Hepatitis C - Complications

If left untreated, hepatitis C can sometimes cause scarring of the liver (cirrhosis). This can develop up to 20 years or more after you first become infected.

A number of things can increase your risk of getting cirrhosis, including:

    drinking alcohol
    having type 2 diabetes
    getting hepatitis C at an older age
    having HIV or another type of hepatitis, such as hepatitis B

Overall, up to one in every three people infected with hepatitis C will develop cirrhosis within 20 to 30 years. Some of these will then go on to develop liver failure or liver cancer.

Cirrhosis

If you have cirrhosis, the scarred tissue in your liver gradually replaces healthy tissue and prevents the liver from working properly.

There are usually few symptoms in the early stages. But as your liver loses its ability to function properly, you may experience:

    tiredness and weakness
    loss of appetite
    weight loss
    feeling sick
    very itchy skin
    tenderness or pain in your tummy
    tiny red lines (blood capillaries) on the skin
    yellowing of the skin and whites of the eyes (jaundice)

Other than a liver transplant, there's no cure for cirrhosis. However, lifestyle measures and hepatitis C medications can help stop the condition getting worse.

Liver failure

In severe cases of cirrhosis, the liver loses most or all of its functions. This is known as liver failure or end stage liver disease.

Each year, around 1 in every 20 people with hepatitis-associated cirrhosis will develop liver failure.

Symptoms of liver failure include:

    hair loss
    build-up of fluid in the legs, ankles and feet (oedema)
    build-up of fluid in your tummy (ascites)
    dark urine
    black, tarry stools or very pale stools
    frequent nosebleeds and bleeding gums
    a tendency to bruise easily
    vomiting blood

It's usually possible to live with liver failure for several years by taking medication. However, a liver transplant is currently the only way to cure the condition.

Liver cancer

It's estimated that around 1 in every 20 people with hepatitis-associated cirrhosis will develop liver cancer each year.

Symptoms of liver cancer can include:

    loss of appetite
    unexplained weight loss
    tiredness
    feeling and being sick
    pain or swelling in your tummy
    jaundice

Unfortunately, it's not usually possible to cure liver cancer, especially in people with cirrhosis, although treatment can help control your symptoms and slow the spread of the cancer.

tags: Hepatitis C - Complications, Hepatitis C, Complications, Liver cancer, Cirrhosis, Liver failure, If left untreated, hepatitis C can sometimes cause scarring of the liver (cirrhosis). This can develop up to 20 years or more after you first become infected.

Hepatitis C - Lifestyle FAQs

Below are answers to some questions about living with hepatitis C, including questions about diet, the workplace, travelling and having a baby.

Could anything I do make hepatitis C worse?

Drinking alcohol can increase the damage to your liver. If you have hepatitis C, you should try to cut out alcohol or limit your intake. If you need advice about this, ask your doctor or contact an alcohol self-help organisation.

If you're concerned that you're addicted to alcohol and are unable to stop drinking, contact your GP. Treatments are available to help you quit.

Is there anything else I can do to help myself?

As well as cutting out alcohol, it can help to:

    control your weight with a healthy diet and regular exercise
    stop smoking
    get vaccinated against hepatitis A and hepatitis B

This is because being overweight, smoking and having more than one type of hepatitis can increase the chances of your liver being damaged if you have hepatitis C.

Do I need a special diet?

You won't usually need to change to a special diet if you have hepatitis C, but you will need to make sure you have a generally healthy, balanced diet.

Your diet should include plenty of fruit and vegetables, starchy foods, fibre and protein. Cut down on fatty, fried and processed food.

If your liver is badly damaged, however, your doctor may suggest limiting your intake of salt and protein to avoid putting too much strain on your liver. A hospital dietitian can advise you on what you can and cannot eat.

How can I avoid spreading the infection to others?

You can reduce the risk of passing hepatitis C on to other people by:

    keeping personal items, such as toothbrushes or razors, for your own use
    cleaning and covering any cuts or grazes with a waterproof dressing
    cleaning any blood from surfaces with household bleach
    not sharing needles or syringes with others
    not donating blood 

The risk of spreading hepatitis C through sex is low. However, the risk is increased if there is blood present, such as menstrual blood or during anal sex.

Condoms aren't usually necessary for long-term heterosexual couples, but it's a good idea to use them when having anal sex or sex with a new partner.

Do I have to tell my boss?

You don't have to tell your boss that you have hepatitis C, unless you're a healthcare worker.

However, if hepatitis C is affecting your performance at work and your employer knows about your condition, they may be obliged to make allowances for you, such as giving you leave of absence for going to the clinic. You may also be entitled to statutory sick pay to cover doctor appointments or time off work.

Therefore, you may want to consider telling your boss about your condition.

Can I travel abroad?

You can travel abroad if you have hepatitis C, but you should speak to your doctor in advance.

You may need to have vaccinations and special arrangements may need to be made to ensure you're able to transport and store your hepatitis C medication safely.

It might also be a good idea to take any documentation, such as details of blood tests or medical records, in case you need medical treatment abroad.

Can I have a baby if my partner or I have hepatitis C?

You can have a baby if you or your partner has hepatitis C, but there's a small risk (around 1 in 20) of hepatitis C passing from mother to baby.

There's also a small risk of the infection spreading to the unaffected partner when having unprotected sex, but this is very unlikely to happen.

Speak to your doctor for advice if you're planning to have a baby and you or your partner has hepatitis C.

tags: Hepatitis C - Lifestyle FAQs, Hepatitis C, Lifestyle FAQs, Can I have a baby if my partner or I have hepatitis C?, How can I avoid spreading the infection to others?, Do I need a special diet?, Is there anything else I can do to help myself?,
Can I travel abroad?, Could anything I do make hepatitis C worse?,Do I have to tell my boss?,Below are answers to some questions about living with hepatitis C, including questions about diet, the workplace, travelling and having a baby.

Hepatitis C - Treatment

Hepatitis C can often be treated successfully by taking a combination of medicines for several months.

If the infection is diagnosed in the early stages, known as acute hepatitis, treatment may not need to begin straight away. Instead, you may have another blood test after a few months to see if your body fights off the virus.

If the infection continues for several months, known as chronic hepatitis, treatment will usually be recommended.

Your treatment plan

Treatment for hepatitis C involves:

    making lifestyle changes to help prevent further damage to your liver and reduce the risk of spreading the infection
    taking a combination of two or three medications to fight the virus – this is known as combination therapy

You'll normally need to take medication for 12 to 48 weeks. This length of time will depend on the exact medicines you're taking and which version (strain) of the hepatitis C virus you have. Your doctor will advise you about this.

