Missionary
Medical
Moment
A brief summary of a current topic of medical interest to missionaries.
Topics are updated frequently; if you have a topic or question, let us know!
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MISSIONARY MEDICAL MOMENT
Hepatitis - (Part 1)
The word hepatitis basically means "inflammation of the liver". There are a number
of different causes of such inflammation, some of which are not related to where
a missionary lives or what type of environmental influences may be encountered.
There may be an uncommon medical condition known as an auto-immune disorder, which
can cause inflammation of the liver (auto-immune hepatitis). Another cause of
hepatitis is exposure to substances that can directly damage the liver (toxic hepatitis).
Such exposure can be accidental (accidental ingestion of certain mushrooms, a reaction
to some types of medication, coming into contact with certain chemical compounds), or
as a result of intentional exposure to substances known to have the potential of
directly damaging the liver. The most common of these substances is alcohol, and
the use of even small amounts of alcohol over time in the susceptible individual
can lead to alcoholic hepatitis.
The more likely threat of hepatitis to missionaries (as well as others who travel
extensively) comes from a third cause, that of infection of the liver with a virus.
There are five different types of virus which are known to cause viral hepatitis;
they are known by the letters A, B, C, D, and E. Of these, the first three are the
most clinically important, and hepatitis A and hepatitis B are the two forms that are
most likely to be encountered by missionaries on the field.
Hepatitis A is the most common and familiar form of "infectious hepatitis". It is
spread by contamination of food and water, and thus is much more common in underdeveloped
countries or areas where sewage management is primitive or where food cleanliness is
problematic. Symptoms usually begin with 2-4 weeks after exposure to a source of infection.
Nausea, vomiting, diarrhea, and a low-grade fever follow generalized tiredness and muscular
aching. Soon thereafter, dark urine may be noticed, and the skin can take on the yellowish
color known as jaundice (which is mild cases may be noticed only by a yellowish
discoloration of the whites of the eyes). These symptoms usually spontaneously subside
over several weeks, although rarely symptoms will persist for several months. Once the
infection has subsided, there is no "carrier state", where the individual might carry the
virus without further symptoms. Full recovery is almost always seen.
Hepatitis B infection is less common, and is not related to contaminated food or water.
Rather, infection with the hepatitis B virus is by direct contact with infected blood or
tissue; the most common means of transmission are by intravenous drug use, sexual contact,
and from infected mother to newborn child. Although screening of potential blood donors
for previous infection is common in the US and other developed countries, there is more
likelihood of contaminated blood being used in lesser-developed areas. Infection with
hepatitis B is often traced back to blood transfusion or needle contamination, even in
individuals whose lifestyles would not otherwise suggest risk for infection. Symptoms
are the same as for hepatitis A as noted above, but the clinical symptoms tend to be
more severe and longer lasting. In addition, there is a possibility that the individual
may continue to harbor the virus even though they notice no symptoms themselves, and
thus can spread the virus to others ("carrier state"). Finally, approximately 2% of
adults with hepatitis B infection will themselves continue to have a low-grade chronic
infection that persists even after the initial acute infection. Although there may be
few or no symptoms with such chronic infection, long term liver damage and even an
increased risk of liver cancer can result.
Hepatitis C is acquired almost exclusively by contact with contaminated blood products,
and more than 50% of cases are reported in intravenous drug users. Like Hepatitis B,
infection with hepatitis C can result in a carrier state, and there is greater than 80%
likelihood of chronic infection, which can lead to cirrhosis, liver failure, or cancer.
In Part Two, we
will discuss prevention of infection and immunization
recommendations for Hepatitis A and B
View Other Missionary Medical Moments
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