In some cases, people come down with a serous illness that can last for months but often people experience only a mild illness and some have no symptoms at all.

Some forms of viral hepatitis go away on their own, but others, like Hepatitis B and Hepatitis C, can go one to become chronic, lifelong infections, which can lead to serious health problems including liver damage, cirrhosis, liver cancer, and even death, the CDC warns.

Most people with chronic hepatitis do not know they are infected and can go 20 or 30 years without showing symptoms.

A simple blood test can determine whether you have hepatitis.

The month of May has been designated Hepatitis Awareness Month in the United States, and tomorrow, May 19th, is being recognized as the first ever Hepatitis Testing Day in the United States.

The National Digestive Diseases Information Clearinghouse has prepared the following material to explain about the different kinds of hepatitis, how to avoid infection and what you can do if you are infected.

Viral Hepatitis: A through E and Beyond

What is viral hepatitis?

Viral hepatitis is inflammation of the liver caused by a virus. Several different viruses, named the hepatitis A, B, C, D, and E viruses, cause viral hepatitis.

All of these viruses cause acute, or short-term, viral hepatitis. The hepatitis B, C, and D viruses can also cause chronic hepatitis, in which the infection is prolonged, sometimes lifelong. Chronic hepatitis can lead to cirrhosis, liver failure, and liver cancer.

Researchers are looking for other viruses that may cause hepatitis, but none have been identified with certainty. Other viruses that less often affect the liver include cytomegalovirus; Epstein-Barr virus, also called infectious mononucleosis; herpesvirus; parvovirus; and adenovirus.

Key Points

• Viral hepatitis is inflammation of the liver caused by the hepatitis A, B, C, D, or E viruses.

• Depending on the type of virus, viral hepatitis is spread through contaminated food or water, contact with infected blood, sexual contact with an infected person, or from mother to child during childbirth.

• Vaccines offer protection from hepatitis A and hepatitis B.

• No vaccines are available for hepatitis C, D, and E. Reducing exposure to the viruses offers the best protection.

• Hepatitis A and E usually resolve on their own. Hepatitis B, C, and D can be chronic and serious. Drugs are available to treat chronic hepatitis.

What are the symptoms of viral hepatitis?

Symptoms include

• jaundice, which causes a yellowing of the skin and eyes

• fatigue

• abdominal pain

• loss of appetite

• nausea

• vomiting

• diarrhea

• low grade fever

• headache

However, some people do not have symptoms.

Hepatitis A

How is hepatitis A spread?

Hepatitis A is spread primarily through food or water contaminated by feces from an infected person. Rarely, it spreads through contact with infected blood.

Who is at risk for hepatitis A?

People most likely to get hepatitis A are

• international travelers, particularly those traveling to developing countries

• people who live with or have sex with an infected person

• people living in areas where children are not routinely vaccinated against hepatitis A, where outbreaks are more likely

• day care children and employees, during outbreaks

• men who have sex with men

• users of illicit drugs

How can hepatitis A be prevented?

The hepatitis A vaccine offers immunity to adults and children older than age 1. The Centers for Disease Control and Prevention recommends routine hepatitis A vaccination for children aged 12 to 23 months and for adults who are at high risk for infection. Treatment with immune globulin can provide short-term immunity to hepatitis A when given before exposure or within 2 weeks of exposure to the virus. Avoiding tap water when traveling internationally and practicing good hygiene and sanitation also help prevent hepatitis A.

What is the treatment for hepatitis A?

Hepatitis A usually resolves on its own over several weeks.

Hepatitis B

How is hepatitis B spread?

Hepatitis B is spread through contact with infected blood, through sex with an infected person, and from mother to child during childbirth, whether the delivery is vaginal or via cesarean section.

Who is at risk for hepatitis B?

People most likely to get hepatitis B are

• people who live with or have sexual contact with an infected person

• men who have sex with men

• people who have multiple sex partners

• injection drug users

• immigrants and children of immigrants from areas with high rates of hepatitis B

• infants born to infected mothers

• health care workers

• hemodialysis patients

• people who received a transfusion of blood or blood products before 1987, when better tests to screen blood donors were developed

• international travelers

How can hepatitis B be prevented?

