What is hepatitis? What is hepatitis A? How is it spread? What are the symptoms? How soon do symptoms appear? How is hepatitis A diagnosed?

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1 Hepatitis A Massachusetts Department of Public Health, 305 South Street, Jamaica Plain, MA What is hepatitis? Hepatitis is any kind of inflammation (a reaction which can include swelling and pain) of the liver. Hepatitis can be caused by many things including viruses (type of germ), drugs, chemicals and alcohol. At this time, there are five viruses known to affect the liver in particular. In the United States, the most common types of viral hepatitis are hepatitis A, hepatitis B and hepatitis C. These viruses are very different from one another, but all are infectious and may cause similar symptoms. They differ in how they are spread, how long the infection lasts, and how they are treated. A health care provider can test a person s blood for hepatitis A, B and C virus infection. What is hepatitis A? Hepatitis A, once called infectious hepatitis, is a liver infection caused by the hepatitis A virus. It is highly contagious and can be spread easily from one person to another. Anyone can get hepatitis A, but it is more common in children. The disease is rarely fatal and does not cause chronic (long-term) liver disease. Once a person has had hepatitis A, he or she cannot get it again. There is a vaccine to prevent hepatitis A. How is it spread? The hepatitis A virus is spread through stool (by the fecal-oral route). This means the disease is spread by putting something in the mouth that has been contaminated with the stool of an infected person. It is often spread when an infected person is not careful about washing his or her hands after using the bathroom. For this reason, people who live with or have sex with a person who has the disease are at high risk of catching it. The virus can also be spread in programs that care for young children in diapers and in food-related businesses, such as restaurants. Hepatitis A can be spread by eating contaminated food (such as raw or undercooked shellfish) or by drinking contaminated water. Outbreaks of hepatitis A have also occurred among illegal drug users. Unlike other hepatitis viruses, hepatitis A is rarely spread through blood. What are the symptoms? The symptoms of hepatitis A include fever, tiredness, loss of appetite, stomach pain, nausea, diarrhea, and jaundice. The signs of jaundice are yellowing of the eyes and skin and dark urine. Teens and adults are more likely to have these typical symptoms than children. Young children with hepatitis A often have mild symptoms or no symptoms at all. Symptoms usually last less than two months. Some adults can feel sick for as long as six months, but this is rare. How soon do symptoms appear? Symptoms of hepatitis A, when they occur, usually appear about three weeks to a month after being exposed to the virus, but it can take from days. How is hepatitis A diagnosed? Hepatitis A is diagnosed with a blood test. This blood test can tell the difference between a current infection and a past one. There are also blood tests to measure if and how much damage has been done to the liver, but these tests do not show what caused the damage. How is hepatitis A treated? There is no specific treatment for a person with hepatitis A. Rest and plenty of fluids are recommended. Avoid alcohol and drugs as they may cause more damage to the liver.

2 Hepatitis A How can I prevent hepatitis A? Follow the tips below. If you make them your habits, you can prevent hepatitis A as well as other diseases: Always wash your hands thoroughly with soap and water before touching or eating food, after using the toilet, and after changing a diaper. When soap and water are not available, use alcohol-based disposable hand wipes or gel sanitizers. You can find them in most supermarkets and drugstores. Don t eat raw or undercooked shellfish. Always wash fruits and vegetables before eating them. For long-term protection, hepatitis A vaccine is best. Vaccine is recommended for all children months of age. It is also recommended for the following persons two years of age or older who are at increased risk of hepatitis A infection or complications: Travelers to areas with increased rates of hepatitis A. Children who live in states, counties and communities that have high rates of hepatitis A. Men who have sex with men. Injecting and non-injecting drug users. Persons who have chronic liver disease, including hepatitis C and hepatitis B. Persons with bleeding and clotting factor disorders. Immune globulin (Ig) is a shot that provides short-term protection. It is used for: Persons who have not received hepatitis A vaccine and are exposed to hepatitis A. Immune globulin must be given within two weeks after exposure to hepatitis A virus for best protection. Persons who are allergic to the hepatitis A vaccine or chose not to get it, and who will be traveling to an area with high rates of hepatitis A. Are there any restrictions for people with hepatitis A? Yes. Because hepatitis A can easily be spread to other people, doctors are required by Massachusetts law to report cases of hepatitis A to the local board of health. To protect the public, a worker in any food-related business who has hepatitis A cannot work until his or her fever is completely gone and a week has passed since the symptoms started. Coworkers may need to get Ig. Food-related businesses include restaurants, sandwich shops, hospital kitchens and dairy or foodprocessing plants. This requirement also includes workers in schools, residential programs, daycare and health care facilities who feed, give mouth care, or dispense medicines. Where can I get more information? Your doctor, nurse or clinic. Your local board of health (listed in the phone book under local government). The Massachusetts Department of Public Health, Division of Epidemiology and Immunization at: (617) or toll-free at (888) , or on the MDPH website at October 2006