There are six main strains of the virus. In the UK, the most common strains are known as "genotype 1" and "genotype 3".

During treatment, you should have blood tests to check if your medication is working. If the test shows treatment is having little effect, it may be stopped as further treatment may be of little use.

Lifestyle measures

There are some things you can do to help limit any damage to your liver and prevent the infection spreading to others. These can include:

    eating a healthy and balanced diet
    exercising regularly
    cutting out alcohol or limiting your intake
    stopping smoking
    keeping personal items, such as toothbrushes or razors, for your own use
    not sharing any needles or syringes with others 

Hepatitis C medications

Currently, treatment for chronic hepatitis C usually involves taking two main medicines:

    pegylated interferon – a medication that encourages the immune system to attack the virus
    ribavirin – an antiviral medication that stops the virus reproducing

These medications may just be taken together, although they're often combined with a third medication, such as simeprevir or sofosbuvir.

These are newer hepatitis C medications that have been shown to make treatment more effective. Read more about all these medications below.

Pegylated interferon and ribavirin

Pegylated interferon is usually taken as a weekly injection. You can be trained to inject yourself at home. It usually needs to be taken for up to 48 weeks, depending on your circumstances.

Ribavirin is available as capsules, tablets or an oral solution. It's normally taken twice a day with food. It needs to be taken alongside pegylated interferon for up to 48 weeks.

Simeprevir and sofosbuvir

Simeprevir and sofosbuvir are two of the newest hepatitis C medications recommended by NICE in 2015. They also work by stopping the hepatitis C virus from reproducing.

Simeprevir may be recommended if you have genotype 1 or genotype 4 hepatitis C. Sofosbuvir is usually given to people with genotype 1 hepatitis C, although it can be used to treat the other genotypes in some cases.

Both medications come as a tablet that's taken with food once a day. They're usually taken for either 12, 24 or 48 weeks, depending on your circumstances.

Other medications

A number of other medications are also available to treat hepatitis C – such as daclatasvir, ombitasvir and paritaprevir – although these haven't yet been recommended by NICE.

How effective is treatment?

The effectiveness of treatment for hepatitis C can depend on the strain of the virus you have.

Genotype 1 used to be more challenging to treat and, until quite recently, less than half of people treated would be cured.

However, with the newer medications now available, the chances of a cure can be much higher. Combinations of tablets can now have a cure rate of more than 90%.

This is higher than the chances of curing most other hepatitis C genotypes.

Treatment for genotype 3 will usually involve the standard treatments of pegylated interferon and ribavirin. About 70-80% of those treated will be cured.

If the virus is successfully cleared with treatment, it's important to be aware that you're not immune to the infection. This means, for example, that you could become infected again if you continue to inject drugs after treatment.

If treatment doesn't work, it may be repeated, extended or tried using a different combination of medicines.

Side effects of treatment

Side effects of combination therapy involving interferon are quite common. The new tablet treatments have far fewer side effects and most people feel unaffected by them.

If your treatment involves interferon, side effects can include:

    flu-like symptoms, such as a headache, fatigue (extreme tiredness) and a high temperature (fever)
    a reduced number of red blood cells (anaemia), which can make you feel tired and out of breath
    a rash
    depression
    itchy skin
    feeling and being sick
    constipation or diarrhoea
    problems sleeping (insomnia)
    loss of appetite and weight loss

Hepatitis C medications can have unpredictable reactions when taken with other medicines or remedies. Always check with your specialist, GP or pharmacist before taking other types of medication.

Any side effects may improve with time as your body gets used to the medications. Tell your care team if any side effect is becoming particularly troublesome.

Coping with side effects can be challenging, but you should continue to take your medication as instructed. Missing doses may reduce the chances of you being cured.

Treatment during pregnancy

The medications used to treat hepatitis C, particularly ribavirin, can be harmful to unborn babies and aren't normally used during pregnancy.

If you're pregnant when diagnosed with the infection, treatment will usually be delayed until you have given birth. Otherwise, you'll be advised to use contraception throughout your treatment and you may need to have regular pregnancy tests.

If you're a man taking ribavirin, you shouldn't have sex with a pregnant women unless you use a condom. If your partner isn't pregnant, you should ensure contraception is used during the course of your treatment and your partner may need to have regular pregnancy tests.

Deciding against treatment

Some people with chronic hepatitis C decide against treatment. This may be because they:

    don't have any symptoms
    are willing to live with the risk of cirrhosis at a later date
    don't feel the potential benefits of treatment outweigh the side effects treatment can cause

Your care team can give you advice about this, but the final decision about treatment will be yours.

If you decide not to have treatment but then change your mind, you can ask to be treated at any point.

tags: Deciding against treatment, Treatment during pregnancy, Side effects of treatment, How effective is treatment?, Other medications, Simeprevir and sofosbuvir, Your treatment plan, Lifestyle measures, Hepatitis C medications, Pegylated interferon and ribavirin, Hepatitis C can often be treated successfully by taking a combination of medicines for several months.

Hepatitis C - Diagnosis

If you think you may have been exposed to hepatitis C, taking a test will put your mind at rest or, if the test is positive, allow you to start treatment early.

GP surgeries, sexual health clinics, GUM (genitourinary medicine) clinics or drug treatment services all offer testing for hepatitis C.

Who should get tested?

You should consider getting tested for hepatitis C if you're worried you could have been infected or you fall into one of the groups at an increased risk of being infected.

Hepatitis C often has no symptoms, so you may still be infected if you feel healthy.

The following groups of people are at an increased risk of hepatitis C:

    ex-drug users and current drug users, particularly users of injected drugs
    people who received blood transfusions before September 1991
    recipients of organ or tissue transplants before 1992
    people who have lived or had medical treatment in an area where hepatitis C is common – high risk areas include North Africa, the Middle East and Central and East Asia
    babies and children whose mothers have hepatitis C
    anyone accidentally exposed to the virus, such as health workers
    people who have received a tattoo or piercing where equipment may not have been properly sterilised
    sexual partners of people with hepatitis C

If you continue to engage in high-risk activities, such as injecting drugs frequently, regular testing may be recommended. Your doctor will be able to advise you about this.

Testing for hepatitis C

Hepatitis C is diagnosed using two blood tests: the antibody test and the PCR test. The results usually come back within two weeks.

The antibody test

The antibody blood test determines whether you have ever been exposed to the hepatitis C virus by testing for the presence of antibodies to the virus. Antibodies are produced by your immune system to fight germs.

The test will not show a positive reaction for some months after infection because your body takes time to make these antibodies.

If the test is negative, but you have symptoms or you may have been exposed to hepatitis C, you may be advised to have the test again.

