UF EPI expert on hepatitis: a surprisingly widespread silent killer 

3D illustration of a liver, with enlarged virus particles floating around the foreground and background.
Hepatitis affects the liver, a vital organ that filters blood, stores vitamins, fights infection and supports metabolism. Rasi – Adobe Stock

Millions of Americans have chronic viral hepatitis and do not even realize it, according to the Centers for Disease Control and Prevention. This disease affects the liver and can cause severe or even fatal complications if left untreated. The CDC recommends all adults get screened at least once in their lifetime for hepatitis B and C.  

Robert Cook, M.D., a member of the Emerging Pathogens Institute and a professor in the College of Public Health and Health Professions, explains how people can have hepatitis without realizing it and answers other common questions about the disease.  

Q: What is hepatitis?

Hepatitis generally refers to inflammation of your liver. There are several types of hepatitis that can be caused by different infections, and the most common infectious causes are viruses. 

Hepatitis A is typically caused by food contamination, sometimes when people don’t wash their hands. Hepatitis B is typically transmitted through sex or blood. Most people get a vaccine for it these days, so we see a lot less of hepatitis B in the United States compared to what we are used to. Hepatitis C is also usually transmitted through blood, so injected drug use and sexual transmission. We do not have a vaccine for hepatitis C now. There is also a hepatitis D and a hepatitis E, which we don’t see very much of in the United States.

Q: What are the symptoms of hepatitis? 

Headshot of Dr. Robert Cook.
Dr. Robert Cook, MD, MPH, is a professor in the UF College of Public Health and Health Professions and a member of the EPI.

When the liver is inflamed, people can become jaundiced. This is a symptom where the skin color or the whites of the eyes become more yellow due to bilirubin, a chemical in the liver that gets released when there’s damage to liver cells. People may have a fever, nausea, vomiting and diarrhea with hepatitis A. 

Q: How do you diagnose hepatitis? 

We typically begin diagnosing hepatitis A, B and C with blood tests for antibodies. We can also directly test for the virus because finding an antibody would just mean somebody had an infection at some point in their life. Oftentimes, the virus has already cleared the body. But usually if people have a positive antibody, we may also need to do a PCR test to see if they actually have virus in their blood.

Q: How can someone have hepatitis without realizing it?  

Usually, there’s an acute illness when someone first gets infected. Your body’s immune system may fight it off and kill all the viruses, and then you’re clear. But for other people, the virus continues to circulate in the body — and the chronic infection symptoms are a little more general. People may have muscle aches, fatigue or have some type of rash. But many times, they just have no symptoms at all; they would have no idea that they were carrying this virus unless they were tested.

Q: What could happen to someone if they don’t know they have hepatitis and don’t get treated? 

Over time, maybe in 10 or 20 years, the virus will continue to inflame the liver, and the liver will develop fibrosis. Fibrosis is like connective tissue that doesn’t function and interferes with the liver. People can then get cirrhosis, a chronic liver disease where the liver stops making things that the body needs and stops clearing out toxins. That’s really bad. Cirrhosis often can’t be cured without getting a liver transplant.

Q: How do you treat hepatitis? 

In general, we try to kill the virus with antiviral medicine — that’s how we cure hepatitis B — but treatment varies for the different types of hepatitis. Hepatitis A is usually a very self-limited infection, so the body usually fights it off, and we really don’t use an antiviral drug for Hepatitis A. But we do need to support people while they are sick by giving them IV fluids or some type of supportive care until the viruses pass. 

I think probably one of the most important breakthroughs in medical care in the last 10 to 20 years has been a new cure for hepatitis C. It can now be cured with a six-week course of pills, which works well with few side effects. 

Previously, if people were doing things that might hurt the liver like drinking alcohol or continuing to inject drugs, the healthcare system would not try to treat them for hepatitis out of a fear that they might get reinfected. I think those attitudes have changed over the past three years as we see how effective the treatment is, especially for hepatitis C. The downside is the treatment is pretty expensive, but knowing we can cure it has created an attitude shift. 

There’s also a lot of new research related to the cure now, including in the Florida Department of Health, which has made testing for and treating hepatitis C one of its top public health priorities for the coming year.

Q: Who is at risk of getting hepatitis? 

A risk factor for hepatitis A is going to another country and eating raw leafy vegetables without knowing what the hygiene is like there. We often encourage people to either get vaccinated or to not eat raw food that they haven’t washed themselves. For hepatitis B and C, healthcare workers are often at high risk because of the potential for a needle stick injury. We do a lot in hospital and healthcare settings to prevent needle sticks.  

People who inject drugs are at high risk for hepatitis C, which we don’t have a vaccine for. That’s why we try things like needle exchange programs, where people can bring in their used needles and exchange them for clean needles. People also often receive advice related to drug addiction when they use a needle exchange program as well, but the main goal is to prevent disease transmission.  

People who are unhoused or unsheltered and men who have sex with men are at increased risk for the types of hepatitis that can be transmitted sexually, especially hepatitis B. Certain sexual practices like oral-anal sex can also increase risk for hepatitis A, which affects the digestive system.

Q: Any closing thoughts? 

I’m excited to report that public health interventions are working. We’re seeing tremendous improvements over the last decade both in terms of vaccines and reduction in hepatitis B cases. Now, we also have a cure for hepatitis C. We just need to get people tested who have never been tested before, so we can cure them. 

It is recommended that everyone in the United States be tested for hepatitis C, at least once. Everybody should have their hepatitis B vaccine, and I would remind people to get a hepatitis A vaccine if they haven’t done it.

Written by: Jiayu Liang