Hepatitis

Hepatitis B & C are commonly referred to as blood borne viruses (BBVs) along with HIV.

“Hepatitis” means inflammation of the liver. Viral hepatitis is a disease which causes inflammation of the liver and, left untreated, can lead to liver cancer and liver failure.

It is estimated that 0.7% of the Scottish population is affected by hepatitis C and it is noted that hepatitis B infections are a growing cause for concern.


Hepatitis B

Hepatitis B mainly affects the liver.  Left undiagnosed, the liver can become damaged and have difficulty carrying out its vital functions.

Hepatitis B is the most infectious blood borne virus – it is approximately 100 times more infectious than HIV. It can survive for up to 7 days outside the body and is present in high levels in blood. It is also present in varying amounts in other body fluids such as semen, vaginal secretions and saliva. Unlike hepatitis C, there is a high risk of hepatitis B being transmitted via unprotected sexual activity. Hepatitis B cannot be cured, however, the majority of people infected as adults clear the virus naturally and there is treatment available to reduce symptoms and disease progression in those who don’t. A very effective vaccine is available that can provide lifelong immunity in most cases.

How is hepatitis B transmitted?

The hepatitis B virus is passed on by infected blood or other body fluids. The infected blood or body fluids must enter the bloodstream of an individual for there to be a risk of infection. In countries where there is a low prevalence of hepatitis B, it is mostly spread through sharing contaminated equipment to inject / snort drugs and through sexual contact

The risk factors include:

  • Unprotected vaginal, anal or oral sex. The virus can be spread by sexual contact. Young adults engaging in high risk sexual behaviours such as unprotected sex without using a condom (penetrative or oral) with multiple sexual partners may be at greater risk.
  • Sharing equipment to inject / snort drugs (including steroids and other performance and image enhancing drugs e.g. melanotan) – even if this only happens once. Equipment includes needles, syringes, water, filters, spoons, swabs, acidifiers, tourniquets and straws (for snorting drugs). For every injecting episode, new sterile equipment should be used. Needle exchange sites and some pharmacies can provide an Injecting Equipment Provision service in each locality.
  • Tattooing, body piercing and acupuncture may also pose a risk if unsterilised equipment is used and shared – including ink.
  • Mother to child transmission. Infection at birth is called perinatal transmission and is the most common way the virus is spread globally. Vaccination at birth prevents the majority of infections. All pregnant women in the UK are screened for hepatitis B.
  • Sharing personal items such as razors nail clippers and toothbrushes that may be contaminated with blood.
  • Undergoing medical or dental treatment in countries with a high prevalence of hepatitis B including South-East Asia, the Middle and Far East, Southern Europe and Africa.
  • Occupational risk. Healthcare and other emergency workers may be at risk from accidental needlestick injuries, injury from sharp objects or direct exposure to blood and body fluids to breaks in the skin.
  • You cannot catch hepatitis B via social contact such as hugging, kissing, shaking hands, sharing crockery or cutlery or sitting in the same toilet seat.

Hepatitis B vaccination

Hepatitis B is very infectious – 100 times more infectious than HIV. Unlike HIV and hepatitis C, an effective vaccine is available that can prevent hepatitis B infection. The vaccinations are free of charge and you can have it done anonymously at any sexual health service (GUM clinic). The vaccination usually involves three injections and will be administered over several weeks. You need to have the full course of vaccinations to be fully protected.

Men who have sex with men are recommended to have the vaccine as there may be a higher risk of transmission.

The vaccination will prevent hepatitis B but does not prevent against other blood borne viruses or STIs.

Hepatitis C

Hepatitis C is a blood borne virus that mainly affects the liver. It can cause fibrosis and cirrhosis of the liver and, left untreated, can lead to liver failure, liver cancer and can be fatal.  There is no vaccine to protect against hepatitis C, however, effective treatment is available that can cure the virus in some cases.  Treatment consists of either 2 or 3 medicines in combination, depending on what subtype (genotype) of Hepatitis C you have.

Hepatitis C is more common in Ayrshire than both hepatitis B and HIV.

How is hepatitis C transmitted?

