How Common Is Chronic Hepatitis C In The United States
An estimated 3.2 million persons in the United States have chronic hepatitis C virus infection. Most people do not know they are infected because they dont look or feel sick. In 2013, hepatitis C-related mortality surpassed the total combined number of deaths from 60 other infectious diseases reported to CDC, including HIV, pneumococcal disease, and tuberculosis.
Unprecedented Hepatitis A Outbreak Another Effect Of The Addiction Crisis
Charleston Just as West Virginia has been one of the hardest-hit states by the ongoing, nationwide opioid drug addiction crisis, it has also been one of the hardest-hit by the ongoing, multi-state Hepatitis A outbreak.
That’s because the incidence of Hepatitis A, like other infectious diseases of the liver , began to increase in West Virginia because of drug use.
“To put it bluntly, when you’re high, you don’t have the best hygiene practices,” said Shannon McBee, senior epidemiologist at the state Department of Health and Human Resources. “So if you are infected with Hepatitis A, during your infectious period, and you roll a dollar bill and you put it up your nose and you pass that bill to someone else, it can be transmitted that way. This is a microscopic amount of fecal matter.”
Hepatitis is an inflammation of the liver. Hepatitis A, B and C are liver infections caused by three separate viruses.
Most people with Hepatitis A have symptoms like fatigue, low appetite, stomach pain, nausea, and jaundice that clear up within two months, and go on to be immune from the disease in the future. Some, especially those with pre-existing liver diseases like Hepatitis B or C, experience more complications. It may take several weeks to exhibit symptoms.
As the outbreak has continued, health officials have explained that it spreads through the “fecal-oral route.”
McBee said West Virginia was harder hit than many other states because of the addiction problem here.
Vaccines For Adults Increasing Opportunities For Health
Historically, vaccines were deemed to be only for children. However, vaccines for adults are becoming increasingly common and necessary. Most adults think only of the tetanus booster recommended every 10 years and even then, many adults only get the vaccine if they injure themselves. In 2005, the Tdap vaccine was licensed as an improved version of the typical tetanus booster, Td. The newer version also contains a component to protect against pertussis . All adults, especially those who are going to be around young infants, should get the Tdap vaccine. Adults often unwittingly pass pertussis to young infants for whom the disease can be fatal. In 2012, the CDC recommended that pregnant women get a dose of Tdap during each pregnancy between 27 and 36 weeks gestation. In 2019, the CDC recommended that Tdap or Td vaccine could be used for booster dosing every 10 years.
Influenza vaccines, available since the 1940s, are now recommended for most adults. Vaccines like MMR and chickenpox are recommended for adults who have not had the diseases, and vaccines including hepatitis A, hepatitis B, pneumococcus, and meningococcus are recommended for sub-groups of the adult population. The HPV vaccine became available in 2006. In 2018, the license was expanded to include people up to 45 years of age.
The first formal adult immunization schedule was published in 2002 and is updated annually.
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Persons At Risk For Hcv Infection
IDU is the most common means of HCV transmission in the United States. Invasive medical procedures pose risks for HCV infection when standard infection-control practices are not followed . Health carerelated hepatitis C outbreaks also stem from drug diversion . Although HCV infection is primarily associated with IDU, high-risk behaviors , primarily among persons with HIV, are also important risk factors for transmission . Other possible exposures include sharing personal items contaminated with blood , unregulated tattooing, needlestick injuries among health care personnel, and birth to a mother with hepatitis C. Receipt of donated blood, blood products, and organs was once a common means of transmission but is now rare in the United States .
How Is Hepatitis C Spread
Hepatitis C spreads through contact with the blood of someone who has HCV. This contact may be through
- Sharing drug needles or other drug materials with someone who has HCV. In the United States, this is the most common way that people get hepatitis C.
- Getting an accidental stick with a needle that was used on someone who has HCV. This can happen in health care settings.
- Being tattooed or pierced with tools or inks that were not sterilized after being used on someone who has HCV
- Having contact with the blood or open sores of someone who has HCV
- Sharing personal care items that may have come in contact with another person’s blood, such as razors or toothbrushes
- Being born to a mother with HCV
- Having unprotected sex with someone who has HCV
Before 1992, hepatitis C was also commonly spread through blood transfusions and organ transplants. Since then, there has been routine testing of the U.S. blood supply for HCV. It is now very rare for someone to get HCV this way.
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What Are The Side Effects Of Treatments For Hepatitis C Infection
Side effects of interferon or pegylated interferon
- The most common side effects of interferon or pegylated interferon include fever, flu-like symptoms, and depression. Patients must be monitored closely for depression. Risk of suicide is a reason to avoid interferons.
- Interferons also reduce white blood cell and/or red blood cell counts . This may cause increased susceptibility to infection. Interferons also increase the risk of certain cancers. Death rarely occurs as a result of therapy, but may occur from progression of liver failure in patients with advanced cirrhosis.