A positive test indicates that you have been infected at some stage. It doesn't necessarily mean you are currently infected, as you may have since cleared the virus from your body.

The only way to tell if you are currently infected is to have a second blood test, called a PCR test.

The PCR test

The PCR blood test checks if the virus is still present by detecting whether it is reproducing inside your body.

A positive test means that your body has not fought off the virus, and the infection has progressed to a chronic (long-term) stage.

Further tests

If you have an active hepatitis C infection, you will be referred to a specialist for further tests to check if your liver has been damaged.

The tests you may have include:

    blood tests – these measure certain enzymes and proteins in your bloodstream that indicate whether your liver is damaged or inflamed
    ultrasound scans – where sound waves are used to test how stiff your liver is (stiffness suggests the liver is scarred)

The specialist can also talk to you about any treatment you may need. 

tags: Further tests, The PCR test, Testing for hepatitis C, The antibody test, Who should get tested?, If you think you may have been exposed to hepatitis C, taking a test will put your mind at rest or, if the test is positive, allow you to start treatment early.

Hepatitis C - Causes

You can become infected with hepatitis C if you come into contact with the blood of an infected person.

Other bodily fluids can also contain the virus, but blood contains the highest level of it. Just a small trace of blood can cause an infection. At room temperature, it's thought the virus may be able survive outside the body in patches of dried blood on surfaces for up to several weeks.

The main ways you can become infected with the hepatitis C virus are described below.

Injecting drugs

People who inject drugs, including illegal recreational drugs and performance-enhancing drugs such as anabolic steroids, are at the highest risk of becoming infected with hepatitis C.

Almost 90% of hepatitis C cases in the UK occur in people who inject drugs or have injected them in the past. It's estimated that around half of the people in the UK who inject drugs have the infection.

The infection can be spread by sharing needles and associated equipment. Injecting yourself with just one contaminated needle may be enough to become infected.

It's also possible to get the infection by sharing other equipment used to prepare or take drugs – such as spoons, filters, pipes and straws – that have been contaminated with infected blood.
Less common causes

Unprotected sex

Hepatitis C may be transmitted during unprotected sex (sex without using a condom), although this risk is considered very low.

The risk of transmission through sex may be higher among men who have sex with men. The risk is also increased if there are genital sores or ulcers from a sexually transmitted infection, or if either person also has HIV.

The best way to prevent transmission of hepatitis C through sex is to use a male condom or female condom. However, as the risk is very low for couples in a long-term relationship, many choose not to use a condom.

If your partner has hepatitis C, you should be tested for the condition.

Blood donations before September 1991

Since September 1991, all blood donated in the UK is checked for the hepatitis C virus. If you received blood transfusions or blood products before this date, there's a small possibility you may have been infected with hepatitis C.

Blood transfusions and treatment abroad

If you have a blood transfusion or medical or dental treatment overseas where medical equipment is not sterilised properly, you may become infected with hepatitis C. The virus can survive in traces of blood left on equipment.

Sharing toothbrushes, scissors and razors

There's a potential risk that hepatitis C may be passed on through sharing items such as toothbrushes, razors and scissors, as they can become contaminated with infected blood.

Equipment used by hairdressers, such as scissors and clippers, can pose a risk if it has been contaminated with infected blood and not been sterilised or cleaned between customers. However, most salons operate to high standards, so this risk is low.

Tattooing and body piercing

There is a risk that hepatitis C may be passed on through using tattooing or body piercing equipment that has not been properly sterilised. However, most tattoo and body piercing parlours in the UK operate to high standards and are regulated by law, so this risk is low.

Mother to child

There is a small chance that a mother who is infected with the hepatitis C virus will pass the infection on to her baby. This happens in around 5% of cases.

It's not thought that the virus can be passed on by a mother to her baby in her breast milk.

Needlestick injury

There's a small (approximately one in 30) risk of getting hepatitis C if your skin is accidentally punctured by a needle used by someone with hepatitis C.

Healthcare workers, nurses and laboratory technicians are at increased risk because they are in regular close contact with blood and bodily fluids that may contain blood.

Hepatitis C myths

The hepatitis C virus isn't spread through social contact, such as hugging, kissing and sharing kitchen utensils.

It can't be passed on through toilet seats.

tags: Hepatitis C myths, Needlestick injury, Mother to child, Tattooing and body piercing, Sharing toothbrushes, scissors and razors, Blood transfusions and treatment abroad, Blood transfusions and treatment abroad, Unprotected sex, Injecting drugs, You can become infected with hepatitis C if you come into contact with the blood of an infected person.

Hepatitis C - Symptoms

Many people with hepatitis C don't have any symptoms and are unaware they have the infection. They may develop symptoms later on as their liver becomes increasingly damaged.

Early symptoms

Only around one in every three or four people will have any symptoms during the first six months of a hepatitis C infection. This stage is known as acute hepatitis C.

If symptoms do develop, they usually occur a few weeks after infection. Symptoms may include:

    a high temperature of 38C (100.4F) or above
    tiredness
    loss of appetite
    abdominal (tummy) pains
    feeling and being sick

Around one in every five people who experiences symptoms will also have yellowing of the eyes and skin. This is known as jaundice.

In around one in every four people infected with hepatitis C, the immune system will kill the virus within a few months and the person will have no further symptoms, unless they become infected again.

In the remaining cases, the virus persists inside the body for many years. This is known as chronic hepatitis.

Later symptoms

The symptoms of long-term (chronic) hepatitis C can vary widely. In some people, symptoms may be barely noticeable. In others, they can have a significant impact on quality of life.

The symptoms can also go away for long periods of time and then return.

Some of the most common problems experienced by people with chronic hepatitis C include:

    feeling tired all the time
    joint and muscle aches and pain
    feeling sick
    problems with short-term memory, concentration and completing complex mental tasks such as mental arithmetic – many people describe this as "brain fog"
    mood swings
    depression or anxiety
    indigestion or bloating
    itchy skin
    abdominal pain

If left untreated, the infection can eventually cause the liver to become scarred (cirrhosis). Signs of cirrhosis can include jaundice, vomiting blood, dark stools and a build-up of fluid in the legs or abdomen.

When to seek medical advice

See your GP if you persistently have any of the later symptoms above, or if they keep returning. They may recommend having a blood test that can check for hepatitis C.

None of the symptoms above mean you definitely have hepatitis C, but it's important to get them checked out.

You should also speak to your GP about getting tested if there's a risk you're infected, even if you don't have any symptoms. This particularly includes people who inject drugs or have done so in the past. 

tags: Early symptoms, When to seek medical advice, Later symptoms, Many people with hepatitis C don't have any symptoms and are unaware they have the infection. They may develop symptoms later on as their liver becomes increasingly damaged.

