For a disease with silent symptoms, the message of hepatitis awareness campaigns is resoundingly clear. Billboards in the Chicago area have posed the query, “Five million Americans have viral hepatitis. Do you? Get tested. Get treated.”
A new publicity effort by the American Liver Foundation and American Digestive Health Foundation is running a print advertisement with a large-type headline: “If you ever eat food, drink water, or have sex, read this.” The ad makes an effort to include everyone as a possible hepatitis victim and describes how you might contract one of its three forms.
One media mailing even presented a postcard featuring a shoulder tattoo of a hard-rock music fan, suggesting a connection to acquiring such body adornments at unsanitary parlors. Another campaign highlighted the support of blues musicians to get out the word.
Why the sudden interest in hepatitis?
“There is growing concern among public health officials about the emerging threat of viral hepatitis in this country,” said Dr. John M. Vierling, a UCLA physician and president of the American Liver Foundation. “More than a million Americans have hepatitis B, and 6,000 die from it each year. Four million have hepatitis C, and deaths are pegged at 10,000. But if we don’t control the spread of hepatitis C, projections are that 30,000 to 38,000 Americans will die from it by 2010.”
The medical community’s call to action came in the form of a recent report by the federal Centers for Disease Control and Prevention in Atlanta. The third National Health and Nutrition Examination Survey (NHANES-3 to insiders) pegged hepatitis as a simmering epidemic and especially warned about the potential pervasiveness of the C form.
Most people who have hepatitis don’t know it. That’s because initial symptoms generally go unnoticed or might be associated with another condition. For example, fatigue could be a result of any number of illnesses or stressful situations. Same for nausea or diarrhea. A person — and more than a few doctors — wouldn’t think about testing for a viral hepatitis infection.
Hepatitis is defined in medical dictionaries as “inflammation of the liver, caused by infectious or toxic agents.” Sounds painful, but any related aches develop only in advanced stages. Unlike, say, the tonsils, the liver has no pain fibers. You wouldn’t be able to feel the swelling until it caused liver dysfunction. That’s when jaundice, abdominal pain or fever set in. Complications of undetected hepatitis B or C can include liver cancer.
Hepatitis A is the mildest of the three viruses. It is caused by eating food or drinking water contaminated by human waste. One possible source derives from the unwashed hands of food preparers; another is the poor water purification methods in some countries, which argues for immunization before certain trips. A minority of patients may become sick with hepatitis A, especially the elderly, but most tolerate it well. It is not a chronic infection.
Hepatitis B, previously known as serum hepatitis, is more serious: It often requires longer recovery periods and turns chronic in about 10 percent of cases. People can be infected through blood and bodily fluids. Specialists warn that anyone who had a blood transfusion 20 or more years ago should be tested for hepatitis B. Sexual contact and IV drug use with shared needles are common forms of transmission, and researchers are debating the dangers of tattoos, acupuncture and sharing razors and manicure tools.
“We have no conclusive proof about the less conventional exposures,” said Dr. John Hamilton, chief of infectious diseases at Duke University Medical Center in Durham, N.C. “But it is certainly feasible that hepatitis B can be contracted at a tattoo parlor that is not properly cleansing its instruments.”
Hamilton said acupuncturists’ accepted practice standards (notably using needles only once), regulated by state laws, make the ancient discipline an unlikely source of contamination.
While treatment options for hepatitis B are limited and not altogether effective, immunization efforts in infants and children have been highly successful.
The “C” in Hepatitis C, once called non-A/non-B hepatitis, could stand for most “common” or “chronic.” There is no known vaccine — Hamilton said he expects a research breakthrough in the next 5 to 10 years — and treatment can only slow the progress of the disease, not cure it.
This virus is rarely transmitted by sexual contact (though people with multiple partners are at a somewhat greater risk). At one time, the most common cause was transfusions, but blood can now be routinely screened for the impurity. Anyone who had a transfusion before 1992 should consider being tested. Even if the liver infection can’t be eliminated, controlling it and taking optimal care of the organ (such as controlling alcohol intake) would be beneficial.
Doctors debate the merits of widespread hepatitis testing, but all agree that greater awareness will prevent new cases and deaths. At a national hepatitis summit in Washington, D.C., last week, Vierling revealed new survey results showing that only 12 percent of Americans know that hepatitis affects the liver and only 1 of 20 teens even recognizes the word.
“If you don’t know the organ involved or the word, then clearly people don’t respect the nature of the viruses,” said Vierling.