Side effects of ribavirin
- Ribavirin most commonly causes anemia due to destruction of red blood cells . This can be severe enough that people with heart disease may suffer a heart attack from insufficient blood flow, so people with heart disease should not receive this drug. Anemia improves with a reduction in the dose of ribavirin. Injected growth factor that stimulates the production of red blood cells often is used to improve the anemia associated with ribavirin. Ribavirin also accumulates in the testicles and ovaries and causes birth defects in animals. Although no birth defects have been reported in humans, both men and women should use contraceptive measures to avoid pregnancy during and for at least six months after ribavirin treatment.
Side effects of DAAs
- The most common and significant side effects of boceprevir , sofosbuvir , and ledipasvir/sofosbuvir include
- fatigue ,
Did Hepatitis C Virus Originate In Horses
12 February 2013 by Vincent Racaniello
About 2% of the worlds population is chronically infected with hepatitis C virus . This enveloped, positive-strand RNA virus was discovered in 1989, but serological and phylogenetic evidence indicates that it has been infecting humans for hundreds of years, perhaps as long ago as the 14th century. All human viral infections most likely originated in non-human species, but the progenitor of HCV is not known. Recent evidence suggests that horses might have been the source of HCV in humans.
For many years there were no known non-human relatives of HCV until canine hepacivirus was discovered in dogs . However two subsequent studies failed to reveal additional evidence for CHV infection of dogs. In one study, no antibodies to CHV were found in sera from 80 dogs in New York State, and in a second study, PCR failed to detect CHV nucleic acid sequences in 190 samples from dogs in Scotland. Samples from rabbits, deer, cows, cats, mice, and pigs were also negative for CHV. However both groups found evidence for infection of horses. These viruses have been called non-primate hepaciviruses .
These results from geographically distinct areas suggest that horses are a reservoir of NPHV. It seems likely that dogs might acquire NPHV infection from horses, as there are opportunities for contact between the two animals on farms or in kennels. Additional NPHV isolates from horses must be studied to confirm this hypothesis.
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What Causes Hepatitis C
Hepatitis C is caused by infection with the hepatitis C virus. The virus is spread from person to person through contact with blood. People who use intravenous drugs can get hepatitis C when they share needles with someone who has the virus. Health care workers can be exposed to hepatitis C. They can become infected if they are accidentally stuck with a needle that was used on an infected patient. You are also at a higher risk if you got a blood transfusion or an organ transplant before 1992.
Hepatitis C cant be spread unless a person has direct contact with infected blood. This means a person who has hepatitis C cannot pass the virus to others through casual contact such as:
- using public toilets
- touching doorknobs
Treatment And Medication For Hepatitis C
If you have acute hepatitis C, there is no recommended treatment. If your hepatitis C turns into a chronic hepatitis C infection, there are several medications available.
Interferon, peginterferon, and ribavirin used to be the main treatments for hepatitis C. They can have side effects like fatigue, flu-like symptoms, anemia, skin rash, mild anxiety, depression, nausea, and diarrhea.
Now youâre more likely to get one of these medications:
Find out more on treatment options for hepatitis C.
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Can A Person Have Normal Liver Enzyme Results And Still Have Hepatitis C
Yes. It is common for persons with chronic hepatitis C to have a liver enzyme level that goes up and down, with periodic returns to normal or near normal. Some infected persons have liver enzyme levels that are normal for over a year even though they have chronic liver disease. If the liver enzyme level is normal, persons should have their enzyme level re-checked several times over a 612 month period. If the liver enzyme level remains normal, the doctor may check it less frequently, such as once a year.
Who should get tested for hepatitis C?
Talk to your doctor about being tested for hepatitis C if any of the following are true:
- You were born from 1945 through 1965.
- You are a current or former injection drug user, even if you injected only one time or many years ago.
- You were treated for a blood clotting problem before 1987.
- You received a blood transfusion or organ transplant before July 1992.
- You are on long-term hemodialysis treatment.
- You have abnormal liver tests or liver disease.
- You work in health care or public safety and were exposed to blood through a needlestick or other sharp object injury.
- You are infected with HIV.
What Are The Treatments For Hepatitis C
Treatment for hepatitis C is with antiviral medicines. They can cure the disease in most cases.
If you have acute hepatitis C, your health care provider may wait to see if your infection becomes chronic before starting treatment.
If your hepatitis C causes cirrhosis, you should see a doctor who specializes in liver diseases. Treatments for health problems related to cirrhosis include medicines, surgery, and other medical procedures. If your hepatitis C leads to liver failure or liver cancer, you may need a liver transplant.
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Hcv Originated At Least 3000 Years Ago
Previous studies provided estimates of the time to the most recent common ancestor of HCV genotypes in a range between 200 and 1000 years ago, with one single study indicating that HCV origin may date 2000 years back . The tMRCA of equine/canine hepaciviruses was estimated to be recent, dating around 1800 CE .
It is well known that the temporal variation in rates of nucleotide substitutions often results in underestimation of the age of viral lineages . Purifying selection and substitution saturation are strongly associated with temporal rate variation .
