Disseminated varicella-zoster virus infection in an aplastic anemia- paroxysmal nocturnal hemoglobinuria syndrome patient: A case report

Jersey Mike's Oceanside Store Customers May Have Been Exposed To Hepatitis A, Health Officials Warn

There was a possible hepatitis A exposure at a Jersey Mike's restaurant.  Credit: Bloomberg/David Paul Morris

People who ate at a Jersey Mike's Subs restaurant in Oceanside between April 5 and April 19 may have been exposed to hepatitis A, the Nassau County Department of Health announced late Friday.

A food handler who worked in the shop at 24 Atlantic Ave. Was confirmed to have hepatitis A, officials said. Anyone who ate food or drinks prepared at the store or used its bathroom could have been exposed.

"Though the risk of transmission is considered low, out of an abundance of caution, individuals who may have been exposed are advised to speak to their health care provider," the health department said in a statement.

The hepatitis A virus causes a disease of the liver that is usually a mild, short-term illness, according to the Centers for Disease Control and Prevention. Symptoms may appear between 2 and 7 weeks after exposure and can include: yellow skin or eyes, nausea, stomach pain, joint pain, dark urine or clay-colored stools.

It can be spread by eating food and drinks handled by an infected person or coming in contact with something contaminated by the stool of a person with hepatitis A.

Anyone who already had hepatitis A or received two doses of the hepatitis A vaccine are protected, the health department said.

One dose of the vaccine may help prevent hepatitis A for people who have been exposed within the past two weeks. But people should consult with their doctors for advice.

The county has set up a weekend call center for anyone who needs more information. People can dial (516) 227-9651 between the hours of 10 a.M. And 2 p.M.

Lisa joined Newsday as a staff writer in 2019. She previously worked at amNewYork, the New York Daily News and the Asbury Park Press covering politics, government and general assignment.

What Your Body Might Be Saying About Hepatitis

That unexplained fatigue dragging you down for weeks. The slight yellowing around your eyes that you blamed on poor lighting. The vague abdominal discomfort you've been treating with over-the-counter remedies. These seemingly unrelated symptoms might actually be your body's way of alerting you to hepatitis, an inflammatory condition affecting your liver that often progresses quietly until it causes serious damage.

With hundreds of millions of people worldwide living with viral hepatitis, this condition ranks among our most significant global health challenges. Yet many people know surprisingly little about the different types, how they spread, and most importantly, how to protect themselves and their loved ones.

Let's dive into the essential facts about hepatitis that everyone deserves to know, from recognizing subtle warning signs to understanding treatment options that have dramatically improved in recent years.

The alphabet soup of hepatitis viruses

Not all hepatitis is created equal. The term itself simply means inflammation of the liver, but the various viral forms of hepatitis differ dramatically in how they spread, who they affect, and what they do to your body.

Hepatitis A spreads primarily through contaminated food and water. This version typically causes acute infection rather than becoming chronic. While it can make you extremely sick for weeks or months, it usually resolves completely without long-term damage. Think of it as the unwelcome but temporary visitor of the hepatitis family.

Hepatitis B transmits through blood and body fluids, making it especially common through unprotected sex, sharing needles, or from mother to baby during childbirth. What makes Hep B particularly concerning is its ability to establish chronic infection in many people who contract it, especially those infected at birth or in early childhood. Left untreated, chronic Hep B can lead to cirrhosis and liver cancer decades after the initial infection.

Hepatitis C also spreads through blood-to-blood contact, with sharing needles during drug use representing the highest risk in developed countries. Before blood supply screening became routine in the early 1990s, many people also contracted it through blood transfusions. The insidious nature of Hep C lies in how quietly it progresses. Many people have no idea they're infected until liver damage appears decades later. The good news is that revolutionary treatments now cure over 95% of Hep C cases.

Hepatitis D is the unusual case that can only infect people who already have Hepatitis B. This "tag-along" virus requires the Hep B virus to replicate. When these two viruses infect someone simultaneously, the liver damage typically progresses much faster.

Hepatitis E transmits similarly to Hep A through contaminated water and food. While usually self-limiting like Hep A, it poses particular danger to pregnant women, who can experience severe complications. This version appears most commonly in regions with poor sanitation but occasionally surfaces elsewhere through undercooked pork products.

Beyond these viral forms, hepatitis also develops from excessive alcohol consumption, certain medications, toxins, and autoimmune conditions where the body mistakenly attacks its own liver tissue.

The warning signs your liver is in trouble

The liver's remarkable ability to function even when partially damaged means hepatitis symptoms often don't appear until significant inflammation has occurred. When symptoms do emerge, they frequently mimic other common conditions, making hepatitis easy to miss.

