• Hepatitis A
• Hepatitis B

Hepatitis A

Hepatitis A virus is common cause of liver inflammation (hepatitis) worldwide. The primary mode of spread of hepatitis A virus is the fecal-oral route through contaminated food and water. The virus can also be transmitted by close and intimate contact.

Many patients with hepatitis A virus infection experience merely flu-like symptoms. These patients may not be aware that they have been infected with hepatitis A virus. In some patients with more severe symptoms, nausea, poor appetite, abdominal pain , fatigue, yellow eyes and skin ( jaundice ), and dark urine can last weeks to months. Very rarely, severe liver failure can lead to coma and death. However, most patients with acute viral hepatitis recover completely from their infection. Unlike viral hepatitis B and C, hepatitis A virus does not cause chronic persistent liver infection.

Patients who recover completely develop blood antibodies against the hepatitis A virus. Antibodies are proteins produced by special immune cells (usually white blood cells). Antibodies specifically target and destroy invading organisms like viruses and bacteria. After viral hepatitis A infection, the blood antibodies will remain and provide life-long immunity against future infections by the same virus.

Aside from personal hygiene, immunoprophylaxis (prevention of infection by immunization) remains the most effective approach for the control of hepatitis A. Immunoprophylaxis is a process of providing immunity for individuals who never had prior hepatitis A infection. Immunoprophylaxis can be accomplished either by administering immunoglobulins or by hepatitis A vaccines. Immunoglobulins are antibodies some of which are directed against the hepatitis A virus and can provide protection against infection within one day of administration. However, the protection only lasts two to four months. Hepatitis A vaccines are made of killed hepatitis A viruses. The vaccine stimulates the body's immune system to produce antibodies against hepatitis A virus. Protection from hepatitis A vaccines takes approximately two weeks to develop. After two doses of hepatitis A vaccine, the protection against hepatitis A infection can last longer than ten to twenty years.

Immunoglobulins are useful in situations where immediate protection against hepatitis A is necessary. For example, immunoglobulins are used to protect household contacts of patients with acute viral hepatitis infection. Protection is only effective if given within 2 weeks of exposure. Immunoglobulins can also be used to protect travelers to regions with high hepatitis A infection rates, when the travelers have to depart sooner than the vaccines can take effect. These travelers can receive both the immunoglobulins and the vaccines simultaneously, and be protected immediately as well as for longer term.

Hepatitis A vaccines are considered for individuals in high- risk settings, when immediate protection is not necessary. Examples include frequent world travelers, sexually active individuals with multiple partners, homosexual men, individuals using illicit drugs, employees of day care centers, and certain health care workers, and sewage workers.

Two hepatitis A vaccines are commercially available in the United States. These vaccines are called HAVRIX and VAQTA. These vaccines are highly effective and can provide protection even after only one dose. Two doses are recommended for adults in order to provide more prolonged protection (10-20 years) against hepatitis A infection. Both vaccines are administered by injection at the deltoid muscles of the upper arms. Both vaccines are well-tolerated. The side effects are mild. They include soreness at the injection site, headache, and fever.

Hepatitis B

Hepatitis B has been referred to as "serum hepatitis" because it can be spread by the transfer of infected blood or serum (for example, through needle sticks, blood transfusions, hemodialysis, and childbirth). However, it is now known that it can also be transmitted by close contact, especially sexual contact. Hepatitis B has even been transmitted by tattooing, body piercing, and sharing razors and toothbrushes. Patients infected with hepatitis B may have minimal symptoms, or can develop symptoms similar to viral hepatitis A. Rare patients with viral hepatitis B can suffer severe liver failure and coma. The mortality rate in these patients are high unless urgent liver transplantation can be accomplished. Majority (90%) of patients with viral hepatitis B develop effective antibodies against the virus and recover completely.

Individuals infected with hepatitis B are immune to future infection by the hepatitis B virus. In approximately 10% of the patients with viral hepatitis B, their antibodies are ineffective in destroying the virus. These patients can become chronic carriers of hepatitis B virus, but without symptoms or chronic liver infection. Others develop chronic liver infection with hepatitis B virus, and risk development of cirrhosis and liver cancer in the future. Chronic carriers of hepatitis B virus, and chronic hepatitis B patients can infect others. In fact, mothers carrying hepatitis B can transmit the virus to their babies. These babies are at risk of developing chronic hepatitis and liver cancer in adulthood.

Immunoprophylaxis of hepatitis B, like in hepatitis A, involves administration of hepatitis B immune globulin (HBIG) and hepatitis B vaccine. HBIG contain antibodies to hepatitis B virus, and offer prompt but short lived protection. Hepatitis B vaccine offers prolonged protection, but three shots over 7 months are usually required to induce the production of sufficient antibodies.

In the United States, all infants receive hepatitis B vaccine. Babies born to mothers tested positive for hepatitis B receive HBIG in addition for prompt protection. Older children (11-12 years) are also advised to receive hepatitis B vaccine. Adults in high risk situations too are advised to receive hepatitis B vaccine. Examples of such adults include health care workers, dentists, intimate and household contacts of patients with chronic hepatitis B infection, male homosexuals, individuals with multiple sexual partners, dialysis patients, IV drug users, and recipients of repeated transfusions.

Health care workers accidentally exposed to materials infected with hepatitis B (such as needle stick exposure), and individuals with known sexual contact with viral hepatitis B patients are usually given both HBIG and vaccine to provide both immediate and long term protection.

Two vaccines are available for hepatitis B in the United States, they are Engerix-B, and Recombivax-HB. Both are safe and effective. Three doses (given at 0, 1, and 6 months) are necessary to assure protection. Some individuals may never respond to hepatitis B vaccination. Treatment strategies for these non-responders are still under investigation.

For further information, please read the following articles: Viral Hepatitis and Immunizations.

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