Hepatitis is an inflammation of the liver that comes in three main types and, worryingly, has no known cure. Lisa McLenahan investigates the implications of this disease
There are three main types of hepatitis - hepatitis A, B and C. Hepatitis is basically inflammation of the liver. There are many causes of hepatitis, including viruses, alcohol, certain drugs and toxins.
The symptoms of hepatitis vary depending on the cause of the illness but can include fever, loss of appetite, nausea, vomiting and jaundice.
There is no specific treatment for hepatitis although abstinence from alcohol would be recommended.
To limit your risk of exposure to hepatitis you should eat only freshly cooked foods, drink bottled water if the water supply is questionable, practice safe sex and limit alcohol consumption.
Quick recovery
Hepatitis A is inflammation of the liver due to a viral infection. Hepatitis A is the mildest and most common form of hepatitis. Recovery is usually complete and fairly quick - around three to six weeks. Hepatitis A is endemic in much of the African continent, the Middle East and the Indian subcontinent. It is rare in industrialised countries where the standard of general hygiene is high.
Hepatitis B is the most common serious liver infection in the world. It is caused by the hepatitis B virus which attacks liver cells and can lead to liver failure, cirrhosis or cancer of the liver. Early symptoms of the hepatitis B virus are flu-like, and the virus is transmitted through contact with blood or bodily fluids that contain blood. It spreads by sexual contact or other close contact and the sharing of needles and razors.
Most people are able to fight off a hepatitis B infection and clear the virus from their blood. This may take up to six months. While the virus is present in their blood, infected people can pass the virus to others. Once the virus is cleared from the blood an immunity is developed and the infection will never return. However, blood tests will always show that the infection was once present.
Approximately 5%-10% of adults, 30%-50% of children and 90% of babies will not get rid of the hepatitis B virus and will develop chronic infection. Chronically infected people can pass the virus on to others and are at an increased risk for liver problems later in life.
The hepatitis B virus is 100 times more infectious than the Aids virus. This year alone, 10 to 30 million people worldwide will become infected with hepatitis B. The World Health Organization estimates that 400 million people worldwide are already chronically infected with hepatitis B and that this leads to over one million deaths each year worldwide.
There is no known cure for hepatitis B, although you can protect yourself with a vaccine prior to infection. Individuals in the medical profession, for example, will be vaccinated against the hepatitis B virus.
Liver damage
Hepatitis C is a virus that can seriously damage the liver and affect its ability to function correctly. It is spread mainly through contact with the blood of a person who is infected. Less commonly it can also be passed on via other bodily fluids. Following the identification of hepatitis viruses A and B in the 1960s and 1970s respectively, the remaining cases of hepatitis were termed non-A and non-B hepatitis. The hepatitis C virus was identified in 1985.
Most people do not experience any symptoms when they become infected. Some people may feel briefly unwell and in rare cases may become jaundiced. Many people with chronic hepatitis C infection will have no symptoms, while others will feel unwell in varying degrees.
Increasingly effective treatments for hepatitis C are available. A form of drug therapy is available that can clear the virus in more than half of those treated. Treatment usually lasts for six or 12 months and is normally offered to people with moderate to severe liver damage. In England, the number of people with chronic hepatitis C infection is estimated to be around 200,000.
Slow burner
Most people with hepatitis C do not realise that they have the virus because it can take years or even decades for symptoms to appear.
Around one in four people with hepatitis C will get rid of the virus naturally. The remainder will develop chronic infection.
Many people with hepatitis C infection will live out a normal lifespan. About one in five people with chronic infection will eventually develop severe liver damage, which can lead to liver cancer or liver failure and the need for liver transplantation.
Lisa McLenahan is a life and disability underwriter at Scottish Equitable Protect
Underwriting implications
Generally speaking, hepatitis A would be of no great concern to an underwriter for any benefits once a full recovery had been made.
However, it is slightly different when it comes to hepatitis B and C. From an underwriter's point of view, interpreting a hepatitis B serology can be a difficult task, but explained as simply as possible:
Hepatitis B surface antigen (HBsAg): A blood marker on the surface of the hepatitis B virus. It can be detected in high levels in blood during acute or chronic hepatitis. The presence of HBsAg indicates that the person is infectious. The body normally produces antibodies to HBsAg as part of the normal immune response to infection.
Hepatitis B surface antibody (anti-HBs): The presence of anti-HBs is generally interpreted as indicating recovery and immunity from hepatitis B. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B. This antibody remains permanently and will show on all future blood tests.
Total hepatitis B core antibody (anti-HBc): Appears at the onset of symptoms in acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with hepatitis B virus in an undefined timeframe.
IgM antibody to hepatitis B core antigen (IgM anti-HBc): This antibody appears during acute or recent hepatitis B infection and is present for about six months.
When assessing an application from somebody suffering from hepatitis B our first step would be to obtain a GP report, which would hopefully provide the results of the hepatitis B serology and liver function test results (LFTs).
An individual who had recovered from a hepatitis B infection (serology would be HBsAG negative and anti-HBs positive) would usually cause no concern for any of the benefits six months after a recovery had been made.
Those individuals who did not fight off the hepatitis B infection and developed chronic hepatitis B but were not suffering any symptoms may still be able to effect cover, but the terms would be dependent on the LFT results. Those with marginally abnormal test results may be able to effect cover for all benefits, but the premiums would be increased by anything from a small to a significant amount. Those whose LFT results were significantly abnormal or those still experiencing symptoms would not be accepted for any benefits.
An underwriter's first step when assessing an application from somebody with hepatitis C would be to obtain a GP report which should detail the hepatitis C serology and LFT results.
Terms would not be available for any benefits if the hepatitis C virus was a new finding. For critical illness and disability benefits, if the virus was not cleared then terms would not be available. If it had been cleared then the case may be considered, but only in the best possible cases, and these would be referred for a specialist opinion.
Life-only cases can be considered but the terms would be dependent on the duration of the virus and the extent of the liver damage, and any premiums would be severely increased.
About hepatitis
• Hepatitis is the latin word for liver inflammation.
• An estimated 200,000 people suffer from chronic hepatitis C in England.
• Around one in four people with hepatitis C will get rid of the virus naturally.
• About one in five people with chronic infection will eventually develop severe liver damage (cirrhosis) which can lead to liver cancer or liver failure.
