Vaccine for Hepatitis Badly Needed
Ian Maclean Smith, M.D.
Department of Internal Medicine
University of Iowa Hospitals and Clinics
Creation Date: April 1998
Last Revision Date: April 1998
Peer Review Status: Internally Peer Reviewed
When we only had tests for hepatitis A and hepatitis B it
was called Non A Non B hepatitis. It most often followed blood
transfusion. We know since 1988 that 97% of Non A Non B
hepatitis is caused by hepatitis C virus (Hepatitis C Virus). It is one of
six viruses (A,B,C,D,E,G) that cause most viral liver damage.
It can cause acute or chronic liver disease, cirrhosis or
scarred liver (Greek for orange yellow the autopsy liver
color) and liver cancer. Alcohol worsens this disease. Two
thirds of new IV drug users acquire Hepatitis C Virus within 12 months.
There are nearly 4 million Americans infected with hepatitis C
with 30,000 new infections yearly. (20% of all hepatitis.) It
causes 9,000 deaths annually and is the leading reason for
Transfusion disease largely has been prevented by switching
from professional to volunteer blood donors and by using
sensitive tests for hepatitis C. Transfusion hepatitis now
only occurs once in every 100,000 transfusions. Hepatitis C Virus still
occurs in intravenous drug users, after unsanitary tattooing
or body piercing, and after needle stick accidents in medical
personnel. Hepatitis C can rarely be sexually transmitted and
there is spread from infected mother to infant in less than
1%.There is no effective vaccine.
Hepatitis C Virus positive individuals should not donate blood or semen.
They should practice safe sex although transmission by this
route is very low, and should not share razors or
toothbrushes. IV drug users should use needle exchange
programs or quit.
Hepatitis C Virus is an RNA virus and its structure varies so its
numerous subtypes can escape body immune surveillance.
Spontaneous cure occurs in only 5 to 15%, the rest become
chronic. Infection is often unrecognized, less than a quarter
are diagnosed early. Those who develop symptoms feel ill
(malaise) and weak or lack appetite. Anti viral antibodies
first present after 1 to 3 weeks, can be detected in 90% by
three months. Liver function tests especially ALT rise above
normal. Liver biopsies show inflammation around the liver
(portal) blood vessels. Later the virus kills liver cells and
leaves scar tissue (cirrhosis), which increases portal blood
pressure, with fluid leakage into the abdomen (ascites),
jaundice, brain cloudiness, and vomiting of blood from
esophageal vessels bypassing the liver. Progress to cirrhosis
occurs in at least 20%, and cirrhosis has a 10-year fatality
rate of 20%. However once complications occur (ascites,
bleeding, or confusion) fewer than 50% survive five years.
Chronic extended hepatitis leads to liver cancer in about 13%
after 10 years especially in older men.
Patients with high sustained ALT for 6 months, positive
evidence of Hepatitis C Virus RNA, and a liver biopsy showing scarring and
liver cell death should be treated with alpha interferon, 3-5
million units 3 times weekly for 12 months. Heavy drinking or
illicit drug use make treatment ineffective. Some patients
treated with interferon get flu-like symptoms. This lessens
with time but about 5% quit. Ribivarin (an experimental drug)
given orally may increase the alpha interferon response rate.
Hepatitis A and B vaccination is recommended for all Hepatitis C Virus
A lot has happened since the 1970s but much more must be
learned. This is a miserable disease. A vaccine and better
antiviral agents are urgently needed.