Fatigue ranks among the most common and overlooked hepatitis symptoms. This isn't your standard tiredness after a poor night's sleep but a persistent exhaustion that rest doesn't seem to improve. Many people describe it as feeling like "walking through mud" with every movement requiring extraordinary effort.

Jaundice, the yellowing of skin and eyes, represents the most recognizable hepatitis sign. This occurs when your liver can't properly process bilirubin, a yellowish compound produced during the normal breakdown of red blood cells. The yellowing often appears first in the whites of the eyes before affecting the skin.

Abdominal discomfort, particularly on the right side beneath your ribs where your liver resides, might feel like a dull ache or fullness. This discomfort typically worsens after heavy meals as your compromised liver struggles to process nutrients.

Digestive disturbances like nausea, vomiting, reduced appetite, and unexplained weight loss occur as the liver's ability to aid digestion diminishes. Some people notice changes in their stool color, with paler than normal bowel movements indicating problems with bile flow.

Darkened urine often precedes other symptoms by days or weeks. If your urine consistently appears dark amber despite adequate hydration, your liver might be struggling to filter waste products properly.

Muscle and joint pain affect many people with hepatitis, creating aches that move around the body and don't respond well to standard pain relievers. This results from inflammatory immune responses and altered metabolism of substances that would normally be processed by a healthy liver.

Skin changes beyond jaundice include unusually intense itching without an obvious rash, spider-like blood vessels visible on the skin surface, and increased bruising or bleeding from minor injuries due to the liver's decreased production of clotting factors.

How hepatitis hijacks your liver's essential functions

Understanding hepatitis begins with appreciating your liver's critical roles in maintaining health. This remarkable organ performs over 500 functions, from producing essential proteins and cleaning your blood to metabolizing medications and storing vitamins.

When hepatitis viruses infect liver cells or inflammation strikes from other causes, these vital functions begin to falter. The inflammation disrupts your liver's architecture, interfering with its ability to filter toxins from your bloodstream. These circulating toxins contribute to the fatigue, brain fog, and general malaise that characterize hepatitis.

As inflammation persists, scar tissue gradually replaces healthy liver cells in a process called fibrosis. Unlike other organs that regenerate cleanly, the liver often rebuilds itself with fibrous tissue that doesn't function like original liver cells.

When scarring becomes extensive, cirrhosis develops. At this advanced stage, the liver takes on a nodular, lumpy appearance as regenerating cells become surrounded by scar tissue. Blood flow through the liver becomes restricted, causing pressure to build in the vessels feeding the liver. This increased pressure can force fluid into the abdomen and create enlarged veins in the esophagus that may rupture and bleed.

The most serious consequence of chronic hepatitis is hepatocellular carcinoma, a form of liver cancer that develops in some people with long-standing liver inflammation. The constant cycle of damage and repair creates an environment where cancer-causing mutations become more likely.

The prevention strategies everyone should know

Despite the serious nature of hepatitis, we have more tools than ever to prevent infection and serious consequences.

Vaccination provides powerful protection against Hepatitis A and B. These vaccines are remarkably effective, with the Hep B vaccine being the world's first anticancer vaccine because it prevents the liver cancer that can result from chronic infection. While no vaccine yet exists for Hepatitis C, preventing infection through other means remains crucial.

Practicing safer sex with barrier methods reduces transmission risk for Hepatitis B and, to a lesser extent, Hepatitis C. This becomes especially important with multiple partners or in situations where a partner's status is unknown.

Never sharing personal items that might contain traces of blood like razors, toothbrushes, nail clippers, or glucose monitoring equipment eliminates common household transmission routes.

Choosing reputable tattoo and piercing providers who follow proper sterilization procedures prevents infections that still occur all too frequently in unregulated settings.

Maintaining food safety practices protects against Hepatitis A and E, particularly when traveling in regions with questionable sanitation. This includes drinking bottled or purified water, avoiding raw shellfish, and thoroughly washing fruits and vegetables.

For those who use injectable drugs, never sharing needles or any injection equipment significantly reduces Hepatitis B and C risk. Many communities now offer needle exchange programs that provide clean supplies to reduce transmission.

Limiting alcohol consumption benefits everyone's liver health, but becomes particularly important for those already diagnosed with any form of hepatitis. Alcohol accelerates liver damage regardless of what caused the initial inflammation.

Testing and treatment options you should discuss with your doctor

The medical landscape for hepatitis has transformed dramatically in recent years, offering new hope for millions. Understanding testing and treatment options empowers you to advocate for appropriate care.

