The Horrendous World Of Hepatitis
All Bobbies and front-line staff should have an understanding of, and respect for, the dangers of the ‘Big H’, firstly because it’s a pretty rotten, potentially life-changing condition but secondly because its symptoms can be misinterpreted as something minor and so might result in you passing it on to your nearest and dearest without even realising it. Take time to read and inwardly digest the following; it’s better that you understand the dangers now instead of later on whilst standing around covered in the blood and spit of someone who your radio operator goes on to disclose has PNC warning markers for ‘… Contagious – diagnosed with Hep ‘C’ … and Officer Safety – previously spat at officer in face … sorry – should have advised you earlier …’
What Is Hepatitis?
Put simply, hepatitis is the medical term for inflammation of the liver. This inflammation is caused either because it’s exposed to harmful stuff which it can’t cope with, such as vast amounts of booze over a long period of time, or, of more relevance to the operational Bobby, through a viral infection picked up from someone else.
While some variations of hepatitis can resolve themselves without causing permanent problems, others cause cirrhosis – scarring – of the liver which, in turn, restricts the ability of this miracle of biological engineering from doing its life-maintaining work of keeping your blood clean, processing food from the intestine while turning it into energy, storing iron and other essential chemicals for later use, making bile to digest fats, fighting infection, regulating hormones and other boring stuff like getting rid of poisons. Oh, and just for fun, if that cirrhosis continues, the entire liver will finally give up leaving you either the option of a quick transplant or your family the aggravation of finding a reasonably priced undertaker.
As discussed above, not everyone infected by hepatitis displays noticeable symptoms so there’s some potential for you to fail to realise the danger you are in from that person or, indeed, later even notice that you’ve caught something yourself until it has affected your liver. Also, some infected people in the early stages display symptoms which could be misinterpreted instead as something else – muscle and joint pain, feverishness, nauseous and vomiting, tiredness, a lack of appetite and tummy pain, itchy skin, dark wee and pale poo. Fortunately, there is one classic sign of hepatitis that sometimes shows itself – the yellowing of the skin and whites of the eyes.
As there’s often this lack of symptoms then your best practice should be to follow the routine example of medical professionals the world over in treating all blood and bodily fluid spills as being potentially hepatitis-infected; wear gloves and other barrier protection where appropriate and make sure that you clean yourself up properly afterwards.
A question to which I have never being able to establish a definitive answer is what to do with police clothing that has been covered in blood. Speaking with ambulance officers they advise me that if they have blood or fluids on their uniform from a person they know has hepatitis they will machine wash it at 60’c but use facilities at their local hospital or ambulance station – not take it home as they don’t wish to chance the danger of any transference of infection to their loved ones. If, for any reason, they did have to take it home they would convey it in a waterproof bag which they would then empty directly into the washing machine, throwing away the bag afterwards. As we don’t tend to have washing facilities at stations I would suggest binning as hazardous waste any uniform contaminated by hepatitis-infected blood. If, however, you have a particular piece of kit, perhaps a decent jacket that you know is unlikely to be replaced anytime soon, then pop it in a bucket in the rear yard and wash it through, getting rid of most of the blood while being careful of splashing, before then putting it in a waterproof bag and taking it home and emptying it directly into the washing machine, throwing away the bag, etc. I suspect also that your own force will have some SOP in relation to this subject so take time to research it before the event occurs.
Here’s a quick guide to the various forms of hepatitis relevant to our role.
… is all about poor sanitation and personal hygiene. The virus, already present in the carrier’s poo, somehow manages to end up in the next victim’s body. The most logical way this occurs is through the carrier not washing their hands properly after a Hep ‘A’ riddled ‘number two’ and then spreading their pooy germs onto something that finally ends up, directly or indirectly, in the next victim’s mouth – perhaps food, cutlery, or secondary contact through objects like the door handle of a public toilet (oh, the OCD paranoia of it all) – and from the victim’s mouth down into their body itself where it makes itself at home.
