Hepatitis is a disease of the liver, and there are three distinct types that are most common, ranging from a preventable and easily curable infection (Hepatitis A) to other variations, including Hepatitis B and C that are acute and chronic diseases—both potentially fatal.
In addition, there are two rare forms of Hepatitis, D and E.
Are you properly vaccinated to prevent Hepatitis A?
How exactly are the other, more serious, forms of the disease transmitted?
It’s important—for both you and your loved ones—to know the differences between types of hepatitis and the symptoms for each, which can be overlapping.
Tune into SMG Radio to hear liver expert Dr. Raymond Kenny discuss the ABC’s of Hepatitis.
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The ABC's of Hepatitis
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Learn more about Raymond P. Kenny, MD
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Raymond Kenny, MD
Raymond P. Kenny, MD, is a gastroenterologist who subspecializes in in liver disease, including chronic hepatitis C and B, autoimmune hepatitis, cirrhosis, and fatty liver. He is the coauthor of articles and abstracts that are published in prestigious, peer-reviewed scientific journals, including Hepatology, Journal of Laparoendoscopic Surgery, and Gastroenterology. He has been Co-investigator for research projects on hepatitis C. Dr. Kenny is Clinical Assistant Professor in the Department of Medicine at Rutgers New Jersey Medical School.Learn more about Raymond P. Kenny, MD
Learn more about The Gastroenterology Group of New Jersey at SMG
Transcription:
The ABC's of Hepatitis
Melanie Cole (Host): Hepatitis is a disease of the liver and there are three distinct types that are most common ranging from a preventable and easily curable infection, Hepatitis A, to other variations, including Hepatitis B and C, that are acute and chronic diseases. My guest today is Dr. Raymond Kenny. He is a gastroenterologist who specializes in liver disease, including chronic Hepatitis C and B, and autoimmune Hepatitis at Summit Medical Group. Welcome to the show, Dr. Kenny. Tell us a little bit about hepatitis and these different subtypes. What exactly is hepatitis?
Dr. Raymond Kenny (Guest): Hepatitis is an inflammation of your liver regardless of cause. It could be drug related; it could be virally related which is particularly what we’re talking about here. Hepatitis A, B and C.--those are three distinctively different viruses that have nothing in common with each other other than their target organ is the liver. Each of them causing hepatitis but they’re different viruses, have different causes and have different implications for the patient.
Melanie: So then, let’s start with "A" like the alphabet. Hepatitis A. Tell us a little bit about each type and how it’s transmitted, whether there’s a vaccine for it and how is contagious.
Dr. Kenny: Classically, Hepatitis A was called infectious hepatitis for that reason. It’s easily transmitted. It can be transmitted by inanimate objects. It’s basically transmitted by a person who got the infection, some inadequate hand-washing transmitted on inanimate objects of other people. So, people who are in close contact get this. Classically, you would think about close communities, armies, for example, soldiers housed together would contract this and it would spread rapidly through the corp. It is not as common in the United States as it once was, basically, for the reasons of handwashing and, importantly, it is one of the vaccines preventable hepatitis’. Hepatitis A and B are vaccine preventable.
Melanie: Are there some symptoms? How would you know if you had Hepatitis A?
Dr. Kenny: Well, in the United States on of the key elements is if you travel to an endemic area. If you travel to an area where it’s more common; if you came back from, that would be one of the things. In the United States, it’s not commonly transmitted but basically these people present with a feeling of having the flu and then finally, they become jaundice. Their eyes turn yellow, their urine turns tea colored and, at that point, they are actually starting to feel a little bit better.
Melanie: Now these are viruses we’re talking about, not bacteria, correct?
Dr. Kenny: That’s correct.
Melanie: So, what are the treatments that you do?
Dr. Kenny: Basically, it’s supported in the case of Hepatitis A. Most people recover from that. The mortality--their chance of dying from Hepatitis A--is only two percent in adults. So, 98% of the time you’re going to go through this illness and in children, you might not even get jaundice. They’ll think that they have the flu, symptoms will go away and there will be no long term consequences of Hepatitis A. It’s very different for Hepatitis B and C. They have situations where, particularly Hepatitis C, you don’t get jaundice or as sick with the acute infection, but it goes on to be chronic. We think that it goes on chronically. In other words, anything beyond six months, but, basically, we’re talking about an infection that goes on for years.
Melanie: So then, let’s move on to Hepatitis B. Tell us about that. What are the symptoms? How is it contracted? What is the treatment?