The hepatitis B vaccine offers the best protection. All infants and unvaccinated children, adolescents, and at-risk adults should be vaccinated. For people who have not been vaccinated, reducing exposure to the virus can help prevent hepatitis B. Reducing exposure means using latex condoms, which may lower the risk of transmission; not sharing drug needles; and not sharing personal items such as toothbrushes, razors, and nail clippers with an infected person.

What is the treatment for hepatitis B?

Drugs approved for the treatment of chronic hepatitis B include alpha interferon and peginterferon, which slow the replication of the virus in the body and also boost the immune system, and the antiviral drugs lamivudine, adefovir dipivoxil, entecavir, and telbivudine. Other drugs are also being evaluated. Infants born to infected mothers should receive hepatitis B immune globulin and the hepatitis B vaccine within 12 hours of birth to help prevent infection.

People who develop acute hepatitis B are generally not treated with antiviral drugs because, depending on their age at infection, the disease often resolves on its own. Infected newborns are most likely to progress to chronic hepatitis B, but by young adulthood, most people with acute infection recover spontaneously. Severe acute hepatitis B can be treated with an antiviral drug such as lamivudine.

Cirrhotic liver showing scarring (Photo by Nephron under a Creative Common license).

Hepatitis C

How is hepatitis C spread?

Hepatitis C is spread primarily through contact with infected blood. Less commonly, it can spread through sexual contact and childbirth.

Who is at risk for hepatitis C?

• People most likely to be exposed to the hepatitis C virus are

• injection drug users

• people who have sex with an infected person

• people who have multiple sex partners

• health care workers

• infants born to infected women

• hemodialysis patients

• people who received a transfusion of blood or blood products before July 1992, when sensitive tests to screen blood donors for hepatitis C were introduced

• people who received clotting factors made before 1987, when methods to manufacture these products were improved

How can hepatitis C be prevented?

There is no vaccine for hepatitis C. The only way to prevent the disease is to reduce the risk of exposure to the virus. Reducing exposure means avoiding behaviors like sharing drug needles or personal items such as toothbrushes, razors, and nail clippers with an infected person.

What is the treatment for hepatitis C?

Chronic hepatitis C is treated with peginterferon together with the antiviral drug ribavirin.

If acute hepatitis C does not resolve on its own within 2 to 3 months, drug treatment is recommended.

Hepatitis D

How is hepatitis D spread?

Hepatitis D is spread through contact with infected blood. This disease only occurs at the same time as infection with hepatitis B or in people who are already infected with hepatitis B.

Who is at risk for hepatitis D?

Anyone infected with hepatitis B is at risk for hepatitis D. Injection drug users have the highest risk.

Others at risk include

• people who live with or have sex with a person infected with hepatitis D

• people who received a transfusion of blood or blood products before 1987

How can hepatitis D be prevented?

People not already infected with hepatitis B should receive the hepatitis B vaccine. Other preventive measures include avoiding exposure to infected blood, contaminated needles, and an infected person’s personal items such as toothbrushes, razors, and nail clippers.

What is the treatment for hepatitis D?

Chronic hepatitis D is usually treated with pegylated interferon, although other potential treatments are under study.

Hepatitis E

How is hepatitis E spread?

Hepatitis E is spread through food or water contaminated by feces from an infected person. This disease is uncommon in the United States.

Who is at risk for hepatitis E?

People most likely to be exposed to the hepatitis E virus are

• international travelers, particularly those traveling to developing countries

• people living in areas where hepatitis E outbreaks are common

• people who live with or have sex with an infected person

How can hepatitis E be prevented?

There is no U.S. Food and Drug Administration (FDA)-approved vaccine for hepatitis E. The only way to prevent the disease is to reduce the risk of exposure to the virus. Reducing risk of exposure means avoiding tap water when traveling internationally and practicing good hygiene and sanitation.

What is the treatment for hepatitis E?

Hepatitis E usually resolves on its own over several weeks to months.

What else causes viral hepatitis?

Some cases of viral hepatitis cannot be attributed to the hepatitis A, B, C, D, or E viruses, or even the less common viruses that can infect the liver, such as cytomegalovirus, Epstein-Barr virus, herpesvirus, parvovirus, and adenovirus.