Blood tests for hepatitis fall into several categories. Antibody tests reveal if you've been exposed to hepatitis viruses, while antigen tests detect actual viral particles. Viral load testing measures the amount of virus in your bloodstream, helping guide treatment decisions and monitor progress.

Liver function tests assess how well your liver continues to perform its duties. Elevated liver enzymes like ALT and AST indicate ongoing liver cell damage, while abnormalities in bilirubin, albumin, and clotting factors suggest more advanced dysfunction.

Imaging studies including ultrasound, CT scans, MRI, and specialized elastography measure liver stiffness and help physicians evaluate the extent of scarring without invasive procedures.

Liver biopsy, once the gold standard for assessing hepatitis damage, is now reserved for specific situations where other tests can't provide clear answers. This procedure involves removing a tiny liver sample for microscopic examination.

Treatment approaches vary dramatically depending on hepatitis type and severity. Antiviral medications can completely cure Hepatitis C in most people after 8-12 weeks of treatment. For chronic Hepatitis B, antivirals suppress the virus long-term, reducing liver damage and cancer risk, though true cures remain rare.

Autoimmune hepatitis responds to medications that modulate the immune system, preventing it from attacking liver tissue. Corticosteroids often serve as first-line treatment, followed by other immunosuppressants for maintenance.

Liver transplantation becomes an option in advanced cases where the organ can no longer function adequately. Remarkable advances in this field have significantly improved survival rates, though demand for organs still far exceeds supply.

Living well with hepatitis – it's possible

A hepatitis diagnosis, while serious, doesn't preclude a full and active life. Many people with various forms of hepatitis thrive for decades by following certain health strategies.

Maintaining consistent medical care with specialists experienced in liver disease ensures appropriate monitoring and timely intervention when needed. Regular checkups help catch complications early when they're most treatable.

Following a liver-friendly diet emphasizing plants, whole grains, and healthy fats provides your liver the nutrients it needs without overworking it. Limiting processed foods, sugar, and saturated fats reduces the metabolic burden on an already challenged organ.

Exercising regularly improves insulin sensitivity and reduces fatty infiltration of the liver, a condition that can compound damage from viral hepatitis. Even moderate activity like walking brings significant benefits.

Avoiding liver-toxic substances becomes essential with hepatitis. This includes being cautious with medications like acetaminophen, certain supplements, and obviously alcohol. Always check with your healthcare provider before taking any new substance.

Managing stress through mindfulness, adequate sleep, and supportive relationships reduces inflammation throughout the body, benefiting liver health along with overall wellbeing.

Armed with accurate information and appropriate medical care, most people with hepatitis can expect good outcomes. The key lies in awareness, early detection, and consistent management of this common but often misunderstood condition. Your liver performs hundreds of vital functions every day. Learning to protect it represents one of the most important health investments you can make.

Closure Of CDC Hepatitis Lab Imperils U.S. Outbreak Response, Prevention

An estimated 4 million Americans are infected with hepatitis C, a disease that can go undetected for years. Another 2.4 million people in this country are chronically infected with hepatitis B, which is the leading cause of liver cancer globally.

Hepatitis B is preventable, and hepatitis C is curable. But the U.S. Capacity to battle these viral scourges has been leveled a devastating blow with the April 1 closure of the country's premier testing laboratory for viral hepatitis, experts warned. 

The lab was one of the targets of this month's Department of Health and Human Services reductions in force, or RIFs, which slashed about 18% of the Centers for Disease Control and Prevention's workforce and abruptly terminated many of the public health programs conducted by the Atlanta-based agency.

The loss of the CDC's viral hepatitis lab will leave the country with no good way to measure the scale of the problem it faces with these diseases, they suggested, and less able to find the sources of — and put an end to — outbreaks that can be linked to contaminated food, in the case of hepatitis A, or poor infection control procedures in medical facilities, in the case of hepatitis B and C. 

"Without [the lab] we won't have any idea of what the distribution of viral hepatitis is in the U.S.," said Chari Cohen, president of the Hepatitis B Foundation, a nonprofit that focuses on finding a cure and improving the quality of life for people living with hepatitis B.

