In 2017, San Diego saw an outbreak of hepatitis A. Public health officials responded by offering free vaccination clinics, installing countywide hand-washing stations and distributing hygiene kits via local homeless outreach organizations.
"The local hepatitis A outbreak primarily affected homeless patients and those with a history of drug use," says Dr. Fadi Haddad, an infectious disease specialist with Sharp Grossmont Hospital. "This patient population is also at high risk for alcoholism, hepatitis C and other conditions that can lead to liver disease. Unfortunately, hepatitis A mortality is higher in patients with underlying liver disease, which is likely why we saw deaths in San Diego County caused by hepatitis A."
While the outbreak was gravely concerning, understanding the differences between the various forms of viral hepatitis — inflammation of the liver — can help to decrease alarm and lead to increased prevention.
According to the World Health Organization (WHO), there are three main types of viral hepatitis common in the U.S. These types are known as hepatitis A, B and C. Symptoms of all three types are similar and can include:
- Loss of appetite
- Joint pain
- Abdominal pain
- Diarrhea, nausea and vomiting
Symptoms can take three or more weeks to appear, though not everyone with hepatitis will exhibit symptoms.
All types of hepatitis can potentially lead to liver scarring, cirrhosis or cancer, and can be caused by heavy alcohol use, toxins, some medications and certain medical conditions, but are usually transmitted as follows:
Hepatitis A is found in the feces of people infected with the virus and is usually transmitted through consumption of contaminated water or food, shared drug paraphernalia and certain sexual practices. While most cases are mild, if left untreated, it can lead to severe illness and death.
Hepatitis B is transmitted through infected bodily fluids, such as blood and semen. It can be shared between mother and infant during birth, as well as via blood transfusions, medical procedures, sexual contact and injected drug use. Chronic infection can occur in infants infected at birth, children infected under the age of 5 and, very rarely, in those infected after the age of 5.
Like hepatitis B, hepatitis C is usually transmitted through exposure to infected blood during transfusions, medical procedures and drug use. It can, on rare occasions, also be shared via sexual transmission. It can be either acute or chronic, meaning it becomes a serious, lifelong illness. The Centers for Disease Control and Prevention (CDC) reports that acute hepatitis C often leads to chronic hepatitis C.
Those at greatest risk for hepatitis include the following:
- Travelers to countries where hepatitis is common
- Members of the homeless population
- Those who have sexual encounters with someone infected with hepatitis
- Men who have sexual encounters with men
- Recreational drug users
- Hemophiliacs (people with a blood-clotting disorder)
- People who live with or care for infected persons
- Care providers for the homeless and drug users
While there are safe and effective vaccines for types A and B, there is no vaccine for hepatitis C. Along with being vaccinated, thoroughly washing hands with soap and running water — both before eating and after using the restroom — as well as avoiding the sharing of food, drinks and drug paraphernalia can help prevent the spread of the hepatitis virus.
"Hand hygiene and washing fresh fruits and vegetables are simple measures that prevent this virus from spreading around," Dr. Haddad says. "Vaccination for those who have not been vaccinated is strongly recommended."
Once a hepatitis virus — whether A, B or C — is diagnosed, the infected should always avoid alcohol consumption to prevent further liver damage. There is no medication to treat hepatitis A or acute hepatitis B and C, other than supportive care of the symptoms including rest, adequate nutrition, fluids and medical monitoring, though some may have to be hospitalized. Chronic hepatitis B and C can be treated with antiviral medications that have a 40 to 50 percent success rate in eliminating the virus.
Talk with your doctor if you are concerned about hepatitis or are at greater risk for developing hepatitis and may need to be tested. Vaccination is strongly recommended for those at risk and for anyone traveling overseas to areas with hepatitis outbreaks.
To learn more about hepatitis and where you can receive a hepatitis A vaccine, visit the San Diego County Health and Human Service Agency's hepatitis A fact sheet.
The County of San Diego urges those vaccinated during the public health emergency to get their second dose, completing the series for long-term prevention. Although the first dose of the vaccine is considered to be around 95 percent effective, that protection will eventually begin to decrease. A second shot boosts immunity for between 20 and 40 years, according to the Center for Disease Control and Prevention.
For the news media: To talk with Dr. Fadi Haddad about hepatitis for an upcoming story, contact Erica Carlson, senior public relations specialist, at email@example.com.
This story was updated in March 2018.