Dr. Kenny: For the most part, there are not a lot of symptoms for Hepatitis B. It really depends on when you contract the illness and the mechanism of transmission is different world-wide. In areas where there’s a high frequency of Hepatitis B, say Asia and Southeast Asia, it’s usually acquired by what we call vertical transmission from the mother to the infant at the time of birth. The body’s reaction at that time is one of what we call "immune tolerance". It doesn’t attack the virus very heavily so that the person--the infant--doesn’t become jaundiced and doesn’t become very sick with it. The consequence with that same immune reaction is that it tends to be lingering. It becomes chronic. It lasts over decades or a lifelong illness when it’s contracted early on by that mechanism. In the United States, the mechanism is different. It is usually contacted as an adolescent or an adult through IV drug use or sexual transmission. More commonly in the United States at that age, the immune system is more developed and it attacks the virus very vigorously, you become jaundice, you become sick and, fortunately, 90% of the time you clear the virus. A very different course depending on when you got it and what the mechanism was.
Melanie: Is there a Hepatitis B vaccine?
Dr. Kenny: Yes. It’s one of the two vaccine-preventable hepatitis. Hepatitis A and B are preventable. We don’t yet have a viable vaccine for Hepatitis C.
Melanie: When do you get that vaccine?
Dr. Kenny: In the United States, it’s basically given to you in childhood for Hepatitis B. Hepatitis A, you would get that when you are going to an endemic area. It’s not that common, as I’ve said before, Hepatitis A in the United States.
Melanie: Let’s move on the Hepatitis C. This is the one we seem to hear the most about. Tell us a little bit about how it’s contracted and what symptoms that you might have that would send you to see somebody to get tested.
Dr. Kenny: Probably the most important thing to recognize with Hepatitis C is that you don’t have any symptoms. Seventy percent of people who have this don’t know that they have it. It’s contracted, generally speaking, in the United States by someone in age, say around 20, through intravenous drug use. In the past, the blood supply before 1990 or 1992 when we had screened the blood supply with serologic testing by iatrogenic use, particularly for hemophiliacs who have received a lot of blood products or packed red blood cell transfusions for people getting, say, a coronary artery bypass or a hysterectomy, that transmitted at that point. The rate of infection has decreased dramatically since the blood supply has cleared up with serologic testing. Unfortunately, as I said before, we don’t have the vaccine to prevent this.
Melanie: What is the treatment if someone is infected with Hepatitis C? This is a chronic thing and they could have it for their whole life. They have to be careful with some things for the rest of their life, right? If they bleed, this is the kind of thing now that they have to watch out for setting it off to other people.
Dr. Kenny: Fortunately, that transmission to other people is actually almost by letter. Most infectious Hepatitis A, more for Hepatitis B. Household contact should all be vaccinated for Hepatitis B. Hepatitis C is not readily transmitted through household contact. We do recommend things that you probably wouldn’t do as a general health recommendation. To begin with, you wouldn’t share toothbrushes. You wouldn’t share your razors, but transmission to household contacts with Hepatitis C is not common. The person with Hepatitis C that is walking out there and really has no symptoms whatsoever. Seventy percent have some abnormal liver tests, so that if the doctor checks the liver enzyme panel they will be elevated. Thirty percent of them actually have normal liver enzymes. So, there’s no way to check for that unless you specifically do that antibody test for it. That’s why the recommendations are now that everyone who was born between 1945 and 1965 be screened for Hepatitis C. The logic for that is that this is basically a baby boomer disease. Seventy percent of the people who have this disease were born between those two years. So, if you are born in those two years, generally recommendation for the population is to be screened for Hepatitis C. If you knew, for example, you had a history of IV drug use in the past--remote past--even if it was 20 or 30 years ago, you certainly should be tested for Hepatitis C.
Melanie: What treatment do you have?
Dr. Kenny: We happen to be in an era here where they’re fantastic. I mean, I’ve been doing this for 25 years and earlier on we had treatments that made you quite sick. They worked probably between 20 and 40 percent of the time. You took the treatment for 48 weeks but we probably made people sicker than we made better. Now, fortunately, we have highly effective medications that are oral medications without injections taken once a day for 12 weeks working 96% effectively with no side effects. It’s really a fantastic revolution in the treatment Hepatitis C.
Melanie: In just the last few minutes, Dr. Kenny, give us your best advice about understanding hepatitis and why people should come to Summit Medical Group for their care.
