Dear Dr. Peg,

How are the different types of hepatitis transmitted?

First let me explain what hepatitis is, for those who don’t know. Hepatitis is a disease of the liver. Your liver is an organ located in your abdomen, on the right side, under your lower rib cage. It has several very important roles in digestion and metabolism.

When you eat, stuff gets absorbed from your intestines into your bloodstream. The first place the blood carries the stuff is through your liver. The liver filters the blood, hanging on to the garbage and letting the good stuff through. The liver also produces bile, a green liquid that helps your body absorb fat. This super organ also serves as a breakdown and storage facility for important vitamins, minerals, immune cells and energy sources and a production facility for blood-clotting substances, not to mention a site for metabolism of many fats, carbohydrates and proteins.

You can’t live without your liver, although if you lose part of it, like in an accident or as a donation to someone who needs it, that part will grow back. It seems like even the ancient Greeks knew this. You might have heard of the myth of Prometheus. He was the Greek god who liked humans so much he gave them the gift of fire, without checking with Zeus first. This infuriated Zeus, so he tied Prometheus to a rock and sent a vulture to eat his liver on a regular basis. Ouch! Between vulture visits, Prometheus’ liver regenerated. Prometheus was eventually rescued, by the way, courtesy of Hercules.

Hepatitis means inflammation of the liver. “Hepa” is from a Greek word meaning “liver” and the “itis” is Latin for “inflammation.” You have heard that Latin suffix in words like appendicitis and laryngitis. Hepatitis is a general term that can describe liver inflammation from various causes, including drugs, alcohol and viruses. I’ll limit my discussion to viral hepatitis.

Viral hepatitis comes in 5 varieties: A, B, C, D and E. The first three are by far the most common in our country. Hepatitis A is passed through what is called the fecal-oral route. Someone who has Hepatitis A excretes it in their feces, and someone else takes it in orally. How? If the excreter didn’t wash their hands carefully after using the bathroom and then prepared food for you or shared food with you, that could do it. Oral sex on someone who has it could do it. Hepatitis A occurs in the U.S. but is more common in developing countries. There is a vaccination for it that we recommend for travelers to areas with a high incidence. Hepatitis A is not a pleasant disease — it causes nausea, vomiting and jaundice, but most people in this country recover from it without incident.

Hepatitis B is passed through blood and bodily fluids. This can happen at birth, from mother to child, if the mother has it, or during sex, or during intravenous drug use if needles are shared. It can also be passed in occupational accidents during health care procedures on infected patients. Hepatitis B is a much more serious disease than Hepatitis A. Some people recover fully, but Hepatitis B can become chronic, meaning it can last a long time and damage your liver. It can also cause cancer of the liver. Vaccination for Hepatitis B has become routine for babies in this country, but that happened relatively recently. If you didn’t get one, I recommend you do so. It is a three-shot series and you can get it at SHAC.

Hepatitis C is the up-and-coming liver monster of the millennium, according to experts. About 3.2 million Americans have Hepatitis C, and many of them don’t know it because it usually has no symptoms to begin with. Like Hepatitis B, it is passed through blood and bodily fluids, although sexual transmission of Hepatitis C is not as efficient as it is for Hepatitis B. Many people with Hepatitis C get it through intravenous drug use. There is no vaccine for Hepatitis C, and a high percentage of people who get this one go on to develop chronic liver disease, cirrhosis and cancer. Hepatitis C is the number one reason for liver transplants.

Hepatitis D is like B, and E is like A. Both are rare and neither has a vaccine.
You can minimize your chances of getting viral hepatitis by getting immunized against B, making sure you see a travel clinic before you travel in case you need a Hepatitis A shot, avoiding intravenous drug use and practicing standard safety procedures if you work in the health fields.

For more info, go to Goaskalice.columbia.edu or Cdc.gov. To get immunized, come to SHAC and see the highly skilled nurses in our Allergy and Immunization Clinic.

Dr. Peggy Spencer has been a UNM Student Health physician for 17 years and a Daily Lobo contributing columnist for three years. She is co-author of the book 50 Ways to Leave Your 40s. E-mail your questions to her at Pspencer@unm.edu. All questions will be considered, and all questioners will remain anonymous. This column has general health information only and cannot replace a visit to a health provider.