3 Hepatitis B Massachusetts Department of Public Health, 305 South Street, Jamaica Plain, MA What is hepatitis? Hepatitis is any kind of inflammation (a reaction which can include swelling and pain) of the liver. Hepatitis can be caused by many things including viruses (type of germ), drugs, chemicals and alcohol. At this time, there are five viruses known to affect the liver in particular. In the United States, the most common types of viral hepatitis are hepatitis A, hepatitis B and hepatitis C. These viruses are very different from one another, but all are infectious and may cause similar symptoms. They differ in how they are spread, how long the infection lasts, and how they are treated. A health care provider can test a person s blood for hepatitis A, B and C virus infection. What is hepatitis B? Hepatitis B is a liver infection caused by the hepatitis B virus. It can be a serious disease that can lead to cirrhosis (scarring of the liver) and/or liver cancer. Most people who get the disease recover from it and can never get it again. However, about 10% of people who get hepatitis B will go on to have chronic infection (long-term infection) and can pass it on to others (be a carrier). The younger a person is when infected, the more likely he or she is to go on to have chronic infection and to develop serious liver disease. How is it spread? The hepatitis B virus is spread by direct contact with blood, semen, vaginal and other body fluids of an infected person. Sharing needles to inject drugs or having sex with an infected person can spread the virus. Health care workers who get stuck with contaminated needles can also get infected if they are not protected by immunity, such as with immunization. Pregnant women who have the virus in their blood can pass it on to their babies at birth. The virus can also be spread by sharing personal items such as a toothbrush, razor, or anything else that may have blood on it. The blood supply in the United States is now tested to prevent the spread of hepatitis B, but in the past, some cases resulted from blood transfusions. The hepatitis B virus is NOT spread by casual contact such as hugging, sneezing, coughing, or sharing food and drinks. You cannot get hepatitis B by donating blood. What are the symptoms? The symptoms of hepatitis B infection may include tiredness, loss of appetite, nausea, stomach ache, and muscle or joint pain. Urine may become darker in color, and then jaundice (yellowing of the skin and whites of the eyes) may appear. How soon do symptoms appear? Many people who are infected with hepatitis B have mild symptoms or no symptoms at all, but they can still pass the virus on to others. Symptoms can begin as soon as six weeks to as long as six months after contact with the virus. How is hepatitis B diagnosed? Hepatitis B is diagnosed with blood tests. These blood tests can be used to tell the difference between a current infection and a past infection. How is hepatitis B treated? Most people with hepatitis B infection get better without treatment. Generally, bed rest is all that is needed. People with chronic hepatitis B infection may be treated with special drugs that fight viruses. People with hepatitis B should avoid drinking alcohol or taking any medications or dietary supplements that are harmful to the liver, as these can make

4 Hepatitis B the liver disease worse. Hepatitis A vaccine may also be recommended to protect the liver against the virus that causes hepatitis A. Ask your doctor about treatment options and steps you can take to protect your liver. How can I prevent hepatitis B? For long-term protection from getting infected, hepatitis B vaccine is best. All newborns, children through age 18, and adults who are at risk of hepatitis B infection should get the vaccine. Adults at risk of hepatitis B infection include: People who have multiple sex partners; Men who have sex with men; People who have sex with infected people; Sex trade workers; Injection drug users; Household contacts of persons with hepatitis B infection; Health care and public safety workers who may have contact with blood or body fluids; Persons undergoing hemodialysis; People with hemophilia and others who receive certain blood products; Staff and residents who live and work with the developmentally disabled; Travelers to countries and areas where hepatitis B is common; Immigrants, refugees, and adoptees from countries where hepatitis B is common; and Alaskan Natives and Pacific Islanders. The best way to prevent hepatitis B infection is to avoid contact with the blood and body fluids of infected people, including the following: If you inject drugs, never share your needles, syringes and other works with anyone. Wash your hands before and after injecting drugs. Don t share cocaine or snorting straws, since these can get blood on them too. Find out about treatment programs that can help you stop using drugs. Use a latex condom every time you have sex. Only get tattoos or body piercings where sterile equipment is used. Wear protective gloves if you handle blood and body fluids. Never share personal items such as toothbrushes and razors. Is hepatitis B vaccine required for anyone? In Massachusetts, 3 doses of hepatitis B vaccine are required for all children attending licensed childcare or preschool, and kindergarten through grade 12. Three doses of hepatitis B vaccine are also required for full-time college and graduate students, as well as health science students attending college. Private employers must offer the vaccine to employees (such as health care workers) who might come in contact with blood and body fluids on the job. Where can I get more information? Your doctor, nurse or clinic. Your local board of health (listed in the phone book under local government). The Massachusetts Department of Public Health, Division of Epidemiology and Immunization at: (617) or toll-free at (888) , or on the MDPH website at October 2006

