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Melanie Cole (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed, so you can make informed healthcare choices for yourself and your whole family. Back to Health features, conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine. I'm Melanie Cole and joining me in this panel today is Dr. Robert Schwartz. He's a Gastroenterologist Hepatologist with a focus in Hepatology and an Associate Professor of Medicine at Weill Cornell Medical College, Cornell University, and Dr. Ype de Jong he's a Hepatologist and an Assistant Professor of Medicine at Weill Cornell Medical College, Cornell University. And they're both here to talk about hepatitis awareness. Doctors, thank you so much for joining me. Dr. Schwartz. I'd like to start with you. I'd like you to kind of explain to the listeners what hepatitis is and the prevalence. How common is it in this country?

Robert Schwartz, M.D., Ph.D. (Guest): Well, it's a real pleasure to be here today with you and very excited to talk to you today about hepatitis. So hepatitis is a process where there is inflammation in the liver due to either an infection or another process. And so there are a variety of different causes of processes that can cause inflammation or injury to the liver.

But today, we're primarily going to focus on viral hepatitis and basically this is a relatively common cause of liver injury and inflammation in the liver. Globally, there is over about 250 million people who have chronic hepatitis B. One of the viruses that cause hepatitis and in the United States is believed to be anywhere from one to 2 million people who have hepatitis B.

There are other viruses that can also cause inflammation or injury to the liver, such as hepatitis A, hepatitis C. And as well as, less common viruses such as hepatitis D and hepatitis E, and these other viruses, also a pretty common. I'm sure many of us have heard about hepatitis C just in the media and things along these lines.

And the reason why this is, is there's anywhere from two and a half million to 5 million people who have hepatitis C chronically and over half these people are completely unaware of the fact that they actually have hepatitis C. So essentially this is running silent. And so as a consequence of this, there's several million people who actually are having an ongoing process, injuring their liver, and they don't even know.

And when you start looking at the numbers, this is anywhere from one to two out of a hundred people in the United States who don't even know that they have an ongoing process that is continually injuring their liver.

Host: Wow. Excellent explanation. And you described it beautifully. You're a great educator, Dr. Schwartz. So now Dr. de Jong, I'd like you to speak about who's at risk and transmission and exposure because as Dr. Schwartz is saying there are possibly millions of people living without knowing that they have this. Can you tell us about transmission and how it is acquired so that we can improve everyone's understanding of viral hepatitis transmission?

Ype P. de Jong, M.D., Ph.D (Guest): Thank you also for being here. So I think to distinguish as Dr. Schwartz was alluding to, there are various different viruses that can cause hepatitis and I think the first distinction, should be to separate the ones that are causing acute infection from chronic infection. And as Dr. Schwartz was saying, the hepatitis B and hepatitis C frequently establish a chromic infection. And then hepatitis A and hepatitis E they tends to establish only acute infection. So those are two separate classes of acute versus chronic hepatitis. The risk of acquiring these two hepatidities, or these groups of hepatitis is also very different.

So hepatitis A and hepatitis E we think it's mostly based on foodborne transmission. So you can get this from contaminated food products that you eat. Whereas hepatitis B and hepatitis C they're mostly bloodborne, so they are either coming from contaminated needles or other, what we see, for example, in the opiate epidemic there is a lot of new hepatitis C infection coming from sharing needles. Hepatitis B can also be transmitted effectively, sexually. So for hepatitis B and C it's either bloodborne or, sexual transmission. So those are the main risk factors for the chronic hepatitis.

Host: Wow. It's really a very comprehensive situation. And as you both have said, there are people living with this and thank you, Dr. de Jong for telling us how it's acquired that there is a separate between foodborne and bloodborne. Now, Dr. de Jong, just very quickly, the difference, because you both have mentioned chronic a few times. Can you tell us the difference between the chronic, like Hep C or acute for listeners? What does that mean?

Dr. de Jong: Yeah. So for example, hepatitis A, which is not uncommon in the United States, you would acquire this typically from contaminated food and people can develop hepatitis or inflammation of the liver as, Dr. Schwartz explained. But this tends to be self-limited and within months, and typically less than a year, the virus is cleared from the body. And you have experienced hepatitis A, but the virus is no longer with you. And this is very different from hepatitis B and hepatitis C, which when they are acquired, typically through blood contact, they can establish a chronic infection that can last for decades or for lifelong even.

