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.

On Saturday, March 17, local health organizations are hosting a free mammogram screening event in southeast Seattle focusing on African American women.

Although women who are white are diagnosed with breast cancer at higher rates, African American women are more likely to die from it. Early detection is the key to survival.

The event is this Saturday from 9 a.m. to 3:30 p.m. at the Columbia Health Center, 4400 37th Avenue South, Seattle, WA 98118.

Women between the ages of 40-64, with limited income and limited or no health insurance are encouraged to call and schedule an appointment at 1-800-756-5437.

Although this screening is targeted for African American women, all women who are over 40, with limited or no health insurance, should call to schedule a mammogram.

This Saturday’s event is organized by Public Health – Seattle & King County in partnership with the Washington State Breast Cervical Colon Health Program, Susan G. Komen for the Cure and Swedish Medical Center.

Photo by Bill Branson/NCI

• For more information about the Breast, Cervical and Colon Health Program, visit: www.kingcounty.gov/healthservices/health/chronic/bchp/about.aspx

Photo: Jean Scheijen

This story is part of a reporting partnership that includes WHYY,  and Kaiser Health News.

It’s not news that Americans are dealing with an obesity epidemic. But the problem is particularly acute among African-American women.

Four in five African-American women are obese or overweight, according to the U.S. Office of Minority Health, and carrying those excess pounds can spike the risk for several conditions including heart disease, Type 2 diabetes, high blood pressure and stroke.

Members of the Anderson Monarchs soccer team practice as their coach looks on. The team, which was started at Philadelphia's Marian Anderson Recreation Center, gives game time to girls who have little chance to play another sport (Photo by Todd Vachon/WHYY).

About half of African-American women in the U.S. are obese, compared to 30 percent of white women. Black women not only carry more weight, but they start adding extra pounds years before their white counterparts.

So when does it begin, this excess and unhealthy weight? Research suggests the problem starts early, and it may have a lot to do with when girls give up regular exercise.

Experts want kids to exercise at least 60 minutes every day, but among all children, black girls are most likely to report they got no physical activity in the past week.

A lack of access to exercise opportunities may be one big reason why, says Shiriki Kumanyika, an epidemiologist and public health professor at the University of Pennsylvania.

Research shows that opportunities for recess, sports, physical education — or just to go outside — aren’t spread evenly among children.

“If you kind of add up those situations in urban, inner-city neighborhoods — where most African-Americans live — they are not as available. That’s been documented,” says Kumanyika, who studies patterns of illness and health behavior.

But research suggests that even those girls who do engage in sports and other forms of regular physical activity tend to abandon it in their teen years — and that’s true not just for urban girls or black girls, but all girls.

A National Institutes of Health study that followed girls for 10 years, beginning at age 8 or 9, found that, over time, leisure-time physical activity declined dramatically. That drop off was steepest for African-Americans girls.

“What they found was that by the age of 17 — so that’s the junior, senior year of high school — more than half of black girls, and nearly a third of white girls were reporting no leisure time physical activity at all,” says Temple University researcher Clare Lenhart.

There are lots of reasons why teen girls drop exercise from their lives, says Lenhart: “They have found changes in enjoyment of activities, in peer support or social support for physical activity. They found a lot of competing interests — be it part-time jobs or caring for younger siblings or other family members.”

Walter Stewart says he’s witnessed the phenomenon first-hand. He’s the longtime coach of the Anderson Monarchs, a soccer team of mostly African-American girls from inner-city Philadelphia.

Members of the Anderson Monarchs soccer team gather as their coach Walter Stewart talks to them. The team, which was started at Philadelphia's Marian Anderson Recreation Center, gives game time to girls who have little chance to play another sport (Photo by Todd Vachon/WHYY).

Members of the Anderson Monarchs soccer team gather as their coach Walter Stewart talks to them.

The team, which was started at Philadelphia’s Marian Anderson Recreation Center, gives game time to girls who have little chance to play another sport (Photo by Todd Vachon/WHYY).

“Eighth grade — that’s where it gets to be difficult,” he says. “They are making the transition from young kids to more teenagers, and they are more interested in boys and what boys think.”

Jennifer Johnson was determined not to let that happen to her daughter, Alexandria. Johnson discovered the Monarchs when she was looking for an affordable way to keep Alexandria active.

Alexandria is now 15 and an assistant coach with the team, but her interest in soccer dipped in middle school, around age 12, says Johnson.

“In come the friends, and in come the extracurricular activities at school, and as a parent you really have to press on. I said to her, ‘If it’s not this, you will be involved in something,’” Johnson says.
So Alexandria stuck with soccer, and so did her mother — Johnson is on the sidelines at games and during most practices.

That’s an approach that obesity researchers would approve of. Researchers say that family support — especially mom’s presence — may motivate girls to keep playing.

Researchers are beginning to count up the cost of obesity, and say women can pay a hefty price in dollars– and health.

