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Viral hepatitis: A silent epidemic killing more people than HIV, malaria or TB (nature.com)
248 points by pseudolus 42 days ago | hide | past | web | favorite | 101 comments

Viruses that cause hepatitis actually embed themselves WITHIN LDL Particles (the "bad" cholesterol) to transport around the body. In doing so, they hide from the immune system.

APOE it turns out, the Alzheimer's gene, ALSO predicts your risk for liver cancer ...... because this is the gene that the virus binds to while assembling into the particle. Hepatitis virus infections are strongly associated with heart disease!


FYI, 23andme provides an Late-Onset Alzheimer's Disease report[1] based via the ε4 variant but does not test for a person's full APOE genotype.

[1] https://you.23andme.com/reports/ghr.alzheimers/

pssst .... APOE genotype predicts how much viral DNA for Herpes is found in the brain .... post mortem .....

It's almost as if Herpes viruses transport around the body the same way ;)

(Bar plots in this paper are LOG!)


There's a theory that amyloid-beta plaques are protective reactions to encapsulate infections, which go out of control in Alzheimer's. As people age, the blood-brain barrier weakens, allowing more viral particles in. This is why people with herpes are at higher risk.


I thought almost everyone had some type of herpes simplex (chicken pox, cold sores, warts, etc). Does that mean almost everyone is at higher risk?

Now I'm scared; 23andme reported that I'm at risk for Late-Onset Alzheimer's. What lifestyle changes can I make to reduce the risk of liver cancer?

Vigorous exercise may help with Alzheimer's.


The results indicate that aerobic exercise is more effective than any currently approved medication in fore-stalling Alzheimer's disease.

Also , keep your weight down.


A new study found a culprit for the increasing rates of liver cancer: obesity. The study published in the journal, Cancer Research, found that high body mass index (BMI) and a large waist circumference were associated with an increased risk for liver cancer. In addition, having type 2 diabetes, another result of obesity, also increases the risk.

Keeping weight down reduces risks across the spectrum, probably linked to the immune system. So nothing specific to Alzheimer.

Im a Phd, not an MD, but I'm currently trying to get my MD to see the light :


Their FAQ actually provides all the pointers I was otherwise able to come up with, so is probably worth a shot:


In addition, you may find it helpful to talk to a genetic counselor about your results; your GP/PCP should be able to get that sorted, although 23andme provides additional resources.


take a daily herpes antiviral https://www.healthline.com/health-news/evidence-of-link-betw... and reduce your alzheimer's risk by 90%


A family member has herpes and recently started showing signs of dementia. I’m going to have them try that regimen. I’m also going to reach out to that doctor.

Hey, I've been taking acyclovir for decades. Maybe I'll luck out. But at least, I avoid the excruciating sores.

Are you taking acyclovir solely for Alzheimer's prevention?

Intermittent fasting is showing promising results. Also probably the best bet for preventing diabetes and obesity.

The same is true for nearly every virus, systemic cancer, and organ disyfunction syndrome. Nothing astonishing about the ones you mentioned.

What if you have low LDL? Do good vascular health and healthy diet protect from the virus?

That's one hypothesis. Another one is simply that in some people, LDL is high because they have an infection that specifically turns on those LDL-making genes. It's known that many viruses hijack cholesterol pathways in cells.

Weird notes on HBV:

- More contagious than HCV or HIV, apparently can even be spread via saliva. Potential infections can happen from uncleaned tattoo guns, razors used for shaves, unchanged soaking water/bowls and cuticle scissors at nail salons, unwashed hotel sheets/towels/robes, etc

- 5-10% of immunized people don't develop enough antibodies to protect against infection

- Remains contagious from 7 days to a month outside the body

- Can be killed by boiling, but 1:9 bleach solution requires up to 20 minutes soaking (hydrogen peroxide is quicker)

I guess we won’t be seeing any coin op electric shaving machines again. http://www.icollector.com/Pitchford-Coin-Operated-Electric-S...

