Today is World Hepatitis Day — a day intended to raise awareness of the global effects of viral hepatitis. It is estimated 300 million people worldwide live with hepatitis and don’t know it.
The disease causes 1.34 million deaths annually. Two-thirds of liver cancer deaths are hepatitis-related.
Hepatitis, affecting the liver, is a highly contagious infection caused by a range of viruses.
The liver processes nutrients, filters the blood and fights infections. In addition to viruses, heavy alcohol use, toxins, some medications and certain medical conditions can cause hepatitis, according to the Centers for Disease Control and Prevention.
But the most common cause of hepatitis is viral. The most common types of viral hepatitis are hepatitis A, hepatitis B and hepatitis C. Effects from the viruses can range from mild illnesses lasting a few weeks to severe illnesses lasting for months.
The World Health Organization endorsed World Hepatitis Day in 2010, making it one of only four disease-specific days it recognizes. That backing has raised awareness of the disease with wider audiences and spurred increased government participation in hepatitis-related activities, according to worldhepatitisday.org. More than 190 countries have adopted WHO’s global strategy on the disease, which includes a plan to eliminate hepatitis B and C by 2030.
When discovered, cases of the illness are reported to the state, according to Jaime Young, Cole County communicable disease and epidemiology director.
Some of the difficulty in identifying the cases is those afflicted rarely show more than a few signs of the illness. Many simply have cold-like symptoms, Young said.
Hepatitis A, a generally less-severe viral infection than the others, is spread when a person ingests fecal matter — even in microscopic amounts — through contact with objects, food or drinks contaminated by an infected person. There are about 4,000 cases per year reported in the United States. Symptoms generally appear two to seven weeks after exposure and include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored stools, joint pain and jaundice. Although most people who contract the disease feel sick for a few weeks, they usually recover without lasting liver damage, according to the Missouri Department of Health and Senior Services. People who recover from hepatitis A develop antibodies that protect them from the virus for life.
Since September of last year, there has been — and the state has been tracking — an ongoing outbreak of hepatitis A in southeastern Missouri. Eleven counties in that area have each had at least one case of hepatitis A reported since September — 145 total cases, according to information reported on health.mo.gov.
Butler County, with 91 cases, had the most by far. Next came Stoddard County, 25; Carter County, 8; and Scott County, 6.
Early this year, the state Health Department issued warnings for possible outbreaks in Poplar Bluff, Butler County and Bonne Terre, St. Francois County (and closer to Central Missouri) after food handlers were found to have the disease.
Largely attributable to the southeastern Missouri outbreak, the number of hepatitis A cases in the state is 24 times higher than the five-year median, Young said.
There have been several outbreaks across the country, Young said.
“A lot of those popping up all over the country have marked risk factors for homelessness or recreational drug use,” she added.
In 2016, Missouri was one of only 18 states meeting a national goal of fewer than 0.3 cases of hepatitis A per 100,000 people, according to the CDC. With the most recent outbreak, that might change, Young said.
Practicing good hygiene — such as washing hands thoroughly after using the restroom or changing diapers and before preparing or eating food — can help prevent spread of the virus, according to the Missouri Department of Health and Senior Services.
The best way to prevent the disease is to be vaccinated. The agency recommends all children age 1 be vaccinated. Others who should receive the vaccination are those who will be in contact with people likely to have the disease (including if they plan to travel to countries where the disease is common or if they are caregivers for people from those countries), men who have sex with other men, recreational drug users and people with clotting-factor disorder.
The CDC estimates between 850,000 and 2.2 million people live with chronic hepatitis B — the leading cause of liver cancer. About two-thirds of people with the virus don’t know they have it. Hepatitis B primarily is spread when infected blood, semen or other body fluids, even in microscopic amounts, enter the body of someone who is not infected, according to the agency.
It also can be spread from an infected mother to her baby during birth, through sex with an infected person, by sharing contaminated equipment — such as needles, syringes or other medical equipment like glucose monitors — and by sharing toothbrushes or razors. Its symptoms can range from mild illnesses lasting a few weeks to lifelong chronic conditions.
More than 90 percent of unimmunized infants who get infected develop a chronic infection. Only 6-10 percent of older children who contract the disease develop chronic hepatitis B. Having the chronic infection means a person’s body was unable to repel the virus after about six months. People diagnosed with chronic infection should be monitored regularly for liver conditions, such as cirrhosis, liver failure or liver cancer.
Missouri remains below the national goal (fewer than or equal to 1.5 cases per 100,000 population) for acute hepatitis B cases, according to CDC data.
Vaccinations for hepatitis B are recommended for all infants at birth; people who travel to regions where the disease is common; adults with diabetes; people living in households with those affected; people with multiple sex partners; men who have sex with men; and people with certain medical conditions, including HIV and chronic liver disease.
Hepatitis C is spread when blood from someone who is infected enters the body of someone who is not. This most often happens when people share contaminated needles or syringes. There is no vaccine available for the disease.
Missouri is above the national goal (0.25 cases per 100,000 population) for incidents of acute hepatitis C.
Seventy-five to 85 percent of people who contract the disease develop chronic infections. Missouri reported 5,068 new chronic cases in 2016.
Cole County does not track cases of chronic infections, Young said.
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