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All about Hepatitis | Diseases and conditions
Table of contents:1. What is Hepatitis
2 hepatitis C and AIDS
3. consumption of alcohol and hepatitis
4. nutrition and hepatitis
5 hepatitis during pregnancy
6 tips for travellers to prevent hepatitis
1. What is Hepatitis
Hepatitis is, therefore, an inflammation of the liver that can be due to different causes, although it is generally a virus responsible for the condition. The consequences of the poor functioning of the liver include:
• Decrease in the production of bile. Bile is a substance that is essential for the absorption of fat in the intestine, so if it reduces the amount of bile that reaches the intestine this can hinder the proper absorption of fats.
• Deficit in the production of proteins, which can lead to fluid retention.
• Hypoglycemia, due to alterations in the storage of glycogen, which is another feature that makes the liver. Glycogen becomes glucose when the body needs it, but if the reserves are not enough can be produced a decrease in the level of sugar in the blood of the patient, what is known as hypoglycemia.
• Deficiencies in the metabolism of substances such as drugs, alcohol and toxins, making it difficult to the Elimination of these substances that have harmful effects on different organs.
• Reduction of the defense capability of the body against bacteria and viruses, due to malfunction of certain liver cells, which act precisely destroying these germs and, facilitate not performing their duties properly, bacteria and viruses from the abdominal area to spread through the bloodstream.
Causes and types of hepatitisHepatitis is a disease from which many causes are known:
• Infections by viruses, bacteria or parasites.
• Like autoimmune disorders.
• Injuries due to the interruption of the normal blood supply of the liver.
• Presence in the body of toxins, certain drugs, medications, etc.
• Presence of disorders such as cystic fibrosis or Wilson's disease hereditary.
In the case of hepatitis caused by viruses can distinguish between specific hepatitis virus (virus of hepatitis A, B, C and D mainly, although others are known) or non-specific virus for hepatitis, which are those that tend to occur with other diseases but that, occasionally, end up causing this disorder; the latter include the virus Cytomegalovirus and Epstein Barr (the cause of infectious mononucleosis or illness of the Kiss).
Types of HepatitisExinten various types of Hepatitis:
Hepatitis AAlso known as infectious hepatitis; This variant is caused by the virus of hepatitis A (HAV). Transmission occurs by consuming water or food contaminated by faecal matter containing the virus, and also spread from person to person, especially if the hygienic conditions are poor.
It is a usually mild hepatitis type especially when it occurs in children; in fact, on numerous occasions important symptoms, are not perceived for what disease does not reach to be diagnosed. When you develop symptoms, these consist of fatigue, jaundice (the skin has a yellowish color), loss of appetite, nausea and vomiting, and dark colored urine. The symptoms tend to be more severe in adults than in children. The condition not be chronic and does not harm the liver permanently, although on rare occasions may arise a complication called fulminant hepatitis, which can be deadly.
Hepatitis BHepatitis B or hepatitis serum; It is caused by the virus of hepatitis B (HBV). Infection occurs through body fluids, such as blood, semen, vaginal secretions, saliva, tears and urine-infected. Transmission usually occurs:
• By sharing syringes contaminated with the blood of an infected person during any type of drug consumption.
• Contact with material infected like needles for acupuncture, tattoos, piercings, etc.
• To share utensils for personal hygiene such as razors or toothbrushes.
• To have sexual intercourse with a person infected by the virus.
• To receive a transfusion of contaminated blood. This is a rare way today, as controls and measures to prevent such accidents have increased much in recent years.
• Mother can infect the baby during childbirth or breastfeeding.
Hepatitis B tends to become chronic with ease, although some patients are cured completely and become immune to the virus, so do not get it. Type B liver disease is considered acute if infection is maintained for a period of less than 6 months. If after that time the virus remains in the body of the individual, happens to be regarded as a chronic course, which does not necessarily imply the presence of symptoms (asymptomatic carriers are an important source of contagion, since not being aware of that have the disease, do not take measures to prevent its transmission). Two types of developments can be differentiated in the chronic course of the disease: chronic stable and persistent, chronic or active, the latter has worst prognosis and usually leads to cirrhosis.
Hepatitis CCaused by the hepatitis C virus, is transmitted by direct contact with the blood of an infected person. Its main forms of transmission tend to be:
• Needles or infected syringes.
• Blood transfusions.
• By infected material: health, material for tattoos, piercings, etc.
• During childbirth; mother-child transmission.