5 Hepatitis C What is hepatitis? Hepatitis is any kind of inflammation (a reaction which can include swelling and pain) of the liver. Hepatitis can be caused by many things including viruses (type of germ), drugs, chemicals and alcohol. At this time, there are five viruses known to affect the liver in particular. In the United States, the most common types of viral hepatitis are hepatitis A, hepatitis B and hepatitis C. These viruses are very different from one another, but all are infectious and may cause similar symptoms. They differ in how they are spread, how long the infection lasts, and how they are treated. A healthcare provider can test a person s blood for hepatitis A, B and C virus infection. What is hepatitis C? Hepatitis C is a liver infection caused by the hepatitis C virus. The hepatitis C virus is found in the blood and liver of people with hepatitis C infection. Most people with hepatitis C will go on to have chronic infection (long-term infection) and can pass it on to others. Some of these people will develop liver damage and will feel very sick while others may remain healthy for many years. The virus can eventually cause cirrhosis (scarring of the liver) and/or liver cancer in some people. How is it spread? The hepatitis C virus is spread primarily by direct contact with the blood (or body fluids containing blood) of an infected person. The most common way that hepatitis C virus is spread is through the use of injection drugs. Sharing needles, works, cotton, water, or any other drug injection equipment with an infected person can spread the virus. In the past, some people became infected after receiving a blood transfusion or organ transplant. Since July 1992, however, the blood supply has been carefully checked for this virus, and the blood supply is considered safe. Health care workers can get infected through needlesticks or sharps exposures on the job. The virus can be spread by sharing personal items such as a toothbrush, razor, or anything else that has blood on it. It can also be spread by tattooing, body piercing or acupuncture needles that have not been sterilized. The hepatitis C virus can spread through sexual activity, but this is not common among people with one steady, longterm partner. People who have multiple sex partners have a greater risk of getting hepatitis C infection. Infected mothers can pass it on to their babies at birth. The hepatitis C virus is NOT spread by casual contact such as hugging, sneezing, coughing, or sharing food and drinks. What are the symptoms? Symptoms of hepatitis C may include yellowing of the skin and eyes (jaundice), tiredness, loss of appetite, weight loss, nausea, stomach ache, and dark urine. Years later, cirrhosis may occur in some who are infected, when scar tissue replaces healthy liver cells. How soon do symptoms appear? Massachusetts Department of Public Health, 305 South Street, Jamaica Plain, MA When first infected with hepatitis C, a person may have no symptoms at all, or may have only mild symptoms. For those who do develop symptoms, the symptoms usually appear between six weeks and six months after infection. Many people with chronic hepatitis C infection do not develop symptoms until years, sometimes even decades, later. How is hepatitis C diagnosed? Hepatitis C is diagnosed with blood tests.

6 Hepatitis C How is hepatitis C treated? Hepatitis C infection can be treated with special drugs that fight viruses. Persons infected with hepatitis C infection should be vaccinated for hepatitis A and hepatitis B, two other viruses that cause liver damage, if they are at risk for these infections. People with hepatitis C should not drink alcohol, use illegal drugs, or take certain medications or dietary supplements that may cause more damage to the liver. Ask your doctor about treatment options and steps you can take to protect your liver. How can I prevent hepatitis C? There is no vaccine for hepatitis C. People are at risk for having hepatitis C if they: Have injected street drugs or shared drug injection equipment, even just once. Have received a blood transfusion, blood products, or an organ transplant before July Have had many sexual partners, especially if they did not use condoms. Are health care workers (like doctors or nurses) who may be exposed to blood or needles. Are babies born to mothers who have hepatitis C. Have been on kidney dialysis. The best way to prevent hepatitis C infection is to avoid contact with the blood of infected people. Other ways to prevent the spread of hepatitis C include the following: If you shoot drugs, never share works with anyone. Wash your hands before and after injecting drugs. Don t share cocaine or snorting straws, since these can get blood on them too. Find out about treatment programs that can help you stop using drugs. Use a latex condom every time you have sex. Only get tattoos or body piercings from places using sterile equipment. Health care workers and people who clean up in hospitals or other places where needles or sharps are found should follow standard (universal) precautions with every patient. Never share razors or toothbrushes. If you have hepatitis C, don t donate blood, sperm, or organs. Where can I get more information? Your doctor, nurse or clinic. Your local board of health (listed in the phone book under local government). The Massachusetts Department of Public Health (MDPH), Division of Epidemiology and Immunization at: (617) or toll-free at (888) , or on the MDPH website at The MDPH Hepatitis C Hotline at hepC (4372). October 2006

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