By Juliana Goodwin
News-Leader
The outbreak led to panic: Hundreds of people lined up in 1997 at the Springfield-Greene County Health Department for inoculations against hepatitis A after the condition popped up at a local restaurant.
It’s been years since there has been such an outbreak locally, and Ron Lawson, a public health investigator for the department, credits a 2001 health ordinance that requires restaurant workers to wear gloves when handling ready-to-eat foods.
Even so, the threat of hepatitis can stoke fear among health officials and the public.
The word hepatitis simply means inflammation of the liver. Alcoholism and an overdose of pills can cause it, but hepatitis A, B and C are all viruses with distinct differences. Hepatitis D and E also exist, but are extremely rare.

There are vaccinations for hepatitis A and B, but not C — which may make it more of a concern.
Here’s more on the most common types of hepatitis, what causes them and how they can be avoided.
Hepatitis A
Hepatitis A is a liver disease caused by the hepatitis A virus (HAV).
What sets A apart from B and C: It’s a fecal-oral virus, which means that fecal matter containing the virus somehow enters the mouth. It is often spread through poor hygiene, such as bad hand-washing habits. According to the Centers for Disease Control in Atlanta, outbreaks can occur in restaurants, child-care centers with many children in diapers, and it can potentially be spread through sexual contact, especially between two men.
While hepatitis A is the most common type of hepatitis nationwide — accounting for 30 percent of cases — it’s also the least serious, said Dr. Georgeanne Freeman. Freeman is a family practice physician at Dade County Family Medical Center in Greenfield who also has a master’s in public health.
Dr. Jonathan Thornsberry with Cox Family Medicine Residency said hepatitis A is acute, not chronic.
“Usually symptoms are gastrointestinal (such as) vomiting and diarrhea,” he said. “It usually runs its course. You don’t have it for life.”
In fact, most people get over it in a few weeks.
Also, a vaccine exists for this type of hepatitis.
The Ozarks is not following the nationwide trend: Linda DeGraffenreid, epidemiologist with the Springfield-Greene County Health Department, said HAV is the least common version locally.
“Currently we’re seeing an increase in hepatitis C. Here and there we see B, and then rarely we see hepatitis A,” DeGraffenreid said.
Hepatitis A can occur in isolated cases or widespread epidemics, such as an outbreak that originates in a restaurant. Lawson said the city health department urges restaurant workers to get vaccinated, and more are volunteering to do so. The department offers discounts on hepatitis A shots for those in the restaurant industry.
Hepatitis A vaccinations are not standard for the public, but people who dine out a lot or who are traveling overseas to an area where there are more cases may want to consider being vaccinated, DeGraffenreid said. The CDC also suggests that men who have sex with men should be vaccinated.
The good news is that once someone has had hepatitis A, according to the CDC, they can never get it again.
The best way to prevent the spread of hepatitis A is by frequent hand-washing, DeGraffenreid said.
Hepatitis B
Hepatitis B is a serious disease caused by the hepatitis B virus (HBV), which attacks the liver. It can cause lifelong infections, cirrhosis of the liver, liver cancer, liver failure and death.
According to the CDC, it occurs when blood or body fluids from an infected person enter the body of a person who is not immune.
“Hepatitis B and C are what we call blood-borne pathogens,” DeGraffenreid said. “They can be transmitted through the blood.”
There are an estimated 1.25 million Americans chronically infected with hepatitis B, the CDC says.
Ann Erving, a registered nurse with Skaggs Community Hospital in Branson who is certified in infection control, said the virus is virile.
“Hepatitis B is very concentrated in the bloodstream and can live a long time outside the bloodstream,” Erving said. In fact, she continued, studies have shown that the virus can be alive even in blood that has been dried for seven days.
Nationwide, cases of HBV have declined significantly in the past two decades, especially among children: There has been a hepatitis B vaccine since 1982, and inoculation is now required before a child can attend school.
The virus is sometimes contracted by sharing needles and through blood transfusions, though all donated blood is tested for hepatitis B and C. It can also be spread from an infected mother to her baby during birth.
But it is most commonly spread through sexual intercourse, Freeman said, and has a higher occurrence in people in their 20s.
In Greene County, the number of hepatitis B cases rose from just fewer than 20 in 1998 to just fewer than 60 in 2003.
Erving said about 30 percent of those with hepatitis B do not display symptoms. And the severity is different for each person, Freeman said — hepatitis B can be an acute or chronic infection. Chronic carriers are infectious and account for about 20 percent of those infected, according to the CDC.
As with any case of hepatitis, alcohol and some over-the-counter medications can make HBV worse.
There is treatment for hepatitis B, and some people get over it without any drugs.
People can protect themselves from the virus by getting vaccinated, not sharing drug or tattoo needles and practicing safe sex.
Hepatitis C
“Hepatitis C scares me,” Freeman, the public health expert, said.
The virus, which has no vaccine, is the leading cause of liver transplants in America, the CDC says.
There are an estimated 3.9 million Americans infected with the hepatitis C virus (HCV), and 2.7 million of those are chronically infected, the organization says.
Like B, hepatitis C is spread when blood or other fluids from an infected person enter the body of a person who is not infected. It can be spread through shared drug or tattoo needles, by being stuck with a needle or other sharp instrument or by an infected mother to a baby during birth. HCV can be spread by sex, but this does not occur very often.
Nationwide, the number of new infections per year has declined from an average of 240,000 in the 1980s to about 30,000 in 2003, according to CDC statistics.
The number of new chronic hepatitis C cases in Greene County has fluctuated: It was 141 in 1999, peaked at 641 in 2001, and had fallen to 362 in 2003, according to figures from the Missouri Department of Health and Senior Services.
Despite the higher number of cases there is no cause for alarm, officials say: The numbers are higher because more doctors are testing for it, DeGraffenreid said.
“Recently (they) are really starting to test for it. If you look for something you will find it, so that will skew the numbers,” she said.
Some health care professionals say this virus is the version of hepatitis that concerns them the most.
“To me, it’s terrifying. This is what health-care workers fear the most because it’s so easy to get from the blood. Back when I delivered babies it was a big fear,” Freeman said.
There are several reasons for this fear; the most obvious is that there is no vaccine to protect against it.
And if someone contracts hepatitis C, it’s more likely he or she will have the more serious form: 55-85 percent of those infected with HCV are chronically infected, according to the CDC.
Also, while there is medicine for hepatitis C, many people cannot tolerate the drugs.
“The problem is the drugs often make the patients sicker than the hepatitis itself,” Freeman said.
Lastly, the treatment doesn’t always work, Thornsberry said: “A large number of these people, after five years will (still) show evidence of hepatitis C in their blood. The problem with the treatment is it’s not extremely effective.”
Another major concern is that hepatitis C can incubate in the body for decades without symptoms showing up, Erving said.
“About 80 percent of people don’t show signs or symptoms. During Vietnam we did a lot of blood transfusions on the field and back then we didn’t even know about (hepatitis) C and so now we are seeing more of that,” Erving said.
People should be tested for hepatitis C if they have ever injected illegal drugs, received a blood transfusion or a solid organ transplant before July 1992, were a recipient of clotting factors made before 1987, have ever been on long-term kidney dialysis or have evidence of liver disease.
Hepatitis is detected with a blood test. People do not need to test for hepatitis C unless they have risk factors, DeGraffenreid said.