By Hannah Calvelli and Lucy Gleysteen
From PHN Issue 51, Winter 2023
Hepatitis refers to inflammation of the liver. There are several types of viruses that cause hepatitis, but this article will focus on types A, B, and C. The liver is a large organ in the body, located under the right rib cage. It has many important roles, including cleaning toxins out of the body; breaking down proteins, carbohydrates, and fats to help digest food; regulating the amount of blood in the body; and helping blood in the body to clot. Hepatitis is caused by infections from different viruses (called hepatitis A, B, and C) that damage the liver.
Hepatitis A
The hepatitis A virus is spread through the fecal-oral route. This means that for people with hepatitis A, the virus leaves the body in their bowel movements and can be spread to others if people who are infected don’t wash their hands after using the bathroom. The virus can also be spread by consuming infected food or water, often by eating raw shellfish from areas with contaminated water. The hepatitis A virus can live outside the body for several months. The presence of hepatitis A can be detected with a blood test.
In adults, hepatitis A causes a flu-like illness that starts around a month after the person is infected. Initial symptoms include feeling tired, nausea or vomiting, fever, and belly pain on the right side. Later symptoms can include dark-colored urine, light-colored bowel movements, itching, and jaundice, which is yellowing of the skin due to liver damage.
Most of the time, hepatitis A will get better on its own, and this can take a few months. Most people fully recover by 6 months without any treatment. Hepatitis A does not lead to lifelong liver problems.
To prevent the spread of hepatitis A, wash your hands, especially after going to the bathroom and before eating. There is also a hepatitis A vaccine, which is recommended for all babies as part of routine childhood vaccinations. Adults can also get the hepatitis A vaccine, and it is recommended for people who use drugs, people experiencing unstable housing or homelessness, people with HIV, people with chronic liver disease, people with clotting disorders, and people who are currently or were recently incarcerated. People who have been in contact with someone with hepatitis A should also get vaccinated as soon as possible.
According to the federal Bureau of Prisons, if there is an outbreak of hepatitis A at your prison, it is recommended that anyone entering the prison completes a screening questionnaire for hepatitis A, which asks questions about symptoms, possible exposures, and risk factors. Vaccination for all people in prison and staff is also recommended during an outbreak.
Hepatitis B
The hepatitis B virus is spread through bodily fluids. It can be transmitted through having sex with someone who has the virus, using infected needles, and (less frequently) by sharing personal items such as toothbrushes, razors, or nail clippers with someone who has the virus. Hepatitis B is not spread through sharing things like cups or eating utensils, and it cannot be spread through coughing and sneezing. If a doctor thinks you may have hepatitis B, they will do a blood test to check for infection.
Hepatitis B can be acute or chronic. With acute hepatitis B, people have symptoms similar to the flu and may experience nausea, belly pain on the right side, and jaundice. Symptoms get better after weeks to months, and the liver is able to heal usually without treatment.
Around 1 in 20 people with acute hepatitis B will develop chronic hepatitis B infection. Most people with chronic hepatitis B have no symptoms, but over time, the infection can lead to a liver condition called cirrhosis. Cirrhosis occurs due to scarring of the liver, and symptoms include swelling in the belly and legs, easy bruising or bleeding, difficulty breathing, feeling full, and confusion. Chronic hepatitis B also increases the risk of getting liver cancer, so people with chronic hepatitis B need to be monitored by a medical provider. Some people with chronic infection will need treatment, which consists of antiviral medications. These medications are taken for many years and sometimes for life. In rare cases, people with chronic hepatitis B may need a liver transplant.
The vaccine for hepatitis B is recommended for all babies. Everyone with chronic hepatitis B should also be vaccinated against hepatitis A unless they are known to be immune. The Centers for Disease Control and Prevention (CDC) recommends that adults up to age 59 receive the vaccine. Adults 60 or older should receive it if they have risk factors. The hepatitis B vaccine is typically given as 3 shots over a period of 6 months. The entire series is needed for long-term protection.
Hepatitis C
Hepatitis C is spread through contact with the blood of someone who is living with the virus, such as by sharing needles, tattoo equipment, toothbrushes, razors, or other things that could have blood on them. The virus can live on surfaces for up to 6 weeks. For people who share needles, the hepatitis C virus can stay on the needle for weeks after it was first used. Boiling, burning, or rinsing needles with water or bleach does not fully protect against transmission. You can also get hepatitis C by having sex with someone who has it, although this is a less common way to catch the virus. It is recommended that all people older than 18 get tested at least once for hepatitis C.
Most people with hepatitis C have no symptoms, but when they do occur, symptoms include feeling tired, nausea, muscle or joint aches, and weight loss. Unlike with hepatitis B, where most people have acute infection and then recover, most people with hepatitis C will develop chronic infection after the acute infection. Chronic hepatitis C means that the infection lasts for many years and the virus remains active in the body during this time. This can lead to cirrhosis, similar to chronic hepatitis B.
Hepatitis C is treated with medications, and treatment usually lasts 2 to 3 months. People take a combination of 2 or more antiviral medications. The specific combination depends on the type of hepatitis C virus you have. With the newest treatments, people are cured over 90% of the time. Only in recent years did these treatments become available in prison. Correctional institutions vary in how much they offer treatment. Despite the overwhelmingly positive impact of hepatitis C treatment, facilities will determine who gets treated based on current liver function, length of sentence, and medical history. If you feel like you are being denied treatment, ask your medical provider why you are being denied. Some people have tried filing grievances in order to get treatment. There is no vaccine for hepatitis C, but it is recommended that all people with hepatitis C are vaccinated against hepatitis A and B.
Some general tips to maintain liver health if you have hepatitis include maintaining a healthy weight, avoiding alcohol, avoiding smoking, and asking your doctor about the medications that you are taking because certain medications can be harmful to the liver at high doses, such as acetaminophen (Tylenol), ibuprofen (Advil/Motrin), naproxen (Aleve), and aspirin (Excedrin).
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