The numbers of people within the UK who contract Hep ‘A’ each year are fairly small, perhaps in the low hundreds, and most of these are as a result of coming into poor sanitary conditions whilst travelling abroad. Other ways you can contract the condition as a Bobby might be from attendance at an incident involving sewage or an establishment where hygiene might not be as good as it should, like a homeless shelter. Classic ways of contracting the condition off-duty may be through eating undercooked or raw seafood from contaminated water, having drinks with contaminated ice or having unprotected sex. There’s no cure and symptoms are pretty rough but will last for only around two months (only two months – oh good!). Vaccinations are available. Get one if you travel to the more undeveloped parts of the world or routinely come into contact with people recently arrived from these places. A person with Hep ‘A’ may not display symptoms for the first couple of weeks after infection and some people don’t display any symptoms at all. You are at your most infectious to others from around a fortnight before your symptoms display themselves to around a week afterwards. As discussed earlier, vaccinations for Hep ‘A’ are available.
… is instead transferred between carrier and victim via infected blood and bodily fluids. Transference can occur via the usual culprits – the sharing of needles between drug addicts and unprotected sex – although having a tattoo or body-piercing in some dodgy-looking parlour where they are a little shaky on needle sterilisation is also asking for trouble (as is using a dentist who doesn’t sterilise their equipment properly – or, talking of teeth, using your mate’s toothbrush or razor if they have Hep ’B’ without you realising it).
If infected your body might simply fight it off without you noticing any obvious symptoms; if those symptoms do develop, it will be between two and three months after contact and consist of perhaps tummy pain, a constant feeling that you are going to throw up and / or actual pain in the belly or liver itself (right-hand side of your body, incidentally – under the ribcage), loss of appetite, general flu-like symptoms and that jaundice yellowing of the skin and eyes.
Hep ‘B’ can be rough, particularly when it drags on longer than six months to become chronic hepatitis ‘B’; by that stage the health service will change your medication from that designed to relieve your symptoms to instead something to reduce the danger of liver damage.
Officers are potentially at risk from contact with spilt blood or bodily fluids or perhaps needle-stick injuries. If you do manage to become infected through some nightmare scenario of cross-contamination, then there is a possibility that you could inadvertently go on to transfer the virus to your partner during unprotected sex … sorry about that Darling …
Again, a vaccination is available but more of that in a moment. If you think you have been exposed to a Hep ‘B’ infection during an incident while not covered by the vaccine you should immediately seek advice from a doctor – straight away, before the end of the shift. They will probably give you medicines to counter the potential infection as well as the Hep ‘B’ vaccine. They will probably also offer some opinion about your judgement in being an operational Bobby whilst not being Hep ‘B’ vaccinated in the first place.
… is the daddy of hepatitis conditions in terms of danger to the operational police officer. Over 200,00 people are currently infected within the UK with Hep ‘C’ – I suspect mostly the type of characters that we come into contact with on a daily basis – which is nice. Hep ‘C’ is mostly carried in the blood and transmitted between carrier and new victim via blood to blood contact, more often through druggies sharing syringes, but more rarely can be present in the salvia or sexually-transferred fluids of the carrier (although the risk in unprotected sex is low, unless blood is present during the interaction). As with Hep ‘B’ you can also contract it by using an infected person’s toothbrush or razor. The salvia risk is of note when dealing with a suspect who wants to gob over everyone before gleefully shouting how he has ‘… f**king Hep C – yeah …!’. If you do get a face-full from someone claiming this and there’s any danger at all that some of it has ended up in your eyes, mouth, nose or an open wound then I would strongly recommend an immediate trip to the local A.& E. to have yourself suitably cleaned and disinfected; the treatment I received last time it happened to me was the slow dousing of the spat-in eye with an entire litre of warm saline – you looking upwards, eye-open, as the nurse spends around half an hour squirting the stuff into your eye socket with the world’s smallest hose while moaning about the yobs who live down the road from her and how she’s going to beat them to death with a baseball bat if they threaten her grandson again.