The preponderance of the CDC cuts were in the areas of chronic disease, environmental health, and injury prevention, with many of the infectious diseases teams at the agency emerging relatively intact so far.  Despite that, the 27 full-time workers who staffed the viral hepatitis laboratory in the National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention were among those axed. Colleagues who work on surveillance and hepatitis control were saved, but will be forced to conduct their work without the evidence generated by their lab, which provided critical data to help them pinpoint the source of outbreaks or revise control policy when needed. Without the lab, public health officials working to stop transmission of hepatitis viruses are like police officers trying to solve a crime without the capacity to analyze fingerprints or test for the DNA of the perpetrator. "They're one of the only labs in the world who did the kind of specimen analysis that they did. Highly, highly specialized molecular analysis of viral hepatitis samples," Cohen said. David Margolius, director of public health for the city of Cleveland, suggested closing the CDC's hepatitis lab is self-defeating.   "It's not saving money. It's setting us backwards," Margolius told STAT in an interview.  "The most recent year of analysis of hepatitis C showed the first decline in nationwide cases for the first time in years, and there is a cure for hepatitis C, which is relatively new. And so with effort and leadership from the federal government, we could end the hepatitis C epidemic in our country and cure everybody," he said. "It's a small investment for a big payoff." Hepatitis is an umbrella term for inflammation of the liver, which can be caused by a variety of things. But a handful of viruses, known as hepatitis A through E, are common causes of the condition, and the targets of study of the recently shuttered lab.  Hepatitis A and E are transmitted through what's known as the fecal-oral route, meaning something contaminated with the virus is ingested. Hepatitis B and C are spread through bodily fluids, with B most commonly passing from an infected person to their baby during childbirth, and C associated with sharing needles during injected drug use, or improperly sterilized medical equipment. Hepatitis B, C, and D can also be transmitted during sex, though that is less common for C. Some people infected with these viruses will clear the infection on their own. But for some people, hepatitis B and C infections become chronic, and eventually life-threatening. There is no cure for hepatitis B, though there is an effective vaccine, which is supposed to be given to newborns to prevent infection at birth. The younger one is when infected with hepatitis B, the higher the chance that the infection will become chronic, potentially leading to liver damage, cirrhosis, or liver cancer. People who develop chronic hepatitis B face a lifetime of medication to control their illness.  One of the key hurdles in preventing transmission of these viruses is that many people who are infected do not know it. And without the CDC lab, estimating how many infections there are nationally and where transmission is most intense may no longer be possible. Commercial laboratories that process tests for clinicians and hospitals generate some data, but tallies based on them only count the infections that have come to the medical community's attention. They cannot be used to calculate how many people are infected and unaware of that fact. The way those estimates have been generated has been through the CDC lab, which every two years tests a nationally representative number of samples from people who take part in the National Health and Nutrition Examination Survey, known as NHANES. Those findings are used to estimate the prevalence of hepatitis A through E among Americans.  The invisibility of good public health work

One of the impacted staff from the viral hepatitis division, who asked not to be named for fear of reprisals, said the lab group was just about to begin analyzing the most recent round of NHANES specimens when the lab was closed.

"We are now blind to a lot of these things. You can't develop a response if you don't know your burden. And you can't pick up hot spots," said Su Wang, an internal medicine specialist in Florham Park, N.J., whose practice treats many viral hepatitis patients and who is on the board of the Hepatitis B Foundation.

Cohen said trends in infections could perhaps be estimated by studying large datasets from private labs, "but they're never going to give you a picture of what's happening overall." 

The lab's closure comes at a time when there are multiple outbreaks in the country, at least two of which are associated with medical facilities. Finding out that cases are linked — and figuring out how the infections took place — is crucial to determining if a clinic or hospital is failing on infection control, said the CDC worker who asked not to be named. 

"It's important for the authorities to know this clinic or this particular facility really is responsible for having this pathogen transmitted because they have a breach in infection control practices," the individual said.

Determining that cases are linked requires a laboratory to generate genetic sequences of viruses from a variety of cases and compare the sequences. This is not something commercial labs can be expected to do, the person said.

"Yes, they can receive a diagnosis from any commercial lab," the individual said. "But whether they are part of the same transmission cluster, whether they got infected at the same facility or they got infected elsewhere, that information they cannot get from a health department. They cannot get this information from any commercial lab. Because there's no money to be made there."

The closure also comes as the lab was making big strides in developing a point-of-care test for hepatitis C, something that has long been needed and does not exist anywhere in the world.

Testing for hepatitis C is currently a two-step process. A single blood draw that could determine on the spot whether a person is infected would be a game-changer, especially now that there are direct-acting antiviral pills that are effectively a cure. "This is a significant need in our field so that you can identify those millions of individuals and they can benefit from this treatment," said the CDC employee. Work on the test was progressing positively, though it still needed fine-tuning. Where that work goes now is unknown, the person said. "In the middle of it, it is all shut down."

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