Transmission, symptoms and screening for hepatitis A, B and C
What are hepatitis A, B and C?
Hepatitis is an inflammation of the liver, usually caused by a virus. Generally, no treatment is necessary as viral hepatitis will spontaneously resolve two to six months after an infection. In doing so, the body produces antibodies against either the A or B virus which protect the individual for life. However, this is not the case for hepatitis C; healing does not protect against a new infection.
Some people with hepatitis B or C can become long-term carriers. By attacking the liver, hepatitis B and C can also cause chronic liver diseases such as cirrhosis or liver cancer.
How are hepatitis A, B and C transmitted?
Hepatitis A is present in the stool of an infected individual. Infected stools can contaminate water, food and various objects. The virus is transmitted by:
consuming contaminated water or food
touching contaminated objects
initiating contact between the mouth and anus
sharing sex toys
preparing or consuming drugs under unsanitary conditions
Hepatitis B is transmitted mainly through:
unprotected sexual intercourse (oral, vaginal or anal)
blood (contaminated blood, open wounds, sharing needles for drug use)
other bodily fluids (tears, saliva and breast milk)
Mothers can pass the virus on to their babies during pregnancy and delivery.
The main means of transmission of hepatitis C is through blood. It is passed on by:
sharing drug or steroid injection equipment
receiving blood, blood products or immunoglobulin (before 1992)
getting tattoos, piercings or acupuncture with non-sterile equipment
sharing razors, toothbrushes, nail clippers, etc.
The C virus can also be contracted during sexual intercourse with an infected person. Mothers can pass the virus on to their babies during delivery.
What are the symptoms of hepatitis A, B and C?
Abdominal aches and pains
Dark urine and pale stools
Loss of appetite, nausea or vomiting
How is hepatitis A, B or C diagnosed?
Acute cases of hepatitis A, B and C are usually diagnosed based on history, symptoms, lab tests indicating a liver disease, or blood that tests positive for either an antigen associated with the virus (hepatitis B) or antibodies produced by the body against each virus. In normal individuals, testing for antibodies is particularly useful for identifying whether a person is protected against the hepatitis A or B virus. In chronic hepatitis B and C cases, measurement of the total amount of viral nucleic acid (DNA) in a blood sample can give an evaluation of the virus load affecting the body.
Most cases of hepatitis A will resolve spontaneously within two months. More severe liver complications will be observed in less than 1% of cases. Therefore, no treatment is necessary except in some acute cases where support and comfort measures can be used to alleviate situations such as fluid loss due to vomiting or diarrhea. In addition to rest, a healthy diet and the avoidance of substances toxic to the liver such as alcohol and certain drugs are indicated. Resolution of the infection will be accompanied by the production of antibodies against hepatitis A, which will confer lifelong immunity against subsequent infections by the virus. Immunization with a potent hepatitis A vaccine constitutes the best preventive measure, particularly for children and travellers.
The course of hepatitis B is usually more severe than that of hepatitis A. Acute liver damage is observed in less than 1% of cases, but progression to a chronic infection state is more frequent and can affect nearly 5% of patients. Subgroups of patients are particularly prone to develop complications, including those with a weak immune system, co-infected with the hepatitis C virus or infected with AIDS. As with hepatitis A, the body will produce antibodies that will free the organism from the B virus within six months and, in 95% of cases, confer lifelong immunity against the virus. In non-severe cases, support and comfort measures can be used to alleviate most symptoms of the disease. In more severe cases, such as those affecting blood clotting or causing persistent jaundice, antiviral agents can be used. In chronic hepatitis B cases, the drug interferon is added to the list of antiviral agents that can limit damage to the liver.
The production of antibodies against the hepatitis C virus will help clear the virus within six months. But contrary to hepatitis A or B, these antibodies will not confer lifelong immunity against re-infection. Cases of hepatitis C also tend to develop in chronic infections much more often than with hepatitis A or B. Chronic hepatitis C cases can degenerate and cause serious liver complications such as cirrhosis or liver cancer. Some of these cases can only be cured by a liver transplant. As with chronic hepatitis B treatment, the use of interferon and other antiviral drugs constitutes the basis of chronic hepatitis C treatment.
Did you know?
The number of reported cases of hepatitis B has stabilized in Quebec in recent years. This demonstrates the importance of vaccination, especially for people at risk.
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