Dr. Kenny: Hepatitis has enormous consequences, particularly for Hepatitis B and Hepatitis C, which are the chronic infections. Hepatitis C is currently the most common reason to have a liver transplant patient and the most common reason for liver failure in the United States. Fifty percent of what people used to think was alcohol related—cirrhosis--is actually Hepatitis C and we now, as I said before, have highly effective non-toxic medication that can cure this disease which has terrible consequences. For the people with Hepatitis B for anyone who’s immigrated to the United States from that belt of Asia where this is common should be screened for Hepatitis B because even those that have normal liver function tests have that immune tolerance phase that we were talking about. They are at risk to develop liver cancer. They should be screened and followed to prevent that from happening. The household contact, everyone else should be vaccinated to prevent the transmission and for carrying this on to future generations.
Melanie: Thank you so much. What a fascinating topic and you’re so well-spoken. Thank you so much. You’re listening to SMG Radio. For more information, you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.
The ABC's of Hepatitis
Melanie Cole (Host): Hepatitis is a disease of the liver and there are three distinct types that are most common ranging from a preventable and easily curable infection, Hepatitis A, to other variations, including Hepatitis B and C, that are acute and chronic diseases. My guest today is Dr. Raymond Kenny. He is a gastroenterologist who specializes in liver disease, including chronic Hepatitis C and B, and autoimmune Hepatitis at Summit Medical Group. Welcome to the show, Dr. Kenny. Tell us a little bit about hepatitis and these different subtypes. What exactly is hepatitis?
Dr. Raymond Kenny (Guest): Hepatitis is an inflammation of your liver regardless of cause. It could be drug related; it could be virally related which is particularly what we’re talking about here. Hepatitis A, B and C.--those are three distinctively different viruses that have nothing in common with each other other than their target organ is the liver. Each of them causing hepatitis but they’re different viruses, have different causes and have different implications for the patient.
Melanie: So then, let’s start with "A" like the alphabet. Hepatitis A. Tell us a little bit about each type and how it’s transmitted, whether there’s a vaccine for it and how is contagious.
Dr. Kenny: Classically, Hepatitis A was called infectious hepatitis for that reason. It’s easily transmitted. It can be transmitted by inanimate objects. It’s basically transmitted by a person who got the infection, some inadequate hand-washing transmitted on inanimate objects of other people. So, people who are in close contact get this. Classically, you would think about close communities, armies, for example, soldiers housed together would contract this and it would spread rapidly through the corp. It is not as common in the United States as it once was, basically, for the reasons of handwashing and, importantly, it is one of the vaccines preventable hepatitis’. Hepatitis A and B are vaccine preventable.
Melanie: Are there some symptoms? How would you know if you had Hepatitis A?
Dr. Kenny: Well, in the United States on of the key elements is if you travel to an endemic area. If you travel to an area where it’s more common; if you came back from, that would be one of the things. In the United States, it’s not commonly transmitted but basically these people present with a feeling of having the flu and then finally, they become jaundice. Their eyes turn yellow, their urine turns tea colored and, at that point, they are actually starting to feel a little bit better.
Melanie: Now these are viruses we’re talking about, not bacteria, correct?
Dr. Kenny: That’s correct.
Melanie: So, what are the treatments that you do?
Dr. Kenny: Basically, it’s supported in the case of Hepatitis A. Most people recover from that. The mortality--their chance of dying from Hepatitis A--is only two percent in adults. So, 98% of the time you’re going to go through this illness and in children, you might not even get jaundice. They’ll think that they have the flu, symptoms will go away and there will be no long term consequences of Hepatitis A. It’s very different for Hepatitis B and C. They have situations where, particularly Hepatitis C, you don’t get jaundice or as sick with the acute infection, but it goes on to be chronic. We think that it goes on chronically. In other words, anything beyond six months, but, basically, we’re talking about an infection that goes on for years.
Melanie: So then, let’s move on to Hepatitis B. Tell us about that. What are the symptoms? How is it contracted? What is the treatment?
Dr. Kenny: For the most part, there are not a lot of symptoms for Hepatitis B. It really depends on when you contract the illness and the mechanism of transmission is different world-wide. In areas where there’s a high frequency of Hepatitis B, say Asia and Southeast Asia, it’s usually acquired by what we call vertical transmission from the mother to the infant at the time of birth. The body’s reaction at that time is one of what we call "immune tolerance". It doesn’t attack the virus very heavily so that the person--the infant--doesn’t become jaundiced and doesn’t become very sick with it. The consequence with that same immune reaction is that it tends to be lingering. It becomes chronic. It lasts over decades or a lifelong illness when it’s contracted early on by that mechanism. In the United States, the mechanism is different. It is usually contacted as an adolescent or an adult through IV drug use or sexual transmission. More commonly in the United States at that age, the immune system is more developed and it attacks the virus very vigorously, you become jaundice, you become sick and, fortunately, 90% of the time you clear the virus. A very different course depending on when you got it and what the mechanism was.
