What is hepatitis?

"Viral hepatitis" is a broad term describing a number of infections that cause inflammation and dysfunction of the liver. Currently, three strains of hepatitis associated with needle sharing have been identified. These are hepatitis B, C and D.

Clinical signs and symptoms of hepatitis include weight loss, malaise, enlargement of the liver, abdominal pain, vomiting, jaundice, dark urine and light or clay-colored stools. Severity of signs and symptoms can vary with the type of viral infection.

Potential complications of hepatitis infection include chronic disease, cirrhosis, cancer of the liver, fulminant hepatitis (massive liver deterioration) and death.

How is hepatitis transmitted?

Hepatitis B is easily transmitted from one person to another through the sharing of drug injection equipment. It can also be transmitted orally, sexually, perinatally (from mother to fetus or newborn) and by any other intimate physical contact. Groups at risk for hepatitis B include injection drug users, sexually active heterosexual/homosexual men, infants born to infected mothers, healthcare workers and hemodialysis patients.

Hepatitis C is transmitted most efficiently through blood transfusions from infected donors and via the sharing of contaminated needles by injection drug users. It can also be transmitted sexually and perinatally. At risk groups include injection drug users, persons with certain medical conditions (such as hemophilia and long-term dialysis patients) and persons receiving transfusions or organ transplants prior to July, 1992.

The hepatitis D virus is found only in the presence of the hepatitis B virus. Similar to the transmission of the hepatitis B virus, hepatitis D is transmitted via injection drug use, through blood or blood products or through sexual contact. It can be contracted at the same time as the initial hepatitis B infection (co-infection) or after an individual is already chronically infected with hepatitis B (super-infection).

What is the impact of hepatitis on Americans and the health care system?

Approximately 1.25 million people in the United States have chronic hepatitis B infection, and between 5,000 and 6,000 people die each year from related complications such as cirrhosis or hepatic carcinoma (cancer of the liver).

Of the 200,000 to 300,000 individuals how acquire new hepatitis B infections annually, approximately 17% require hospitalization, with related medical costs and work loss totaling an estimated $700 million per year.

Hepatitis B reigns as the major occupational health risk for health care workers in the United States. The CDC estimates that approximately 8,700 health care workers are infected with hepatitis B each year through occupational exposure. Of this number, more than 400 will be hospitalized, about 200 will die and more than 800 will become chronic carriers.

An estimated four million people in the U.S. are infected with the hepatitis C virus, and about ten percent of these patients will die of cirrhosis. Additionally, approximately 85% of infected individuals will develop chronic hepatitis C infection, and 70% will develop chronic liver disease, including hepatic carcinoma. The medical and work loss costs associated with hepatitis C total approximately $600 million annually.

Hepatitis D has associated mortality rates of up to 20 percent. Some data shows that, compared with chronic hepatitis B, chronic hepatitis D infections result in cirrhosis and other associated complications much more frequently.

How can hepatitis be prevented?

The most effective way of preventing hepatitis B is through the hepatitis B vaccine. Given in a series of three intramuscular doses, this vaccine enables over 95% of children and adolescents and more than 90% of adults to develop antibodies against the virus. Hepatitis B vaccination is recommended for individuals who fall in high-risk groups, including health care and public safety workers, hemodialysis patients, household and sexual partners of hepatitis B carriers, injection drug users, sexually active homosexual and bisexual men, and non-monogamous sexually active men and women.

Barriers to reduce contact with another person's body fluids (such as the use of latex condoms during sexual intercourse) reduce the chance of contracting or spreading the disease.

There is currently no vaccine available against the hepatitis C virus. Treatment of chronic hepatitis C infection with medication is only 20 to 30 percent effective. Reducing the risks of contracting hepatitis C include reducing exposure to blood products. Using latex condoms can reduce the chance of contracting or spreading the disease sexually.

Individuals with hepatitis C should not donate blood, body organs, tissue or sperm. Cuts and open sores should be covered, and personal care items such as toothbrushes and razors should not be shared.

Hepatitis D is most easily prevented by preventing hepatitis B infection. Immunization against hepatitis B automatically protects a person from hepatitis D.

Hepatitis and the efficacy of needle exchange programs

Injection drug users are among those at highest risk for hepatitis B, C and D viral infections. Studies conducted in Europe and the United States have found serological evidence of hepatitis B infection in 65% to 95% of intravenous drug users and evidence of hepatitis C infection in 65% to 80% of this population.

While approximately 38% of hepatitis C infections are associated with sharing dirty needles, studies reveal a six-fold and seven-fold reduction in hepatitis B and hepatitis C, respectively, in Pierce County, Washington, where a needle exchange program has been operating since 1988. Numerous studies of the risks and benefits of needle exchange programs show no evidence that drug use is increased or initiated among participants.

In 1997 a consensus panel of the National Institutes of Health indicated that needle exchange programs reveal as much as an 80% reduction in risk behavior (such as sharing dirty needles) by the injection drug user. They recommended that the government lift the restrictions on needle exchange programs and other harm reduction measures.

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