Hepatitis C is mainly spread when the blood of an infected person enters the bloodstream of someone who is not infected. Blood is the main source of infection; however, the virus is present in other body fluids in varying levels.

Risk factors include:

  • Sharing equipment to inject / snort drugs (including steroids and other performance and image enhancing drugs e.g. melanotan) – even if this only happens once. In Scotland, this is the most common way hepatitis C is passed on. Equipment includes needles, syringes, water, filters, spoons, swabs, acidifiers, tourniquets and straws (for snorting drugs). For every injecting episode, new sterile equipment should be used. Needle exchange sites and some pharmacies can provide an Injecting Equipment Provision service in each locality
  • Tattooing, body piercing and acupuncture may also pose a risk if unsterilised equipment is used and shared – including ink.
  • Sharing personal items such as razors nail clippers and toothbrushes that may be contaminated with blood.
  • Unprotected vaginal or anal sex (uncommon through oral sex but it can happen), especially if blood or sores are present. The risk of sexual transmission of hepatitis C is increased if there is co-infection with HIV. Although sexual transmission is possible, it is not common.
  • There is little risk of transmission through receipt of blood products. All blood in the UK is screened for hepatitis C. There would be risk to recipients of blood transfusions before 1991.
  • Undergoing medical or dental treatment in some countries where hepatitis C is more common and where poor standards of infection control may pose a risk.
  • Mother to baby transmission does occur but is not common. The risk is greater if the mother is co-infected with HIV. Mothers are not routinely screened for hepatitis C.

For more information on Hepatitis visit: www.britishlivertrust.org.uk

Symptoms of Hepatitis B and C

You cannot tell by looking at someone if they have hepatitis B or C. For many, there may be no symptoms for many years. Although there may be no symptoms, the virus is still present and can be damaging the liver due to chronic infection. The virus can still be passed on to others.

Early symptoms can include:

  • No symptoms
  • Fatigue
  • Nausea
  • Jaundiced (Yellow) eyes or skin
  • Sickness, stomach ache, and or diarrhoea
  • Pain in the liver area
  • Fever/ Night sweats
  • Depression
  • Difficulty concentrating
  • Joint and / or muscle pain

These symptoms are almost flu-like in nature and are often missed as the early stages of hepatitis infection.

Getting a Hepatitis B or C blood test:

If you are worried about hepatitis, a simple blood test can tell if you have been infected. You can request a blood test from your:

  • GP
  • Sexual Health Clinic – see website details for a clinic near you
  • Addiction Services – South Ayrshire 01292 559800, North Ayrshire 01294 476160, East Ayrshire 01563 574237

Hepatitis B:

The initial screening test is a blood test which checks for virus antigen and antibody.  The test looks for antigens which show there is virus present; and antibodies which are created by the immune system when Hepatitis B has entered the body,  It can take up to 3 months for the body to produce enough antibodies to show up on a blood test.  This is known as the window period.

If antigens or antibodies are detected in the blood, further tests will be carried out to determine whether you are:

  • Currently infected with hepatitis B
  • Previously immunised against hepatits B
  • Previously infected with hepatitis B, but cleared the virus.

Hepatitis C:

The initial screening test is an antibody test. The test looks for antibodies which are created by the immune system when Hepatitis C has entered the body.   It can take up to three months for the body to produce enough antibodies to show up on an antibody test. This is known as the window period.

All antibody-positives samples should undergo further testing (polymerase chain reaction (PCR) testing) to determine if there is current infection. A person who is antibody-positive but PCR-negative has cleared their infection. A repeat test should be taken to confirm that they have cleared the virus.

A positive result:

If your screening test for Hepatitis B or C shows current infection, you will be seen at the Blood Borne Virus Clinic (Annanhill suite) at Crosshouse Hospital.  Patients are seen at clinic to ensure they remain well, and started on treatment as required.

A negative result:

If screening test for Hepatitis B or C shows no evidence of current infection this means you do not have the virus.  This will be more accurate if test is done after the window period (3 months).

For further information:
www.hepatitisscotland.org.uk
www.hepctrust.org.uk
www.britishlivertrust.org.uk