> can even be spread via saliva.

While possible, is extremely unlikely. For it to be spread by saliva a) the saliva of the infected person would have to contain blood (e.g. bleeding gums) b) come into contact with an open wound in the other person (also has a cut or cold sore etc)

Not extremely unlikely given that most saliva swapping likely goes on between partners who kiss on a daily basis and hence are extremely likely to have at least one interaction where both parties have a combination of cuts, bleeding gums, cold sores or similar.

It's complicated. The level of infectiousness to others varies depending on the state of the virus in the person who carries it. People with a chronic infection (long term) typically have low level infectivity. So it would be a very unlikely combination of factors coming together for transmission to occur that way.

It's still 50x-100x more infectious than HIV, because of the very high concentrations of it in bodily fluids. This combined with its very long lived potency out of the body makes for much easier infection.

In theory, you could drink from a glass and leave the virus in saliva on the rim. If nobody cleans the glass, and five days later someone with bleeding gums drinks out of it, it's still infectious.

I'm glad awareness is increasing. These asymptomatic viruses are so scary and probably make it trickier to diagnose and help people, let alone at scale.

I wasn't diagnosed with Hep C until my mid-20s even though I was likely born with it - it was just sheer luck I found it before living a few more decades until surprise liver failure. I hate to think of the many who might be in a similar circumstance.

I'm a white, western male in my late 30's with a chronic Hep B infection, picked up as a child living in Africa. The only difference it's made in my life is having to have some awkward conversations with prospective intimate partners, having to get regular blood checks (every 6-12mths), and not being able to join the military.

The good news with Hep B is a) there is a very effective vaccine against it b) if you pick it up as an adult you have a good chance of getting rid of it. The bad news is there is no cure for chronic infections and the risk of liver disease is greatly increased. As the article mentioned, in recent years there have been breakthroughs in treatment of Hep C leading to a cure so I'm hopeful there will be a cure for Hep B in my lifetime.

What happened in Canada? You see charts like this with sub-Saharan Africa and Mongolia are lit up and that's no surprise, but then Canada shows up and you wonder what happened. They scored worse than the US at a healthcare metric! They scored worse than Mexico.

Is this one of those things where the Indigenous population has a real problem that is skewing the numbers for the entire country or did the government not believe in the vaccine for some reason?

I don't know _what_ is going on but I have a guess.

I live in Canada. We see these 'Hepatitis vaccine' posters at every doctors office/clinc. They are all related to "going on vacation somewhere warm".

So the implication is "Caribbean vacation = hepatitis".

There were even TV commercials that tried to show "unexpected places you could get hepatitis from", from the ice-cube, from the sand on the beach (showing a cut foot), from a nail salon, etc. Just to try and raise awareness.

Hepatitis rates among First Nations, Metis and Inuit are apparently significantly higher than hepatitis rates among other Canadians.

That does sound plausible.

Free health care? Sure! Drinkable water? Fuck no!

The only good thing you can say about Canadas treatment of it's First Nations is that we haven't recently given them small-pox filled blankets.*

*that has been caught on film and verified by 300 independent labs.

A not insignificant contributor to the higher levels of hepatitis is intravenous drug use. You could also depress yourself to no end if you reviewed the levels of suicide amongst indigenous Canadians. It's genuinely shocking.


We didn't give them any ever. And the only reservations that don't have drinkable water are doing it by choice. They get millions of dollars and band leaders choose to spend it on themselves instead of their communities. Stop acting like non-whites are all retarded children that white people must babysit and do everything for. The more you treat people that way, the more they act that way.

It's the same with the Australian Aborigines, but then virtually every other kind of disease is also much higher amongst that group - especially those living in remote communities. As the article says, Hep B is largely "a disease of the poor".

I don't follow. You're saying posters and TV commercials about hepatitis cause more hepatitis? (I bet you're not, but I really don't get it)

The suggestion seemed to be implying those that produce those commercials are telling people that vacation spots could be a common time + location to get the infection.