These cases are called non-A–E hepatitis. Scientists continue to study the causes of non-A–E hepatitis.

Hope through Research

The National Institute of Diabetes and Digestive and Kidney Diseases, through its Division of Digestive Diseases and Nutrition, supports basic and clinical research into the nature and transmission of the hepatitis viruses, and the activation and mechanisms of the immune system. Results from these basic and clinical studies are used in developing new treatments and methods of prevention.

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.

For More Information

American Liver Foundation

75 Maiden Lane, Suite 603

New York, NY 10038–4810

Phone: 1–800–GO–LIVER (465–4837), 1–888–4HEP–USA (443–7872), or 212–668–1000

Fax: 212–483–8179

Email: info@liverfoundation.org

Internet: www.liverfoundation.org

Centers for Disease Control and Prevention

Division of Viral Hepatitis

1600 Clifton Road

Mail Stop C–14

Atlanta, GA 30333

Phone: 1–800–CDC–INFO (232–4636)

Fax: 404–371–5488

Email: cdcinfo@cdc.gov

Internet: www.cdc.gov/hepatitis

Hepatitis Foundation International

504 Blick Drive

Silver Spring, MD 20904–2901

Phone: 1–800–891–0707 or 301–622–4200

Fax: 301–622–4702

Email: hfi@comcast.net

Internet: www.hepatitisfoundation.org

You may also find additional information about this topic by visiting MedlinePlus at www.medlineplus.gov.

This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit www.fda.gov. Consult your doctor for more information.

Dr. Larry Corey

Dr. Larry Corey, M.D., president and director of Fred Hutchinson Cancer Research Center, has been elected to membership in the American Academy of Arts and Sciences.

The Academy is one of the nation’s oldest and most prestigious honorary societies and independent policy-research centers.

The current membership includes more than 250 Nobel laureates and more than 60 Pulitzer Prize winners.

Dr. Corey has led the Hutchinson Center since January 2011 and has held other leadership positions there since 1996, first as head of infectious disease sciences in the Clinical Research Division and later as senior vice president and co-director of the Center’s Vaccine and Infectious Disease Division.

Dr. Corey is an expert in virology, immunology and vaccine development. His research has focused on herpes viruses, HIV and other viral infections, particularly those associated with cancer.

He also is principal investigator of the Hutchinson Center-based HIV Vaccine Trials Network, an international collaboration of scientists and institutions that combines clinical trials and laboratory-based studies to accelerate the development of HIV vaccines.

Dr. Corey is a professor of laboratory medicine and medicine, adjunct professor of pediatrics and microbiology, and holder of the Lawrence Corey Endowed Chair in Medical Virology at the University of Washington. He is also an infectious disease physician at Seattle Cancer Care Alliance.

Dr. Corey is the Hutchinson Center’s second president to be elected to the Academy. Yeast geneticist Lee Hartwell, Ph.D., a 2001 Nobel laureate, was elected in 1998. He led the Center from 1997 until 2010.

Corey is among 220 leaders in the sciences, social sciences, humanities, arts, business and public affairs who have been elected to the American Academy of Arts and Sciences 2012 class of fellows.

Since its founding in 1780, the Academy fellows have included: George Washington and Benjamin Franklin in the eighteenth century, Daniel Webster and Ralph Waldo Emerson in the nineteenth, and Albert Einstein and Winston Churchill in the twentieth.

The new class will be inducted at a ceremony Oct. 6 at the Academy’s headquarters in Cambridge, Mass.

By Sarah Barr

Higher U.S. spending for cancer care pays off in almost two years of additional life for American cancer patients on average compared to their European counterparts — a value that offsets the higher costs –according to a study in the April issue of the journal Health Affairs.

While previous studies have suggested U.S. cancer patients have better survival prospects than their European counterparts, the researchers wanted to examine whether those prospects justify higher U.S. costs.

To do so, they translated the longer lives of U.S. patients into dollar amounts using a conservative estimate of the value of a human life year — in the context of the tradeoffs people are willing to make to reduce their risk of death — and compared those amounts to U.S. spending on cancer care.  The method does not take into account quality of life or individuals’ earnings.

