ALBUQUERQUE, N.M. — Q: Why don’t you give blood every three months? It could save a life!
A: I have wanted to give blood as my wife does, but 40-some years ago, I suffered briefly from hepatitis, and the New Mexico Blood Bank, understandably cautious, will not let me donate. I would much rather have donated a pint of blood 160 times since then than have had hepatitis (viral infection of the liver). It wasn’t much fun.
Forty years ago, New Mexicans were much more likely to contract hepatitis A than residents of most other states. It was said that about one in 10 Indian Health Service doctors serving in the Four Corners area got the disease, and I was that one. It was fall of 1971 – I remember, because I went to a Halloween party as a pumpkin, and I didn’t need much of a costume, since I was orange.
I was lucky – it wasn’t terribly severe, though I felt nauseous for a couple of weeks, had little energy and little appetite, and my eyes and my skin turned a bright orange color. In those days, it was thought necessary to rest hepatitis patients (later Army studies showed no difference in recovery in rested as compared with calisthenics-assigned patients). Rest wasn’t necessary, but what was very important was being very careful with bowel movements and vomit, since I could have infected contacts with just a small amount of poor handwashing. Fortunately, my wife did not get the virus, and so she gives blood. Now hepatitis A is very uncommon even here in the Southwest, thanks to a vaccine, recommended for all young children.
Hepatitis A – that name suggests there might be some other letters, and indeed there are. We’re up to E now, with B and C being especially important, as both can cause very serious, chronic and life-threatening disease. Hepatitis B virus can lead to cancer of the liver; in fact, we are happy to be able to point out that the hepatitis B vaccine was the first available vaccine to prevent cancer (now joined by the human papillomavirus vaccine). Hep B vaccine is highly effective, and should be given to all children in early infancy.
Hepatitis B was once very common among Asians and certain Native Americans. Unlike hepatitis A, the hep B virus is an insidious culprit, becoming evident only months after exposure. And unlike hep A, which is spread through fecal contamination, hep B is usually contracted through sexual contact or exposure to blood, although sharing toothbrushes or other articles that might be contaminated with blood can also spread the disease.
Newborns can be infected through their mothers’ blood, though that is much less common now that we test all pregnant women for hep B and use very effective injections, including hepatitis B vaccine, to prevent the infants of positive mothers from being infected.
That’s especially important, because newborns infected with hepatitis B are especially likely to become chronically infected, to have serious ongoing disease, and to have liver cancer. Ninety percent of infected newborns, but “only” 5 percent to 10 percent of infected adults, become chronically infected – chronic infection leads to cirrhosis (liver destruction like that occurring in alcoholics) and may lead to cancer.
Advancing down the alphabet, we have no vaccines to prevent infection. Hepatitis C resembles hep B in several ways, including its propensity for causing chronic hepatitis and its usual transmission routes: mostly from infected blood, though possibly also from sexual contact. In the past, blood transfusions had the potential for causing hep C infection, though virtually never anymore, given testing of all blood units in this country for the virus. Now blood exposure is most likely to come from sharing contaminated needles for injection drug use. Hepatitis C is a bad actor – without treatment, some 70 percent to 80 percent of adults (slightly fewer children) infected have a chronic infection. Treatment of this infection is very involved; Dr. Sanjiv Arora at UNM provides an excellent telemedicine consultation service for treatment of hepatitis C throughout New Mexico.
Hep D is a parasite, not that the others aren’t! The virus causing hepatitis D cannot cause disease in the absence of hepatitis B, so, when present, it helps the hepatitis B virus destroy the liver. It cannot do that by itself.
Hepatitis E is the final member of the “five-virus team,” and is most likely to be encountered in developing countries in Africa and the Indian sub-continent in places with contaminated water supplies. Right now there’s an outbreak in refugee camps in South Sudan, with symptoms like those I had with hepatitis A in northwestern New Mexico 40 years ago. The difference: about 10 percent of those who become jaundiced die, whereas few hepatitis A sufferers die, even though they may feel like they’d rather die for a short period of time.
The take home messages: give blood if you can, but don’t get contaminated with blood. Get the hepatitis A and hepatitis B vaccines for your children, and consider them at older ages if you’re traveling to the developing world (hepatitis A) or have high risk for hep B (men who have sex with men or people who are injecting drugs). Get expert help if you have hep C. And wash your hands!
Lance Chilton, M.D., is a pediatrician at the Young Children’s Health Center in Albuquerque, associated with the University of New Mexico. Send questions to firstname.lastname@example.org.