I still don't get it. Is that true or not?

Perhaps related, right now there is a 6 month waiting list for the Hep B vaccine here in Canada.

WTF. I am a hepatitis B and Hepatitis D chronic active patient.

There is a plethora of medication for hepatitis B treatment and cure. There is a cure for Hepatitis C as well.

But there is no cure for Hepatitis Delta yet. Even Pegylated Interferon works on about 20% of the patients and that's with dual therapy alongside Telbivudine. Of course after treatment you relapse.

http://replicor.com/science/hepatitis-d/ http://replicor.com/science/hepatitis-b/ http://replicor.com/patients/ http://replicor.com/pipeline/

:( literally going through this right now with my mother

O am an active chronic hepatitis B and hepatitis D patient (27 years old).

I was checking this the other day: http://replicor.com/

Based in Canada BTW.

Incidentally, if you live in SF, it's worth getting the vaccines for hepatitis A and B as an adult.

San Diego just had a major hepatitis A outbreak.


If you are living anywhere it's worth getting vaccines for hepatitis A and B.

Hep A is a waterborne disease. If you live somewhere with proper sanitation and don't have contact with sewage you are at low risk and the funds for the vaccine are better directed elsewhere.

San Francisco residents have extra contact with sewage than the normal person because the feces and urine that are everywhere.

Not sure why you were downvoted. This is absolutely correct and why the city is paying for street cleaning in the areas most affected, in line with the efforts of the City of San Diego in their downtown areas.

Are the street sweepers in SF effective at actually sanitizing the urine and feces or are they really aerating the excrement so any diseases contained within are more easily transmitted to passersby? I'm guessing the latter.

Why is there faeces and urine everywhere?

Large homeless population.

and a lack of public toilets. People are people — we generally would rather go to the bathroom in private if it's an option. Homeless people don't shit in the street because it's their first choice.

You can thank Richard Stallman and the toilet communism brigade.


Can I? How much do you think someone who shits in the street today is willing or can afford to pay for private toilet infrastructure? I disagree with RMS about a lot of things, but I don't see how this would be solved without public spending.

Lack of public toilets, and a lot of people.

God, SF is so overrated.

For about $100 every 10 years, I'd rather be safer than sorry.

That's entirely your choice. But the British NHS says that the taxpayer won't pick up the bill unless you have chronic liver problems.

At $10/year I'm not sure why it would matter one way or the other whether a health insurance program picks up the tab or not.

HepA is more accurately transmitted via what's called the "oral-fecal route". If you eat food prepared by other people, people who may not be completely diligent in washing their hands, it's worth getting vaccinated. There's a large outbreak in Los Angeles currently. https://www.cdc.gov/hepatitis/hav/afaq.htm#statistics

I agree that it's a low risk disease but disagree that funds would be better spent elsewhere as it is a cheap vaccine. Most people here probably were already vaccinated as a baby or had it as a child without obvious symptoms. If you get it as an adult it can make you quite sick and put you out of commission for a few days but rarely kills people, unless you have chronic liver disease already for another reason. It's the cirrhotics who suddenly get exposed for the first time as an adult who wind up with fulminant liver failure and die.

Tangent: The headline brings up an interesting thought.. I wonder what anti-vaxx people will do when a new scary virus emerges. Something actively and aggressively flying through the population.

So much of the anti-vaxx mindset is supported by herd immunity. But when a scenario finally happens where herd immunity is compromised.. It'll be interesting to see how the vaccination discussion plays out.

edit: The downvotes must indicate that this is too off-topic, so sorry for the post :). I just had the thought and wanted to see your opinions on it. Appreciated.

I'm involved in a study of vaccinations. One good thing I'm seeing is that many peds clinics, if you are a pure, down the line anti-vaxxer, will politely ask you to choose another provider.

How does this go, usually? They ask you to choose someone else then decline future appointments?

