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$Title{Hepatitis B}
$Subject{Hepatitis B Diffuse Hepatocellular Inflammatory Disease Liver Disease
Hepatitis HBV }
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Copyright (C) 1987, 1990, 1991, 1992 National Organization for Rare Disorders,
Inc.

345:
Hepatitis B

** IMPORTANT **
It is possible the main title of the article (Hepatitis B) is not the
name you expected.  Please check the SYNONYMS listing to find the alternate
names and disorder subdivisions covered by this article.

Synonyms

     Diffuse Hepatocellular Inflammatory Disease
     Liver Disease
     Hepatitis
     HBV

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.


Hepatitis B Virus (HBV) is one of three viral agents which cause
inflammation of the liver known as "hepatitis" or "diffuse hepatocellular
inflammatory disease".  Hepatitis B 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 if left untreated.  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.

Symptoms

Hepatitis B Virus usually has a one to six week incubation period during
which a certain antigen (immune response agent) circulates in the blood
before symptoms of the illness develop.  Hepatitis B may initially appear as
influenza symptoms (fever, headache, eye-ear-nose-throat involvement, chills,
tiredness, itchy rash, etc.), followed by nausea, vomiting and yellow
discoloration of skin (jaundice).  Because similar symptoms can be caused by
other diseases such as mononucleosis or chronic liver disease, Hepatitis B
may be difficult to diagnose.

Hepatitis B usually runs its course in four to eight weeks, except in
some variations of the disease.  For information on these, please see the
Related Disorders section of this report.

Causes

Hepatitis B is a form of acute viral hepatitis.  It is usually transmitted by
injection (parenterally).  Transfusion of contaminated blood or blood products
to hospitalized patients is a typical source of the disorder.  Sharing
contaminated hypodermic needles by drug abusers often spreads the disease.  An
increased risk to patients and personnel working in renal dialysis units has
also been identified.  The infection can also be spread through sexual
activity.  However, hepatitis A virus is even more contagious than Hepatitis
B.  In many cases the source of infection with Hepatitis B virus is unknown.

The diagnosis of the three different types of Hepatitis (Hepatitis A,
Hepatitis B, and Non-A, Non-B Hepatitis) is confirmed through antibody tests.

Affected Population

About 200 new hepatitis B infections occur each year in the United States,
primarily in young adults.  Up to ten percent of those infected become
chronic carriers.  Seven hundred and fifty thousand to one million Americans
are carriers and one in four of them will develop chronic hepatitis.  While
sixty-five percent of the cases of hepatitis B are reported in the twenty to
thirty-nine year age group, the male-to-female ratio remains 2:1.

Related Disorders

There are three major types of Hepatitis:  Hepatitis A, Hepatitis B, and
Non-A, Non-B Hepatitis (Hepatitis C).

Hepatitis A virus infection is the most common form of Hepatitis.  It is
spread primarily through fecal-oral contact, although improperly cooked
contaminated shell fish, blood infusion or possibly sexual activity may
spread the infection.  Water and food-borne epidemics of Hepatitis A are
common, especially in underdeveloped 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.

Non-A, Non-B Hepatitis (Hepatitis C) virus infection is a little known
infectious agent which can cause liver disease.  Increasing evidence points
to at least two separate viruses.  In general, symptoms of this disease
appear similar to Hepatitis B.  It is usually spread through blood
transfusions.

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.

Anicteric Hepatitis is an acute viral form of hepatitis which 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 acute viral hepatitis that
occurs in a minority of patients during their recovery phase from other
Hepatitis infections.  The outlook remains good and chronic hepatitis rarely
follows.

The symptoms of Cholestatic Hepatitis may include jaundice, elevated
alkaline phosphatase, and itching (pruritis).  Complete recovery is usual
with this form of acute viral hepatitis.

Fulminant Hepatitis is a rare acute viral Hepatitis 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 or
exchange transfusions have not proven to be effective treatment.  Patients
may recover completely with no permanent liver damage in some cases, but the
majority of cases become very serious with little hope of full recovery.
Fulminant Hepatitis may also be caused by excessive use of the sustained-
release form of the vitamin, Niacin.  Use of this form of the vitamin is
usually very well tolerated but on occasion may cause liver toxicity.

Bridging Necrosis is an uncommon variant of acute viral hepatitis.  This
variation may be indistinguishable from ordinary viral hepatitis, but differs
through a slow rather than sudden onset.  Fluid retention or mild
degenerative brain disease (encephalopathy) usually develops.  Most patients
with Bridging Necrosis do recover fully, although chronic active hepatitis
may occur in this subgroup of patients.

Chronic Hepatitis is a group of disorders that merge into acute hepatitis
or liver disease (cirrhosis).  Most of these cases can be classified into
chronic persistent or chronic active forms.  The chronic persistent is
usually a mild form of hepatitis which may persist for years.  Eventual
recovery usually will 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.  With
adequate therapy, patients usually live several years, although liver
diseases eventually develop in most cases.

