- The Washington Times - Tuesday, June 4, 2002

Tim Halloran has a virus that won't go away. Mr. Halloran, 55, who lives in Silver Spring, discovered he had hepatitis C when he developed flu-like symptoms in 1983. A blood test revealed the illness, which Mr. Halloran believes he contracted from a blood transfusion during the Vietnam War. Although he remained asymptomatic for many years, the sickness became chronic, leading him to have a liver transplant in June 1997. Even with a new liver, the disease lingers in his body.
"There are times when I don't have any energy," says Mr. Halloran, who receives Social Security Disability Income. "But I've made it a point to try to be a positive element for as many people as possible by running support groups."
Hepatitis, which creates an inflammation of the liver, is caused by infectious or toxic agents in the body. It is characterized by jaundice, fever, liver enlargement and abdominal pain. Hepatitis has many origins, but viral infections from hepatitis A, hepatitis B and hepatitis C are the most common causes in the United States. Each of these comes from a different viral family, and each has specific preventive measures, methods of spreading and treatments.
Thelma King Thiel, chairman and chief executive officer of the Hepatitis Foundation International in Cedar Grove, N.J., says she fears that young people have not been taught how to avoid liver-damaging activities.
Hepatitis A, which comes from the family of picornaviruses, one of the oldest known to man, is spread by putting something in the mouth such as food or water that has been contaminated with the stool of a person with hepatitis A. This is why it is important to always wash hands with soap and water after using the bathroom or changing a diaper, and before handling food. The virus is spread more easily by people lacking proper hygiene. Sometimes feces has caused outbreaks of hepatitis A in restaurants that serve raw shellfish because they have been harvested from contaminated waters. The virus also can be spread through oral or anal sex.
The best way to prevent hepatitis A is to be vaccinated, Mrs. Thiel says. The vaccine can give at least 20 years' protection from the virus. Since almost all people infected with it recover on their own after a couple of months of intense sickness, there is no specific treatment for the illness. Once a person has hepatitis A, one cannot contract it again. About one-third of Americans have had a past infection that has led to immunity.
Mrs. Thiel says that rarely does someone develop an overwhelming infection that leads to a liver transplant or death. She reminds those who suffer from the sickness that consuming alcohol makes any type of hepatitis worse because the liver has to work harder to process the toxins in the alcohol as well as the virus.
"There are lots of ramifications of this disease," Mrs. Thiel says. "The majority of people say if they knew how they could get hepatitis that they would have changed their behavior."
• • •
Molli Conti, associate director of the Hepatitis B Foundation in Doylestown, Pa., says hepatitis B is easily transmitted through the blood and body fluids of an infected person, especially during sexual activity and intravenous drug use. She warns people considering getting a tattoo or body piercing to make sure they find an artist who uses sterile equipment.
She says the best protection against hepatitis B, which comes from the viral family hepadnaviridae, is to receive the three-dose vaccination, which has been available since 1982. She suggests vaccinating children before they become sexually active. An estimated 1.25 million Americans suffer from chronic hepatitis B, and about 20 percent to 30 percent of those people became infected in childhood. About 5,000 people die each year from complications of hepatitis B, such as cirrhosis and liver cancer.
"This is one sexually transmitted disease that we can prevent," Ms. Conti says. "But the vaccine doesn't do any good unless you've had it before you've been exposed."
According to the Centers for Disease Control and Prevention in Atlanta, about 6 percent of people infected with hepatitis B after the age of 5 become chronically infected. About 40 percent of those people respond to the drugs alpha interferon and lamivudine, which should not be taken by pregnant women.
There are ways for pregnant women who are chronic carriers of hepatitis B to prevent their child from becoming infected. Since the virus cannot be transmitted until delivery, the baby would usually receive hepatitis B immune globulin and the first shot of the hepatitis B vaccine at birth. The second and third doses of the vaccine should be given about two months and six months later.
This is about 95 percent effective in helping the baby not become chronic, Ms. Conti says. She says babies contracting hepatitis B from their mothers is a bigger problem in foreign countries where health care is not so comprehensive.
Unfortunately, the younger someone is when contracting the disease the more likely the person is to become chronically infected. About 90 percent of infants infected with hepatitis B at birth and 30 percent of children infected from ages 1 to 5 develop the chronic form of the virus.

Chronic infection is more common in hepatitis C than in hepatitis B, says Dr. Gregory Everson, who is professor of medicine and director of hepatology at the University of Colorado School of Medicine in Denver. About 75 to 85 percent of people with hepatitis C develop chronic infection. This is because the virus usually adapts itself to antibodies that are naturally created to fight the illness.
He says about 20 percent of chronic patients develop a risk of cirrhosis or liver failure, which makes hepatitis C the leading cause of liver transplants in the United States.
Hepatitis C, which comes from the viral family flaviviridae, is transmitted similarly to hepatitis B, through blood or body fluids. About 3.9 million Americans have been infected with the virus, which is an overwhelming number of people for health professionals to accommodate. Hepatitis C is passed through intravenous drug use, sex, tattooing or body piercing, and personal items that could have blood on them such as razors and toothbrushes, according to the CDC. The majority of infections originate from illegal drug use.
Unlike hepatitis A and hepatitis B, there is no vaccine to prevent hepatitis C. Those people who contract hepatitis C are usually treated with the drugs interferon and ribavirin. In about 40 percent of the cases, the combination of the two drugs removes the virus.
"It's not easy therapy," Dr. Everson says. "Even the best candidates can have trouble with the treatment. It requires a big commitment by the patient and the nursing staff."
Hedy Weinberg, 62, of Denver, is among the 40 percent of people chronically infected with hepatitis C who have been helped by the interferon and ribavirin treatment. She is a patient of Dr. Everson's. Together they wrote the books, "Living with Hepatitis B" and "Living with Hepatitis C."
She believes she contracted hepatitis C during an emergency hysterectomy in 1967, but doctors didn't diagnose her condition until 1993. According to the CDC, transfusion-associated cases of hepatitis C that resulted prior to blood donor testings now happen in less than one in a million transfused units of blood.
"When I was finally diagnosed, it was a relief," she says. "It explained what I was going through. If you go to a doctor and say you're fatigued, it's so non-specific … I blamed myself and thought I wasn't trying hard enough."
Even though Ms. Weinberg received hepatitis C through a medical procedure and not drug use or unprotected sex, she has experienced the stigma that is associated with the virus.
"I and everyone else with hepatitis C feels a little contaminated," she says. "You feel kind of ashamed and dirty until you get over it, which involves talking a lot about it. One of the problems is that one feels so isolated. I felt really alone."
Despite the struggle of overcoming the virus, Ms. Weinberg says she views the illness as a blessing in disguise.
"You learn some gifts of gratitude," she says. "You are grateful for the medical people. It was a challenge to deal with this for so long."


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