$Unique_ID{BRK03815} $Pretitle{} $Title{Hepatitis, Non-A, Non-B (Hepatitis C)} $Subject{Hepatitis Non-A Non-B Hepatitis C Hepatitis NANB Hepatitis Hepatitis C Hepatitis A Hepatitis B Neonatal Hepatitis Anicteric Hepatitis Recrudescent Hepatitis Cholestatic Hepatitis Fulminant Hepatitis Bridging Necrosis Chronic Hepatitis Delta Hepatitis Alcohol-Induced Hepatitis Toxic-Induced Hepatitis Drug-Induced Hepatitis Chemically-Induced Hepatitis} $Volume{} $Log{} Copyright (C) 1987, 1990, 1991, 1992 National Organization for Rare Disorders, Inc. 344: Hepatitis, Non-A, Non-B (Hepatitis C) ** IMPORTANT ** It is possible the main title of the article (Non-A, Non-B Hepatitis) is not the name you expected. Please check the SYNONYMS listing to find the alternate names, disorder subdivisions, and related disorders covered by this article. Synonyms Hepatitis NANB Hepatitis Hepatitis C Information on the following diseases can be found in the Related Disorders section of this report: Hepatitis A Hepatitis B Neonatal Hepatitis Anicteric Hepatitis Recrudescent Hepatitis Cholestatic Hepatitis Fulminant Hepatitis Bridging Necrosis Chronic Hepatitis Delta Hepatitis Alcohol-Induced Hepatitis Toxic-, Drug-, or Chemically-Induced Hepatitis General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Non-A, Non-B (NANB) Hepatitis (Hepatitis C) is a contagious liver disease that appears to be caused by at least two different viruses. Diagnosis is usually established by excluding Hepatitis A, Hepatitis B or a variety of other similar liver diseases. The main sources of Non-A, Non-B Hepatitis infection include blood transfusions, intravenous drug use, or rarely personal contact with infected people. This disorder causes symptoms that appear similar to Hepatitis A or Hepatitis B, but it usually causes less serious forms of chronic liver disease such as cirrhosis or hepatocellular carcinoma. The symptoms of NANB Hepatitis may linger on for quite a long time, but they tend to regress in most cases. Symptoms Symptoms of NANB Hepatitis (Hepatitis C) are quite similar to those of Hepatitis B. Influenza-like symptoms (fever, aches, eye-ear-nose-throat involvement, weakness, nausea, vomiting, etc.) and yellow discoloration of the skin (jaundice) usually occur. The incubation period of this form of Hepatitis is usually from four to twenty-five weeks. Although NANB Hepatitis symptoms tend to be less severe than in other forms of hepatitis during the acute stage of the illness, chronic hepatitis may linger for some time. A carrier form of chronic NANB Hepatitis without symptoms (asymptomatic) seems to occur more frequently than the chronic Hepatitis B Virus carrier form. Causes Non-A, Non-B Hepatitis (Hepatitis C) is transmitted predominately by blood transfusion, inoculation, or other medical procedures which involve penetration of the skin. In 1989 scientists identified the virus that causes most cases of Non-A, Non-B Hepatitis. it is expected that the blood supply will now be screened for antibodies to the virus before transfusion. Scientists have named the virus "hepatitis C." Testing blood donors for the hepatitis C virus will substantially diminish the risk of transmitting the disease through blood transfusions. The most frequently occurring type of NANB Hepatitis is spread through intravenous drug abuse (sharing contaminated hypodermic needles) and blood transfusion. In some areas of the world, this disorder seems to be transmitted by fecal-oral contamination similar to the contagious process of Hepatitis A. In addition, there is an epidemic form of NANB Hepatitis (Hepatitis C) that resembles Hepatitis A in mode of transmission. Affected Population To date there are approximately 170,000 cases of Hepatitis C in the United States each year. Forty-two percent of Hepatitis C patients have a history of intravenous drug use, six to 10 percent have a history of blood transfusions, and the remainder become infected from other sources such as sexual contact with an infected person or occupational exposure to blood. About 85,000 of these infected individuals go on to develop chronic liver inflammation and 17,000 develop cirrhosis of the liver. Related