So, we're really sort of distinguishing between say six months, an acute infection that's for self resolves within six months versus hepatitis B and hepatitis C that's if they become chronic, they can basically stay with you for decades or even in your entire life.

Host: This is so interesting. Dr. Schwartz, is it more prevalent in one race than another? Can you tell us some of the risk factors, as we've talked about foodborne versus bloodborne and opiates and all of these ways, can you tell us a little bit about the risk for those of us living in this country, what is our risk?

Dr. Schwartz: Obviously talking about the foodborne hepatidities as Dr. de Jong just had mentioned, so hepatitis A, hepatitis E thankfully, although they are present in the United States, they are not super common. And so, I think the most important thing from the viral hepatidities that cause let's say foodborne infections, cooking your food well, proper hygiene, washing your hands. Things along these lines really does go a long way to preventing outbreaks or acquiring these types of infections. So that's, as it relates to hepatitis A and hepatitis E. Now, hepatitis B and hepatitis C, which more likely to cause chronic infections, these viruses as Dr. de Jong had mentioned are spread through, essentially blood contacts and hepatitis B essentially is also transmitted not only through blood contact, but is more easily also transmitted through sexual contact. And so it's a way to essentially protect oneself from these is appropriate and good sexual health practices and protection, as well as similarly, with blood contacts. To basically minimize those types of exposures. So the thing is, is that if someone has, let's say, chronic hepatitis C or chronic hepatitis B, you wouldn't want to be let's say sharing their razor, with that, just because of the potential risk of that type of exposure.

But with all that said, I don't want anyone to walk away from this and be concerned, if someone's living with someone who has chronic hepatitis B or chronic hepatitis C, they can give them a hug or they can do all these things. It's not, spread in that type of manner. It's really through these direct kind of very intimate type of contacts. So through needle exposures, as in drug abuse or direct exposures to blood.

Host: Dr. Schwartz along those lines have you noticed a stigma, especially with B and C similar to HIV where people, because you just mentioned that it's okay to hug and all of those things. In your many years in this business, have you noticed that there is a stigma that it's looked at a different way, similar to HIV where people assume certain things?

Dr. Schwartz: I think the answer to that is that there's definitely stigmas in certain communities. So the thing is, hepatitis B, for example, is more common in certain ethnic or immigrant groups that have come to this country. And a lot of people in those communities are completely unaware that they have chronic hepatitis B. And the thing is, is that, although they know that there is increased risk of them having this in their community, there is a far less likelihood that they want to be tested because of the stigma that's attached to this. And the one thing that, I didn't mention as a, cause let's say in the context of chronic hepatitis B is the most likely way of getting chronic hepatitis B is from a very close blood contact, which is actually from your mother when you're being delivered.

And so the thing is, is the most common way people get hepatitis B is just from transmission, from mom to child, this obviously, is not result of anything, that that child has done. But even with that said, there is pretty significant stigma in a variety of communities related to this.

And so as a result of people don't get tested. And so essentially they don't know that they have this problem. And as a result, they don't actually get appropriate care. And that stigma also attaches to other viral hepatidities, like hepatitis C, where different groups, age groups, things like this, they just don't get tested.

Host: That's so interesting. So along those lines, then Dr. de Jong speak about screening. I think I remember getting tested for hepB when I was giving birth. Right. And so can you speak about screening? Who should get tested, how it is diagnosed?

Dr. de Jong: So for the acute hepatidities, we don't screen, unless people have symptoms, but for the chronic hepatidities, hepatitis B and C, there is a little screening going on actually for hepatitis B, surely pregnant women are screened for this vertical transmission, this mother to baby transmission, that's, that Dr. Schwartz just alluded to. And also certain other high risk groups are typically screened, healthcare workers, et cetera. For hepatitis C, there's now nationwide screening, is the newest recommendations is everybody should get screened at least one time.

Until recently, we only screened the baby boomers or the people born between 1945 and 1965 for hepatitis C, because those were the highest risk of having chronic hepatitis C. But more recently, the recommendation is that everybody should undergo a one time screening test for hepatitis C.

Host: Dr. de Jong, is there a vaccination against hepatitis?

