A woman speaks with her doctor. May is Hepatitis Awareness Month and the Michigan Department of Health and Human Services is highlighting the importance of testing for hepatitis C and hepatitis B during pregnancy, as these viruses can be passed from mother to fetus. All pregnant women are encouraged to get tested for hepatitis C early in prenatal care and get tested for hepatitis B during every pregnancy. Pregnant women are also encouraged to get vaccinated for hepatitis B. (U.S. Military photo)

MARQUETTE — The Upper Peninsula as a region has the highest rate of hepatitis C for young adults in Michigan. In Marquette County alone, there were 82 cases of hepatitis C in 2018, compared to three cases of hepatitis B and no cases of hepatitis A, Marquette County Health Department officials said.

Throughout Michigan, the number of new hepatitis C diagnoses in women who were of childbearing age more than doubled from 2007 to 2018, increasing from 817 new diagnoses in 2008 to over 2,000 new diagnoses in 2018, according to data from the Michigan Department of Health and Human Services.

With this substantial increase in hepatitis C diagnoses in young adults over the past decade, the Michigan Department of Health and Human Services is recognizing May as Hepatitis Awareness Month.

“Hepatitis B and C can cause ongoing liver disease and damage. In fact, hepatitis C is a leading cause of liver cancer in the U.S.,” Marquette County Health Department Medical Director Dr. Teresa Frankovich said. “Make sure your children are fully vaccinated against hepatitis B and talk with your healthcare provider or the health department about whether you should be vaccinated. There is no vaccine at this time against hepatitis C so avoiding exposure is the best strategy along with testing if you are pregnant or have risk factors for exposure.”

While some may have “such mild symptoms that they do not know they have hepatitis,” people with hepatitis may develop: abdominal pain, dark urine, fever, joint pain, loss of appetite, nausea/vomiting, weakness and fatigue and/or jaundice, which is the yellowing of the skin and whites of the eyes, Frankovich said.

Because people can live with hepatitis “for decades without experiencing any symptoms or feeling sick,” the “only way to know if you are infected is with a blood test,” MDDHS officials said.

“Some people who become infected with hepatitis B or hepatitis C will clear the infection and remain healthy,” Frankovich said. “However, a large percentage of individuals who become infected will continue to carry the virus. These people can not only pass the infection on, they are at risk for significant ongoing damage to their liver.”

Throughout Hepatitis Awareness Month, the MDHHS is highlighting the importance of testing for hepatitis C, as well as hepatitis B during pregnancy, as these viruses can be passed from mother to fetus.

The American Association for the Study of Liver Diseases recommends all pregnant women get tested for hepatitis C, “ideally at the start of prenatal care,” as there there is no vaccine or prophylaxis for hepatitis C and no known method to reduce the rate of mother-to-child hepatitis C transmission, an MDHHS press release states.

“Although hepatitis C is less commonly transmitted at birth than hepatitis B, transmission does occur in about 20% of cases,” Frankovich said. “That is why it is recommended that all pregnant women be screened for hepatitis C. Infants who become infected will need ongoing monitoring of their liver function.”

Hepatitis C is “primarily spread through contact with the blood of an infected person,” she said.

“It spreads easily in intravenous drug user groups who share needles and other drug paraphernalia and can be spread through tattooing, if unclean needles are used. It is infrequently transmitted through unprotected sex.”

Because the virus can be transmitted through blood, the disease can be prevented by avoiding contact with blood from individuals that are infected. However, “since you cannot tell who may be infected and often folks do not even know they are infected for some time, general prevention strategies are useful,” Frankovich said.

General prevention strategies include: not using intravenous drugs; never sharing needles or other paraphernalia if intravenous drugs are used; making sure tattoos are done at a licensed facility and only having protected sex if a partner’s status is unknown, particularly if s/he has risk factors for exposure.

While the disease can cause on-going health issues if not treated, there are new hepatitis C treatments that have minimal side effects and can cure over 90% of those who have hepatitis C.

“Early detection, linkage to care and treatment are key to identifying current HCV infection, slowing disease progression and liver damage and lowering risk of liver cancer,” MDHHS officials said.

Hepatitis B, which is spread through contact with blood or bodily fluids from a person who is infected, can also be spread during unprotected sex, childbirth or “through other contact with blood and body fluid,” she said.

While hepatitis B does have a vaccine available, hepatitis B can transmitted to infants of unvaccinated mothers who have the infection, and it can have dire consequences, Frankovich said.

“We now vaccinate infants against hepatitis B but if a mother is unvaccinated and acquires the infection, it can be passed to her infant,” Frankovich said. “Without rapid treatment of the infant after delivery, about 40% of infants will develop chronic hepatitis B infections and about 25% of this group will eventually die from chronic liver disease over their lifetime.This is why it is critically important that women be tested for hepatitis B with each pregnancy.”

The Centers for Disease Control and Prevention recommends that all women get tested for the hepatitis B surface antigen during each pregnancy. The hepatitis B vaccine is also recommended for those who are “identified as being at risk for HBV infection during pregnancy,” according to the MDHHS. “The HBV vaccine contains no live virus and there is no apparent risk of adverse events to developing fetuses when hepatitis B vaccine is administered to pregnant women.”

For more information on perinatal HBV, visit Cdc.gov/hepatitis/hbv/perinatalxmtn.htm. For more information on perinatal HCV, visit Michigan.gov/documents/mdhhs/PerinatalHCV_617775_7.pdf