Hepatitis C

 Hepatitis C is a virus that can infect the liver. If left untreated, it can sometimes cause serious and potentially life-threatening damage to the liver over many years.

However, with modern treatments it's often possible to cure the infection and most people with it will have a normal life expectancy.

It's estimated that around 215,000 people in the UK have hepatitis C.

You can become infected with it if you come into contact with the blood of an infected person.

Symptoms of hepatitis C

Hepatitis C often doesn't have any noticeable symptoms until the liver has been significantly damaged. This means many people have the infection without realising it.

When symptoms do occur, they can be mistaken for another condition. Symptoms can include:

    flu-like symptoms, such as muscle aches and a high temperature (fever)
    feeling tired all the time
    loss of appetite
    abdominal (tummy) pain
    feeling and being sick

The only way to know for certain if these symptoms are caused by hepatitis C is to get tested (see below).

Read more about the symptoms of hepatitis C.

How do you get hepatitis C?

The hepatitis C virus is usually spread through blood-to-blood contact.

Some ways the infection can be spread include:

    sharing unsterilised needles – particularly needles used to inject recreational drugs
    sharing razors or toothbrushes
    from a pregnant woman to her unborn baby
    through unprotected sex – although this is very rare

In the UK, most hepatitis C infections occur in people who inject drugs or have injected them in the past. It's estimated that around half of those who inject drugs have the infection.

Read more about the causes of hepatitis C.

Getting tested for hepatitis C

Seek medical advice if you have persistent symptoms of hepatitis C, or there's a risk you're infected, even if you don't have any symptoms. A blood test can be carried out to see if you have the infection.

Your GP, sexual health clinic, GUM (genitourinary medicine) clinic or drug treatment service all offer testing for hepatitis C.

Early diagnosis and treatment can help prevent or limit any damage to your liver and help ensure the infection isn't passed on to other people.

Read more about testing for hepatitis C.

Treatments for hepatitis C

Hepatitis C can be treated with a combination of medicines that stop the virus multiplying inside the body. These usually need to be taken for several months.

Most people will take two main medications called pegylated interferon (a weekly injection) and ribavirin (a capsule or tablet), although newer tablet-only treatments are likely to replace the interferon injections for most people in the near future.

These newer hepatitis C medications have been found to make treatment more effective. They include simeprevir, sofosbuvir and daclatasvir.

Using the latest medications, up to 90% or more of people with hepatitis C may be cured. However, it's important to be aware that you won't be immune to the infection and should take steps to reduce your risk of becoming infected again (see below).

Read more about treating hepatitis C and living with hepatitis C.

Complications of hepatitis C

If the infection is left untreated for many years, some people with hepatitis C will develop scarring of the liver (cirrhosis). Over time, this can cause the liver to stop working properly.

In severe cases, life-threatening problems such as liver failure (where the liver loses most or all of its functions) or liver cancer can eventually develop.

Treating hepatitis C as early as possible can help reduce the risk of these problems occurring.

Read more about the complications of hepatitis C.

Preventing hepatitis C

There's no vaccine for hepatitis C, but there are ways to reduce your risk of becoming infected, such as:

    not sharing any drug-injecting equipment with other people – including needles and other equipment such as syringes, spoons and filters
    not sharing razors or toothbrushes that might be contaminated with blood

The risk of getting hepatitis C through sex is very low. However, it may be higher if blood is present, such as menstrual blood or from minor bleeding during anal sex.

Condoms aren't usually necessary to prevent hepatitis C for long-term heterosexual couples, but it's a good idea to use them when having anal sex or sex with a new partner.

tags: Preventing hepatitis C, Complications of hepatitis C, Treatments for hepatitis C, Getting tested for hepatitis C, How do you get hepatitis C?, Symptoms of hepatitis C, Hepatitis C is a virus that can infect the liver. If left untreated, it can sometimes cause serious and potentially life-threatening damage to the liver over many years.

Hepatitis B vaccine

Who should be vaccinated against hepatitis B?

You can get infected with hepatitis B if you have contact with an infected person's blood or other body fluids. People at risk of hepatitis B and who should therefore consider vaccination are:

    people who inject drugs or have a partner who injects drugs
    people who change their sexual partners frequently
    men who have sex with men
    babies born to infected mothers
    close family and sexual partners of someone with hepatitis B
    anyone who receives regular blood transfusions or blood products
    people with any form of liver disease
    people with chronic kidney disease
    people travelling to high-risk countries
    male and female sex workers
    people who work somewhere that places them at risk of contact with blood or body fluids, such as nurses, prison staff, doctors, dentists and laboratory staff
    prisoners
    families adopting/fostering children from high-risk countries

How to get vaccinated against hepatitis B

Ask your GP to vaccinate you, or visit any sexual health or GUM (genitourinary medicine) clinic for the hepatitis B vaccination.

Find a local genitourinary medicine clinic.

If your job places you at risk of hepatitis B infection it is your employer's responsibility to arrange vaccination for you rather than your GP. Contact your occupational health department.

What does hepatitis B immunisation involve?

For full protection, you will need three injections of hepatitis B vaccine over four to six months.

If you are a healthcare worker or you have kidney failure you will be followed up to see if you have responded to the vaccine. Anyone vaccinated by their own occupational health service can also request a blood test to see if they have responded to the vaccine.

Five year boosters are recommended for anyone thought to be at continuing risk of infection.

How safe is the hepatitis B vaccine?

The hepatitis B vaccine is very safe and other than some redness and soreness at the site of the injection, side effects from it are rare.

Emergency hepatitis B vaccination

If you've been exposed to the hepatitis B virus and have not been vaccinated before, you should seek medical advice immediately as you may benefit from the hepatitis B vaccine.

In some situations, you may also need to have an injection of antibodies called specific hepatitis B immunoglobulin (HBIG) along with the hepatitis B vaccine.

HBIG should ideally be given within 48 hours, but you can still have it up to a week after exposure.

Hepatitis B vaccination in pregnancy

Hepatitis B infection in pregnant women may result in severe disease for the mother and chronic infection for the baby so it's advised that hepatitis B vaccination should not be withheld from a pregnant women if she is in a high-risk category.

There is no evidence of any risk from vaccinating pregnant or breastfeeding women against hepatitis B. And since it's an inactivated (killed) vaccine, the risks to the unborn baby are likely to be negligible.

Babies and hepatitis B vaccination

Babies born to mothers infected with hepatitis B need to be given a dose of the hepatitis B vaccine after they are born. This should be given within 24 hours of birth and followed by a further dose of the vaccine at one, two and twelve months after birth.