Again, as with Hep ‘B’, there is a danger for the operational Bobby of innocently becoming infected at work before then passing it on to their partners during some bare-backed sauciness at home. This problem is aggravated by the fact that Hep ‘C’ mostly doesn’t display any noticeable symptoms for the first six months after contact or instead only flu-like or upset tummy symptoms which the carrier might well disregard while failing to realise the carnage that is being caused to their liver. Only 20% of sufferers will have that yellowing jaundice. Once the person does realise that something is wrong or, heaven forbid, their partner who they have passed it on to realises something is wrong, the person could well be on the path to permanent liver damage.
Oh, it gets better; statistically only around 25% of people with Hep ‘C’ are able to fight off the infection without medical assistance. Treatment is via anti-viral drugs, although the side effects of this medication can be pretty ghastly, and I even came across someone recently who told me they were undergoing chemotherapy in an attempt to control the condition, which is even more fun.
I suspect the more switched on amongst you are already thinking vaccination! … Yeah … well there isn’t one for Hep ‘C’ at the time of writing … Still glad you joined? Hep
There are other forms of hepatitis but information about them isn’t really relevant to a book of this nature, so I think it’s better to discuss protection now.
Hep ‘A’ And ‘B’ Vaccinations.
A vaccination is available for Hep ‘A’ (that the ‘someone else’s poo ending up in your mouth’ variant) and, as previously discussed, it’s probably worth having if you travel a lot to countries with poor sanitation or you often deal with people from these countries.
There is also a vaccination course that provides protection against Hep ‘B’. This is a series of three separate jabs over a period of four to six months, but IT IS IMPORTANT THAT YOU HAVE ALL THREE JABS. Sorry about the rabid use of capital letters there but this is a common oversight of young Bobbies – they enthusiastically have the first two vaccinations done (probably because they’re at Training School and it’s all laid on) and then forget all about the third (probably because they’re sent off to Area and have to look after themselves), thereby rendering their protection levels severely reduced. Don’t take it for granted that your surgery or Occupational Health Department are going to chase you up to have these later jabs, it tends to be more down to you. A month after the third jab you will also need to have your immunity levels checked as some people are found to be ‘non-responders’ in terms of hepatitis and don’t develop immunity even after a full course of injections (or even a second course). Generally, though, as a result of the course, you should be Hep ’B’ proof for around five years, after which time you will need a booster to keep your immunity levels up to scratch.
In these times of financial gloom you might discover that your local surgery isn’t prepared to go to the expense of vaccinating you against Hep ‘B’ and instead insist that this is the responsibility of your police service – who in turn would probably claim it’s the responsibility of your surgery. I would personally argue that the cost of vaccination is nothing compared with that they would incur should you suffer liver damage, but that discussion might not get you too far locally. If the surgery refuses to fund the vaccination, then formally request that your force provides it; I would suggest it would be a brave police service that refuses to provide funding for protection of its officers against such an obvious risk and perhaps even a Health & Safety requirement as well.
It bears repeating – no vaccination is available for Hep ‘C’.
Before Finishing with Hepatitis, A Whimsical Interlude From Way-Back-When.
At one time in the department in which I was then working, a local arrangement was drawn up that we would have our Hep ‘B’ jabs, amazingly, at the Special Clinic of the district general hospital; whoever could have dreamt up that idea, I can’t imagine, although admire their sense of humour. I suspect you can appreciate the effect on the various pasty-faced, nervous and groin-scratching out-patients in the waiting room as a couple of uniformed Bobbies came strolling into their midst, before sitting at a safe distance and flipping through the more colourful pages of Cosmopolitan and nodding to the gravel-voiced receptionist loudly attending to her phone enquires (and I promise you this is absolutely true) “… I’m checking your results now … okay … well it looks like the syphilis is all clear but …” – disconcertingly sharp intake of breath -“… we’re gonna need to see you again about the gonorrhoea …”
If you want to learn more about police officer health then check out our book … in fact, buy a copy – treat yourself!.