Similar to hepatitis B, form C of this disease has an acute course and a chronic course, with the latter being often develop with greater frequency (85% of cases). In the majority of cases, the patient remains asymptomatic, although the disease can progress slowly, by which there is a risk of cirrhosis and liver cancer.
Hepatitis DIt is the form of more severe viral hepatitis. Virus hepatitis D (HDV), also called hepatitis delta, is transmitted by the same means as the virus of hepatitis B. It is a very special viruses, you need the existence of an infection by the hepatitis B virus in order to survive in the human being. Therefore, when someone is also infected with the VHD is certainly infected by HBV. This is due to be wrapped outside the VHD is formed by HBV. It is estimated that 5% of patients with hepatitis B are co-infected by hepatitis d virus
When simultaneous infection with HBV and HDV occurs the patient suffers from acute symptoms (jaundice, fever, general malaise, etc.) that can be very serious. If you exceed the acute phase likely is that you get both infection control and, therefore, cure the two diseases. In the event that the VHD infects a person who already has the infection by HBV evolution is different. Not there is often a picture with serious acute symptoms but HDV infection tends to become chronic very often. The co-infection with HBV and HDV acquired in this way leads often to a liver cirrhosis within a few years, and is associated with a high risk of liver cancer.
Autoimmune hepatitisAutoimmune hepatitis is a type of progressive and chronic hepatitis of unknown origin. It occurs mostly in women and is characterized, inter alia, by the presence in the liver of antibodies from the patient, who do not recognize as their own to liver cells, and to confuse them with strange and harmful elements for the body, act destroying them.
Origin-toxic hepatitisOrigin-toxic hepatitis can be caused by the presence in the liver of various substances such as drugs, toxins, etc. Damage may occur by the alteration of one of these enzymes normally in the liver called cytochrome P-450. This alteration may result in an increase of toxic products, or prevent forming the elements required for the degradation of the same. It can also happen that certain substances are recognized by the immune system as a foreign agent that must be defended, so their cells liver will attend and will trigger the inflammatory response.
Symptoms of hepatitisHepatitis may manifest itself either acute or chronic. The acute form assumes that the pathology will begin and will disappear quickly; If, on the other hand, is chronic, disease will endure over time, and can result in liver failure and, even in the appearance of cancer.
Gravity will depend on various factors, including the triggering agent of pathology (cause), or the presence of other previous illnesses in the patient.
The symptoms that can be seen in the first moments of the disease (first 5-7 days after infection) are easily confused with those of a flu or any other common disease; shown:
• General malaise, fatigue and lack of concentration.
• Low-grade fever (tenths) or fever of up to 39 ° C.
• Muscle and joint pain.
• Photophobia (light phobia).
• Digestive symptoms, lack of appetite, nausea, vomiting and diarrhea.
After that first week in which little specific symptoms are seen, they will begin to show others who are beginning to offer clues about the origin of the pathology:
• Jaundice, yellowing of the skin and mucous membranes, easily noticeable appearance on the white of the eye. Jaundice occurs by an increase of bilirubin in the blood. In an inflamed liver will be an alteration in the enzymatic functions, among which is dissolving the bilirubin to allow their excretion as part of bile juices.
• Dark-colored urine and feces discolored or stained, as a result of a disorder in the hepatic circulation.
• Bad breath, sour taste in the mouth.
• Occasionally occurs abdominal pain on the right side or the left, depending on whether this pain comes from the liver or spleen.
• Cirrhosis, fibrosis of the liver tissue (deposit of collagen fibers), which has resulted in a change in the morphology of the body and the blood supply of the same.
Inflammation can disappear by itself, but if, on the other hand, persists and is chronic, can cause a liver failure:
• Acute or fulminant: characterized by the decrease of the production of certain proteins (such as albumin and some involved in the coagulation proteins), and the development of hepatic encephalopathy, which implies changes in sleep, confusion, alterations in the motility patterns, and even coma.
• Chronic: usually occur prior appearance of a cirrhotic picture.
In some cases it may occur that the patient is totally asymptomatic, or experience very mild symptoms who do not suspect a liver problem; This happens on numerous occasions in people infected with hav.
Diagnosis of hepatitisWhen it comes to query a patient with symptoms that may cause to suspect the presence of a disorder of hepatic origin, etc is done, first, study your medical history to see if it follows some kind of drug treatment, if you have a family history of liver disease. In addition, shall be submitted to the patient to a series of questions intended to know their habits of life, or the activities that plays that they can be considered risk factors for the acquisition of the disease.
