By Amy Harris 

More than 4 million people in the U.S. currently live with either hepatitis A, hepatitis B, or hepatitis C, which are all liver infections caused by different viruses. Worldwide, hepatitis D and hepatitis E are health concerns as well, but the most common hepatitis viruses in Maine and the U.S. are A, B, and C.  

Amevi Assoutovi, a Community Health Worker with the Portland Public Health Division, reports widespread confusion and misunderstanding about hepatitis, including the differences between the different viruses. Hepatitis can travel from person to person, and a lack of knowledge and understanding about the types of hepatitis, how they are spread, and how to prevent infection puts all Mainers at risk.  

When untreated, certain forms of hepatitis can lead to liver cancer or other serious liver diseases. Symptoms include fever, tiredness, and jaundice (yellowing of the eyes and abnormal coloring of stool and urine), but because some people do not display symptoms at all, feeling fine does not necessarily mean someone is healthy. Assoutovi recommends learning the different risk factors for each type of virus, as well as asking about possible treatments and getting recommended vaccines to prevent sickness.  

Assoutovi informally surveyed his clients at the Screening, Prioritization, and Urgent Referral Program (SPUR) health clinic, located at 39 Forest Avenue, Portland, dand found they had little to no knowledge about preventive measures such as vaccination, safe needle exchanges, and screening for hepatitis. He said he worries that a lack of information limits his patients’ ability to avoid infection or get early treatment. 

Nationwide, the number of hepatitis C infections increased by 7% between 2020 and 2021. Chloe Manchester, Infectious Disease Epidemiologist at Maine Center for Disease Control and Prevention, said cases of hepatitis B and C in Maine decreased a small amount during the same period, but she thinks fewer cases may have been reported during the COVID-19 pandemic as a result of less medical screening. Manchester said hepatitis C remains “a very concerning public health issue in Maine and across the U.S.,” and worries that undiagnosed hepatitis C could be transmitted from pregnant women to their babies. “It’s widely acknowledged perinatal hepatitis C is very likely undercounted,” she said. 

Education about screening, treatment options, and vaccination options must be expanded across the state, said Manchester. “We have all the tools we need to disentangle ourselves from this public health issue,” including highly effective treatments, proven harm-reduction strategies, and routine screening recommendations.  

The Church of Safe Injection has a mission “to reduce harm associated with active drug use and to lift up and support the intersectionality of poverty, poor access to health care and homelessness.” It is one of the organizations working on the ground to educate the public and provide care in relation to hepatitis. They have several community events planned for 2024, complete with interpreters, translated materials, and free hepatitis screenings and vaccinations.  

But Executive Director Zoe Brokos said outreach is not easy. “The work we do is highly stigmatized in most communities,” she said. She is working with Generational Noor, Maine People’s Alliance, and Maine Inside Out on outreach efforts. A key part of the harm reduction strategy for hepatitis B and C is providing opportunities for people to exchange dirty syringes for clean syringes. In addition to increasing access to clean syringes, healthcare advocates believe universal screening should be a part of routine medical care. Screening would help those who are sick and also reduce transmission.  

In order to help people, more organizations in Maine have realized that culturally appropriate treatment options need to be available. According to Manchester, Greater Portland Health and Maine Medical Center’s Virology Treatment Center are examples of organizations that work with community partners to ensure that those who test positive have a “warm handoff to a place where they can receive culturally appropriate and stigma-free treatment.”  

Hepatitis A transmission can be prevented by routine handwashing, safe hygiene practices, and thoroughly washing and cooking food items. Hepatitis A is more contagious than hepatitis B or C. It spreads through fecal-oral transmission or by consuming contaminated food or water. 

Hepatitis B spreads through bodily fluids like blood and semen, through unsterile needles, and from mother to baby during childbirth. Most people with hepatitis B do not experience symptoms when first infected, so they are less likely to seek healthcare or be screened.  

Most people become infected with the hepatitis C virus by sharing needles or other equipment used to prepare and inject drugs, according to the U.S. Centers for Disease Control and Prevention. The opioid epidemic and rise in people injecting drugs may be partly to blame for continued cases of hepatitis C. 

Of the three, hepatitis C is most likely to be a silent infection, and people may not notice any symptoms until their disease has progressed to advanced liver disease.  

Most people infected with hepatitis A will only be sick for a short time before recovering completely, and most will not have any lasting liver damage. 

Both hepatitis B and C have an acute form of infection that lasts up to six months, as well as a chronic form that lasts for a lifetime. There is no cure for hepatitis B, but if managed correctly over time, hepatitis B does not need to become chronic and result in severe liver damage (called cirrhosis) or liver cancer.  

Recent advances in hepatitis C treatment mean higher cure rates and shorter treatment times. Treatments usually involve eight to 12 weeks of oral therapy (pills), and over 90% of patients are cured, with few side effects, according to the U.S. CDC. 

Vaccines 

There are vaccines to prevent hepatitis A and hepatitis B infection. People living with hepatitis B or C are advised to also receive the hepatitis A vaccine.