Have you seen anything similar for urgent-care clinics?

I don't see this in urgent care. I am talking about peds. You bring your newborn in, but start refusing vaccinations. I have spoken in person with over a dozen clinics who categorize themselves as "no-refusal" clinics. They will medically defer, and in some cases allow refusal of STD vaccines. But a person who just doesn't want vaccinations will likely be disenrolled from the register.

That's an interesting moral problem. I don't begrudge those clinics their choice. Maybe they think they're protecting the other patients in the waiting room.

But what would you think of a doctor who declines to treat an alcoholic because the alcoholic persists in his drinking? Does a doctor have a duty to care for people regardless of their actions?

I'm not a doctor, I just study their data. But I think from what I'm hearing, they've made what they think is the most moral choice. Vaccines have very specific age ranges, and if they continue to see a patient without giving them the vaccine, I think they've decided that that interferes with their do no harm.

I agree that pediatric practices refusing service to no-vaxers is the norm in the US.

I've have a few friends who range between full on anti-vax vs being skeptical of one or two, and I’ve heard a few stories.

It seems that a parent asking for their child to not receive one or two of the 20-50 vaccines the pediatrician gives by default has about a 50% chance of being kicked out of the practice. As you said, asking for no vaccines is about a 99% chance.

However, pediatricians have a racket where they will not accept a new child (unless they moved to the area) unless they saw the child within a week of its birth. Thus, when you get kicked out, you are out. You can't see a pediatrician anymore unless you drive 80 miles to sketchy 90's new-age pediatrician in a dingy strip mall, and you can't get any more vaccines unless you go on the correct afternoon of the second week of the month to a government clinic in the part of town with litter and shootings.

This has pushed several people I know into not getting further vaccinations when they were getting 95%.

Maybe it's just our area, and the whole US isn't doesn’t have pediatric practices like this...

I can't say I've actually heard this being a thing in my part of the country. However, you mentioned the following:

> (unless they moved to the area)

Why not just lie and say you just moved to this part of the city/town/state? The only downside is that they'll ask about previous records which could get you caught.

And further, what would be a potential reason for refusing to take care of a patient if you didn't follow them from week 1? I honestly can't think of one besides continuity of care.

I'm guessing it's a malpractice concern. All kinds of things can happen in the first week that aren't visible until a few years later. Who's to blame? The pediatrician who has been taking care of the child for 99% of their life... except for the first critical week...

Not sure I understand. If you're even less likely to be at blame since you weren't even there for those "critical" days, I would imagine there'd be less liability.

"Why not just lie"

Some people care about being truthful. ;)

"What would be a potential reason for refusing to take care of a patient if you didn't follow them from week 1"

It's something like the Apple/Google/Adobe/Intel agreement to not hire each other's engineers. It gives one group more power by making the other party in the relationship have worse options if they leave.

If you leaving your current pediatrician means having no pediatrician at all, then the all of the pediatricians in the town benefit. Each can use it as a threat for compliance, force appointments, or have more room to act in ways that parents/patients don't like.

Is the refusal to care in relation to a parent not wanting their child to be vaccinated, or solely due to not having been the primary care provider since birth?

Edit: I guess my reasoning for this question is based on new guidance from the American Academy of Pediatricians regarding refusal of care to those who refuse childhood immunization. I can't say I agree with that sentiment, and I would also argue that the majority of pediatricians in the US do not refuse care to families who refuse immunization. Why? Because it makes far more sense for a physician to continue to follow up with patients to continue recommending they get immunized. I assure you that most doctors, including pediatricians, don't want kids to die, so most don't refuse care just cause of a family not wanting to vaccinate their kid. It's unfair to a kid that likely doesn't have the competence or capacity to make decisions for themselves. I can't speak towards any pediatrician refusing care, or their reasoning, because I literally have not met one that does.

Edit 2: here is some explanation from the AAP as to when they would recommend dismissal of a family. Note that they specifically note that dismissal should be "a very last resort".