“We found that the value of the survival gains greatly outweighed the costs, which suggests that the costs of cancer care were indeed ‘worth it,’” the researchers wrote in the study. They cautioned the findings do not prove that all treatments are cost-effective or a that a causal link exists between spending on cancer care and survival gains.

Michael Eber, a senior analyst at Precision Health Economics, a health care consulting company, and a co-author of the study, said that the findings point to the need for further research into what drives the survival differences between U.S. and European patients.

“It calls for a closer look at the value of individual treatments and interventions,” he said.

For the study, the researchers looked at the survival outcomes for U.S. patients compared with those from 10 European countries and found that for most cancer types, U.S. patients lived longer.

Specifically, from 1995 to 1999, U.S. patients lived an average of 11.1 years after diagnosis, while European patients lived 9.3 years.

The researchers used those numbers as a baseline and based their findings on how survival gains improved in each country over time.

They also found that from 1983 through 1999, U.S. spending increased from $47,000 to $70,000 per cancer case, while in the 10 European countries, spending on cancer care increased from $38,000 to $44,000 per case.

The additional U.S. spending during that time period on the kinds of cancer the researchers examined totaled $158 billion.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

By 

According to the latest data on nationwide death rates from cancer, overall mortality from cancer declined from 1999 to 2008, maintaining a trend seen since the early 1990s.

Mortality fell for most cancer types, including the four most common types of cancer in the United States (lung, colorectal, breast, and prostate), although the rate of decline varied by cancer type and across racial and ethnic groups.

The complete Annual Report to the Nation on the Status of Cancer, 1975–2008 appeared March 28 in Cancer.

The declines in cancer death rates (mortality) averaged 1.7 percent per year for men and 1.3 percent per year for women from 1999 through 2008.

Among men, the overall rate of new cancer cases (incidence) fell by an average of 0.6 percent annually from 1999 to 2008.

Among women, incidence dropped by an average of 0.5 percent annually from 1999 to 2006 but held steady from 2006 to 2008.

Cancer incidence in children ages 0 to 14 rose from 1999 to 2008 (by 0.5 percent a year), continuing a trend seen in previous Annual Reports to the Nation.

However, advances in treatment contributed to a steady decline in mortality rates for children with cancer in the last 5 years (an average of 2.8 percent per year).

“Steady progress, as measured by declines in cancer death rates for many cancers, is good because we have an aging, growing population,” said Dr. Brenda K. Edwards, NCI’s senior advisor for surveillance.

“While the number of people diagnosed with cancer or who die of the disease may be increasing, the decline in cancer death rates for more than a decade is the best indicator of progress due to prevention, screening, diagnosis, and treatment,” she added.

NCI, the American Cancer Society, the Centers for Disease Control and Prevention (CDC), and the North American Association of Central Cancer Registries (NAACCR) collaborated on the report. Cancer incidence data came from NCI’s Surveillance, Epidemiology, and End Results (SEER) database and from the CDC, with analyses of pooled data by NAACCR. Mortality data came from the CDC’s National Center for Health Statistics.

Not All Good News

There were some notable exceptions to the overall decreases in incidence and mortality. From 1999 to 2008, death rates rose for pancreatic cancer in men and women, for liver cancer and melanoma in men, and for endometrial cancer in women.

The cervical cancer death rate, which had been falling for decades, showed no further decrease over the last 5 years.

And, although incidence rates fell overall for men and women from 1999 to 2008, the decline was not distributed evenly across racial and ethnic groups.

Cancer incidence rates did not decrease significantly among American Indian/Alaska Native men and women combined or among black, Asian and Pacific Islander, and American Indian/Alaska Native women.

Although incidence rates in black men did decline, this group still had the highest cancer incidence rate of any racial and ethnic group, 15 percent higher than that of white men and nearly double that of Asian and Pacific Islander men.

Major Modifiable Risk Factors

Each Annual Report to the Nation includes a special feature that focuses on a topic of importance to the cancer research community and the public.

This year’s report featured an analysis on the contribution of excess weight (overweight and obesity) and insufficient physical activity to the nation’s cancer burden.

More than 60 percent of the U.S. adult population is estimated to be overweight or obese, and a similar percentage of adults do not get the recommended amount of physical activity.

