"I was at work one day, in fact I was on my way out to the doctor's office because I'd been feeling so lethargic -- so unlike me -- and I was losing my appetite, which was really unlike me," says Marx on a warm afternoon this month at a SOMA cafe. She is a slender woman, now 28, whose exuberance -- she positively oozes health -- seems almost surreal, considering her story.
"I was walking out of the office," Marx says, "when a friend stopped me and said, 'I don't want to freak you out, but your eyes look really yellow to me.' "
The comment meant little to Marx, who like most Americans knew nothing about what jaundice, what yellow eyes and skin, what tea-colored urine, fatigue, and nausea might mean. In fact, even doctors had missed the clues: Marx had gone to a San Francisco public health clinic and given a urine specimen -- strangely brown -- and doctors mistakenly told her she was only suffering from a urinary tract infection.
But now, as she entered the office of a new physician, her eyes attracted immediate attention.
"You have hepatitis," the doctor told her. "I don't know what kind it is, but you definitely have hepatitis."
A nurse took Marx's blood, and the lab results were shocking: Marx not only had an acute case of hepatitis B, a disease she'd only vaguely heard of, but her liver was already scarred. The hepatitis B virus, the doctor explained to Marx, is 100 times more contagious than the virus that causes AIDS, and though less deadly than AIDS, the disease is so widespread that it ultimately kills more people. In fact, Marx found out, hepatitis B is a stealthy plague, one of the world's leading causes of death and the major precursor to liver cancer. The virus' ingenious capacity for replication allows it to live in its host for 20 or 30 years before slowly killing it off -- not as flashy as Ebola virus, which leaves people drowning in their own blood, nor as swift and sure as HIV. Instead, the hep B virus brings a quieter tragedy, leveling most people near their "golden" years, destroying them with cirrhosis and lethal malignancy, or, in the rarer cases where it invades with a vengeance, a sudden coma and early death.
In the U.S., the virus kills about 6,000 and infects nearly 250,000 people each year. Many of those people -- like those infected with HIV -- become "silent carriers," unaware that they've been exposed and that they're also exposing others. And like the AIDS virus, hepatitis B can be transmitted sexually or through intravenous drug use or contact with contaminated blood or bodily fluids.
But unlike AIDS, Marx was stunned to find out, hepatitis B is completely preventable. A vaccine -- the only one available for a sexually transmitted disease -- has been on the market since 1982, and a genetically engineered improvement on the original has been sold since 1986.
Not many. Marx, like millions of Americans, had never heard of the vaccine -- not in school, not from friends, not on TV. And now she had unwittingly become a player in one of the most confounding dramas of modern preventive medicine: A safe and effective weapon had been found to stamp out an insidious killer, and the news had gone nowhere. Bells were supposed to ring; flags were supposed to fly. Instead, hepatitis B became the only disease in history to grow more prevalent after a vaccine appeared. Even Marx's doctors had never told her to get immunized -- many doctors themselves weren't. And now there was nothing she could do to get well, aside from go home and rest?
Incredulous, she lay in bed in a rented row house at Oak and Steiner -- and only got worse. Within three weeks, she was hospitalized. Days later, she was in a coma, her brain swollen with poisons that her liver could no longer detoxify. Her ventilator hissed and gasped. Her family and family friend Carl Lewis, the Olympic champion, hovered at her bedside. She had 24 hours to live, they were told, unless a liver transplant was performed, and the chances were slim that a sudden, fatal accident, a tragic godsend, would result in the donation of a healthy organ.
When Marx's liver was finally removed, her mother would be unable to tear herself away from the sight of that shriveled organ in a jar -- the organ that had so failed her youngest child, owing to a virus that any one of us could have. Owing to a lack of knowledge.
Owing to a lack of three, simple injections.
FACT: Like Wendy Marx, one out of 20 Americans will become infected with hepatitis B during their lifetimes, most of them as teen-agers and young adults.
FACT: Anyone can get it. There is no established cure.
FACT: Like Marx, about 40 percent of those infected will never be able to pinpoint the source of their exposure. Far sturdier than HIV, the hepatitis B virus can survive for days outside of the body, posing a threat even to people who share a household (and might share a toothbrush or razor).
FACT: About 90 percent of those infected by the virus successfully shrug off its flulike symptoms and gain lifelong immunity, much as they would if they recovered from measles. But 5 to 10 percent never beat hep B. They become lifelong carriers -- forever capable of transmitting the disease to others, even if they themselves don't feel sick.