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Hepatitis

Hepatitis is an inflammation of the liver. The liver is a vital organ, and when it is inflamed or damaged, its function can be affected, including the ability to process nutrients, filter the blood, and fight infections. Hepatitis is commonly caused by a viral infection, but there are other possible causes including heavy alcohol use, toxins, some medications, certain medical conditions.

The ABCs of Viral Hepatitis

The most common types of viral hepatitis in the US are hepatitis A, hepatitis B, and hepatitis C. Although each can cause similar symptoms, they have different modes of transmission and can affect the liver differently. Hepatitis A is usually a short-term infection and does not become chronic. Hepatitis B and hepatitis C can begin as short-term, acute infections, but they also have the potential to lead to chronic disease and long-term liver problems.

There are effective vaccines to prevent hepatitis A and hepatitis B. Although there is currently no vaccine for hepatitis C, there are effective treatments, which is why testing and early diagnosis of infection is crucial. Millions of people in the US are living with chronic viral hepatitis, and most do not know they have the virus.

Hepatitis A

Hepatitis A is a contagious liver disease caused by the hepatitis A virus (HAV). The virus is most commonly spread by eating contaminated food or drinking contaminated water, but it can also be spread by close person-to-person contact such as household or sexual contact with an infected person. Hepatitis A is the most common vaccine-preventable disease acquired during travel.

Most adults with hepatitis A have symptoms, including yellow skin or eyes (jaundice), tiredness, stomachache, fatigue, loss of appetite, or nausea, that usually resolve within two months of infection. Most children less than 6 years of age are asymptomatic; however, they are very contagious and can spread the infection to others very efficiently.

The hepatitis A vaccine is 94-100 percent effective in preventing the disease. Protection begins approximately two-four weeks after the first injection. A second injection results in long-term protection.

Burden

  • Adults who get hepatitis A lose an average of one month of work.
  • About 70-90 people die from hepatitis A in the US each year.
  • From 2016 to 2019, 30 states reported HAV outbreaks which were spread by person to person contact resulting in close to 30,000 infections.

Causes

Hepatitis A can be transmitted through close person-to-person contact with an infected person, sexual contact with an infected person, eating contaminated food, or drinking contaminated water.

Groups at increased risk include:

  • People who have direct contact with infected individuals
  • Travelers to countries where hepatitis A is common
  • Men who have sex with men
  • Users of injection and non-injection drugs
  • People with clotting factor disorders
  • People working with nonhuman primates
  • Household members and other close personal contacts of adopted children newly arriving from countries where hepatitis A is common
  • People who are HIV positive
  • People who are experiencing homelessness

Symptoms

Children younger than age 6 years usually do not have symptoms of hepatitis A. In older children and adults, symptoms of hepatitis A may include:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dark urine
  • Diarrhea
  • Clay-colored stool
  • Joint pain
  • Jaundice

Symptoms are usually mild and subside within two months, although symptoms can relapse for up to 6 months.

Prevention

The hepatitis A vaccine is the best way to prevent HAV infection. The Advisory Committee on Immunization Practices (ACIP) recommends hepatitis A vaccination for the following people:

  • All children at 1 year of age
  • Travelers to countries where hepatitis A is common
  • Family and caregivers of adoptees from countries where hepatitis A is common
  • Men who have sexual encounters with other men
  • Users of recreational drugs, whether injected or not
  • People suffering from homelessness
  • People with chronic or long-term liver disease, including hepatitis B or hepatitis C
  • People with clotting-factor disorders
  • People with direct contact with others who have hepatitis A
  • Any person wishing to obtain immunity (protection)

Treatment

There are no specific medications or treatments for hepatitis A.  Care is focused on maintaining comfort and adequate nutrition.

Hepatitis B

Hepatitis B is a serious liver disease caused by the hepatitis B virus (HBV). The virus can affect people of all ages. Once infected, some people carry the virus their whole lives. This is called “chronic” infection and it can lead to liver cirrhosis, liver cancer, and death. The virus is found in the blood and body fluids of infected people. It is most often spread among adults through sexual contact, by sharing needles and other drug paraphernalia, or from an HBV-infected mother to her newborn during birth. HBV can also be spread through normal household contact with HBV-infected people.

Some people get sick within the first six months after getting infected. The symptoms of this “acute” hepatitis are loss of appetite, tiredness, stomachache, nausea, and vomiting. These people might also experience yellowing of the whites of the eyes (jaundice) or joint pain. For some people, acute infection leads to chronic infection. People with chronic HBV infection usually do not feel sick for many years, but will have symptoms if they develop the most serious complications from hepatitis B, like cirrhosis or liver cancer. A person infected with the virus can pass it on to others even if he or she does not feel sick or show symptoms. The best way to prevent hepatitis B is by getting vaccinated.

Burden

  • It is estimated that about 22,200 cases of hepatitis B occur in the US each year.
  • Up to 2.2 million individuals in the US have long-term or “chronic” HBV infection, which can lead to liver cirrhosis, liver cancer, and death.
  • HBV infection kills about 2,000 people in the US each year, usually as a result of complications from liver disease.
  • Hepatitis B infections have declined substantially since 1991 when a strategy to eliminate HBV transmission through immunization in the US began. In recent years, however, there has been an increase linked to the opioid crisis and low vaccination rates in adults.