The rates of insufficient physical activity are even worse for children; for example, up to 90 percent of high school girls do not engage in recommended levels of physical activity.

Excess weight “is a major modifiable risk factor for cancer and other diseases—probably second only to tobacco use in terms of its impact on cancer incidence and mortality,” said Dr. Edwards. “The risk may be modest but it’s so pervasive that we felt this was the time to look at [cancer] incidence in this context.” Physical inactivity not only contributes to excess weight but is itself a risk factor for several cancer types.

The report was not designed to quantitatively link the trends in excess weight and lack of physical activity to the national trends for cancer, explained Dr. Rachel Ballard-Barbash, associate director of the Applied Research Program in NCI’s Division of Cancer Control and Population Sciences.

Many other studies have shown convincing links between excess weight and several cancer types, including endometrial, postmenopausal breast, colorectal, kidney, esophageal, and pancreatic cancer.

The point of the special feature, she noted, “is to highlight specific types of cancer that are related to [excess weight and lack of sufficient physical activity], show how these behaviors relate to these cancers in terms of their relative risks, and briefly describe some of the mechanisms by which they relate.”

The special feature also highlights national- and state-level prevention strategies in policy and environmental change that are intended to help people achieve recommended changes in their diets and physical activity levels.

As the nation’s weight has risen, so has the incidence of some, although not all, types of cancer related to excess weight and lack of sufficient physical activity. From 1999 to 2008, incidence rates of kidney cancer and of adenocarcinoma of the esophagus each rose about 3 percent per year for men and women, while incidence of pancreatic cancer rose 1.2 percent per year among men and women.

In addition, incidence rates of endometrial cancer rose significantly among black, Asian and Pacific Islander, and Hispanic women. Incidence of postmenopausal breast cancer stabilized from 2005 to 2008, after a period of decline.

“Although all of these cancers are influenced by multiple factors, the high prevalence of excess weight and insufficient physical activity likely contributed to these observed increases and to the lack of decline in breast cancer,” the authors wrote. “Continued progress in reducing cancer incidence and mortality rates will be difficult without success in promoting healthy weight and physical activity, particularly among youth.”

Excess weight and lack of physical activity also influence cancer survivorship, explained Dr. Ballard-Barbash, as both can negatively affect outcomes after a cancer diagnosis, further increasing the need for these risk factors to be addressed on a personal and societal level.

The NCI Cancer Bulletin is an award-winning biweekly online newsletter designed to provide useful, timely information about cancer research to the cancer community. The newsletter is published approximately 24 times per year by the National Cancer Institute (NCI), with day-to-day operational oversight conducted by federal and contract staff in the NCI Office of Communications and Education. The material is entirely in the public domain and can be repurposed or reproduced without permission. Citation of the source is appreciated.

Davis

Seattle’s global health organization PATH announced today that Steve Davis has been appointed president and CEO.

In his new position Davis will oversee PATH’s annual budget of $305 million, a staff of nearly 1,200, and a portfolio of projects based in PATH offices in 22 countries.

PATH projects include the development of an affordable meningitis vaccine, improved screening and treatment for HIV/AIDS and tuberculosis, and low-cost filters for safe drinking water.

Davis comes to PATH  from McKinsey & Company, where he was global director of social innovation.

In that position, Davis led a global team that consults for nongovernmental organizations (NGOs), governments, and the private sector, with a focus on global health and development, research and development, and Asia and Africa.

Previously, Davis was a long-term CEO of Corbis, a global digital media leader, and served as interim CEO of the Infectious Disease Research Institute, a nonprofit biotech working on vaccines, diagnostics, and drug discovery for infectious diseases of poverty.

His previous experiences also include serving as interim director of PATH’s India program, practicing law with K&L Gates, and working on refugee and human rights issues.

Mr. Davis earned his bachelor’s degree from Princeton University, his master’s degree from the University of Washington, and his juris doctor from Columbia University.

Davis will join PATH on June 11 and be based at PATH’s Seattle headquarters.

He succeeds former president and CEO Dr. Christopher J. Elias, who led PATH through significant growth for ten years.

Dr. Elias left PATH in January to become president of the Global Development Program at the Bill & Melinda Gates Foundation.