The ABCDEs of Hepatitis
Words by Daniel Hirsch
Every year, World Hepatitis Day is marked on July 28. It’s an occasion to raise awareness about the spread and prevention of the disease. Given that the World Health Organization (WHO) reports that more than 354 million people live with either hepatitis B or C, and that roughly 4.5 million premature deaths could be prevented by 2030 through education, vaccination, testing, and treatment, it’s a very good thing to know about.
I spoke with DAP Health Director of Infectious Diseases Dr. Shubha Kerkar about what can be done to slow the spread of hepatitis, and why some forms of it are dubbed “the silent killer.” With three decades of experience fighting infectious disease, Dr. Kerkar is intimate with the complex factors involved in ending pandemics.
Why is hepatitis serious?
Untreated viral hepatitis B or C causes three things: liver failure, liver cirrhosis (permanent liver scarring), and liver cancer. Almost always, the number one reason for liver cancer or liver transplant in the U.S. — up until very recently — was hepatitis C-related cirrhosis. Untreated, hepatitis B or C can be fatal.
There are many types of hepatitis — A, B, C, D, E — why focus on types B and C?
Since 1982, hepatitis B has been preventable via a vaccine administered to children before they are two years of age. Still, we have 254 million people living with hepatitis B today. There are certain medicines to control it, but it can still lead to liver cancer. We need to get more people vaccinated, but people have developed tremendous distrust in vaccines over the last few years, so there are challenges.
Hepatitis C was a bigger pandemic until 2015 or so. We are now rapidly able to cure hepatitis C. The burden went down, but currently, 50 million people still live with hepatitis C.
So, of these two viruses, C is curable, and B is preventable. That’s the bottom line.
How does hepatitis C spread?
Primarily through contact with infected blood, which means intravenous drug users are at especially high risk.
However, about 50 to 60% of people who have hepatitis C may not even know it because they’ve never been tested — and there are often no symptoms initially. Over two to four decades, it then slowly scars the liver. Symptoms of liver failure occur when the liver decompensates, and a cure may not save the need for transplant. That’s why it’s known as “the silent killer.”
Because the test was only developed in 1992, hepatitis C has spread all over the world. So regardless of risk factors, baby boomers have a five-fold higher risk of unknowingly having hepatitis C. They need to get tested to see if they have it. Then, we can cure them.
The other thing about hepatitis C is that you can get reinfected after being cured, so it’s important to learn how to stay cured by managing risk factors and avoiding exposure, which led to the infection in the first place.
And hepatitis B?
Hepatitis B is mainly transmitted through sexual contact, but can also spread through contaminated food or water. Most importantly, pregnant-mother-to-child transmission can occur during labor.
What can be done to stop the spread?
I have been treating and trying to cure hepatitis C since 1996. From 1996 to 2015, there was a 35 to 45 % cure rate. However, since the newer medications — which are easy to tolerate without any side effects — the cure rate is nearly 100%. So, the easiest part of treating hepatitis C is getting people tested so they know they have it, then linking them to care.
Hepatitis B is preventable via vaccine, yet I do manage several patients who have hepatitis B. It is treatable but prevention is best.
To eliminate viral hepatitis, we need education, prevention, screening, and linkage to care. Here in the Coachella Valley, DAP Health has been doing a lot of free testing.
For both hepatitis B and C, elimination and cure are the goals. Eliminate hep B by vaccination. Eliminate hep C by widespread testing and linkage to care, and cure those who have it with treatment.
For free hepatitis C testing, please contact one of DAP Health's three sexual wellness clinics, in Palm Springs, Cathedral City, or Indio.
To be tested for other forms of the disease, for vaccination, or for treatment, please see your primary care physician — at DAP Health or elsewhere.
And to learn more about individual types of the disease, read below.
The ABCDEs of Hepatitis
Each type of hepatitis has unique transmission methods, symptoms, potential for chronic infection, and prevention strategies. Read on…
Hepatitis A (HAV)
- Transmission: Fecal-oral route, often through contaminated food or water.
- Symptoms: Acute illness with jaundice, fatigue, abdominal pain, and fever.
- Chronicity: Does not become chronic.
- Prevention: Vaccination and good hygiene.
Hepatitis B (HBV)
- Transmission: Blood, sexual contact, and from mother to child during childbirth.
- Symptoms: Acute and chronic liver disease. Can lead to cirrhosis or liver cancer.
- Chronicity: Can become chronic.
- Prevention: Vaccination prevents infection
Hepatitis C (HCV)
- Transmission: Blood, primarily through sharing needles or blood transfusions. Tattoos
- Symptoms: Often asymptomatic initially, it can lead to chronic liver disease.
- Chronicity: Often becomes chronic.
- Prevention: No vaccine but avoid sharing needles and ensure safe blood products.
- Cure: Can be easily cured, but cure does not give immunity.
Hepatitis D (HDV)
- Transmission: Blood, similar to HBV; requires HBV for replication.
- Symptoms: Similar to HBV but more severe liver disease.
- Chronicity: Can become chronic.
- Prevention: HBV vaccination (since HDV requires HBV to propagate).
Hepatitis E (HEV)
- Transmission: Fecal-oral route, similar to HAV, often through contaminated water.
- Symptoms: Acute liver disease with jaundice, fever, and abdominal pain.
- Chronicity: Rarely becomes chronic.
- Prevention: Good sanitation and hygiene practices; vaccination