It's Hepatitis Awareness Month and Baby Boomers Need to be Educated
By Don Drake, Connelly Law Offices, Ltd.
"May is designated as Hepatitis Awareness Month, with this Friday, May 19, being Hepatitis Testing Day," said professional fiduciary and certified elder law Attorney RJ Connelly III. "During this month, the Centers for Disease Control (CDC) and public health advocates are attempting to shed light on the impact that viral hepatitis has on individual and public health. This is especially important for baby boomers who may have been exposed to hepatitis C (HCV) and harbor the virus in their bodies even today. HCV will be the focus of our discussion on viral hepatitis because of its impact on today's seniors."
"Even though our society has grown regarding the discussion of formally taboo subjects, there still exists a stigma around viral hepatitis. In today's blog, we will take a deep dive into this issue, but first, let's start by looking at some key facts highlighted by the CDC."
Critical Facts About Viral Hepatitis
There are several types of viral hepatitis, with the most common being hepatitis A (HAV), hepatitis B (HBV), and hepatitis C (HCV).
Chronic HCV and HBV are this country's leading causes of liver cancer.
HAV and HBV are preventable with vaccines, and HCV is now curable with treatment.
The CDC recommends vaccinating all adults with risk factors against HAV and HBV, and those aged sixty or older without risk factors be vaccinated against HAV and HBV.
One out of three people with HBV are unaware that they have an infection, and four out of ten with HCV are unaware that they are infected.
The CDC recommends that all adults be tested for HBV and HCV at least once, and those pregnant get tested during each pregnancy.
"Simply put, hepatitis means liver inflammation," stated Attorney RJ Connelly III. "It's a vital organ that processes nutrients, filters the blood, and fights infections. Not every hepatitis is viral, as chemicals, medications, and alcohol can also cause this condition. Before we take a closer look at the types of viral hepatitis, let's look at the liver and everything this remarkable organ does."
The Importance of the Liver
Weighing in at just over three pounds and about the size of a football (making it the body's second-largest organ behind the skin), it can hold up to 13% of the body's blood supply and is the leader of the digestive system. The liver performs over five hundred tasks to keep the body healthy.
Everything we eat, consume, or put on our bodies (food, alcohol, medication, perfumes, and, yes, toxic substances) is filtered by the liver. It can detoxify the body by sending these unhealthy substances out through urine and stools. It is smart enough to identify the "good" substances and store them as essential nutrients to be released when needed by the body. The liver also keeps the blood sugar in the body at stable levels.
This organ is often compared to a factory, breaking down fats eaten and converting excess carbohydrates and proteins into forms that can be utilized by the body later. It produces bile that ushers waste products and toxins through the stool (bile gives it the brown color).
"This is just a brief description of what this remarkable organ does," said Attorney Connelly. "So, any damage to the body's liver should be considered a severe and potentially deadly problem. With that, we are going to discuss viral hepatitis."
As stated previously by Attorney Connelly, hepatitis is an inflammation of the liver. This inflammation can be caused by viruses, such as Hepatitis A, B, C, D, and E (add F and G), or by noninfectious agents (non-viral type). Non-viral hepatitis includes:
Toxic hepatitis - This type of hepatitis is caused by exposure to chemicals, drugs, and medications (including street drugs, prescription, over-the-counter medications, and even supplements).
Alcoholic hepatitis - This is what it sounds like, inflammation caused by drinking too much alcohol that causes serious harm to the liver.
Autoimmune hepatitis - This is caused by the immune system attacking the liver. This attack can cause inflammation, scarring of the liver, liver cancer, and liver failure. Little is known as to why this occurs.
There are five main hepatitis viruses: types A, B, C, D, and E. These five types are of most concern because of the illness and death they cause and the potential for outbreaks and epidemics these viruses spread. Let’s start with hepatitis A (HAV).
Hepatitis A (HAV)
The ingestion of fecal matter causes this type of viral hepatitis. Those who live in southern New England have heard the warnings after a heavy rainstorm not to ingest raw shellfish. This is because heavy rain tends to overwhelm sanitation systems, causing a release of sewage into the waterways and eventually into the bay. Bivalves, such as oysters and clams, filter copious amounts of water when feeding. If shellfish live in water contaminated with stool containing HAV, they can carry the virus in their digestive systems and spread it to humans.