Causes

Hepatitis B is transmitted through exposure to infected blood or body fluids, including through:

  • Sex with an infected partner
  • Injection-drug use that involves sharing needles or syringes
  • Birth to an infected mother
  • Contact with blood from or open sores on an infected person
  • Injuries due to needle sticks or sharp instruments

Learn about risk factors for hepatitis B

Symptoms

Symptoms of hepatitis B vary by age. Most children under age 5 years do not have symptoms. In older children and adults, symptoms may include:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dark urine
  • Clay-colored stool
  • Joint pain
  • Jaundice

Chronic Infection

The risk for chronic infection with hepatitis B also varies greatly by age. Approximately 90 percent of infected infants and up to 50 percent of infected children age 1–5 years will remain chronically infected with HBV. By contrast, approximately 95 percent of adults recover completely from HBV infection and do not become chronically infected. Complications of chronic HBV infection can include cirrhosis or liver cancer.

Prevention

Vaccination is the best way to prevent HBV infection and potential complications, including cancer.

Hepatitis B vaccine is recommended for infants, older children and adolescents who were not previously vaccinated, and certain adults, including:

  • People whose sex partners have hepatitis B
  • Any sexually active adult who is not in a long-term, mutually monogamous relationship
  • Persons seeking evaluation or treatment for a sexually transmitted disease
  • Men who have sexual contact with other men
  • Those with close household contact with an infected person
  • Adults who share needles, syringes, or other drug-injection equipment
  • Healthcare professionals

View the complete list of adults who need hepatitis B vaccine

Treatment

There is currently no medication to treat acute hepatitis B. Healthcare professionals usually recommend rest, adequate nutrition, and plenty of fluids. Some people may need to be hospitalized. People with chronic hepatitis B should be monitored regularly for signs of liver disease and evaluated for possible treatment, including antiviral drugs.

Hepatitis C

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV), which is a blood-borne virus. For some people, hepatitis C is a short-term illness, but 75-85 percent of people who become infected with hepatitis C will have a long-term, chronic infection. Chronic hepatitis C is a serious disease than can result in long-term health problems, even death. The majority of infected persons might not be aware of their infection because they are not clinically ill. There is no vaccine for hepatitis C, but there is effective treatment available. The best way to prevent hepatitis C is by avoiding behaviors that can spread the disease, especially injecting drugs and sharing needles.

Burden

  • It is estimated that about 44,700 cases of acute hepatitis C occur in the US each year.
  • Between 2010 and 2017, acute HCV infections quadrupled, largely due to the ongoing opioid abuse epidemic in the US.
  • There are an estimated 2.4 million people living with hepatitis C in the US.

Causes

HCV is primarily transmitted through contact with infected blood. Transmission can occur through:

  • Sharing needles, syringes, or other equipment to prepare or inject drugs
  • Needlestick injuries in healthcare settings
  • Being born to a mother who has hepatitis C

Less commonly, a person can also get hepatitis C virus through:

  • Sharing personal care items that may have come in contact with another person’s blood
  • Having sexual contact with a person infected with the hepatitis C virus
  • Getting a tattoo or body piercing in an unregulated setting

Symptoms

People with acute HCV infection usually do not have symptoms or have mild symptoms.
When symptoms do occur, they can include:

  • Fever
  • Fatigue
  • Dark urine
  • Clay-colored bowel movements
  • Abdominal pain
  • Loss of appetite
  • Nausea
  • Vomiting
  • Joint pain
  • Jaundice

Most people with chronic HCV infections do not experience symptoms making it difficult to diagnose and treat. Many people eventually develop chronic liver disease, which can range from mild to severe. Complications can include cirrhosis and liver cancer.

Prevention

There is currently no vaccine to prevent hepatitis C. The best way to prevent HCV infection is to avoid contact with contaminated blood and avoid or stop high-risk behaviors including intravenous drug use and unprotected sex. Screening and testing are also important.

Treatment

A new or acute HCV infection does not usually require treatment. However, when HCV infection becomes chronic, treatment is necessary. There are several medications available for chronic HCV infection. Over 90 percent of people with hepatitis C can be cured with 8-12 weeks of oral therapy.

Hepatitis D

Hepatitis D is a liver infection caused by the hepatitis D virus (HDV). Hepatitis D only occurs in people who already are infected with the hepatitis B virus and is uncommon in the US. There is no vaccine for hepatitis D, but it can be prevented by hepatitis B vaccination.

The Centers for Disease Control and Prevention has more information about hepatitis D.

Hepatitis E

Hepatitis E is a liver infection caused by the hepatitis E virus (HEV). People infected with HEV usually recover fully from the disease without any complications. Hepatitis E is rare in the US but common in many parts of the world. No vaccine for hepatitis E is currently available in the US.

The Centers for Disease Control and Prevention has more information about hepatitis E.

 

Updated May 12, 2020

Sources: Centers for Disease Control and Prevention, Mayo Clinic, US Department of Health and Human Services, World Health Organization

 


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