What is Hepatitis?

Hepatitis simply means inflammation of the liver. There are several different types of hepatitis with varying prevalence across the UK and they are most commonly the result of a viral infection.

Hepatitis A is uncommon in the UK with only 452 cases reported to Public Health England in 2018. Hepatitis B is relatively uncommon in the UK according to the Health and Safety Executive with between 0.1% and 0.5% of the UK’s population being affected.

For hepatitis C, the prevalence is between 0.5% and 1%. Hepatitis D infection coincides with some hepatitis B infections and apparently affects only 4.5% of those with hepatitis B globally. As such, incidences of hepatitis D in the UK are tiny. As for hepatitis E, Public Health England states that there are 100,000 infections each year in England alone, indicating a prevalence of around 13% of the general population.

So, now that we know a little about the disease prevalence across the country, it’s important to explain a little more about what hepatitis is, the different types of the condition, its signs and symptoms and treatments.

What is hepatitis?

Hepatitis can be an acute (sudden onset) condition or chronic (long-term) condition. Usually, the liver becomes inflamed due to a viral infection. If the hepatitis infection is left untreated, it can cause permanent scarring on the liver. This is called cirrhosis and it stops the liver from working efficiently. Some severe cases lead to liver failure or even liver cancer.

There are several types of hepatitis:

• Hepatitis A.
• Hepatitis B.
• Hepatitis C.
• Hepatitis D.
• Hepatitis E.

Each type of hepatitis outlined above is caused by a distinct virus. However, with hepatitis D you also need to have hepatitis B as the D virus needs the B virus to survive. This is called a ‘co-infection’.

Aside from the viral causes, there are other types of liver inflammation including alcoholic hepatitis and autoimmune hepatitis.

For those with any kind of hepatitis, the symptoms in the early stages are often similar to those of other types of infection such as a high temperature, loss of appetite and fatigue. There may also be nausea and vomiting. Some other symptoms may include a yellowing of the whites of the eyes and skin (jaundice) and mild abdominal pain. Having said that, some people may not have any symptoms until the condition becomes much more advanced.

What is hepatitis A?

Hepatitis A is caused by a virus that’s been named the hepatitis A virus. Usually, this viral infection is picked up by consuming contaminated food and drink. As a result, it is much more common in countries where there is poor sanitation. Hepatitis is often considered one of the ‘milder’ forms of hepatitis as it usually passes after a few months. However, it can still be life-threatening in a few cases.

Hepatitis A does not have any specific treatment and treatments are focussed on relieving the associated symptoms such as itching, pain and nausea. There is a vaccination for hepatitis A which is recommended for those who react severely to infections or when someone is travelling to an area of the world where the virus is common. This includes areas such as Africa, Central and South America, the Indian Subcontinent, Eastern Europe and the Far East.

What is hepatitis B?

Hepatitis B is also caused by a virus – the hepatitis B virus. This type of hepatitis infection is the most common in the world. It is often transmitted in childbirth from a mother to her baby or by a child becoming infected very young from another source. It is transmitted through blood and other bodily fluids and, as such, is transmitted through unprotected sex or by the sharing of needles to inject drugs. This is the most common method of hepatitis B transmission in the United Kingdom.

Unlike hepatitis A, hepatitis B is not transmitted through water, food or casual contact with an infected person, such as sneezing, coughing or holding hands. There is also a vaccine that protects against hepatitis B infection.

What is hepatitis C?

Hepatitis C is caused by the hepatitis C virus and is transmitted through contaminated blood. This means that the risk factors for contracting the disease include sharing personal items such as razors with an infected person, having unprotected sex, and sharing needles during intravenous drug use. It can also be transmitted to a baby from his/her mother during childbirth.

Previously, people in the UK also contracted hepatitis C from blood products during transfusions. However, blood products are now rigorously tested so this is now no longer the case.

Sadly, there is no vaccine for hepatitis C, but there are very effective treatments.

What is hepatitis D?

Hepatitis D is different to the other viral hepatitis infections in that it is a co-infection with hepatitis B. This means that you cannot contract hepatitis D unless you are already infected with hepatitis B. This is because the D virus needs the B virus to survive in the human body.

Hepatitis D is normally spread through sexual contact or blood-to-blood contact. Normally, hepatitis D is contracted after hepatitis B; however, there are cases where the two viruses have been contracted simultaneously.