Once infected, HAV can be spread to others through intimate kissing (oral secretions) or stool (poor hand washing or sexual behaviors). Poor hygiene by employees working in the food service industry is responsible for the major outbreaks of HAV in restaurants.
There have also been episodes of HAV infections because of lettuce and other leafy vegetables that are served raw. This has been traced to human waste in fields where these products are harvested (workers who defecate in the fields rather than using the available bathroom resources or have poor hygiene practices after using the bathroom).
HAV signs and symptoms typically don't appear until a person has had the virus for a few weeks. But not everyone with HAV develops symptoms, but if they occur, they can include fatigue, sudden nausea and vomiting, abdominal pain, or discomfort, especially on the upper right side beneath your lower ribs (by the liver), clay-colored bowel movements, loss of appetite, low-grade fever, dark urine, joint pain, yellowing of the skin and the whites of the eyes (jaundice) and intense itching.
HAV is a hearty virus that can live outside the body for months and survive under certain conditions in seawater and dried feces. The disease is usually mild and does not result in any long-term issues for most people, and the good news is that once infected with HAV, you cannot be infected again as the body develops antibodies against it. There is also a vaccine for HAV.
Hepatitis B (HBV)
This type of hepatitis is transmitted through blood-to-blood contact but is sexually transmitted for the most part and does have serious side effects. For most, HBV tends to clear the body after several weeks, but a chronic HBV infection will result for some.
HBV is a robust virus that is 50 to 100 times easier to transmit than HIV (the virus that causes AIDS). HBV is found in infected blood, vaginal secretions, saliva, and semen. It can be transmitted through oral, vaginal, and anal sex, whether in a heterosexual or homosexual context.
There is evidence that it can also be transmitted through deep kissing, especially if the partner wears braces or has open cuts or sores in their mouth. The chances of becoming infected with HBV rise as the number of sexual partners increases.
HBV symptoms usually appear about one to four months after a person has been infected, although they could occur as early as two weeks post-infection. Some people, typically young children, may not have any symptoms. Those who do may develop abdominal pain, dark urine, fever, joint pain, loss of appetite, nausea and vomiting, weakness, fatigue, and yellowing of the skin and the whites of the eyes (jaundice).
HBV can survive outside the body for at least seven days and cause an infection. There is no cure for Hepatitis B, and long-term chronic infection with this virus can cause other serious health problems, including liver cancer. And like HAV, there is a series of vaccines for HBV.
Hepatitis D (HDV)
This hepatitis virus cannot survive without the presence of an HBV infection. This is because HDV requires a protein from HBV to cause damage to the liver. Those with HBV and HDV are said to have a “superinfection,” and treating the person is difficult. Superinfections can cause the victim to develop cirrhosis rapidly.
Shared needles, contaminated blood, blood products, and sex can spread HDV. However, if the vaccine for HBV is received, HDV cannot exist.
Hepatitis E (HEV)
This type of hepatitis is similar in many ways to HAV regarding what kind of virus it is.
It is confined to North Africa, Mexico, and Asia, where it is transmitted by contaminated water. Unlike HAV, there is no vaccine for HEV.
Hepatitis F (HFV) and Hepatitis G (HGV)
Because there is some disagreement over whether F and G are "true hepatitis viruses", we did not include them among the other viral hepatitis types. Some cases of hepatitis transmitted through contaminated food or water are attributed to the hepatitis F virus (HFV), first reported in 1994.
Another virus isolated in 1996, the hepatitis G virus (HGV), is believed to be responsible for many sexually transmitted and bloodborne cases of hepatitis. HGV causes acute and chronic forms of the disease and often infects persons already infected with HCV. Now let’s talk about hepatitis C (HCV), the focus of this blog, and the concerns for seniors.
Hepatitis C (HCV)
Most of us now know the term "baby boomers," which refers to those born between 1945 and 1965. Studies have shown that this group is five times more likely to have HCV than other adults. Infection with this virus can lead to liver damage, cirrhosis, and even liver cancer. The problem here is that most people with HCV do not know they are infected. Because many people can live with HCV for decades without symptoms or feeling sick, testing is critical for those infected so they can get treated and cured – yes, cured.