Some mothers infected with hepatitis B are considered especially high-risk because they are highly infectious. Babies born to these high-risk mothers should also receive an injection of HBIG at birth (in addition to hepatitis B vaccination) to give them rapid protection against infection.

All babies born to mothers infected with hepatitis B should be tested at 12 months of age to check if they have become infected with hepatitis B.

tags: Hepatitis B vaccine, Hepatitis B, vaccine, Babies and hepatitis B vaccination, How safe is the hepatitis B vaccine?, What does hepatitis B immunisation involve?, How to get vaccinated against hepatitis B, Hepatitis B vaccination in pregnancy.

Hepatitis B - Treatment

If you are diagnosed with hepatitis B, it is likely that your GP will refer to you a specialist, usually a hepatologist (a liver specialist).

Most people tend to be free of symptoms and recover completely within a couple of months, never going on to develop chronic hepatitis.

There is usually no specific treatment for acute (short-term) hepatitis B. Unless your symptoms are particularly severe, you should be able to manage them at home.

You can take over-the-counter painkillers such as paracetamol and may be prescribed codeine if the pain is more severe. Nausea (feeling sick) can often be controlled with a medication called metoclopramide.

If you are diagnosed as having a hepatitis B infection, you will be advised to have regular blood tests and physical check-ups.

Once your symptoms get better, you will need further testing to check that you are free of the virus and have not developed chronic hepatitis B.

Treating chronic hepatitis B

If you have chronic hepatitis B, you will be symptom-free for much of the time. However, you may need to take medication to prevent liver damage, possibly for many years.

There are now very effective medications that can suppress the virus over many years. These can slow down the damage being done to the liver, allowing the body to repair itself. However, it is unusual for this treatment to clear the virus permanently.

You may also need regular tests to assess the state of your liver. This might include blood tests, an ultrasound or a FibroScan, which measures liver stiffness, and possibly a liver biopsy. This is to assess whether the virus is currently damaging the liver and how much damage has been done.

The medication used to treat chronic hepatitis B will depend on whether there is evidence of ongoing liver damage. In some patients, their immune system suppresses the virus without causing damage.

If your liver is shown to be working fairly well, the first treatment offered will be a drug called peginterferon alfa 2-a.

Depending on the results of monitoring tests, you may need to take different medication at a later date. If your liver is showing signs of failing, or peginterferon alpha-2a is not suitable or not working for you, your doctor is likely to offer antiviral medication. This is usually tenofovir or entecavir.

In some cases, treatment works well and it is possible for your immune system to regain control over hepatitis B. In this case your doctor may advise you to stop taking medication altogether.

It is very important that you take your treatment as prescribed, even if you feel well or are finding side effects troublesome, as stopping treatment early can lead to drug resistance and could also lead to liver damage. Always speak to your doctor before you come off these drugs.

Peginterferon alfa-2a

Peginterferon alfa-2a can be used in the treatment of hepatitis B where there are very high levels of the virus. It stimulates the immune system (the body's defence against infection) to attack the hepatitis B virus and regain control over it.

The medication is usually given by injection once a week over 12 months. Your doctor will be able to tell whether the treatment is likely to work for you during tests at three and six months. They may suggest an alternative antiviral if the treatment is not working.

It's common to experience flu-like symptoms such as a high temperature and muscle and joint pain after beginning to take peginterferon alfa-2a. Taking paracetamol can often help relieve these side effects and they should get better with time.

However, in some people peginterferon alfa-2a can cause a wide range of persistent and unpleasant side effects. This may mean that treatment needs to be withdrawn and an alternative antiviral will need to be used.

If you start to feel any uncomfortable side effects, discuss this with your doctor or nurse.

Tenofovir

Tenofovir is available in tablet form and should usually be taken with food.

Side effects of tenofovir include:

    diarrhoea
    feeling sick
    being sick
    skin rash
    feeling weak
    dizziness
    in rare cases, kidney problems

Entecavir

Entecavir is available as a tablet.

Side effects of entecavir include:

    being sick
    feeling sick
    insomnia
    dizziness

If you feel dizzy, avoid driving or using tools or machinery.

Lactic acidosis

A rare but serious side effect that can occur with tenofovir and entecavir is that the medication can cause a build-up of lactic acid in your blood. This is known as lactic acidosis and is potentially serious if left untreated.

Initial warning signs and symptoms of lactic acidosis include:

    feeling very weak or tired
    having unusual muscle pain
    breathing difficulties
    having stomach pain, along with feeling or being sick
    feeling unusually cold, especially in your arms and legs
    feeling dizzy or lightheaded
    having a fast or irregular heartbeat

If you experience any of these warning signs and symptoms, contact the doctor in charge of your care for advice.

Preventing the spread of hepatitis B

While the medications mentioned above can slow the spread of chronic hepatitis B and hopefully prevent complications such as cirrhosis, they cannot cure the infection. This means you can still pass hepatitis B on to other people.

You should avoid having unprotected sex with someone, including anal and oral sex, unless you are sure they are immunised against hepatitis B.

If you are an injecting drug user, never share your needles or other injecting or preparation equipment with other drug users.

You should also take some sensible precautions to avoid the spread of infection, such not sharing toothbrushes or razors with other people.

Hepatitis B and pregnancy

It is unclear whether many of the medications discussed on this page are safe to take during pregnancy.

Ideally, if you are trying to have a baby, discuss your plans with your doctor first, as it may be necessary to switch medication.

Tell your doctor as soon as possible if you think you may be pregnant.

Liver transplant

For some people with severe liver disease or complications such as cirrhosis, having a liver transplant may be an option.

However, you will need treatment to prevent infection of the new liver

tags: Liver transplant, Hepatitis B and pregnancy, Preventing the spread of hepatitis B, Lactic acidosis, Entecavir, Tenofovir, Peginterferon alfa-2a, Treating chronic hepatitis B, If you are diagnosed with hepatitis B, it is likely that your GP will refer to you a specialist, usually a hepatologist (a liver specialist).

Hepatitis B - Complications

Without treatment, about a third of people with chronic hepatitis B infection go on to develop a disease of the liver, which can be very serious.

It is estimated that 15-25% of people with untreated chronic hepatitis B die of liver disease.

Cirrhosis

Scarring of the liver (cirrhosis) affects around one in five people with chronic hepatitis B, often many years after they first contracted the infection.

Cirrhosis doesn't usually cause any noticeable symptoms until extensive damage to the liver has occurred. It can then trigger symptoms such as:

    tiredness and weakness
    loss of appetite
    weight loss
    feeling sick
    very itchy skin
    tenderness or pain around the liver
    swelling of the abdomen
    swelling of the ankles

If you do develop cirrhosis, it is important to prevent it getting worse by avoiding drinking any alcohol, which has a damaging effect on the liver.