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.

Hepatitis which is induced by long-term alcoholism is marked by abdominal
swelling, distress, (anorexia) loss of appetite, nausea with or without
vomiting, weight loss, and a general feeling of discomfort.  Other symptoms
of hepatitis usually occur including jaundice and weakness.  Abstinence from
alcohol will usually bring about great improvement with liver function
possibly returning to normal.  With continued drinking, the hepatitis may
evolve into serious liver disease (cirrhosis).

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 symptoms of
this form of hepatitis may include anorexia, nausea, vomiting and/or
diarrhea.  Timely withdrawal of the substance causing it is important in
treating this disorder.  If left untreated, this form of hepatitis could
cause serious liver damage.

For more information, choose "hepatitis" as your search term in the Rare
Disease Database, and see the article "Weighing the Risks of the Raw Bar" in
the Prevalent Health Conditions/Concerns area of NORD Services.

Therapies:  Standard

The best treatment of Hepatitis B infection is prevention.  The first
genetically engineered Hepatitis vaccine was approved by the Food and Drug
Administration during the mid-1980's.  The new vaccine, called Recombivax HB
(like the less effective plasma-derived vaccine developed in 1981), is
produced by Merck, Sharp & Dohme, West Point, PA.

The FDA urges that the new vaccine be used by individuals who are at high
risk of becoming infected with hepatitis B, including dental and medical
workers, homosexuals, drug users, and personnel who work with mentally
disabled individuals in institutional or day care settings.

Because the vaccine can be given to newborns, passage of hepatitis from
infected mothers to their offspring can be prevented.  Pregnant women from
high-risk groups can be tested to determine if they are carriers.  Then their
infants can be protected by early vaccination.  Three injections are
recommended for high-risk individuals, including infants of infected mothers.

An appropriate formulation of the new vaccine for kidney patients on
dialysis is not yet available.

Other treatment of Hepatitis B is symptomatic and supportive.  Personal
hygiene should be maintained carefully, and infection should be guarded
against.  In general, extended rest and a light diet seem to be of benefit.
There are no effective antibiotics to treat Hepatitis, but Schering-Plough's
Intron A (Interferon-alpha 2a-2b) has been shown to be a safe and effective
treatment for Hepatitis B and C (Non-A, Non-B).

Therapies:  Investigational

Scientists are studying all forms of hepatitis to learn how it can better be
prevented, diagnosed, and treated.  A new drug, Thymosin Alpha-1, is being
developed by Alpha 1 Biomedicals, Inc., 777 - 14th St., NW, Suite 410,
Washington, DC, 20005, for the treatment of chronic active Hepatitis B

Sandoz Pharmaceuticals Corp., 59 Route 10, East Hanover, NJ, 07936, has
developed a new biologic to help prevent hepatitis B reinfection of patients
who are receiving liver transplants as a result of end-stage liver damage
from chronic Hepatitis B infection.  The biologic is Human Monoclonal
antibody against Hepatitis B. virus.

Oclassen Pharmaceuticals, Inc. is sponsoring the development of an
adjunctive treatment of Chronic Active Hepatitis B.  The product name is
FIAU.

This disease entry is based upon medical information available through
November 1992.  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 Hepatitis B, please contact:

     National Organization for Rare Disorders (NORD)
     P.O. Box 8923
     New Fairfield, CT  06812-1783
     [phone]

     National Sexually Transmitted Diseases Hotline

     American Social Health Association
     100 Capitola Dr., Suite 200
     Research Triangle Park, NC  27713
     [phone]

     Council for Sex Information and Education
     444 Lincoln Blvd., Suite 107
     Venice, CA  90291

     American Liver Foundation
     998 Pompton Avenue
     Cedar Grove, NJ  07009
     [phone]
     [phone]

     The United Liver Foundation
     11646 West Pico Blvd.
     Los Angeles, CA  90064
     [phone] or 445-4200

     Children's Liver Foundation
     14245 Ventura Blvd.
     Sherman Oaks, CA  91423
     [phone]

     Centers for Disease Control (CDC)
     1600 Clifton Road, NE
     Atlanta, GA  30333
     [phone]

     NIH/National Institute of Allergy and Infectious Diseases
     9000 Rockville Pike
     Bethesda, MD  20892
     [phone]

References

PILOT STUDY OF RECOMBINANT HUMAN ALPHA-INTERFERON FOR CHRONIC TYPE B
HEPATITIS:  J.S. Dooley, et. al., eds.;  Gastroenterology (Jan. 1986, issue
90 (1)).  Pg. 150-157.

WEIGHING THE RISKS OF THE RAW BAR:  Carol Ballantine; FDA Consumer
(Sept. 1986 issue).