The doctor will then request an analytical to check levels of transaminases; the presence of elevated levels of these proteins in blood is due to their release to the outside by the rupture of the hepatocytes (liver-forming cells) and, therefore, indicates the degree of hepatic necrosis. The highest levels of transaminases are observed in acute hepatitis cases while, in chronic hepatitis, figures are not as high, but its concentration varies. We will also analyse serum bilirubin, γ-glutamyl-transpeptidase and alkaline phosphatase levels; This lets you know the status of liver function.
To rule out or confirm a viral hepatitis are carried out tests that detect the presence of antibodies specific for each type of virus. With some of these tests, in addition, the medical can find out the amount of virus that there are in the body of the patient and in what time disappear after the treatment antiviral, for example.
Liver biopsy and elastrometiaAfter the diagnosis of the type of hepatitis, can be a test to determine the degree of hepatic illness by disease. Liver biopsyIt is sometimes used. The test involves taking a sample of the liver through a small puncture. This sample is analyzed under a microscope and informs us of the evolution of the disease, which helps make decisions regarding treatment.
Liver biopsy is a test that, although of uncommon form, may be associated with serious complications. For this reason, in recent years tests have been developed non-invasive for determining the degree of hepatic impairment without taking biopsies of the liver. The most useful test is possibly elastometry, which is done by a machine similar to a ultrasound and called FibroScan ®. This test measures the propagation of sound waves by the liver. Chronic hepatitis cause fibrosis in the liver which make these waves are transmitted faster. The faster you go the wave more fibrosis have liver. When there is a significant degree of fibrosis sick is considered a liver cirrhosis.
This test is performed on an outpatient basis, does not take more than five or 10 minutes, does not have any complications, and offers information possibly as reliable as that can give a liver biopsy. It is used mainly to assess the need to begin treatment with antiviral drugs in patients with chronic hepatitis C.
Treatment of hepatitisBoth the hepatitis of type to, as it's type B, can cure is without intervention medical. If it isn't, the Optional will establish a treatment or another depending on the cause of the disorder, age of the patient, sensitivity to certain drugs, etc. There is no specific treatment for hepatitis A; It is usually recommended diet low in fats, avoid drinking alcohol and other toxins and rest. For types B, in addition to the recommendation follow the directions above, there are some medications available which include interferon-alfa, lamivudine, telbivudine, adefovir and, more recently, entecavir or tenefovir. Alpha interferon is a treatment that is given in the form of subcutaneous injections and can remove the virus of hepatitis B, but in a small percentage of cases. The rest of the mentioned drugs are administered orally and do not cure the infection, but they can keep the virus under control for many years. It must be borne in mind that many patients infected with HBV can have inactive disease and, therefore, do not require any treatment.
At present, is considered to be the most effective pharmacological treatment against hepatitis C combination of Ribavirin (an antiviral which is taken by mouth) with Pegylated alpha interferon (which is administered subcutaneously). The treatment lasts between 24 and 48 weeks, and presents certain side effects that sometimes are not well tolerated by patients. The response to the treatment depends on the stage that is the disease, the type of virus that is infected and the amount of virus in the blood, among other factors. However, the use of these medications can cure the disease in many patients.
A recent advance in the field of hepatitis C is the incorporation of a diagnostic technique that allows to know with reliability if a patient is cured with treatment of hepatitis C. It is a mutation in a gene of the organism that produces a substance called interleukin-28b. This mutation is present naturally in many patients and can be determined very easily by means of a blood test. His determination is very useful when making the decision to treat or not to treat a patient.
It also should be noted that in recent years there has been a revolution in the treatment of hepatitis C. This is due to that many drugs that attack different enzymes essential to the development of the C virus, and manage to eradicate the disease much more often than with the treatments of the past have been developed. Two drugs called 'protease inhibitors' that, associated to the standard treatment with interferon and Ribavirin are available in Spain from the year 2011, get a high rate of cures. These medications are called boceprevir and telaprevir. They are not free from side effects and can only be used in patients with special characteristics, but they are a hope for the healing of many people. New treatments that have fewer side effects and which may be used in the majority of patients infected with HCV will be incorporated in the coming years.
It is very important that people with hepatitis take no drugs or other substances without prior consultation with the doctor, even vitamin supplements or herbs, that can be hepatotoxic. In addition, they must suppress alcohol consumption and a diet balanced and appropriate to your State to prevent malnutrition.