There are range of treatments that can sometimes relieve some of the symptoms of cirrhosis. Antiviral medication may help prevent further damage. However, for some people the only option is a liver transplant.

Liver cancer

Around 1 in 10 people with cirrhosis caused by chronic hepatitis B will go on to develop liver cancer.

Symptoms of liver cancer include:

    unexplained weight loss
    being sick
    feeling sick
    jaundice

Fulminant hepatitis B

An uncommon and serious complication of acute hepatitis B is known as fulminant hepatitis B, where the immune system attacks the liver and causes extensive damage to it.

Fulminant hepatitis B occurs in around 1 in 100 adults with chronic hepatitis B, but is much rarer in children.

It can lead to symptoms such as:

    mental confusion
    swelling of the abdomen caused by a build-up of fluid
    jaundice

This complication is a medical emergency and 7 out of 10 people will die from it.

tags: Hepatitis B - Complications, Hepatitis B, Complications, Fulminant hepatitis B, Cirrhosis, Liver cancer, Without treatment, about a third of people with chronic hepatitis B infection go on to develop a disease of the liver, which can be very serious.

Hepatitis B - Causes

You can become infected with hepatitis B if you are not immune (resistant) to the virus and you come into contact with the blood or body fluids of an infected person.

Many people with hepatitis B do not know they are infected.

The risk of hepatitis B for tourists is considered to be low. However, this risk will increase with certain activities, such as unprotected sex or receiving medical or dental treatment in a developing country.

Travellers are advised to get vaccinated against hepatitis B before visiting any country where this is a problem.

Exposure to infected blood

You are at risk of catching hepatitis B if you:

    inject drugs and share needles and other equipment, such as spoons and filters, or you are having a sexual relationship with someone who injects drugs
    have an open wound, cut or scratch and come into contact with the blood of someone with hepatitis B
    have medical or dental treatment in a country where equipment is not sterilised properly
    work closely with blood – for example, healthcare workers and laboratory technicians are at increased risk of injury when the skin is accidentally punctured by a used needle
    have a blood transfusion in a country where blood is not tested for hepatitis B
    have a tattoo or body piercing in an unsafe, unlicensed place – read more about the risks of body piercing
    share toothbrushes, razors and towels that are contaminated with infected blood

All blood donations in the UK are tested for hepatitis B.

Exposure to infected body fluids

You are at risk of catching hepatitis B if you have sex with an infected person without using a condom.

Generally, your risk increases if you are sexually active and have unprotected sex with several different partners. This includes unprotected anal and oral sex.

Commercial sex workers (both women and men) also have an increased risk of contracting hepatitis B.

Geographical risks

You also have an increased risk if you or your sexual partner grew up, lived or worked in a part of the world where hepatitis B is relatively common.

Hepatitis B is most common in:

    sub-Saharan Africa
    east and southeast Asia
    the Middle East
    southern and eastern Europe

Hepatitis B and pregnancy

Mothers with hepatitis B can pass the virus to their babies during pregnancy or when giving birth.

All pregnant women in the UK are therefore offered a blood test to check if they have hepatitis B. If they are infected, the baby is vaccinated immediately after birth to help prevent infection developing.

A mother with hepatitis B can breastfeed her baby if the baby receives a vaccine course starting at birth.

tags: Hepatitis B - Causes, Hepatitis B, Causes, Geographical risks, Exposure to infected body fluids, Exposure to infected blood, Hepatitis B and pregnancy, You can become infected with hepatitis B if you are not immune (resistant) to the virus and you come into contact with the blood or body fluids of an infected person.

Hepatitis B - Symptoms

Most people remain healthy without any symptoms while they fight off the virus. Some will not even know they have been infected.

However, until the virus has been cleared from their body, they can pass it on to others.

If there are any symptoms, these will develop on average 40 to 160 days after exposure to the virus and will usually pass within one to three months.

Symptoms of hepatitis B include:

    flu-like symptoms, such as tiredness, general aches and pains, headaches and a high temperature of 38ºC (100.4ºF) or above
    loss of appetite and weight loss
    feeling sick
    being sick
    diarrhoea

Some people may experience more severe symptoms, including abdominal pain and yellowing of the skin and eyes (jaundice).

Jaundice happens because your damaged liver is unable to remove bilirubin, a yellow substance in the blood that is a by-product of red blood cells. Bilirubin may also turn your urine very dark, and you may have pale stools (faeces).

Chronic hepatitis B

Hepatitis B is said to be chronic when you have been infected for longer than six months.

The symptoms are usually much milder and tend to come and go. In many cases, people with chronic hepatitis B infection will not experience any noticeable symptoms.

However, without treatment, chronic hepatitis B can lead to more serious conditions such as liver disease (inflammation) or cirrhosis (scarring of the liver) in a small number of people.

When to seek medical advice

Always make an appointment to see your GP if you have unusual symptoms that persist for more than a few days. Ask your GP for a hepatitis B test if you think you may have been exposed to hepatitis B in the past.

When to seek immediate medical advice

If you suspect that you have been recently exposed to the hepatitis B virus, seek immediate medical advice.

It is possible to prevent infection with treatment, but to be most effective it should be given in the first 48 hours after exposure (although it can sometimes be effective up to a week after exposure).

Phone your GP as soon as possible. If this is not possible, telephone NHS 111 or your local out-of-hours service for advice.

tags: Hepatitis B - Symptoms, Hepatitis B, Symptoms, When to seek immediate medical advice, When to seek medical advice, Chronic hepatitis B, Most people remain healthy without any symptoms while they fight off the virus. Some will not even know they have been infected.

Hepatitis B

 Hepatitis B is a type of virus that can infect the liver.

Symptoms can include:

    feeling sick
    being sick
    lack of appetite
    flu-like symptoms, such as tiredness, general aches and pains, and headaches
    yellowing of the skin and eyes (jaundice)

However, many people don't realise they have been infected with the virus because the symptoms may not develop immediately, or even at all.

It takes between 40 and 160 days for any symptoms to develop after exposure to the virus.

Read more about the symptoms of hepatitis B.

How does hepatitis B spread?

Hepatitis B can be spread through blood and body fluids such as semen and vaginal fluids, so it can be caught:

    during unprotected sex, including anal and oral sex
    by sharing needles to inject drugs such as heroin

Hepatitis B in pregnancy

A mother can also pass on the hepatitis B infection to her newborn baby, but the infection can be prevented if the baby is vaccinated immediately after birth.