In our town at least, all of the pediatrician practices that I know about, will not accept a child either did not start with them as newborn, or who moved to the town. This is handled by the front desk, before any discussion of care or vaccinations.

At least one pediatrician in our area will also dismiss your child as a patient if you do not schedule something approximating their recommended appointments schedule with them.

I agree 100% with you that refusing to care because of vaccination choices should not be done, and that it does harm the cause of vaccinations. (That's the point I was trying to get across in my original post.)

Hmm, that's weird then. I can see how a pediatrician would stop accepting any new patients, if they are totally booked, but not these criteria.

Healthcare in general in our small city is fairly messed up. I'm glad to hear this kind of thing isn't as widespread as I thought.

They'll double down and blame the government for the ensuing deaths.

It's God's Will until it happens to you.

Maybe this is too off topic for here but I have always wondered why people are so angry at Anti-Vaxx people?

Yes... the compromise our Herd Immunity, but don't they also serve as a "Canary in The Coal Mine", risking their own health so that the human genome can keep battling with and evolving natural defenses against disease?

  risking their own health so that the human genome can keep
  battling with and evolving natural defenses against disease?
Diseases evolve orders of magnitude faster than humans. Giving ourselves a chance to evolve also gives the disease a chance to respond and they will always find ways around our defenses faster than we find defenses. Remember, the usual result of failing to complete a course of antibiotics is a new strain of antibiotic-resistant bacteria. Leaving a reservoir of a disease that we have a vaccine for is far, far more likely to result in a new strain of that disease that can bypass the vaccine.

Additionally... what's the point? Any disease that has a voluntarily unvaccinated population also necessarily has an effective vaccine. The development of a effective vaccine equally necessarily indicates that developing vaccines is easier, faster, and better than attempting to evolve defenses. Why try to go back to evolution at all? The existing vaccine works. If it stops working, make a new one. No need for these ad-hoc primitivist schemes.

Society generally takes a dim view toward people who endanger others through ignorant recklessness.

Because they aren’t the canaries at all. Instead they volunteer their kids (and the kids who interact with their kids) as the canaries.

Furthermore, they risk infecting others who, through no fault of their own, rely on herd immunity. Such as those who due to allergies cannot take a certain vaccination, or who did take it but it was ineffective. Herd immunity protects more than just the ignorant.

Young child affected by leuchemia can't go to school nowadays in Italy, because they risk being infected by anti-vaxxers'child and risk their life

People are angry at them because the herd-immunity they are compromising is the only thing keeping certain members of our population alive and healthy. There are some people who, for various reasons, CANNOT receive vaccinations. Not WILL not, or DO not, but CANNOT. When herd-immunity is compromised it's not just the anti-vaxxers children's lives that are at risk, it's everyone who doesn't GET the choice to vaccinate or not that are more vulnerable to disease since it can now spread through the population more easily.

It’s not just that. Some vaccines are less than 100% effective. When everyone is vaccinated, the disease generally doesn’t spread. When enough people aren’t vaccinated, the disease can spread to some fraction of vaccinated people as well.

Vaccinations are not always effective, nor are they permanent. They are a statistical firebreak against an epidemic. Think of vaccinations like transistors. They are modelled as 1 (vaccinated, won't get sick) or 0 (unvaccinated), but that's not the reality. The reality is very few people have an immunity level of 1.0 (won't get sick) on that scale even after vaccination, and some of those who do seem completely immune are that way because their immune system is particularly good at making a particular disease asymptomatic, not (necessarily) because they were vaccinated.

You can still get infected even if you were vaccinated recently. Many vaccinations lose effectiveness after a decade or two at most. Most adults (who are less affluent/wealthy or who don't travel) don't get re-vaccinated for most things because they're at lower risk. The highest risk is in places like preschool, daycare, grade school and college with lots of people in close proximity, and some poor hygiene mixed in.

And hospitals and doctors offices.