Dr. de Jong: The simple answer is no, there's no vaccination for hepatitis C. People have been working on this for decades now, but it's a very tough problem to solve. And this contrasts with hepatitis B, where we've had a very good vaccine for over three decades now. So for hepatitis B, we routinely now I think all the babies or young children are all vaccinated for hepatitis B. And we also recommend particularly people at risk to be vaccinated for hepatitis B. There are several very good vaccines for hepatitis B. So most people respond to the vaccines and they're safe. For hepatitis C, there's still a little research ongoing to make an, a safe vaccine, because so far we don't have a vaccine for hepatitis C.

Host: Well, then this is just so interesting. So educational Dr. Schwartz speak about the treatment options and how treatment is easier for the patient than say, 20 years ago. Speak about the evolution and what is the latest treatment today?

Dr. Schwartz: It's pretty remarkable how much treatment has changed over the last 20 years. It is quite amazing the context for hepatitis C, 20, 25 years ago, our treatment options were pretty limited. They involved essentially an injectable, meaning they would have to inject themselves with interferon, which basically made the patient feel like they had the flu. They would also take another medication. And this was pretty much the standard of treatment up until maybe about 10 years ago. And basically this only had at best, 10% chance of clearing the virus in that patient. So essentially the patients would have to take this for a year. Feel like they have the flu, feel pretty miserable the whole time for just a potential five, 10%, maybe even a 15% chance of clearance of the virus. This has been completely revolutionized over the last decade.

And we now have oral drug combinations that people can take for very limited periods of time, anywhere from eight to 12 weeks. The drugs themselves have very minimal to no side effects. They're very well tolerated. And, over 95% of patients will clear the virus completely and be cured of their hepatitis C. And this is one of the most remarkable things that I've gotten to see over the course of my medical career, because there's not many times you get to say that a disease was cured. And so that's the reason why we've been pushing so hard for people to get tested. Because now today we have a safe, very effective and very well tolerated treatment regimen. And that basically everyone who has chronic hepatitis C should be treated, should get cured. So we can really prevent the adverse effects of having hepatitis C chronically for a long time. Now for hepatitis B, 30 years ago, we really didn't have much to offer patients as well. Now over time that has changed with the development of antivirals that target the virus. And essentially today we have the choice of two very highly effective drugs that are not able to cure patients of their hepatitis B, but are able to very effectively suppress and prevent viral replication or prevent the virus itself from replicating.

And by doing that, we actually prevent the downstream adverse effects of having the infection. So we now for hepatitis B have a very safe and effective, well tolerated almost no side effects in a drug that is able to really control the virus well. The only difference is, is compared to hepatitis C, we're not generally able to cure patients with these drugs. So patients do need to be on them long-term and there's some nuances of therapy that I'm not getting into right now and some other treatments as well, but overall, the big bottom line is, we have very safe and effective treatments for both of these viruses. We just really need to identify the people that are chronically infected so they can get access to these treatments.

Host: Dr. de Jong, I'd like to give the last word to you. I'd like you to speak to the listeners now about reducing their risk of hepatitis, being aware, because that's what we're really trying to do here with you two brilliant gentlemen is raise awareness for hepatitis, the different types and the risk. I'd like you to summarize it for us with your best advice on prevention and reducing that stigma that Dr. Schwartz was mentioning, but kind of wrap it up for us.

Dr. de Jong: So I think people should be aware that the are two chromic viruses in the liver, hepatitis B and hepatitis C. That you could be a carrier off without having any symptoms. So you may feel completely fine, but you could still have this virus growing in your liver and in a subset of those people that have these two viruses chronically, it can actually do damage over typically over many years.

So I strongly urge people get tested at least once in a lifetime for both hepatitis B and for hepatitis C, because as Dr. Schwartz nicely explained, for hepatitis C, we have fully curative treatments. And for hepatitis B, we have very safe suppressive regimen so there's no reason to hide from it if you have it. There's options, treatment options available. So it's much better to be aware that you have these viruses and that they can be managed by someone that you're not aware of it. So please get tested.

Host: Beautifully said, I thank you both so very much for joining us today and sharing your incredible expertise with the listeners and Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back to Health. We'd like to invite our audience to download subscribe, rate, and review Back to Health on Apple podcast, Spotify and Google podcast. And for more health tips, go to weillcornell.org and search podcasts. And parents do not forget to check out our Kids HealthCast. Lots of great information there. I'm Melanie Cole.

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