In England, people who are most at risk of contracting hepatitis B include:

    people who inject drugs
    people who change sexual partners frequently

Read more about the causes and risk factors for the hepatitis B infection.

How is it diagnosed?

Hepatitis B is diagnosed by a blood test that shows a positive reaction to hepatitis B surface antigen (the outer surface of the hepatitis B virus that triggers a response from your immune system).

A positive result means your liver is releasing hepatitis B protein into your blood, which suggests chronic infection.

Your GP may also request a liver function test. This is a blood test that measures certain enzymes and proteins in your bloodstream, which indicates whether your liver is damaged. It will often show raised levels if you are infected with the hepatitis B virus.

Stages of infection

In most cases, the hepatitis B virus will only stay in the body for around one to three months. This is known as acute hepatitis B.

In around 1 in 20 cases in adults, the virus will stay for six months or longer, usually without causing any noticeable symptoms. This is known as chronic hepatitis B.

Chronic hepatitis B is particularly common in babies and young children: 9 in 10 children infected at birth and around 1 in 5 children infected in early childhood will develop a long-term infection.

People with chronic hepatitis B can still pass the virus on to other people, even if it is not causing any symptoms.

Around 20% of people with chronic hepatitis B will go on to develop scarring of the liver (cirrhosis), which can take 10 to 20 years to develop, and around 1 in 10 people with cirrhosis will develop liver cancer.

Read more about complications of hepatitis B.

How is it treated?

There is currently no specific treatment for acute hepatitis B, other than using painkillers to relieve symptoms.

Treatment for chronic hepatitis B depends on how badly your liver is affected. It can be treated using medications designed to slow the production of the virus and prevent damage to the liver.

Read more about the treatment of hepatitis B.

Can it be prevented?

There is a vaccine thought to be 95% effective in preventing hepatitis B. Because of the relative rarity of hepatitis B in England, the vaccine is not given as part of the routine childhood vaccination schedule.

Vaccination would usually only be recommended for people in high-risk groups, such as:

    people who inject drugs or have a sexual partner who injects drugs
    people who change their sexual partner frequently
    people travelling to or from a part of the world where hepatitis B is widespread
    healthcare workers who may have come into contact with the virus

Pregnant women are offered screening for hepatitis B. If they are infected, their baby can be vaccinated shortly after birth to prevent them also becoming infected.

Read more about hepatitis B vaccination.

Who is affected?

Hepatitis B is uncommon in England and cases are largely confined to certain groups, such as drug users, men who have sex with men, and certain ethnic communities (for example, South Asian, African and Chinese). There were 5,478 newly reported cases in England during 2011.

In contrast, hepatitis B is common in other parts of the world, particularly east Asia and sub-Saharan Africa. The World Health Organization estimates that hepatitis B is responsible for 600,000 deaths a year worldwide.

Outlook

The vast majority of people infected with hepatitis B are able to fight off the virus and fully recover from the infection within a couple of months.

Most people with chronic hepatitis B have very little liver damage. A small minority of people go on to develop cirrhosis of the liver and, in some cases, liver cancer.

It's therefore important to get yourself vaccinated if you fall into one of the high-risk groups for catching hepatitis B.

The liver

Your liver is your body's "factory", carrying out hundreds of jobs that are vital for life, including:

    storing glycogen (carbohydrate that produces short-term energy)
    making bile, which helps to digest fats
    making substances that clot the blood
    processing and removing any alcohol, toxins and drugs

You only have one liver, but it's very tough. It keeps going even when badly damaged, and it can keep repairing itself until it is severely damaged.
 

tags: Hepatitis B, Hepatitis, The liver, Who is affected?, How does hepatitis B spread?, Hepatitis B in pregnancy, Can it be prevented?, How is it treated?, Stages of infection, Outlook, Hepatitis B is a type of virus that can infect the liver.

Hepatitis A - Complications

Complications of hepatitis A can include the infection returning (relapse), cholestasis, or, in rare cases, liver failure.

Relapse

Around 15% of people with hepatitis A experience a relapse, where the infection returns with the same symptoms.

A relapse usually occurs around one to four months after the original illness, and this can happen more than once.

Cholestasis

A complication that can affect older adults with hepatitis A is bile building up inside the liver. Bile is a substance used to help digest fats and is normally moved out of the liver into the gallbladder. The medical term for this build-up is cholestasis.

Symptoms of cholestasis include:

    persistent jaundice (yellowing of the skin and eyes) that can often last longer than three months
    a high temperature (fever) of or above 38ºC (100.4ºF)
    diarrhoea
    weight loss

Cholestasis will normally resolve by itself without the need for treatment.

Liver failure

A rare and potentially fatal complication of hepatitis A is that the infection stops the liver working properly. This is known as liver failure.

This complication usually occurs in those:

    with a pre-existing liver disease, such as cirrhosis (scarring of the liver) or hepatitis C (a more serious type of liver infection)
    with a weakened immune system (which could be the result of a condition such as diabetes, or as a side effect of a treatment such as chemotherapy)

Some symptoms of liver failure are similar to hepatitis A and include jaundice, nausea and vomiting.

Other symptoms of liver failure include:

    a tendency to bruise and bleed easily (for example, frequent nosebleeds or bleeding gums)
    hair loss
    fever and shivering attacks because you're more prone to infections
    oedema – a build-up of fluid in the legs, ankles and feet
    ascites – a build-up of fluid in the abdomen, which can make you look heavily pregnant
    drowsiness and confusion

It is often possible to compensate for the loss of normal liver function using medication, but a liver transplant is necessary to achieve a complete cure. 

tags: Relapse, Liver failure, Cholestasis, Complications of hepatitis A can include the infection returning (relapse), cholestasis, or, in rare cases, liver failure.

Hepatitis A - Vaccination

There are three main types of Hepatitis A vaccination, which are all highly effective.

Who should be vaccinated

Vaccination against hepatitis A is recommended if you:

    are planning to travel to or live in parts of the world where hepatitis A is widespread, particularly if levels of sanitation and food hygiene are expected to be poor
    have any type of long-term (chronic) liver disease
    have haemophilia (a blood disorder than can affect the ability of blood to clot properly)
    are a man who has sex with other men
    regularly inject illegal drugs
    work with or near sewage (untreated sewage is often contaminated by hepatitis A)
    work in institutions where levels of personal hygiene may be poor, such as a homeless shelter
    work with primates (monkeys, apes, baboons, chimps, gorillas) as these can also be infected with hepatitis A

If you are unsure whether you should be vaccinated against hepatitis A, check with your GP.

Vaccination is not considered necessary if you are travelling to northern or western Europe, North America, Australia, New Zealand or Japan.

