Other Forms Of Hepatitis
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Other Forms of Hepatitis
There are five know hepatitis viruses in the world: hepatitis A, B, C, D and E. Additionally, there is alcoholic hepatitis although it is not a virus and is not caused by the above hepatitis’ it is not contagious like the above hepatitis viruses.
Hepatitis D is inflammation of the liver caused by the hepatitis D virus.
- It is estimated that globally around 20 million people are living with hepatitis D
- Approximately 5% of people living with chronic hepatitis B in Australia are co-infected with hepatitis D
- Very little is known about hepatitis D (HDV), which is sometimes called hepatitis delta because hepatitis D can only live alongside hepatitis B. This means it is transmitted at the same time as hepatitis B. Alternatively, someone living with hepatitis B can contract hepatitis D later on.
- Vaccination against hepatitis B
- Practicing safe sex
- Not sharing injecting equipment (including tourniquets, spoons and filters)
- Avoid non-professional tattooist and piercing salons
- Avoid blood to blood contact
- Follow blood rule when playing contact sport
- Not sharing razors, toothbrushes, nail and hair clippers or any personal hygiene items
- Covering all cuts and open wounds with a band aid or bandage
- Follow standard precautions when handling blood spills
Hepatitis D can only occur when hepatitis B is present:
- This can be simultaneous (at the same time) and is called co-infection, or contracting hepatitis D when a person is already hepatitis B positive is known as a superinfection
- Co-infection with hepatitis B and D can speed up the progression of liver disease.
- Transmission of hepatitis D is the same as hepatitis B:
- blood to blood
- sexual fluids
- Successful vaccination against, or natural clearance of, hepatitis B provides indirect protection from hepatitis D (since you need to have hep B to contract hep D)
Hepatitis B and D are the most fatal of all the hepatitis co-infections
with a high fatality rate (approx. 20%).
Hepatitis D co-infection
- will generally clear after about 6 months
- Sometimes it can lead to life-threatening or fatal liver failure
Hepatitis D Superinfection
- Is more common in Australia through injecting drug use
- Leads to more severe liver disease than chronic hepatitis B alone
- Around 90% of superinfected people will develop chronic hepatitis D
- Around 70% of those people will develop cirrhosis - in comparison people living only with hepatitis B 15 – 30% will develop cirrhosis.
Hepatitis D is most common in:
- Sub-Saharan Africa
- The Middle East,
- Parts of Eastern Europe, and
- The Amazonian river basin in South America
ASHM Complex situations Co-infection and Immunosuppression
Hepatitis SA Community News #76 Jan 2018 Hepatitis D Special https://issuu.com/hepccsa/docs/hcn76
Hepatitis E is inflammation of the liver caused by the hepatitis E virus.
Hepatitis E is not common in Australia, but is found worldwide, mostly in countries with poor sanitation and poor water supply. The virus can be caused by chemicals or drugs, or by different kinds of viral infections, although it is mainly transmitted through faecal–oral, which is due to faecal contaminated drinking water.
If travelling to countries with poor sanitation and water supply:
- Only use bottled or boiled water for drinking and brushing teeth
- Do not drink untreated water or ice
- Only eat fruit and vegetables that you have prepared yourself
- Only eat food that is freshly cooked and is piping hot
- Wash hands with soap for at least 10 seconds – dry with clean paper towel after visiting the toilet, if caring for someone with diarrhoea or vomiting and before preparing food
- Pork (including pork liver) should be cooked at 75º C at the centre of the thickest part for two minutes, using a digital probe meat thermometer before you remove it from the pan/oven
- Hepatitis E symptoms usually start within 40 days (ranging from 15 – 64 days) from the time of exposure to the virus.
- Most people will recover from hepatitis E after 2 - 6 weeks.
- Hepatitis E can be quite serious in pregnant women, especially in the second or third trimester
Symptoms of hepatitis E typically in the last 1 – 6 weeks may include:
- Loss of appetite
- Abdominal pain
- Yellow skin and eyes (jaundice)
- Dark urine, and
- Pale faeces
Testing for hepatitis E is a blood test. There is no treatment for hepatitis E and most people will clear the virus naturally.
If diagnosed with hepatitis E a person should wash hands thoroughly, especially after using the toilet and avoid the following:
- Preparing food
- Providing health care to others
- Sharing eating and drinking utensils
- Sharing linen and towels
- Swimming or use hot tubs
- Having sex, and
- Donating blood
ACT Health factsheet: https://www.health.act.gov.au/sites/default/files/2018-10/Hepatitis%20E.pdf
World Health Organisation: https://www.who.int/news-room/fact-sheets/detail/hepatitis-e
Alcoholic Hepatitis is inflammation of the liver caused by alcohol.
Alcohol is one of the major causes of liver disease in Australia and the incidence of end stage liver disease among young adults in Australia is on the rise.
- People living with hepatitis C should avoid drinking alcohol
- Alcoholic liver disease is often silent until complications develop.
Liver disease due to alcohol consumption is common in Australia and presents in a number of ways, such as:
- Fatty liver disease
- Alcoholic hepatitis, and
- Alcoholic cirrhosis
Fatty liver disease
Usually there are no symptoms of fatty liver disease, although a person may have some mild nonspecific symptoms such as nausea and liver enlargement.
Acute inflammation of the liver and symptoms can vary from:
- mild abdominal pain
Is scarring of the liver caused by years of heavy drinking and most often occurs in middle-aged men.
Usually cirrhosis does not have any symptoms until complications present themselves such as:
- bleeding from varices (varices are veins that are enlarged or swollen)
- infection, and
- neuropsychiatric changes such as symptoms of Alzheimer’s or dementia
Testing requires a full blood examination and the doctor may send the person for further examinations such as:
- liver biopsy
Management requires the person to abstain from drinking, which excepting people with advanced cirrhosis, can improve the health of the liver. Even if a person has advanced cirrhosis if they can abstain from drinking their life expectancy is greater than if they continued to drink.
Medications need to be considered when a person has chronic alcoholic liver disease, as the liver may not be able to process some medications and could do more harm to the liver. It is always a good idea to talk to your doctor about medications including herbal remedies.
Malnutrition is common among people with advanced liver disease so talk to your doctor about how you can improve your diet.