Melanie: Is there a Hepatitis B vaccine?
Dr. Kenny: Yes. It’s one of the two vaccine-preventable hepatitis. Hepatitis A and B are preventable. We don’t yet have a viable vaccine for Hepatitis C.
Melanie: When do you get that vaccine?
Dr. Kenny: In the United States, it’s basically given to you in childhood for Hepatitis B. Hepatitis A, you would get that when you are going to an endemic area. It’s not that common, as I’ve said before, Hepatitis A in the United States.
Melanie: Let’s move on the Hepatitis C. This is the one we seem to hear the most about. Tell us a little bit about how it’s contracted and what symptoms that you might have that would send you to see somebody to get tested.
Dr. Kenny: Probably the most important thing to recognize with Hepatitis C is that you don’t have any symptoms. Seventy percent of people who have this don’t know that they have it. It’s contracted, generally speaking, in the United States by someone in age, say around 20, through intravenous drug use. In the past, the blood supply before 1990 or 1992 when we had screened the blood supply with serologic testing by iatrogenic use, particularly for hemophiliacs who have received a lot of blood products or packed red blood cell transfusions for people getting, say, a coronary artery bypass or a hysterectomy, that transmitted at that point. The rate of infection has decreased dramatically since the blood supply has cleared up with serologic testing. Unfortunately, as I said before, we don’t have the vaccine to prevent this.
Melanie: What is the treatment if someone is infected with Hepatitis C? This is a chronic thing and they could have it for their whole life. They have to be careful with some things for the rest of their life, right? If they bleed, this is the kind of thing now that they have to watch out for setting it off to other people.
Dr. Kenny: Fortunately, that transmission to other people is actually almost by letter. Most infectious Hepatitis A, more for Hepatitis B. Household contact should all be vaccinated for Hepatitis B. Hepatitis C is not readily transmitted through household contact. We do recommend things that you probably wouldn’t do as a general health recommendation. To begin with, you wouldn’t share toothbrushes. You wouldn’t share your razors, but transmission to household contacts with Hepatitis C is not common. The person with Hepatitis C that is walking out there and really has no symptoms whatsoever. Seventy percent have some abnormal liver tests, so that if the doctor checks the liver enzyme panel they will be elevated. Thirty percent of them actually have normal liver enzymes. So, there’s no way to check for that unless you specifically do that antibody test for it. That’s why the recommendations are now that everyone who was born between 1945 and 1965 be screened for Hepatitis C. The logic for that is that this is basically a baby boomer disease. Seventy percent of the people who have this disease were born between those two years. So, if you are born in those two years, generally recommendation for the population is to be screened for Hepatitis C. If you knew, for example, you had a history of IV drug use in the past--remote past--even if it was 20 or 30 years ago, you certainly should be tested for Hepatitis C.
Melanie: What treatment do you have?
Dr. Kenny: We happen to be in an era here where they’re fantastic. I mean, I’ve been doing this for 25 years and earlier on we had treatments that made you quite sick. They worked probably between 20 and 40 percent of the time. You took the treatment for 48 weeks but we probably made people sicker than we made better. Now, fortunately, we have highly effective medications that are oral medications without injections taken once a day for 12 weeks working 96% effectively with no side effects. It’s really a fantastic revolution in the treatment Hepatitis C.
Melanie: In just the last few minutes, Dr. Kenny, give us your best advice about understanding hepatitis and why people should come to Summit Medical Group for their care.
Dr. Kenny: Hepatitis has enormous consequences, particularly for Hepatitis B and Hepatitis C, which are the chronic infections. Hepatitis C is currently the most common reason to have a liver transplant patient and the most common reason for liver failure in the United States. Fifty percent of what people used to think was alcohol related—cirrhosis--is actually Hepatitis C and we now, as I said before, have highly effective non-toxic medication that can cure this disease which has terrible consequences. For the people with Hepatitis B for anyone who’s immigrated to the United States from that belt of Asia where this is common should be screened for Hepatitis B because even those that have normal liver function tests have that immune tolerance phase that we were talking about. They are at risk to develop liver cancer. They should be screened and followed to prevent that from happening. The household contact, everyone else should be vaccinated to prevent the transmission and for carrying this on to future generations.
Melanie: Thank you so much. What a fascinating topic and you’re so well-spoken. Thank you so much. You’re listening to SMG Radio. For more information, you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.