Types of vaccine

The three types of vaccine that protect against hepatitis A infection are:

    monovalent vaccine, which provides protection against hepatitis A
    combined hepatitis A and hepatitis B vaccine – hepatitis B is another type of liver infection most common in China, Africa and southeast Asia
    combined hepatitis A and typhoid fever vaccine – typhoid fever is a serious type of bacterial infection

If you need vaccination because you are travelling, a single injection of the vaccine should be given two weeks before you leave, although it can be given up to the day of your departure if necessary.

This will protect you against hepatitis A for about a year. A booster dose, given six to 12 months after the first dose, will protect you for at least 20 years.

The type of vaccine that is best for you will depend on your individual circumstances. For example, combined vaccines may be recommended if you are planning to travel to parts of the world that also have high levels of hepatitis B and typhoid fever. The combined vaccines will need to be given four to six weeks before you travel.

Your GP can give you a vaccination for hepatitis A on the NHS. Travel health clinics can also give this vaccination, but there may be a charge.

The hepatitis A vaccine cannot be given to babies under the age of one.

Side effects

After having the hepatitis A vaccine, some people develop temporary soreness, redness and hardening of the skin at the injection site. A small, painless lump may also form at the injection site. This usually disappears quickly and is not a cause for concern.

Much less common side effects include:

    tiredness
    headache
    loss of appetite
    nausea
    a slightly raised temperature – a normal temperature is 36-36.8ºC (96.8-98.24ºF)

Where further advice is required

Speak to your GP before having any vaccinations if:

    you are pregnant
    you are breastfeeding
    you have an immune deficiency
    you have any allergies

tags: Where further advice is required, Types of vaccine, Side effects, Hepatitis A - Vaccination, Hepatitis A, Vaccination, Who should be vaccinated, There are three main types of Hepatitis A vaccination, which are all highly effective.

Hepatitis A - Causes

Most cases of hepatitis A are thought to occur when a person is travelling in parts of the world that:

    have high levels of poverty
    are overcrowded
    have limited access to sanitation and clean water

The most common cause of hepatitis A is eating food contaminated by the stools of an infected person as a result of poor personal hygiene.

For example, you may get hepatitis A if you eat food prepared by an infected person who has not washed their hands properly.

It is also possible to become infected with hepatitis A by drinking contaminated water. This includes using ice cubes made from contaminated water and eating raw fruit or vegetables washed in contaminated water.

Also, shellfish can be infected if harvested from sea contaminated with sewage.

Hepatitis A in England

Although it is much less common, it is still possible to catch hepatitis A in England.

Known risk factors include:

    being a man who has sex with other men – read more about issues related to gay health
    regularly injecting illegal drugs
    working with or near sewage – untreated sewage is often contaminated by hepatitis A
    working in institutions where levels of personal hygiene may be poor, such as a homeless shelter
    living or working in closed environments, such as student halls, boarding schools and army barracks
    working with primates (monkeys, apes, baboons, chimps, gorillas), as these can also be infected with hepatitis A
    having haemophilia – people with this blood clotting disorder often require a type of medication called a clotting agent derived from human blood, which can sometimes become infected with the hepatitis A virus

If you are in one of the above groups, it is usually recommended you receive the hepatitis A vaccine.

At-risk destinations

Regions where hepatitis A is widespread include:

    sub-Saharan and North Africa
    the Indian subcontinent (particularly Bangladesh, India, Nepal and Pakistan)
    some parts of the Far East (excluding Japan)
    the Middle East
    South and Central America

 

tags: At-risk destinations, Hepatitis A in England, Most cases of hepatitis A are thought to occur when a person is travelling in parts of the world that:, have high levels of poverty, are overcrowded, have limited access to sanitation and clean water.

Hepatitis A - Treatment

There is currently no cure for hepatitis A, so treating the condition is based on making you feel as comfortable as possible until the infection passes.

The following self-care advice may help.

Plenty of rest

It is important to get plenty of rest, especially during the initial stages of the infection, as it is likely you will be feeling very tired.

You will probably need to stay off work (or school or college) until the flu-like symptoms of hepatitis A pass. Your GP will tell you when you can return to normal daily activities.

Pain relief

Paracetamol or ibuprofen can help relieve any abdominal pain, though it is important not to take too many tablets as this could damage your liver.

Always read the information leaflet that comes with your medication.

Itching

Itching can sometimes be difficult to treat, but there are steps you can take that may help:

    maintain a cool, well-ventilated environment
    wear loose clothing
    avoid hot baths or showers

For severe cases you may be prescribed an antihistamine, but this is not always suitable.

Coping with nausea and vomiting

If you are having problems with feeling sick (nausea) or vomiting, the following advice may help:

    try eating six smaller meals a day rather than three larger meals
    avoid eating fatty foods, as this can often make you feel worse

If you still have nausea and vomiting despite following this advice, your GP may prescribe a type of medication called an antiemetic. An antiemetic called metoclopramide is usually recommended.

Metoclopramide is available in tablet or capsule form, as a powder you can mix with water, or as an injection (the injected form of the medication is usually only required in severe cases).

Side effects of metoclopramide are uncommon and include:

    diarrhoea
    drowsiness – do not drive or use tools or machinery if you do develop drowsiness

Severe vomiting could lead to dehydration, which is potentially very serious. Symptoms of dehydration include:

    dry, wrinkled skin that sags slowly into position when pinched up
    an inability to urinate, or not passing urine for eight hours
    sunken eyes

Contact your GP immediately if you think you are dehydrated. If this is not possible, call NHS 111 or your local out-of-hours service.

Resting your liver

It is important to rest your liver as much as possible until it fully recovers. This means you should not drink any alcohol until your GP or the doctor in charge of your care says it is safe to do so, as your liver is responsible for filtering alcohol out of your blood.

Your liver is also responsible for processing many different medications, including over-the-counter painkillers, so it may be necessary to avoid certain medications or reduce the dosage until you recover.

Your GP can advise you on what, and how much, medication is safe to take.

Vaccines and immunoglobulin

If testing finds you have contracted the hepatitis A virus but have not developed symptoms, it may be possible to prevent infection taking hold.

This can be done using a combination of the hepatitis A vaccine and a type of medication called immunoglobulin.

Immunoglobulin is a blood product derived from the blood of people who have an immunity to hepatitis A.

This type of treatment tends to only be effective if given within 14 days of exposure to the virus.

tags: Coping with nausea and vomiting, Plenty of rest, Pain relief, Itching, Resting your liver, Vaccines and immunoglobulin, There is currently no cure for hepatitis A, so treating the condition is based on making you feel as comfortable as possible until the infection passes.