World Hepatitis Day is July 28: There’s nothing to celebrate

July 28th is World Hepatitis Day. That date was picked because it’s Dr. Baruch Blumberg’s birthday. Blumberg, who died recently, was the first to identify the hepatitis B virus and, several years later, develop a test to detect it and, even later, a vaccine to prevent it. For this work, and work on other diseases, like Kuru, he was awarded the Nobel Prize in Medicine. Interesting and amazing work.

What’s the big deal about hepatitis?

About 1 in 12 people world-wide have some form of viral hepatitis. The majority of infected people don’t know even know that they have hepatitis. Those people are able to continue passing the disease to others. And, since they don’t know they have it, their infection may, in many cases, become chronic. Patients with chronic hepatitis have a much higher risk of developing cirrhosis and/or liver cancer.

World Hepatitis Day is used to try to raise awareness of hepatitis, and encourage people to get tested for the hepatitides and treated for them. Could you (or someone you know) have hepatitis? It’s possible. Should you get tested? Are vaccines available? Are medications available? What even is hepatitis? Read on…

HYDERABAD, PAKISTAN - JUL 28: Participants participate in "Walk against Hepatitis" organized by Hepatitis Control Program on the occasion of "World Hepatitis Day" on July 28, 2011in Hyderabad, Pakistan. (Asianet-Pakistan /

HYDERABAD, PAKISTAN – JUL 28: Participants participate in “Walk against Hepatitis” organized by Hepatitis Control Program on the occasion of “World Hepatitis Day” on July 28, 2011 in Hyderabad, Pakistan. (Asianet-Pakistan /

Hepatitis is a broad term that means “inflammation of the liver”. Inflammation is the body’s response to the injury of tissues. The body tries to contain, dilute and destroy the infection or the agent that is causing damage. Hepatitis can be caused by things other than viruses. Other causes of hepatitis include: alcohol and other toxins, side effects of some medications, diseases of the pancreas of gallbladder, and a few others, along with viruses.

The most common cause of hepatitis is viral hepatitis. And that’s what World Hepatitis Day focuses on, the viral hepatidides. Next, a little information on the several types of hepatitis.

The 5 major types of Hepatitis

There are five major types of viral hepatitis, all caused by different viruses. They are hepatitis A, B, C, D (also called delta hepatitis) and E. There are probably others, possibly hepatitis F and G. Research is continuing on those at this point. But the major ones are A-E.

Hepatitis A is caused by a virus that is spread by the fecal-oral route. However, it can be contracted through blood-blood contact as well, e.g., sharing contaminated needles.

People who have hepatitis A shed virus in their feces. This virus can contaminate water supplies, can concentrate in shellfish, can get on fruits and vegetables, can contaminate served food, can be found in ice as well as other sites. When these products are eaten and drunk, the virus gains entry to the GI tract and then the liver. It can be sexually transmitted as well, if there is anal-oral contact, or if the hands are contaminated with even small amounts of stool and then placed near the mouth.

Hepatitis A can be a mild infection. The infected patient may have few symptoms, or symptoms he attributes to “stomach flu.” As such, it may go unnoticed and he never considers that he was ever infected. Often the lay public thinks that hepatitis A is a “mild” disease. It can be. However it can also be a killer. There have been outbreaks of hepatitis A in the US from contaminated food served in restaurants. At one place, over 400 people were infected after eating at a Chi-Chi’s restaurant in Pennsylvania. There were a few deaths. Similar outbreaks have occurred elsewhere in the US. Many more in other areas of the world. Hepatitis A does not become chronic. There is no specific drug treatment. There is a vaccine available.

Hepatitis B is often a more severe and debilitating form of hepatitis.

Again, some people can be infected and have only mild symptoms, never realizing that they’ve been infected. Others may be severely ill, and some can even die from acute hepatitis B.

Hepatitis B can be spread through blood-blood contact (IV drug use, tattooing, reusing needles) and as a sexually transmitted disease. Hepatitis B particles can be found in semen and vaginal fluids, as well as in blood. This type of hepatitis may cause an acute disease with gastrointestinal symptoms, jaundice, liver damage and then be successfully managed by the body’s immune system.

