Acute and chronic viral hepatitis revisited.

Hepatitis A is an acute fecal-spread disease without chronicity. Gamma immunoglobulin is preventative. Eventually a vaccine will be used for those in developed countries, who have not acquired antibody in childhood. Hepatitis B is a blood-borne disease which can lead to chronic hepatitis, cirrhosis, and liver cancer. It is carried worldwide by many millions, especially in South-East Asia, the Pacific, Africa, and Southern Europe. Australian Aboriginals have a very high carrier rate. It also affects drug abusers, many partner homosexuals, and hospital workers in contact with blood. A safe vaccine is effective and particularly valuable for babies born to carrier mothers. Treatment of chronic hepatitis depends on whether the patient is in the replicative ('e' antigen positive) stage, where anti-viral therapy might be considered, or in the integrated ('e' antibody positive) stage where a trial of corticosteroids may be justifiable. Non-A, non-B hepatitis is a diagnosis of exclusion. There is no diagnostic test and no proven therapy. There are probably at least four types, parenteral short and long incubation and enteric sporadic and epidemic.