Hepatitis means inflammation of the liver and is usually caused by a virus. The three main types of hepatitis are Hepatitis A, Hepatitis B, and Hepatitis C, and all may result in serious illness by causing several weeks to several months or lifelong disease, even death. The great news is there are vaccines available for prevention of two types, Hepatitis A and Hepatitis B. While there is more recently treatment available for Hepatitis C, there is no preventative vaccine. Symptoms of hepatitis, no matter which type, often include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain, and jaundice, and can develop weeks to months after exposure. Rarely does Hepatitis A cause death, but chronic Hepatitis B and chronic Hepatitis C may lead to liver cancer and death.
Hepatitis A is caused when a person ingests even the tiniest amount of fecal matter from a person who is infected by the virus. This can happen very easily when a person who is infected doesn’t properly wash his hands, and contaminates something the other person touches or eats or drinks from. A person becomes sick anywhere from 15 to 50 days after exposure, usually by day 28. Treatment of Hepatitis A is the support of symptoms, and a person can be sick for weeks or months. Hepatitis A is spread from person to person and is spread through the stool from two weeks before he becomes sick to ten days after symptoms begin. The CDC does not recommend routine testing for Hepatitis A. The Hepatitis A vaccine is given beginning at age 12 months and may be started at any age. It is a routine childhood vaccine, and just two shots provide lifelong coverage.
Hepatitis B (HBV) is caused when a person comes into contact with a bodily fluid of an infected person. Common methods of exposure are the sharing of drug paraphernalia, such as needles or snorting straws and sexual contact, but exposure may also happen during birth from a mother to her baby or the sharing of items, such as razors or toothbrushes or medical equipment, such as glucose monitors. Symptoms, if present, happen about 90 days after exposure. Like Hepatitis A, treatment of symptoms is supportive care. In those diagnosed with chronic Hepatitis B, monitoring for advancing liver disease is recommended, and in some cases, anti-viral medications are given. Many people may be carriers of Hepatitis B and not even know it; this is one reason it is vital to receive the Hepatitis B vaccine, which is a series of three vaccines given starting at birth and finishing by six months of age. Like the Hepatitis A vaccine, the Hepatitis B vaccine can be given or started at any age. Hepatitis B testing is recommended for people born in countries with 2% or higher HBV prevalence, men who have sex with men, people who inject drugs, people with HIV, household and sexual contacts of people with Hepatitis B, people requiring immunosuppressive therapy, people with end-stage renal disease (including hemodialysis patients), people with Hepatitis C, people with elevated ALT levels, pregnant women and infants born to HBV-infected mothers.
Hepatitis C (HCV) is also caused when a person comes into contact with a bodily fluid of an infected person. In addition to the sharing of drug paraphernalia or other medical equipment or objects contaminated with the blood of a person who has Hepatitis C, people who received blood products or organ transplants prior to 1992, when Hepatitis C screening became widespread, are also at increased risk for the virus. Like Hepatitis B, Hepatitis C may not cause symptoms in the infected person. Acute infection with Hepatitis C has no recommended treatment; once the condition becomes chronic, an eight-to-twelve-week regimen of oral medication will cure over 90% of people. There is no vaccine to prevent Hepatitis C infection. The CDC recommends Hepatitis C testing for all adults aged 18 years and older, all pregnant women during each pregnancy, people who have ever injected drugs and shared needles, syringes, or other drug preparation equipment, including those who injected once or a few times many years ago. Regular testing is recommended for people who currently inject and share needles, syringes, or other drug preparation equipment. Testing is also recommended for people with HIV, people who have ever received maintenance hemodialysis (regular testing), people with persistently abnormal ALT levels, people who received clotting factor concentrates produced before 1987, people who received a transfusion of blood or blood components before July 1992, people who received an organ transplant before July 1992, people who were notified that they received blood from a donor who later tested positive for HCV infection, health care, emergency medical, and public safety personnel after needle sticks, sharps, or mucosal exposures to HCV‑positive blood, children born to mothers with HCV infection and any person who requests hepatitis C testing.
Because Hepatitis A, B and C are reportable diseases in the state of Ohio, the Meigs County Health Department (MCHD) monitors for cases in Meigs County residents through the Ohio Disease Reporting System (ODRS) and attempts to contact those who have received a positive test result for the virus. Our case investigation is an attempt to identify that the person has been able to follow up with a physician for proper diagnosis and treatment as well as to manage infectious diseases in sensitive work or other settings, such as food service and daycare, which require exclusion from the setting for ten days after symptom onset of Hepatitis A due to its ability to spread from person-to-person. Case investigation helps identify other residents who may not be vaccinated against Hepatitis A and educates contacts in what to watch for after exposure. In June 2018, Ohio became part of the multi-state Hepatitis A outbreak, in which Meigs County had several cases, but moreover, the MCHD was able to provide over 200 adult and nearly 100 pediatric Hepatitis A vaccinations to help prevent illness and help control spread of the outbreak.
Often contributed to the lifestyle of people who are addicted to illegal drugs, chronic Hepatitis C is often Meigs County’s top reportable disease with anywhere from 25 to 86 new cases diagnosed yearly just since 2017. Some reportable diseases are more easily controlled or addressed than others, but with timely notification and preventative measures and response plans in place, public health is an integral factor in the prevention and spread of serious infectious diseases.
For more information about Hepatitis or other infectious diseases, please call the MCHD at 740-992-6626, visit us at www.meigs-health.com or visit cdc.gov.
Leanne Cunningham is the Director of Nursing at the Meigs County Health Department.