But in some patients, this does not happen. The immune system cannot destroy the hepatitis B, and the disease progresses into the chronic form. When this happens, the patient is at risk of developing cirrhosis and liver cancer, either of which can be fatal. A vaccine is available. Chronic hepatitis B can be treated with some medications like peg-interferon and others. Many HIV positive patients have evidence of a past infection with hepatitis B.

Hepatitis C is much more insidious.

Before it was identified, it was called “non-A, non-B hepatitis” and was seen in some people after blood transfusions. The majority of people infected with C have virtually no symptoms, and never suspect that they have it. If there are symptoms, they often, again, get passed off as “stomach flu.” Even when hepatitis C becomes chronic, there may be no symptoms till late in the disease as they progress to cirrhosis. So they may have hepatitis C for dozens of years before it is even suspected. Because of this, infected people appear and feel well while they are capable of transmitting the disease to others.

Hepatitis C is most often transmitted by blood-blood contact (IV drug use, tattoos if needles are reused); it can also be transmitted as a sexually transmitted infection (STI) via semen, saliva, or vaginal fluids. But sexual transmission happens much less often than when needles are shared by IVDAs.  Sexual transmission is less efficient, but it does happen.  The risk is higher where there are multiple partners bedded who carry hep C. Roughly 25% or people who have HIV also have hepatitis C disease. A reliable vaccine is not yet available. Treatment is available using peg-interferon and antiviral medications.

Hepatitis D (delta hepatitis) is fairly uncommon in the US.

Hepatitis D is unusual that, to have hepatitis D the patient must ALSO have hepatitis B. Delta requires the hepatitis B be present in order for delta to replicate. It is blood borne, like hepatitis B. When present with hepatitis B, it causes a serious, sometimes fatal, disease. Someone who currently has hepatitis B can contract delta at a later time. There is no specific approved treatment for hepatitis D. There is no vaccine for delta. However, once a patient is successfully immunized against hepatitis B, infection with hepatitis D doesn’t occur.

Hepatitis E causes an acute (not chronic) form of hepatitis. Contact is through the fecal-oral route. Hepatitis E is uncommon in the US, but common in countries with poor sanitation. As such, it can be gotten through travel to those countries if the water or food is contaminated.. There is no FDA approved vaccine, though a vaccine is being used in China. There is no specific treatment as most people are able to clear the virus through their immune systems in time.

In severe cases of hepatitis, liver transplant may be an option.

The CDC recommends being tested for these viruses. In fact, they recommend that ALL persons born between 1945 and 1965 be tested for, at least, hepatitis C. Obviously, since several of these hepatitides can be life-threatening and/or fatal, it’s a good idea to be tested at least once and certainly more often if you are in a high-risk group (IV drug use, oral-anal sex, etc.). Getting tested, and treated if you’re positive, can be very important for you and those around you. It may just save your life.

So maybe there IS a reason for celebrating World Hepatitis Day. And, thank you, Dr. Blumberg!

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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4 Responses to “World Hepatitis Day is July 28: There’s nothing to celebrate”

  1. benb says:

    I was vaccinated against Hep B and, after several years when I tested okay, my doctor tested me and told me I’d lost my immunity. Scary. A friend of mine got Hep B years ago and was one of the unfortunate few who couldn’t clear it; he’s had to watch and be tested for liver cancer. The hep viruses are really nasty.

  2. John says:

    You state that Blumberg worked on kuru. He did not. This association comes from his sharing the Nobel Prize with Daniel Gajdusek, the person most responsible to showing that kuru was due to a “slow virus” or what we now call a prion.

  3. Whitewitch says:

    Hepatitis is an odd one…years ago I tested positive and was never ill (in fact I found out by donating and getting a very “not nice” letter from the Blood Bankpeople threatening criminal/legal action if I donated again…it was shortly after, I think I got the Hep B vaccine in the 80’s. Now they say I don’t have…however, based on this I never donate blood for fear so little is known that they can’t really tell. I would hate to be Hep Hanna passing it along unknowingly

  4. Indigo says:

    There’s more to hepatitis than I knew. Thanks for the reminders. I’m vaccinated but it’s always wise to be wary.

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