Once infected, some people can clear or get rid of the virus. Most people, however, develop a chronic or long-term infection. Over time, chronic HCV can cause serious health problems. HCV is a leading cause of liver cancer and the leading cause of liver transplants.
HCV has six genotypes, one through six. There are also subtypes labeled with letters, such as genotypes 1a and 1b. A single, dominant genotype infects most people, but it is possible to have more than one simultaneously (called a mixed infection).
A genotype allows medical providers to categorize HCV based on genetic makeup. Why is this important? Because certain medications work better than others on specific genotypes, and at one time, only one genotype responded to treatment.
Although all HCV genotypes can cause severe liver damage, those infected with HCV genotype 1, specifically 1b, have a far greater chance of developing cirrhosis than other genotypes. Genotypes 1b and 3 have also increased the risk of liver cancer. Recent research also suggests that HCV is associated with increased risk for diseases outside of the liver, including heart and kidney disease -- and even diabetes.
Long-term infection with HCV is known as chronic HCV and is called the "silent" infection since it may be undetected for many years - even decades. However, during this time, the virus is busy damaging the liver enough to cause the signs and symptoms of liver disease later in life.
Symptoms of HCV include excessive bleeding and bruising, fatigue, poor appetite, jaundice, dark-colored urine, itchy skin, fluid buildup in your abdomen (ascites), swelling in the legs, weight loss, confusion, drowsiness, and slurred speech (hepatic encephalopathy), and spiderlike blood vessels on your skin (spider angiomas).
The Good News With HCV
HCV can be cured using direct-acting antivirals (DAAs) taken orally. These medications interfere with HCV making copies of itself and furthering the infection. By doing this, the body’s immune system can clear the virus quickly. These tablets are the safest and most effective medicines for treating HCV and are highly effective at clearing the infection in more than 90% of people. The tablets are taken for 8 to 12 weeks.
But why the focus on baby boomers? Simply this, the generation we are concerned with has been linked with high rates of drug use in the 1960s, 1970s, and 1980s when transmission of this virus was at its highest. But a boomer need not have been a part of the free love and sex era to have contracted HCV. Since HCV is spread through blood and blood products, boomers could have become infected from medical and dental procedures before blood supplies were tested and instruments underwent different sterilization processes.
HCV was also spread through the many nail salons that opened from the 1970s through the early part of this century. Of particular concern were nail files, nail brushes, finger bowls, foot basins, buffers, razors, clippers, and scissors.
Before they were regulated, tattoo parlors also have been implicated in the spread of HCV. Remember, HCV can live for a prolonged period outside of the body.
The only way to know if you have HCV is to get tested. A blood test called the HCV antibody test, can indicate if a person has ever been infected with HCV. This test looks for antibodies to HCV, chemicals released into the bloodstream when someone gets infected. When getting tested for HCV, ask when and how test results will be shared (for confidentiality reasons).
There are two antibody test results:
Non-reactive, or negative, means that a person does not have HCV. However, if someone thinks they may have been recently exposed to HCV, they must be tested again.
Reactive, or positive, means that HCV antibodies were found in the blood and that person has been infected with the virus at some point. However, a reactive antibody test does not necessarily mean a person has HCV.
Once infected, they will always have antibodies in their blood. This is true even if they have cleared the virus. A reactive antibody test requires an additional follow-up test to determine if a person is infected with HCV.
Again, the good news is that all types of HCV respond well to the new treatments available today. Just a few short years ago, using the word cure when speaking about HCV was a fantasy, yet a cure is not only possible but probable in most cases today.
"And there is more good news, Medicare and Medicaid will cover HBV and HCV screening tests if your PCP orders them," said Attorney RJ Connelly III. "Remember, HBV and HCV are serious health issues, so we recommend getting screened to prevent their spread. If you're a baby boomer, discuss the risk factors associated with HBV and HCV with your doctor and consider getting tested for the infection. Your PCP may also suggest the vaccine if certain risk factors remain in your life."