A long-term (chronic) co-infection of hepatitis B and D increases the person’s risk of having significant liver diseases such as liver cancer and cirrhosis. Those who have been diagnosed with hepatitis B should also be tested for hepatitis D.

There is no vaccine for hepatitis D but those who have been vaccinated against hepatitis B are therefore protected from the hepatitis D virus due to its concurrent nature.

What is hepatitis E?

Hepatitis E is usually spread via water and food that has been contaminated with faeces from animals or humans that have the infection. It does not spread easily from person-to-person contact within a family setting unless all members of the family were exposed to the virus through the same drinking water, for example. For many people, they have no idea where they have picked up the virus.

Those infected are told to avoid preparing food or cooking for others for a period of two weeks after their symptoms first start. They are also told to avoid contact with pregnant women, those with liver conditions and people who are immunosuppressed. Scientists do not believe that hepatitis E can be transmitted through needle sharing, sexual contact or bodily fluids.

What is alcoholic hepatitis?

Alcoholic hepatitis is not caused by a virus, unlike most forms of hepatitis. As may be apparent from its name, alcoholic hepatitis is inflammation of the liver that is caused by long-term heavy use of alcohol. It ranges in severity and if a person stops drinking alcohol, the person often recovers, at least to some degree. However, not all heavy drinkers will develop the condition and it can also occur in those who drink much more moderately.

Alcoholic hepatitis happens because the alcohol a person drinks damages their liver. However, how and why it does that is not very clear. Essentially, the liver breaks down alcohol and, in the process, produces chemicals that are highly toxic. It is these chemicals that trigger inflammation in the liver and destroy its cells. With this action repeated over time, scars develop. When there are a lot of scars replacing healthy tissue, it interferes with the liver’s function. Irreversible scarring is called cirrhosis, and this is the final stage of alcoholic liver disease.

Alcoholic hepatitis can also develop in people who have other hepatitis infections such as hepatitis C, especially if they continue to drink alcohol despite their liver condition. Malnutrition also plays a role as many people who drink alcohol do not eat well.

It is not known how much alcohol a person needs to have consumed to develop alcoholic hepatitis. Indeed, it will be different for each person. However, the majority of those with this condition have a history of heaving drink that is equivalent to drinking 100g of alcohol daily for at least 20 years. This equates to around seven glasses of wine, seven shots of spirit or seven pints of strong larger/beer each day. As said, however, many people drink much less than this and still go on to develop alcoholic hepatitis.

What is autoimmune hepatitis?

Autoimmune hepatitis is not caused by a virus or by the misuse of alcohol. It is a lifelong condition of the liver that is an autoimmune disorder. This means that the body’s defence mechanisms, i.e., the immune system, attack the body’s own cells.

This type of hepatitis is uncommon and there are only likely to be around 10,000 people in the UK who live with the condition, according to the British Liver Trust. It is 3 or 4 times more likely to develop in women and affects all ages. The most commonly diagnosed group are women who are around 45 years of age. All ethnic groups are equally affected.

As is often the case with autoimmune conditions, between 30% and 50% of those who have autoimmune hepatitis also have another autoimmune condition. The causes of it are unknown but it is commonly thought to be a combination of a genetic predisposition and an environmental trigger, such as contacting a virus or coming into contact with a toxin.

What are the signs and symptoms of hepatitis?

The signs and symptoms of hepatitis are often similar amongst different types of the disease. Additionally, many people have a form of hepatitis without any obvious symptoms at all. This is often the case with acute (short-term) hepatitis infections.

The symptoms of hepatitis include:

• Joint and muscular pain.
• High temperature.
• Nausea and vomiting.
• Fatigue.
• Feeling generally unwell.
• Loss of appetite.
• Abdominal pain.
• Dark-coloured urine.
• Grey or pale stools.
• Itchy skin.
• Jaundice (yellowing of the eyes and skin).

Chronic (long-term) hepatitis is often only picked up via a blood test or when the liver starts to fail. In the later stages, it can cause swelling in the ankles, feet and legs, blood in vomit or in the stools, and confusion.

What causes hepatitis?

As mentioned, most cases of hepatitis are caused by viral infections of different viruses. The viruses are usually shorted to HAV, HBV, HCV, HDV and HEV. However, for alcoholic hepatitis, the cause is chronic alcohol abuse. This means drinking around seven or more alcoholic drinks each day for a period stretching into multiple decades. Having said that, some people develop alcoholic hepatitis by drinking moderately rather than excessively.