As the last option in cases in which the liver damage is irreversible may be transplantation. In Spain the first liver transplant was carried out on February 23, 1984, and there are 25 hospitals where more than a thousand patients each year are subjected to this intervention.
Hepatitis preventionThese are some questions to consider if you want to prevent a spread of hepatitis:
• Maintain proper hygiene habits, to avoid overcrowding and unsanitary conditions.
• Promote the purification of drinking water, and avoid drinking water in areas where sanitary conditions are poor and there is no proper control.
• Avoid sharing needles, syringes, etc.; addicts can go to social centres for sterile material.
• Do not undergo aesthetic procedures (piercings, tattoos, minor surgeries, etc.) in centers that are not approved.
• Sexual intercourse with protection.
Hepatitis vaccination.It currently exists and applies the hepatitis A and B vaccine; There is still vaccine against hepatitis C. Vaccination in adults guideline involves an initial dose and dose 6-12 months in the case of hepatitis A reminder. Routine vaccination of hepatitis B includes an initial dose, one a month, and one to six months. There is a combined vaccine against the virus of hepatitis A and B, which is given in three doses at 0, 1 and 6 month. The pattern of vaccination in children may vary according to the type of vaccine and the age of the patient.
He is recommended to get vaccinated against hepatitis A to all those who may have personal contact with carriers of the virus, suffering from hemophilia, day care personnel, medical and paramedical, workers in contact with wastewater untreated, drug users injecting, and people with multiple sex partners, as well as the people expected to travel to developing countries.
The vaccine against hepatitis B applies to newborn infants, individuals undergoing dialysis, sick kidney, chronic hepatitis, or carriers of the AIDS virus, people who have been in contact with carriers, drug users injecting, and people with multiple sex partners.
2 hepatitis C and AIDS
People who suffer from hepatitis C and AIDS at the same time have a ten times higher risk of developing cirrhosis, due to the fact that the coexistence of both viruses (HCV and HIV) significantly accelerates the progression of liver damage. Thus, when a person is infected by the virus of hepatitis C may take 20 years to express damage in the liver, but this time period is reduced to 10 years if you also suffer from AIDS. Therefore, not only HIV increases the chances of a patient with chronic hepatitis C develop cirrhosis, but that it also reduces the time of occurrence of this pathology.
Studies in this regard reveal that between both virus co-infection increases the odds of suffering a serious liver failure, which can put an end to the life of the patient.
Another factor that negatively affects the quality of life and prognosis of patients who suffer from both disorders, is related to treating HIV. And it is that drugs used to treat AIDS are processed by the liver, and if this body is damaged by HCV you may not be able to perform its function properly. On the other hand, many of these medications also cause liver, even though he is not infected with HCV; in this way, the treatment anti-HIV can further aggravate the damage caused to the liver for hepatitis C.
Advances in AIDS treatment have managed that patients can live a long time with the infection, but its long-term survival is seriously threatened if they contract hepatitis C, whose major complications, cirrhosis, and liver cancer, are the leading cause of death among HIV affected by HCV. Controlling hepatitis C is, therefore, essential to improve the prognosis of these patients.
3. consumption of alcohol and hepatitis
Some people have enough tolerance to alcohol, so it can be consuming an amount of this substance which is harmful to the body without getting drunk. This tolerance gives them a false sense of security and incapacitates them to perceive the physical discomfort associated with excessive intake of alcohol, which in reality act as alarm signals that sends the Agency a potential danger situation.
Alcohol and hepatitis are a dangerous combination. and it is that abuse of these drinks can cause an alcoholic hepatitis, which usually manifests itself after a season in which the affected has ingested a quantity of alcohol higher than usual. The most frequent in these cases symptoms are: fatigue, listlessness, loss of appetite, jaundice, weight loss, fever, and pain in the upper right area of the abdomen. If it is a severe alcoholic hepatitis patient can present also ascites (fluid in the abdominal cavity), signs of malnutrition and hepatic encephalopathy (altered brain function that occurs when the liver cannot eliminate toxins properly and they accumulate in the blood).
When the liver disease has been caused by alcohol the initial and most effective measure is the removal of their consumption immediately. A balanced diet is also very important for the recovery of the patient, that may require nutritional supplements in certain cases. In the event that the patient retain liquids it will be necessary that you remove salt from the diet and take diuretics, always under medical advice.
In people who suffer from chronic hepatitis C liver damage worsens and accelerates when they consume alcohol, in addition to increasing the risk of developing cirrhosis, which is an irreversible process that can stop or slow down if the spirit, shall be deleted but that once established prevents the liver to regain normalcy, and can lead to severe such as severe liver failure or cancer. Therefore, it is essential for patients with hepatitis C to completely eliminate alcohol from your diet.
