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$Unique_ID{BRK03813} $Pretitle{} $Title{Hepatitis B} $Subject{Hepatitis B Diffuse Hepatocellular Inflammatory Disease Liver Disease Hepatitis HBV } $Volume{} $Log{} 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 (203) 746-6518 National Sexually Transmitted Diseases Hotline 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 American Liver Foundation 998 Pompton Avenue Cedar Grove, NJ 07009 (201) 857-2626 (800) 223-0179 The United Liver Foundation 11646 West Pico Blvd. Los Angeles, CA 90064 (213) 445-4204 or 445-4200 Children's Liver Foundation 14245 Ventura Blvd. Sherman Oaks, CA 91423 (818) 906-3021 Centers for Disease Control (CDC) 1600 Clifton Road, NE Atlanta, GA 30333 (404) 639-3534 NIH/National Institute of Allergy and Infectious Diseases 9000 Rockville Pike Bethesda, MD 20892 (301) 496-5717 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).