. T., Cheung, K. W., & Jourdain, G. (2021). 
7. Viral hepatitis and pregnancy. Nature Reviews Gastroenterology & Hepatology, 18(2). 
8. https://doi.org/10.1038/s41575-020-00361-w
9. Toxic Hepatitis. (2018, August 27). Cleveland Clinic.