Other Viral Hepatitis
There are three other types of viral hepatitis identified: Hepatitis A, Hepatitis D and Hepatitis E.
All three are uncommon in Australia, are transmitted in different ways, and have different outcomes.
Hepatitis A is an acute (short-term) infection of the liver that can be serious and require medical attention. It is spread through the faecal-oral route or when infected faecal matter enters the mouth. Symptoms can be debilitating but most people infected with hepatitis A recover completely. Once you have had hepatitis A you cannot get it again.
Hepatitis A is diagnosed by a simple blood test. Hepatitis A is preventable with good personal hygiene. There is a vaccine for hepatitis A, usually recommended for people travelling to high prevalence countries.
In Australia, there are approximately 300–500 cases of hepatitis A reported per year. The number of cases reported has been declining nationally since the late 1990s (DoHA 2006). In 2013 there were 170 diagnosed cases of hepatitis A in Australia.
In Australia infection with hepatitis A is more likely in particular locations and amongst specific groups of people, including child day-care centres and pre-schools; men who have sex with men; injecting drug users; residential facilities for the intellectually disabled; and; travellers to countries where the infection is common (Asia, Africa, South-Pacific, Central and South America). Drinking or eating contaminated water or food could result in infection.
Symptoms generally include fever, weakness, fatigue, loss of appetite, nausea, joint aches and pains, vomiting, and jaundice (yellowish eyes and skin, dark urine and pale-coloured faeces).
Hepatitis D is a liver disease caused by the hepatitis D virus, a defective virus that needs the hepatitis B virus to exist. Infection can occur as a co-infection, which means it occurs at the same time as hepatitis B infection; or it can occur as a superinfection in people who already have chronic hepatitis B.
People who are co-infected with hepatitis B and hepatitis D may experience a more seriously acute illness and have a higher risk (2%–20%) of developing acute liver failure compared to people infected with hepatitis B alone. However, most people who are co-infected will clear hepatitis D and never develop chronic hepatitis D infection.
People with chronic hepatitis B who are infected with hepatitis D (superinfection) usually develop chronic (long term) hepatitis D infection. Long-term studies of people with hepatitis D superinfection show that between 70% and 80% develop cirrhosis (liver scarring) compared to 15% to 30% of people with chronic hepatitis B alone.
The hepatitis B vaccine can prevent infection with hepatitis D. Diagnosis can be made by a blood test. There is no specific treatment for hepatitis D. Research indicates that the medication used to treat hepatitis B has a limited effect on the activity of hepatitis D virus.
Worldwide the pattern of hepatitis D infection is similar to the occurrence of hepatitis B infection and it has been estimated that 15 million people with hepatitis B are infected with hepatitis D. Hepatitis D is not a common infection in Australia. Over the past 6 years there have been between 20 and 30 cases diagnosed and reported each year (NNDSS).
Hepatitis D is spread in similar ways to hepatitis B because the virus is found in blood. Therefore, whenever blood from an infected person enters the bloodstream of a person who is not immune there is the risk of transmission. For example, hepatitis D infection can occur through sharing injecting equipment, or through needle stick or sharps injuries. It is less common for hepatitis D to be spread through sexual contact, or mother to baby transmission compared to hepatitis B.
Symptoms of hepatitis D include loss of appetite, nausea and vomiting, tiredness, pain in the liver (upper, right side of abdomen), muscle and joint pain, and jaundice (yellowish eyes and skin, dark urine and pale-coloured faeces).
Hepatitis E is caused by an infection with hepatitis E virus. Hepatitis E does not develop into a chronic (life-long) infection, however, the infection is more severe among pregnant women in the third trimester.
In general, people with hepatitis E recover with no long lasting illness. There is a very small chance (1–4%) of developing sudden and life threatening liver disease. Pregnant women who become infected with hepatitis E are at greater risk of severe illness and liver failure and 20% may die because of the infection. However, this occurs mainly in developing countries where hepatitis E is very common and where there is limited healthcare for pregnant women.
Diagnosis of hepatitis E is performed by a blood test that detects either the antibodies or the virus itself. The blood tests needed to diagnose hepatitis E are not widely available. At present, no vaccine exists for the prevention of hepatitis E, and there is no treatment: as it is caused by a virus, antibiotics are of no value in the treatment of the infection. Bed rest and fluid replacement is recommended.
Travellers to developing countries are advised to take precautions against drinking contaminated water (including beverages with ice), eating uncooked shellfish and uncooked fruits and vegetables that are not peeled or prepared by the traveller. They also need to be aware of personal hygiene including hand washing.
The highest rates of hepatitis E infection occur in regions where there is poor sanitation and sewage management that promotes the transmission of the virus. For example, hepatitis E is common in Central and South-East Asia, North and West Africa and Mexico.
Hepatitis E is not a common cause of liver disease in Australia. Over the last six years, there have been approximately 10 to 30 cases of hepatitis E diagnosed and reported to the government each year.
Hepatitis E is found in the faeces and spread via the faecal-oral route, similar to hepatitis A. Drinking or eating contaminated water or food could result in infection. Person-to-person transmission of hepatitis E is uncommon. There is no evidence that hepatitis E is spread sexually or through blood or blood product transfusion.
Symptoms may include fever, weakness, fatigue, loss of appetite, nausea, vomiting, and jaundice (yellowish eyes and skin, dark urine and pale-coloured faeces).