Better education needed to prevent hepatitis

Often liver is 'out of sight-out of mind'

Love your liver, says Thelma King Thiel, chairwoman and CEO for Hepatitis Foundation International based in Silver Spring, MD. Thiel would like this statement to be as common as "Fasten your seatbelt."

Why? Few people give much thought to their liver. While they think about other organs, such as the heart and lungs, the liver rarely comes to mind, yet it is vitally important.

A "healthy liver is essential to a healthy life," according to the American Liver Foundation located in New York City. The liver performs over 5,000 functions minute by minute including converting food to nutrients, storing vitamins and minerals, and detoxifying harmful substances.

An important part of liver health is preventing hepatitis, which is inflammation of the liver, in its various forms categorized as A, B, C, D and E, says Thiel. That is why Hepatitis Foundation International has declared May as Hepatitis Awareness Month.

A large percentage of people with hepatitis do not know they are infected because the liver is a non-complaining organ, says Thiel. Therefore, they do not seek treatment and are spreading their disease to others and damaging their liver.

To curb the spread of hepatitis, people with behaviors either in the past or present that put them at risk for contracting the disease should be tested. Also, more people need to learn the steps to preventing hepatitis and healthful habits that keep the liver in good condition.

"I feel very strongly that if you do not know how important your liver is, you will not be motivated to either change your behaviors or assess your own risk behaviors," says Thiel.

There are many areas in which hepatitis awareness must be increased. Health care professionals need to do a better job of teaching about the liver and the dangers of hepatitis, says Thiel.

To teach the difference between hepatitis A, B, C, D, and E Thiel suggests the use of vowels — A, E, I, O, U. Hepatitis A and E, which are vowels, are found in the bowels, while the others are found in the blood. Hepatitis D and E are not common in the United States.

This simple definition helps clarify the different types of hepatitis in a person's mind so they can more easily understand how the disease is transmitted and what puts them at risk.

At-risk behaviors

For hepatitis A and E the virus is transmitted via the feces of an infected person either directly or indirectly from contaminated food, raw shellfish, drinking water, cooking utensils, or someone's fingers.

"If someone who is infected does not wash their hands after they have a bowel movement and prepares your salad in a restaurant you are eating their virus," says Thiel.

Hepatitis A is an acute condition with flu-like symptoms if any are present. Most people recover completely from hepatitis A; however B and C can result in a chronic, lifelong infection.

Hepatitis B is transmitted through sexual contact or exposure to an infected person's blood through transfusion, cuts, open sores, or sharing sharp instruments such as needles and razors. It can also be spread from mother to child at birth.

About 90% of people who contract hepatitis B clear the virus on their own, says Thiel. Those who don't are considered chronic and are at risk for cirrhosis of the liver, which is caused by damaged cells. They are also at risk for liver cancer or liver failure. While there is no effective treatment for the cure of hepatitis B, there is a vaccine available to prevent it.

Thiel says people with at-risk behaviors, such as those in prison and those being treated at clinics for sexually transmitted diseases, are now being given the vaccine. She adds the virus would not be so widely spread today if health care professionals treating patients at STD clinics had begun routinely using the vaccination in the 1980s when it became available.

Hepatitis C is mainly transmitted via direct blood contact. Prior to 1992, blood donated for transfusions was not routinely screened for the virus and, therefore, about 15-20% of people who had a transfusion prior to that date could be infected with hepatitis C.

About 75% of hepatitis C cases are chronic and can lead to cirrhosis. While there are drugs available to treat hepatitis C, not everyone responds to these treatments, says Thiel.

While physicians routinely order blood tests as part of a physical examination, they do not automatically screen for hepatitis B or C. While it would not be cost effective to routinely screen for hepatitis, those who should be screened could easily be identified if the right questions were asked during the health assessment, says Thiel.

For example, patients could be asked if they have ever done any of the following behaviors that put them at risk for hepatitis: used IV drugs, had extensive dental work, had a blood transfusion, had unprotected sex, shared needles or other sharp instruments such as a razor or ear piecing tools, or snorted cocaine.

Table tents in a physician's office with similar information could prompt people who might be at risk to get tested.

Professionals who work in clinics and other areas where patients are at high risk should routinely tell them how to adopt healthier lifestyles to avoid hepatitis. About 70% of all new cases of hepatitis C are related to injection drug use.

School-age children should be taught about their liver and the prevention of hepatitis. Just as children are taught how to brush their teeth they should be taught how to wash their hands after going to the bathroom, says Thiel.

"Prevention is a team effort, starting in the schools and continuing into adulthood," says Thiel.

To aid in this effort, the Hepatitis Foundation International has created several short educational videos. The organization also routinely develops campaigns to increase awareness, such as the Social Drinkers Alert to educate about hepatitis C.

"Alcohol accelerates the disease process for those who have hepatitis C," says Thiel. "People may feel fine yet be infected and therefore damage their liver each time they drink a six-pack of beer while watching a football game."

When awareness of viral hepatitis, a disease affecting more than 500 million people around the world, is raised through education the chances of eradicating it are increased, says Thiel.

[For more information about ways to raise awareness about liver health and the dangers of hepatitis, contact:

Thelma King Thiel, chairman and CEO, Hepatitis Foundation International, 504 Blick Drive, Silver Spring, MD 20904-2901. Phone: (800) 891-0707 or (301) 622-4200. E-mail: Web site:]