4. nutrition and hepatitis
As for carbohydrates, the body stores them in the form of glycogen, which will be transformed into glucose when the body needs it. The diet may vary depending on the functioning of the liver, but normally it is advisable to increase the amount of carbohydrates in proportion to protein. However, too much reduce protein intake can cause malnutrition, so it is very important to follow the advice of your doctor, who will establish the proper amount of protein depending on its physical characteristics and liver damage. A guideline that hepatitis patients should be followed is to consider the meat as a complement of vegetables, pasta and legumes (e.g., Spaghetti Bolognese), and not to the contrary.
Hepatitis can affect the absorption of nutrients and influence the appetite of the sick, causing a loss of weight, reducing its energy reserves and hampering the recovery from illness. A balanced diet will help the patient maintain fluid and electrolyte balance in the body, and will decrease the workload of the liver, which is an organ involved in the conversion of food into energy.
Nutrition for hepatitis tipsHere are some tips on nutrition and dietary guidelines to keep in mind if you suffer from hepatitis:
• Carbohydrates should be the main source of calories from your daily diet.
• The fat be eaten sparingly, but no to remove them completely from the diet because they are necessary for the intestinal absorption of some vitamins. You should avoid sausages and meats with high fat content (pork, duck, lamb) and cook your food steamed, baked, boiled or grilled.
• Vitamin supplements, especially vitamins of the B group, can help to prevent nutritional deficiencies, but always under medical prescription, since vitamins are metabolized in the liver, and an excess can be counter-productive.
• It is suitable to limit the intake of salt, because it promotes water retention. Remember that packaged foods and sauces, unless they indicate otherwise, have a high content in salt, so you should avoid them.
• You should not self-medicate. The drugs can cause liver damage. For the same reason should always consult with your health care provider before taking herbs, since some can also be harmful to the liver.
• The recommended intake of protein for a patient with hepatitis is one gram of protein per kilogram of body weight; in this way, a person weighing 60 kg should eat 60 grams of protein daily. Your doctor must nonetheless indicate the most appropriate amount in your case.
• Do not take alcoholic drinks, even sporadically. You should not take drinks.
• It is better distribute food in four or five shots throughout the day because the liver works regularly and without excess load.
Foods allowed for the sick of hepatitisThese are some of the foods allowed for the sick of hepatitis. Also attached is a tasty menu recommended for liver patients:
• Fruits (apples, pears, oranges, bananas, plums, strawberries, peaches, tangerines, melon, watermelon, pineapple, apricots, kiwis, grapes,...).
• Vegetables (spinach, green beans, artichokes, asparagus, potatoes, lettuce, cucumbers, onions, peppers, Escarole, chicory, peas, lentils, chickpeas, beans).
• Dairy products (milk, cheese, yogurt,...). It is best if they are skimmed or semi-desnatados to reduce fat intake.
• Olive oil.
• Dried fruits (walnuts, almonds, hazelnuts...).
• Bread, rice, pasta (mostly integral), corn.
• Lean meat (rabbit, skinless chicken, Turkey, veal).
• Sugar and sweets (in moderation). We must opt for desserts and homemade sweets because industrial products contain fats that should be avoided.
5 hepatitis during pregnancy
Tests carried out moms include blood analyses to detect the presence of the virus of hepatitis B and C (and other infectious diseases), mostly because women carriers of the hepatitis B virus are likely to transmit the virus to her baby. There are, however, at present, preventive measures to protect these children when they are born (if Infected due to exposure to the blood of the mother during childbirth), and given a preparation of gamma globulin and vaccine against the virus, which prevents the transmission in more than 90% of the cases.
Hepatitis C does not interfere with pregnancy, childbirth or the health of the baby, except that the expectant mother suffer advanced liver disease or other complication, requiring to be treated. However, women with HCV have a high risk of cholestasis of pregnancy, which is often benign and disappears spontaneously, but increases the risk of preterm birth.
Treatment of hepatitis during pregnancyTreatment of hepatitis during pregnancy focuses on minimizing liver damage and manage the complications of the disease (although not be given to the pregnant such as Ribavirin and interferon antiviral agents because they could affect the fetus), and reduce the risk of transmission of the virus to the newborn.
