Hepatitis is a term that simply describes inflammation of the liver of any cause. It has become a bit confusing because we often hear people use the term as if it is a specific disease, which it is not.

There are many causes of inflammation of the liver including medication side effects, excessive alcohol, some toxic chemicals, disorders of the gall bladder or pancreas, and infections. There are many infective agents that can cause inflammation of the liver, or hepatitis, however the term is unfortunately commonly used to refer to a particular group of viruses identified not very imaginatively by letters of the alphabet.

Hepatitis A and B have been known for decades. When blood tests were invented which allowed doctors to identify and classify these two viruses of course it came to pass that some people had symptoms and signs that fitted a hepatitis picture but the test was negative. Historically these people were diagnosed with hepatitis non A non B ( scientists are so creative aren’t they ! ). Eventually more specific tests were invented and in 1989 Hepatitis C was indentified.

The identification of the different viruses and causes is of enormous importance because although the patients all presented with inflammation of the liver the course of the diseases and the prognosis for each was very different. The mode of infection and public health ramifications is also different for each type of hepatitis.

Hepatitis A tends to be transmitted through contaminated water or food via other infected people. The disease is short lived and people usually always recover with no long term problems. Once they have recovered from the virus they usually remain immune to any further contact ( a blood test can determine immunity).

Hepatitis B is transmitted from one person to another through body fluids eg blood to blood like transfusions or needle sharing, sexual contact or sometimes even extremely close personal contact. The course of the disease and its prognosis is variable. Some people recover after about 6 weeks with no permanent damage and remain immune forever. Others go on to recover but remain infectious to others and still others never completely recover but continue with a chronic liver problems or even develop cancer of the liver. Occasionally Hepatitis B is fatal.

The identification of these viruses has allowed scientists to develop vaccines to both.

Hepatitis C was the new kid on the block in the early 90’s, however since its identification there have been still other viruses found which cause hepatitis that are still under investigation – I believe we are up to H.

Hepatitis C is the fastest growing infectious disease in Australia ! With about 20,000 new cases each year it currently affects 230,000 people in this country.

Hepatitis C is transmitted via infected blood. Even microscopic amounts of blood may allow transmission. Sharing of contaminated needles is the most common mode of infection. It is not common to acquire the disease via sex and it is not considered a sexually transmitted infection. However sexual activity that involved exposure to another person’s blood would be risky, for example – sex during menstruation, anal sex where small tears in skin may occur. In fact any time there are small cuts or abrasions in the skin can be a potentially risky time.

Generally speaking you should not be able to acquire Hepatitis C by sharing cups, plates, toilet seats, swimming pools, or other casual contact. However sharing toothbrushes, razors, tweezers or nail scissors may allow transmission even if only microscopic amounts of infectious blood remains on the utensils.

Prior to 1990 and the identification of the Hepatitis C virus unfortunately some people became infected via blood transfusions. Now blood donations are screened for Hepatitis C and discarded if infection is identified. The Blood Bank recommends blood products since 1990 are safe from Hepatitis C infection.

There are 11 sub types of Hepatitis C so even if some one is infected with Hepatitis C they may still be infected with another strain of it. So it is never safe to share needles, even if you have Hepatitis C !

Our immune system is not equipped to destroy Hepatitis C and the virus lives on in the liver where it can go on to cause long term damage and even cancer.

A vaccine is not yet available against Hepatitis C.

When the liver becomes inflamed its normal activities of dealing with waste starts to play up. One of the cardinal signs of hepatitis is jaundice. Usually the liver processes a pigment called bilirubin which is a by product of old blood cell disposal. This pigment is yellow and is disposed of as bile where it flows from the liver to the gall bladder and is expelled onto the duodenum in the digestive tract. Bilirubin is responsible for the brown colour of faeces. When the liver is inflamed the bilirubin is not processed properly and it there is a back log that builds up in the blood stream. The body tries to get it out of the blood stream. The kidneys deal with some, while the rest is deposited in skin and eyes. So, the person with hepatitis will note a significant darkening of urine colour (almost tea coloured) and paleness of faeces, an obvious yellowness of the whites of the eyes occurs and a distinctive yellow colour develops in the skin – particularly noticeable in the lines of the palms of the hands. This process does not indicate the cause of the hepatitis, but does point towards a problem occurring in the organ. Hepatitis may also result in pain or tenderness under the lower right rib edge due to the organ swelling.

On discovery of jaundice or suspicion of hepatitis a doctor will commence a series of investigations to determine the cause of the liver dysfunction. History of medication or drug use as well as travel or contacts is important. The tests will include blood tests looking for infective causes as well as monitoring the actual liver function and ultrasound to image the liver . Depending on what shows up on the investigations other tests may well be indicated.

Infectious causes of hepatitis may also give flu like symptoms within weeks of infection before the jaundice occurs ( 5% of people with hepatitis C report this) .

What happens long term if you have Hepatitis C ?

Generally people infected with hepatitis C get over the initial infection and may notice any problems for 10 years or so. The symptoms of chronic hepatitis C may be continuous or come in bouts. They can include tiredness, abdominal discomfort in the region of the liver, or nausea – especially after drinking alcohol or fatty food.

It is suggested that 25% of people, infected with hepatitis C will clear the virus within 2 – 6 months of infection and remain immune to that strain. These are usually people who contracted the condition at a young age. However the remaining 75% will go on to develop a chronic liver condition. About a quarter of these may never notice any symptoms but they are infectious to others.

Of those infected with hepatitis C it is estimated that about 40-60% will , after 15 years develop some level of long term liver damage. After 20-40 years between 8-20% of those infected will develop cirrhosis of the liver which is serious liver damage. And between 2 – 5% of those infected will predictable develop cancer of the liver.

How is Hepatitis C treated ?

There are specialist units at hospitals and doctors with interest in this condition who can provide individual treatment regimes. It is important for all people diagnosed with Hepatitis C to be monitored regularly to check their liver function. There are treatments offered which may slow down the effects of the virus. Ask you doctor for a referral to a specialist.

Because the virus is transmitted through contact with infectious blood it is important to adopt protective living behaviour.

People who inject themselves with drugs should never share needles, and always wash hands before injecting.

• People should dispose of blood stained items ( including sanitary pads, tampons, etc safely)

• People should not share razors, toothbrushes, nail scissors or tweezers.

• Tattooing, or body piercing must be done using properly sterilised equipment.

• Safer sex practices should be always used if having casual sex or more than one partner or when indulging in "rough" sex or when blood may be exposed such as during menstruation.

** NB there are vaccines available against Hepatitis A and B from your local doctor – talk about whether you need vaccination . Hopefully one day a vaccine will be available for Hepatitis C too.

Federal Department of Health - Public Health Division - list of research projects - use the search facility to find more articles   http://www.health.gov.au:80/pubhlth/strateg/hiv_hepc/hepc/register/epidemi.htm

1997 stats with graphs showing distribution of cases in Australia : http://www.health.gov.au:80/pubhlth/cdi/cdi2301/cdi2301b.htm

a German site on hepatitis C ( in English ) that looks comprehensive and has some stories about people's own experiences : http://www.hepatitis-c.de/hepace.htm

a literature review on treatment of hepatitis C from 1989 to 1997 listing hundreds of articles that can be sourced : http://www.nlm.nih.gov/pubs/cbm/Hepatitis_C.html