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When you hear statistics on hepatitis, it may seem like something far removed from you, but there were several outbreaks in the state of California last year—predominantly in the counties of San Diego, Santa Cruz, Monterey, and Los Angeles. A little information about the three types of hepatitis can help us all be more aware of the illness and its symptoms.
The San Diego outbreak, called Hepatitis A (or HAV), is a highly contagious virus that causes liver infection and inflammation. Most likely, individuals who become infected have either been in close contact with a person who already has hepatitis A, or they've consumed food or water contaminated with fecal matter. The symptoms typically appear after the virus has incubated in the body for a few weeks and can include:
- Fatigue and joint pain
- Nausea and vomiting
- Abdominal pain, especially near the upper right side, near your liver
- Clay-colored bowel movements and dark urine
- Yellowing of the skin and whites of the eyes
- Intense itching
Sometimes mild illness and symptoms resolve on their own, but an infection can result in severe illness causing liver damage. Getting a hepatitis A vaccine or injection of immunoglobulin (antibody) within two weeks of exposure may protect you from infection.
Here in Tulare County, hepatitis A rates declined from 2015 with the average 2015–2017 rate being 0.5 per 100,000. The best way to prevent hepatitis A is to practice good hygiene by frequently washing hands and being aware of risk factors, such as having sexual contact with someone who has the virus, eating food handled by persons who do not thoroughly wash their hands after using the toilet, eating raw shellfish from water polluted with sewage, and using illegal drugs (not just those that are injected). Persons with chronic liver disease or who travel or work in areas of the world where hepatitis A is common are also at risk. It is recommended that children aged 12 months or older (and older children who missed the childhood vaccine) should get the hepatitis A vaccine.
Hepatitis B (or HBV) has some of the same symptoms but should not be confused with hepatitis A. Hepatitis B can be a mild illness lasting a few weeks or can become a chronic, lifelong illness that increases the risk of liver failure, cancer, or cirrhosis (scarring of the liver). Children and infants are more likely to develop the chronic (long-lasting) condition, while most adults recover completely and do not become chronically infected. Some infected young people lack any symptoms of hepatitis B, while most infected adults have symptoms that reflect the list given for hepatitis A.
Here in Tulare County, rates for hepatitis B have slightly decreased, from 34 cases in 2016 to 29 in 2017. There is a preventive treatment that can be helpful if received within 24 hours of exposure via sexual contact, needle sharing, or accidental needle sticks. Mothers can pass HBV to their children; newborns should be vaccinated if the mother has the infection. You can reduce your risk of HBV if you know the status of your sex partner and practice safe sex, don’t use illegal drugs (and if you can’t stop, use a sterile needle every time you inject—never share needles), and use a reputable tattooist or body-piercing professional who will use clean needles and sterilized equipment. If you travel to a region of the world where HBV is common, get the HBV vaccine in advance (three injections over a six-month period).
Hepatitis C (or HCV) is only spread through contaminated blood and is a viral infection causing liver inflammation that can lead to severe liver damage. The early symptoms of HCV tend to be very mild and therefore go unnoticed until after the virus has already been doing damage to the liver for many years. When symptoms do develop, they may include:
- Bleeding and bruising easily
- Fatigue and poor appetite
- Yellow discoloration of the skin and eyes
- Dark-colored urine
- Itchy skin
- Fluid buildup in the abdomen
- Swelling in the legs
- Weight loss
- Confusion, drowsiness, and slurred speech
- Spider-like blood vessels on your skin
After rising from 377 in 2015 to 454 in 2016, numbers here in Tulare County decreased to 356 in 2017.. You’re at risk for HCV if you are a health care worker who has been exposed to infected blood, have ever injected or inhaled illicit drugs, have HIV, received a body piercing or tattoo in an unclean environment, were in prison, received a blood transfusion or organ transplant before 1992 or a clotting factor concentrate before 1987, receive hemodialysis treatments, or were born between 1945 and 1965 (the age group with the highest incidence of HCV infection).
Treatment includes an oral medication taken for two to six months. Unfortunately, about half of people with HCV don’t know they’re infected because of the apparent lack of (“silent”) symptoms. Anyone at risk for the infection should be screened.
Although Tulare County is below the state average for each strain, each strain of hepatitis is unique, and prevention and education efforts are needed to ensure all our community members are aware of the risk factors and treatment options.