Autoimmune hepatitis is caused when the body’s immune system essentially “gets it wrong” and attacks healthy tissues in the liver. This can be triggered by environmental factors, but the cause is not really known. Many people with this type of hepatitis also have other autoimmune conditions too.

Who is more at risk of developing hepatitis?

People are at increased risk of developing certain types of hepatitis infection if they meet any of these criteria:

• Known direct contact with someone who has the condition (hepatitis A).
• Travel to a country where the hepatitis viruses are more prevalent (hepatitis A and E).
• Close contact with someone who has recently travelled to these areas (hepatitis A and B).
• Males having sexual relationships with other males (hepatitis A and B).
• Intravenous drug users, even just on one occasion (hepatitis A, B and C).
• Those with blood clotting disorders (hepatitis A).
• People who work with primates (hepatitis A).
• Being born in a country where the virus is endemic (hepatitis B).
• Those with chronic kidney disease (hepatitis B).
• Pregnant women (hepatitis B).
• People who have recently had or have more than one sexual partner (hepatitis B).
• People on immunosuppressants (hepatitis B).
• Children whose mothers had hepatitis in pregnancy (hepatitis B and C).
• Those with some high liver function blood tests (hepatitis B).
• Those receiving organ transplants or transfusions pre-July 1972 (hepatitis C).
• Those with HIV.
• Those born between 1945 and 1965 (hepatitis C).
• Those who have had long-term kidney dialysis (hepatitis C).
• Chronic alcohol abusers (alcoholic hepatitis).
• Those with autoimmune conditions (autoimmune hepatitis).

Can hepatitis be prevented?

In many cases, hepatitis can be prevented. However, this is not the case for all types of hepatitis. There are vaccines available for hepatitis A and B. The hepatitis B vaccine also protects against hepatitis D since this infection can only occur if a person has hepatitis B already.

There are no vaccines for hepatitis C or E. To prevent infections of these, there are other measures that a person can take to help protect themselves from infection. Hepatitis E, like hepatitis A, is transmitted when faecal matter from an infected person contaminates water or food which is then ingested. As such, practising good food hygiene and not drinking potentially contaminated water is of vital importance. This is particularly important for people travelling to areas where there is a greater prevalence of the virus.  Personal hygiene in these places is also of utmost importance.

Aside from this, avoiding risky behaviours such as injecting intravenous drugs, sharing needles and/or razors, and having unprotected sex are all things that people should do to avoid contracting viral hepatitis.

When it comes to alcoholic hepatitis, the amount of alcohol you consume directly correlates with the incidence of the disease. Reducing one’s intake of alcohol to safer levels is the best preventative strategy for this condition if abstaining from alcohol is not the preferred option.

Autoimmune hepatitis is not something that is easily understood and therefore cannot easily be prevented. Having said that, having a healthy lifestyle with good quality nutrition and moderate levels of exercise is always a good way of aiming to prevent the development of many medical conditions.

How is hepatitis diagnosed?

Hepatitis is usually diagnosed with a combination of blood tests, imaging studies such as ultrasound, CT or MRI scans, and liver biopsies. If a clinician suspects a form of viral hepatitis, blood tests may be performed to test for antibodies that will identify the type of infection.

Liver function blood tests are also used to test whether the liver is working properly or if it is becoming damaged by inflammation. These tests will test for common enzymes called ALT, AST, GGT and total bilirubin. Generally, elevated liver enzymes show that the liver is inflamed or damaged.

How is hepatitis treated?

How hepatitis is treated depends on the type of hepatitis. For hepatitis A and B, treatment is usually just to treat the symptoms of the virus and includes bed rest, fluids and good nutrition. Occasionally, anti-viral medication may be administered for a severe case of hepatitis B. For hepatitis C, the treatment often includes antiviral medications (called direct-acting antivirals – DDA), liver tests and lifestyle changes. The medication is taken for a period of 8 to 12 weeks and clears the infection in around 90% of cases.

Final thoughts on hepatitis

Hepatitis, or inflammation of the liver, has a number of different causes and routes of transmission. The treatments are also different as are the ways of preventing the condition. Here’s a handy table summary of the different types of hepatitis: