On Friday, the Centers for Disease Control and Prevention’s vaccine advisory panel is expected to recommend against routinely providing the hepatitis B vaccine at birth. It’s a move that public health experts worry will put more infants at risk of infection.
It would be just the latest mixed message by the Trump administration on the issue of hepatitis, or liver inflammation. While the Department of Health and Human Services has announced a new initiative to increase hepatitis B screening, and revived a yearslong effort to eliminate hepatitis C, it has also closed the nation’s viral hepatitis laboratory. And Robert F. Kennedy Jr., the health secretary, has sown doubt about the safety of hepatitis B vaccines.
The political confusion is unfortunate, said Dr. Dave Chokshi, the former commissioner of the New York City Department of Health and Mental Hygiene. Already in the United States, hepatitis is diagnosed late too often, after patients have developed cirrhosis, liver failure or cancer, he added, even though there are vaccines and treatments to combat the disease.
Given the added uncertainty, here’s what you need to know about hepatitis.
What is hepatitis?
There are five main hepatitis viruses that cause inflammation of the liver, but the A, B and C types are most prevalent in the United States.
Hepatitis A tends to spread through contaminated food or water, causing a sudden bout of illness that typically resolves on its own, said Dr. Judith Feinberg, an infectious diseases physician at West Virginia University.
Hepatitis B and C are different. Both are bloodborne and commonly spread from mother to child or through intravenous drug use. Hepatitis B can also spread through bodily fluids and sexual contact, making it quite contagious. In rare cases, hepatitis C can spread through blood-to-blood contact during sex as well.
But hepatitis isn’t always caused by a virus, said Dr. Robert Wong, a hepatologist at Stanford Medicine. Since the liver breaks down alcohol, heavy drinking can injure the organ and cause inflammation. Similarly, obesity and diabetes are tied to liver inflammation, specifically metabolic dysfunction-associated steatohepatitis, Dr. Wong added.
The main risk with hepatitis B and C, as well as alcohol-related hepatitis and MASH, is that the liver inflammation becomes chronic, setting the stage for cirrhosis, liver failure and cancer.
What are the symptoms?
Hepatitis doesn’t always announce itself. While hepatitis A often comes on abruptly, as with a bad stomach bug, most cases of hepatitis B and C are asymptomatic at first. Alcohol-related hepatitis and MASH tend to be quiet until the later stages, too.
But whatever the underlying cause, hepatitis often produces a similar set of symptoms, Dr. Feinberg said.
Many patients may notice fatigue, nausea and belly pain initially. But the most distinctive signs, like yellowing of the skin or eyes, bloated bellies and bouts of confusion, often only appear when the disease has advanced, said Dr. Otto Yang, an infectious diseases physician at UCLA Health.
Many patients with hepatitis show up to the hospital only “when they start to fall off the cliff,” Dr. Yang said.
How is hepatitis diagnosed and treated?
Hepatitis A and B can be prevented with vaccines, given as part of routine childhood immunization schedules. And all adults should be screened for hepatitis B and C once in their life, although additional testing may be warranted. For example, hepatitis B is endemic in many parts of the world, so people born outside the United States may be at higher risk.
There isn’t a stand-alone test for alcohol-induced hepatitis and MASH; clinicians usually diagnose it with a combination of patient history, laboratory tests, imaging and sometimes a biopsy.
Timely treatment can prevent major complications, said Dr. Francis Collins, the former director of the National Institutes of Health. For those infected, long-term antiviral medications can suppress hepatitis B, while hepatitis C can be cured with an eight-to-12-week regimen. For nonviral hepatitis, newer treatments are emerging, but the main priority is to tackle the root cause and prevent further damage, Dr. Chokshi said.
Still, public health experts say that reaching patients remains an issue. Stigma complicates the landscape, since hepatitis is often tied to obesity, drugs and alcohol. In the United States, hepatitis B and C are also most prevalent among people who often lack access to health care, Dr. Collins said, including immigrants, homeless individuals and incarcerated people.
As a result, only about one-fourth of people with hepatitis B get treated, and only one-third of people with hepatitis C get cured.
“This is a solvable problem,” Dr. Collins said, adding, “we just have to work a lot harder.”
Simar Bajaj covers health and wellness.
The post Do You Know What Hepatitis Is? appeared first on New York Times.
