What you need to know about hepatitis

Hepatitis is the medical word for inflammation of the liver. Depending on the cause, it can lead to damage to the liver, including, in some cases, cirrhosis (scarring of the liver) or liver cancer. Without treatment, some types of hepatitis can be deadly.

What causes hepatitis?

Broadly speaking, hepatitis can be split into two categories - viral and non-viral. In viral hepatitis, an infection causes the liver to become inflamed. This includes hepatitis A, B, C, D and E and viruses like the Epstein-Barr virus which causes glandular fever. There are also a number of non-viral causes including:

• Alcohol.

• Autoimmune conditions - in which your body's immune system turns on itself.

• Medication.

• Non-alcoholic fatty liver disease.

• Haemochromatosis.

• Wilson's disease.

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Hepatitis

Hepatitis is the medical term for inflammation of the liver. It has a number of causes, leading to different types of hepatitis, which are treated and managed differently. This leaflet signposts to leaflets with more information on some of the more common types of hepatitis.

by Dr Doug McKechnie, MRCGP

Types of hepatitis to be aware of

Certain types of hepatitis are more common than others. Hepatitis B is the most widespread form of hepatitis worldwide. According to the World Health Organization, more than 300 million people live with the long-lasting (chronic) hepatitis B. A further 256 million people have hepatitis B or C but do not know it.

Hepatitis E is rare in the UK, with around 1,000 cases diagnosed each year. It used to be thought that you could only catch the virus abroad but since 2010 there's been an increase in the number of UK-borne cases, attributed to eating processed pork products.

Not only can hepatitis E be passed through poo to mouth (faecal-oral) transmission, but also from animals (zoonosis). Eating undercooked meat increases your risk of contracting the virus.

Alcohol-related hepatitis is fairly common in the UK and yet many people don't know that they have it. Whilst it's reversible if alcohol intake is reduced, alcohol-related hepatitis can go on to cause cirrhosis. In order to minimise a variety of health risks, UK guidelines say that you should avoid drinking more than 14 units of alcohol a week.

Here we take a closer look at three of the most common types: hepatitis A, B and C.

Hepatitis A

Whilst hepatitis A is normally a short-term illness that people recover from, it can be unpleasant and make you feel quite unwell. It's highly infectious, passed when infected poo gets into the mouth, often through contaminated water or food. It can also be passed through close contact with someone who has the virus and hasn't washed their hands after using the toilet, or through sharing food or cutlery.

Those travelling to high-risk countries - generally areas with poor sanitation - and those in high-risk groups should have the hepatitis A vaccine.

Hepatitis B

Hepatitis B is passed through bodily fluids such as semen and blood, but not through coughs and sneezes. Pamela Healy, Chief Executive of the British Liver Trust says: "The majority of people with hepatitis B acquire it from their mother at birth" she says that the virus can also be transmitted through unprotected sex and injecting drugs, including steroids. Certain jobs can put people at risk from hepatitis because they involve contact with infectious body fluids.

The only way to know for certain if you have hepatitis B is to get tested. "As the virus enters your body, there may be no symptoms for one to six months. As with most liver diseases, many people with hepatitis B never have any symptoms and people can pass on the virus without realising," Healey explains.

There isn't currently a cure for hepatitis B. In more than 9 in 10 adults, the virus clears within three to six months. In people who develop a chronic infection, up to seven in ten remain well but can pass on the virus to other people. Some continue to experience related symptoms, some may go on to develop cirrhosis, and a small number will develop liver cancer.

"If you think you may have hepatitis B, see your doctor as soon as possible. A simple blood test will find out if you have the virus. If your test result is positive, you will be referred to a specialist who will look at your test results, age and general health to recommend the appropriate treatment for you. Not everyone with hepatitis B will require treatment but some people will need to be treated long-term."

There is a safe and effective vaccine against hepatitis B. You should get vaccinated if you are likely to be travelling to an area where hepatitis B is common, if you use drugs, have regular blood transfusions or you're considered to be at high risk because of your lifestyle or job. You can also protect yourself by having safe sex, avoiding sharing drug equipment and ensuring that any piercings or tattoos are done using disposable sterile needles.

Hepatitis C

The UK Government says there are 61,600 people living with a chronic hepatitis C infection in the UK - this is down from 143,000 people in 2015. This substantial reduction of those with hepatitis C infection is largely due to improved access to direct-acting antivirals.

Hepatitis C is passed blood-to-blood. It only takes a tiny amount to get into the bloodstream for it to be passed on. Unlike hepatitis B, there is an effective cure available - the biggest challenge is getting people to get tested, as many underestimate their risk.

With the NHS self testing portal, it has never been easier to test for hepatitis C as you can do a free, confidential test at home. You prick your finger to get some blood and then send the blood to get tested.

Those most at risk of having hepatitis C? "The first group is anyone who's ever injected drugs, whether they did it once or whether it's been ongoing. It's not just the needles - it's sharing needles, spoons, syringes, filters," explains Samantha May, from the Hepatitis C Trust.

"The next big risk group would be people who have had blood or blood products in this country before September 1991," she says. During the contaminated blood scandal in the 1970s and 1980s, thousands of people in the UK received blood products which were infected with viruses like hepatitis C and HIV.

Hepatitis C can also be transmitted through any other route where infected blood could get into the bloodstream, including piercings, tattoos and mother-to-baby.

It may not be until liver problems develop decades after infection that you start noticing symptoms.

The typical symptoms of hepatitis C include:

• Feeling tired.

• Having tummy problems.

• Feeling a bit run-down.

It's very easy for you and your GP to put these symptoms down to a range of other possibilities. Untreated hepatitis C can go on to cause cirrhosis. "Although you can cure hepatitis C, there isn't currently a cure for cirrhosis. People need to be identified and treated before they get to that point," says May. Hepatitis C can also increase your risk of liver cancer and lead to other complications like type 2 diabetes, rheumatoid arthritis and thyroid problems.

"If you find out that you have it, there are excellent treatments available so it's highly curable," says May. "Treatments are more than 97% successful. They take between eight to 12 weeks. It's tablets only and there are very few side effects. If you get tested and get treated, you can make a full recovery."

Reducing your risk of hepatitis

Thankfully, many types of hepatitis are preventable and treatable. The hepatitis A and B vaccines are recommended to anyone in a risk group or travelling to a high-risk area. Since 2017, babies receive the hepatitis B vaccine as part of their routine 6-in-1 vaccine.

If you're travelling in an area where hepatitis viruses are prevalent, practise good hygiene, wash your hands properly and avoid untreated water and uncooked food, especially when in areas of poor sanitation. This can help to prevent faecal-oral transmission of hepatitis A and E.

You should always take precautions to avoid exchanging potentially infected bodily fluids, including blood and semen. Having protected sex, not sharing drug apparatus and ensuring that piercings and tattoos are done in a sterile and professional way can all reduce your risk. And limiting your alcohol intake has many health benefits, including preventing and reversing alcohol-related hepatitis.

Many people don't experience symptoms of hepatitis until later stages of infection. But if you do think you're experiencing any symptoms like jaundice, unexplained tiredness or muscle or abdominal pain, there could be a variety of causes so speak with a doctor to alleviate your concerns. If you've been in a risk group for hepatitis B or C, ask for a blood test so that, if necessary, you can start treatment as soon as possible.