Disorders The CDC announced that Hepatitis A cases rose 58% between 1983 and 1989 in the United States. Most cases were traced to restaurant food contaminated by employees infected with the disease. Others came from shellfish harvested in polluted water. Hepatitis A virus infection is the most common form of Hepatitis. It is spread through fecal-oral contamination, insufficiently cooked contaminated shellfish, and possibly sexual activity or blood infusion. Water and food-borne epidemics of Hepatitis A are common, especially in developing countries. Symptoms are much the same as Hepatitis B infection (influenza-like symptoms, nausea, vomiting, weakness, yellow skin discoloration or jaundice). Hepatitis A seems to be remarkably widespread in some countries where over three-fourths of the adult population appears to have been exposed. Hepatitis A virus can quickly spread through institutions and day care facilities where personal hygiene is less than adequate, particularly when mentally disabled individuals may not regularly wash their hands after using toilet facilities. (For additional information, see "Weighing the Risks of the Raw Bar" in the Prevalent Health Conditions/ Concerns area of NORD Services.) Hepatitis B is also caused by a virus and is characterized by fever, nausea, vomiting and yellow discoloration of the skin (jaundice). In its most serious form, Hepatitis B can become a chronic infection, or may cause liver cancer. The Hepatitis B virus can be passed from mother to unborn child, and is highly contagious through bodily fluids such as blood, semen and possibly saliva. It is often spread from person to person through intravenous drug use. (For more information on this disorder, choose "Hepatitis B" as your search term in the Rare Disease Database.) Neonatal Hepatitis is a disorder in which the bile ducts inside the liver are closed and liver cells are of varied size; some are giant cells with multiple nuclei. Infants of both sexes may be affected by this form of Hepatitis. (For more information, choose "neonatal hepatitis" as your search term in the Rare Disease Database.) Anicteric Hepatitis usually causes minor flu-like symptoms without jaundice. This type of Hepatitis may be far more prevalent than other types of Hepatitis, but the diagnosis is usually overlooked. Recrudescent Hepatitis is a recurrent form of Hepatitis that occurs in a minority of patients during their recovery phase from Hepatitis infections. The outlook remains good and chronic hepatitis rarely follows. The signs and symptoms of Cholestatic Hepatitis may include very marked jaundice, elevated alkaline phosphatase, and itching (pruritus). Fulminant Hepatitis is a rare syndrome usually seen in intravenous drug abusers. Rapid physical deterioration with the onset of liver degeneration may be initial symptoms. There is massive liver cell death, and a decrease in liver size ("acute yellow atrophy"). Bleeding is common, resulting from functional liver (parenchymal) failure, and widely distributed blood vessel clotting (disseminated intravascular coagulation). Kidney failure may also develop. Massive doses of corticosteroids and exchange transfusions have not proven to be effective treatment. Rarely, patients may recover completely with no permanent liver damage, but the majority of cases become very seriously ill with little hope of full recovery. Bridging Necrosis is an uncommon variant of Hepatitis. This variation may be indistinguishable from ordinary viral hepatitis, but has a slow rather than sudden onset. Fluid retention or mild degenerative brain disease (encephalopathy) usually develops. Most patients with Bridging Necrosis will recover fully, although chronic active hepatitis may occur in this subgroup of patients. Chronic hepatitis can progress to cirrhosis of the liver. Most of these cases can be classified into chronic persistent or chronic active forms. The chronic persistent form is usually a mild form of hepatitis which may persist for years. Eventual recovery will usually occur. The chronic active (aggressive) form of hepatitis may result in liver failure and/or cirrhosis. It is regarded as a group of closely related