The placenta acts as a barrier that prevents contagion to the baby, which occurs at the time of the birth or after birth. In the case of hepatitis C the factors that increase the chances of such transmission are related to the characteristics of the mother, such as high concentrations of HCV, or the coexistence of the AIDS (HIV) virus hepatitis. That type of birth is vaginal or cesarean not has been linked to the increase or decrease in the transmission of HCV the baby.
Breastfeeding and hepatitisAs for breastfeeding, there is no evidence that hepatitis C transmission through breast milk, so most pediatricians do not advise to avoid breast-feeding a baby even if the mother is infected with hepatitis C.
However, if the mother is taking medication to treat the disease, you should consult with your doctor the possibility of drug effects to short- or long-term health of the baby and, in that case, suspend the treatment or breast feeding.
A woman infected with hepatitis B can also breastfeed your baby. In Spain, all the newborns are vaccinated against the virus of hepatitis B (HBV). Babies whose mothers are carriers of HBV should be vaccinated during the first twelve hours of life, and also supplied them specific immunoglobulin against disease.
6 tips for travellers to prevent hepatitis
Hepatitis A, for its part, although it is more mild (except in rare cases in which causes fulminant liver failure) and not be chronic, is a disease that is endemic in some areas of the planet. They are considered risk countries: all of Africa, Asia and Middle East, Central America and Caribbean, Eastern European, and the islands of the Pacific except Australia.
Below are a few tips that you must follow if you want to make your adventure a nightmare:
Vaccinate youAlthough hepatitis C vaccine is not yet ready, they are available, on the other hand, vaccines against viruses A and B. Travel to countries where hepatitis A is endemic is recommended before vaccination ideally at least four weeks before the trip. However, if the trip is unexpected, is currently considered that a single dose of vaccine is still effective but get the same day of the start of the journey. The second dose will be administered between 6 and 12 months later, to achieve long-lasting immunity.
Currently the hepatitis B vaccine is indicated for all babies, but most adults aren't vaccinated, so you should inform you in this regard if you are planning to travel to countries with high incidence of the disease, especially if the stay is going to be extended, or the trip involves close contact with the population. The vaccine has an efficiency of 90% in adults and adolescents, protective levels are reached within two weeks of the 2nd dose, and the effect lasts for at least 10 years.
Learn about your place of destinationBefore leaving, always it is convenient to know the characteristics of the country and, especially, of the specific areas that you are going to go; not only to know in advance if it's endemic areas for certain diseases, but also to find health resources with which you can count in case of contracting any infection or an accident as, for example, the bite of an animal or a wound with material likely to be contaminated.
Extreme hygieneEspecially in the hands. Wash your hands frequently and dry with handkerchiefs or single-use paper towel, especially after going to the bathroom, is a step that you must follow, even if you don't travel. Hepatitis A virus is transmitted through food or beverages previously contaminated with fecal matter, and also by close contact with infected individuals, favored by situations of overcrowding and poor hygiene.
If you aren't forced to use a bathroom whose cleaning leave much to be desired, avoid touching the door and the toilet lid directly with your hands and use a piece of paper to do so. In these cases, and although it seems exaggerated, can also take up a package of disposable latex gloves.
Be careful with what you eatAnd, of course, with what you drink. Do not consume food or beverages that are sold in stalls, although its appearance is appetizing and you're hungry. You should also avoid salads and raw vegetables, because they have been able to be irrigated or washed with contaminated water. For the same reason, in the case of fruits, eat only those yourself peles and, if you want to wash before, do it with mineral water.
Baby only drinks or bottled water, purchased at sites offering you guarantees (sometimes street vendors offer water bottles that they themselves have completed); to brush your teeth would not be more that use mineral water, even if staying at a good hotel.
Practice safe sexHepatitis, AIDS and many other sexually transmitted diseases, can also get through sexual intercourse. Remember that many people are chronic hepatitis B virus carriers, even if they are not ill and appear healthy. So if during your stay you keep sex with any person resident in the area where hepatitis is endemic (or with anyone you do not know well), always use condoms to reduce the risk, and prevents practices such as anal penetration, oral sex, and any other that may cause cuts or abrasions that could increase the risk of infection.
Avoid contact with the alien bloodYou can get if you enter in contact with the blood of a person infected with the virus of hepatitis B or C. Therefore, if necessary, help someone who, for example, has had an accident and is bleeding, seeks not you splashing blood, and wash immediately after.
In the case that you're the victim, it rejects treatments involving injections, surgery and, above all, blood transfusions, unless it is strictly necessary, or are sure that the health centre and materials are properly sterilized.