Anti-vaxx parents put everyone else at disproportional risk, because children are a prime infection distribution hub for all kinds of contagious diseases.

Because they are not just risking their own health.

I am not a doctor, but my understanding is there is a small bug significant number of people who cannot get certain vaccines due to e.g. immune system issues. "Herd Immunity" through a highly-immunized population generally protects these people because there are fewer reservoirs for a given disease.

Edit: The reason people are mad at anti-vaxxers: their foolishness directly impacts the welfare of some already unfortunate folks.

Am a PhD, and you are correct. These people are however in the minority, and its important to ensure that people don't use this fact as false justification for not getting vaccinated.

They don't just endanger their own health, they endanger us all. Some people can be carriers but not be symptomatic for a pathogen, so they can be walking around spreading a disease like measles but not even know it. With high herd immunity this is not much of a problem because almost all of the people with whom they come into contact will be vaccinated and not catch the disease before the carrier's body eventually fights it off, but with low herd immunity they become a major problem.

If humanity has not evolved a natural defense to these diseases after thousands of years it is not going to happen by some anti-vaxer volunteering to be an evolutionary petri dish. Actually, now that I think of it, humanity has already evolved a defense against these diseases -- by evolving a big brain it figured out how to develop vaccines...

Anti-vaxxers threaten the lives of not only their own children but the lives of others. There are people that legitimately cannot be vaccinated due to deadly allergies or reactions and the selfish behavior of parents who refuse to vaccinate their children puts them at severe risk. Herd immunity is important to protect people that have no other option and when people compromise it for the sake of perpetuated lies it results in disaster.

My mom is currently going through chemo for cancer. Her immune system is essentially zero despite being fully vaccinated.

You bet I get angry: anti-vaxx people are trying to kill my mom and there is nothing I can do about it.

They're not trying to kill your mom. That may be the effect, but it's not the intent. They're trying to have their kids not be autistic. (You can claim that the evidence doesn't support that as a possibility. But it's still what their intent is.)

That's like saying "I'm trying to make it dark by turning on the lights." You can;'t make excuses for them by saying that, even though they are recklessly endangering other lives, they're doing it under pretenses that are false, so it's ok.

I mean, people who attempt to pray away disease instead of seeking proper care has potentially good intent. But that doesn't make them any less negligent when their child dies as a result.

There’s a research paper out there where people who were prayed for had worse clinical outcomes then the control group.

Someone shooting a gun randomly in the middle of a busy shopping mall might honestly claim they just wanted to hear a loud bang - yet there is no reasonable way to say their actions won't kill someone. Therefore they are trying to kill someone despite their stated intention.


What about vaccines for nuisance illnesses where the vaccines have potentially severe consequences? For example, the rotavirus vaccine has been known to cause intussusception in some small but non-negligible fraction of recipients. This is sometimes fatal, and generally involves surgery. Rotavirus typically causes diarrhea, which can be dangerous, but generally isn’t if monitored closely.

Do you call CPS on parents that refuse that one?

“The only vaccine that is missing from many state mandates is the rotavirus vaccine.”

- Vaxopedia.org

Anecdotally, when we were vaccinating our kids, rotavirus was presented as optional or not crucial. I don’t remember the precise wording the doctor used, but I recall it was the one we skipped. A big factor in that was our kids were not in any kind of daycare.

> Failure to vaccinate should result in intervention by CPS and the parents placed on a watch list.

Failure to vaccinate is a big issue, but I'd rather have anti-vaxxers than government taking kids away from parents because the parents refused a medical intervention.

I would rather the government step in than allowing anti-vaxers to keep polio, measles and whooping cough around.

Frankly the government steps in on a lot of things, like when a parent is caught driving drunk with their kids in the back of the car.

What about daily beatings? Anti-Vaxxers put not only their children but many people in the general population at serious of death and should be sent to prison.

We don’t let people drive drunk for good reason, vacations are far more critical.

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