Simulations experiments indicated that classic models tend to underestimate branch lengths in the presence of purifying selection and substitution saturation . Because both phenomena are more pronounced for internal branches, length underestimation is more severe for these branches and dating inferences are consequently affected . The use of models that allow site- and branch-specific variation in selective pressure can improve branch length estimates in the presence of both purifying selection and substitution saturation .
FIGURE 2. tMRCA estimation. Comparison of branch lengths obtained using the aBS-REL and the GTR models for the NS5B abd EHV phylogenies. Timescaled phylogenetic tree estimated for 67 HCV subtypes. The scale bar below the phylogeny represents years before present. The tMRCAs of analyzed nodes are reported in red with 95% confidence intervals. Geographic distribution of HCV endemic transmissions .
What Are The Treatment Guidelines For Hepatitis C
Hepatitis C treatment is best discussed with a doctor or specialist familiar with current and developing options as this field is changing, and even major guidelines may become outdated quickly.
The latest treatment guidelines by the American Association for the Study of Liver Disease and Infectious Disease Society of America recommends use of DAAs as first-line treatment for hepatitis C infection. The choice of DAA varies by specific virus genotype, and the presence or absence of cirrhosis. In the U.S., specific insurance providers also might influence the choice due to the high cost of DAAs. Although the individual, public health, and cost benefits of treating all patients with hepatitis C is clear, the most difficult barrier to treating all people with HCV is the very high cost of the drug regimens. Patients are encouraged to discuss options with their health care professional.
Treatment is recommended in all patients with chronic hepatitis C unless they have a short life expectancy that is not related to liver disease. Severe life-threatening liver disease may require liver transplantation. Newer therapies with DAAs have allowed more and more patients to be treated.
What are the goals of therapy for hepatitis C infection?
The ultimate goals of antiviral therapy are to
- prevent transmission of hepatitis C,
- prevent progression to cirrhosis and liver cancer, and
- improve survival and quality of life.
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Stages Of Hepatitis C
The hepatitis C virus affects people in different ways and has several stages:
- Incubation period. This is the time between first exposure to the start of the disease. It can last anywhere from 14 to 80 days, but the average is 45
- Acute hepatitis C. This is a short-term illness that lasts for the first 6 months after the virus enters your body. After that, some people who have it will get rid of, or clear, the virus on their own.
- Chronic hepatitis C. For most people who get hepatitis C — up to 85% — the illness moves into a long-lasting stage . This is called a chronic hepatitis C infection and can lead to serious health problems like liver cancer or cirrhosis.
- Cirrhosis. This disease leads to inflammation that, over time, replaces your healthy liver cells with scar tissue. It usually takes about 20 to 30 years for this to happen, though it can be faster if you drink alcohol or have HIV.
- Liver cancer. Cirrhosis makes liver cancer more likely. Your doctor will make sure you get regular tests because there are usually no symptoms in the early stages.
Learn more about the stages and progression of hepatitis C.
Who Is At Risk For Hepatitis C
You are more likely to get hepatitis C if you
- Have injected drugs
If you have chronic hepatitis C, you probably will not have symptoms until it causes complications. This can happen decades after you were infected. For this reason, hepatitis C screening is important, even if you have no symptoms.
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Hepatitis C Treatment Today
In 2016, sofosbuvir/velpatasvir was developed as the first drug therapy to treat all hepatitis C genotypes in tablet form. The side effects are considered low . The cure rate is as high as 98 percent in those without severe liver scarring and 86 percent in those with cirrhosis.
In July 2017, sofosbuvir/velpatasvir/voxilaprevir was approved by the U.S. Food and Drug Administration to treat chronic hepatitis C of all genotypes. This fixed-dose combination pill prohibits the development of the specific protein NS5A. In recent research, this troublesome protein has been associated with growth and progression of hepatitis C. In its earliest drug trials, this combination drug had a 96 to 97 percent cure rate, and hopes are high for it today.
Most recently, glecaprevir/pibrentasvir was approved in August 2017. This treatment is for adults with chronic hepatitis C genotypes 1 through 6, and treatment duration can be as little as eight weeks. Results from early trials showed that
Symptoms And Causative Agent
Hepatitis is a general term for inflammation of the liver, which may result from infectious or non-infectious causes. Viruses responsible for many cases of infectious hepatitis include hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E. Hepatitis A and B are the only hepatitis viruses for which vaccines are currently available in the United States .
The hepatitis B virus is a partly double-stranded DNA virus in the hepadnavirus family. The hepatitis A virus is a single-stranded RNA virus in the picornavirus family. Both viruses, though they are structurally unrelated to one another, infect and replicate primarily in liver cells.
The symptoms of acute hepatitis A infection are identical to those of hepatitis B infection. Early symptoms are headache, nausea, vomiting, abdominal pain, fever, rash, body aches and pains, and dark colored urine. Following this phase, jaundice , light stools, and liver pain may appear.
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