A sedentary lifestyle and obesity may account for 25 to 30 percent of some major cancers, including colon, kidney and breast cancer in postmenopausal women, according to the National Cancer Institute. Avoiding weight gain, by contrast, can cut cancer risk.

In September 2011, researchers at Boston University reported that overweight and obesity in African-American women increases their risk of death, particularly from heart disease.

The investigators reviewed body mass index–a measure of body fat–and death rates for participants in the ongoing Black Women’s Health Study. A BMI of 25 is considered overweight. The study found a significant increased death risk at a BMI of 27.5–that’s the BMI for a 5-foot-4-inch tall woman who weighs 160 pounds.

Nearly 10 percent of all health care spending in the United States, $147 billion a year, is related to the obesity epidemic. Individually, obese people cost nearly $1,500 more a year in medical expenses compared to healthy-weight people, according to estimates from researchers at George Washington University. Some of that extra expense is paid by individuals, some is passed along to their employers.

Photo of soccer ball courtesy of Jean Scheijen

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.

Economist: A Person Already?

One evening in late September John Perkins, a veteran of the civil-rights movement, attended a rally at a Baptist church in Jackson in support of what he called “a total justice issue,” … It was concerned with Amendment 26, a measure on Mississippi’s ballot this November that defines a person as being “every human being from the moment of fertilisation, cloning or the functional equivalent thereof”. The reason for the measure is straightforward; its consequences less so. The Supreme Court, in its landmark Roe v Wade ruling in 1973, held that the right of a woman to terminate her pregnancy in the first trimester was guaranteed by her constitutional right to privacy. … The measure is expected to pass. … But what happens once the measure passes is unclear. … Would embryos be counted as people for the purposes of a census? Could a pregnant woman be charged with child abuse if she smokes, or be denied chemotherapy if it might hurt the fetus? From Mississippi’s tiny unborn people come strange legal questions (10/8).

The Economist: A New Prescription For The Poor

Medicaid, America’s health programme for the poor, is in the process of being transformed. Over the next three years, New York will move its entire Medicaid population into “managed care”, paying companies a set rate to tend to the poor, rather than paying a fee for each service. New York is not alone. States from California to Mississippi are expanding managed care. It is the culmination of a steady shift in the way most poor Americans receive their health-care treatment. Medicaid is America’s single biggest health programme. This year roughly one in five Americans will be covered by Medicaid for a month or more. It gobbles more federal and local money than any state programme, other than education. … Most Americans with private insurance are still horrified by thoughts of health-management organisations and prefer to pay fees for each medical service. For the poor, managed care is becoming the norm (10/8).

The Atlantic: The Quiet Health-Care Revolution

CareMore, through its unique approach to caring for the elderly, is routinely achieving patient outcomes that other providers can only dream about: a hospitalization rate 24 percent below average; hospital stays 38 percent shorter; an amputation rate among diabetics 60 percent lower than average. Perhaps most remarkable of all, these improved outcomes have come without increased total cost. Though they may seem expensive, CareMore’s “upstream” interventions—the wireless scales, the free rides to medical appointments, etc.—save money in the long run by preventing vastly more costly “downstream” outcomes such as hospitalizations and surgeries. As a result, CareMore’s overall member costs are actually 18 percent below the industry average (Tom Main and Adrian Slywotzky, November 2011).

Mother Jones: Herman Cain: Alive Because He’s Rich

Herman Cain by Gage Skidmore

Last month, during a GOP presidential debate, former Godfather’s Pizza CEO Herman Cain scored major points when he spoke about his personal experience surviving stage IV cancer. Cain claimed that if he’d been covered under President Barack Obama’s health care plan, he’d be dead by now. He suggested that if bureaucrats had been involved, his treatment would have been delayed and probably would have led to an early death. It was a compelling story, but an incomplete one. As Cain makes clear in his new book, This is Herman Cain! My Journey to the White House, he is probably alive today because he’s rich. And that’s not something Obamacare would have affected one way or another. … The sort of treatment Cain received would have put many people into bankruptcy, even if they had health insurance, thanks to caps and co-payments and other tricks insurance companies use to shift costs onto patients. Cain has never mentioned just what sort of health insurance he had during his cancer treatment, or what he has now. Multiple calls and emails over several weeks requesting information about his health care coverage went unreturned. These omissions are glaring because as a 65-year-old stage IV cancer survivor, Cain would be all but uninsurable if he tried to get insurance now on the private market (Stephanie Mencimer, 10/11).

American Medical News: Pain Management For Practice Breakups

Attorney John Fanburg likes to say that medical partnerships are “marriages without love.” He should know, as part of what keeps him busy is helping medical practices divorce as peacefully as possible. There may not be love, but there is plenty of emotion embedded in a medical practice partnership, whether the practice is made up of two or two dozen doctors. When the partnership fails, there is much at stake: Professional reputations, health insurance contracts, vendor relationships, employees’ livelihoods — and, most important, patients’ health and happiness — are at risk. Even a relatively amicable split can be emotionally and professionally draining (Emily Berry, 10/10).

PHOTO: Photo: Michal Zacharzewski

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.