conditions rather than a single disease. Delta Hepatitis, a longstanding infection seen in patients in the Los Angeles area, has caused fulminant Hepatitis and progressive liver disease in both intravenous drug users and male homosexuals. Toxic, drug, or chemically induced Hepatitis may be caused by inhalation, ingestion, or skin-penetration of chemical agents or industrial toxins such as carbon tetrachloride, yellow phosphorus, toxic cyclic peptides of mushroom "Amanita Phallorides" or drugs used in medical therapy. Typical initial symptoms of this form of hepatitis may include anorexia, nausea, vomiting and/or diarrhea. Timely withdrawal of the toxic substance is important in treating this disorder. If left untreated, this form of hepatitis can cause serious liver damage. Hepatitis which is induced by long-term alcoholism is marked by abdominal swelling, (anorexia) loss of appetite, nausea with or without vomiting, weight loss, and a general feeling of discomfort. Other symptoms of hepatitis include jaundice and weakness. Abstinence from alcohol will usually bring about great improvement in liver function, possibly even returning to normal. With continued drinking, the hepatitis may evolve into serious liver disease (cirrhosis). Therapies: Standard Treatment for NANB Hepatitis is symptomatic and supportive. Personal hygiene should be carefully maintained, and infection should be guarded against. In general, rest and diet seem to be of benefit. There are no effective antibiotics to treat Hepatitis. The FDA has approved Schering-Plough's Intron-A (Interferon-alpha-2b) for the treatment of Non-A, Non-B (C) Hepatitis and chronic Hepatitis B. This drug has shown better results than anything yet tried for these disorders. The drug appears to return liver function to near normal. Patients may relapse after the alpha interferon is discontinued. Therapies: Investigational Scientists are trying to develop a preventive vaccination to for Non-A, Non-B Hepatitis (Hepatitis C). Biogen, Inc. is sponsoring the development of the orphan product, Interferon Beta (Recombinant Human) for the treatment of Non-A, Non-B Hepatitis. This disease entry is based upon medical information available through September 1991. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Non-A, Non-B Hepatitis, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 National Sexually Transmitted Diseases Hotline (800) 227-8922 American Social Health Association 100 Capitola Dr., Suite 200 Research Triangle Park, NC 27713 (919) 361-8400 Council for Sex Information and Education 444 Lincoln Blvd., Suite 107 Venice, CA 90291 Centers for Disease Control (CDC) 1600 Clifton Road, NE Atlanta, GA 30333 (404) 639-3534 American Liver Foundation 998 Pompton Avenue Cedar Grove, NJ 07009 (201) 857-2626 (800) 223-0179 Children's Liver Foundation 14245 Ventura Blvd. Sherman Oaks, CA 91423 (818) 906-3021 The United Liver Foundation 11646 West Pico Blvd. Los Angeles, CA 90064 (213) 445-4204 or 445-4200 NIH/National Institute of Allergy and Infectious Diseases 9000 Rockville Pike Bethesda, MD 20892 (301) 496-5717 References NON-A, NON-B HEPATITIS: EVOLVING EPIDEMIOLOGIC AND CLINICAL PERSPECTIVE: J.L. Dienstag, et. al.; Semin Liver Dis (Feb. 1986, issue 6(1) ). Pp. 67-81. NON-A, NON-B HEPATITIS: AN UPDATE: J.A. Hellings; Vox Sang (1986, Supplement 51 (1)). Pp. 63-66. LONG-TERM ANALYSIS OF NON-A, NON-B HEPATITIS--CLINICAL, HISTOLOGIC AND IMMUNOLOGIC FINDINGS: M. Wiese, et. al.; Dtsch A Verdau Stoffwechselkr. (1986, issue 46(2)). Pp. 103-112. Published in German. HEPATITIS IN CLINICAL PRACTICE: D.K. Sarver. Postgrad Med (Mar. 1986, issue 79(4)). Pp. 229-230. WEIGHING THE RISKS OF THE RAW BAR: Carol Ballantine; FDA Consumer (Sept. 1986, issue 90 (1) ). Pp. 150-157. TREATMENT OF CHRONIC HEPATITIS C WITH RECOMBINANT INTERFERON ALFA: A MULTICENTER RANDOMIZED, CONTROLLED TRIAL. New Eng J Jed; Davis, Gary L., et al.; (November 30, 1989, issue 321 (221)). Pp. 1501-1506. RECOMBINANT INTERFERON ALFA THERAPY FOR CHRONIC HEPATITIS C. A RANDOMIZED, DOUBLE-BLIND, PLACEBO CONTROLLED TRIAL. Di Bisceglie, Adrian M., et al.; New Eng J. Med (November 30, 1989, issue 321 (2)). Pp. 1406-1410.