Hepatitis

What is 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, and 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 help 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.

Many people infected with hepatitis do not have symptoms and do not know they are infected. Symptoms of acute hepatitis can include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain, and jaundice. Symptoms of chronic viral hepatitis can take decades to develop.

Types of Hepatitis

Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E

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 international travel.

Burden

Those who get hepatitis A may feel sick for a few weeks to several months
Adults who get hepatitis A lose an average of one month of work
More than 5,700 cases of hepatitis A were reported in the US in 2021, but due to underreporting, the actual number of cases is likely around 11,500

Causes

Hepatitis A can be transmitted through close person-to-person contact, including sexual contact with an infected person, eating contaminated food, or drinking contaminated water.
Those at increased risk include:

International travelers
Men who have sex with men
Those who use or inject illegal drugs
Those with occupational risk for exposure
People who anticipate close personal contact with an international adoptee
Those experiencing homelessness

People at increased risk for severe disease from hepatitis A infection include those with chronic liver disease, including hepatitis B and hepatitis C and those with HIV.

Symptoms

Not everyone with hepatitis A will develop symptoms and adults are more likely to have symptoms than children. If symptoms do develop, they usually appear 2 to 7 weeks after infection and may include:

Fever
Fatigue
Loss of appetite
Nausea
Vomiting
Abdominal pain
Dark urine
Diarrhea
Light-colored stools
Joint pain
Jaundice (yellow color in the skin or eyes)

Symptoms are usually mild and subside within 2 months, although symptoms can relapse for up to 6 months. An infected person can transmit the hepatitis A virus to others up to 2 weeks before symptoms appear.

Prevention

Hepatitis A vaccination is the best way to prevent HAV infection. The hepatitis A vaccine is 94-100% effective in preventing the disease. Protection begins approximately 2-4 weeks after the first injection. A second injection results in long-term protection.
The Centers for Disease Control and Prevention (CDC) recommends hepatitis A vaccination for the following:

All children age 12-23 months
All children and adolescents age 2-18 years who have not previously been vaccinated
People at increased risk for hepatitis A
Pregnant women at risk for hepatitis A or risk for severe outcomes from hepatitis A infection
Any person who requests vaccination

Once you recover from hepatitis A, you cannot get it again as you develop antibodies, protecting you for life.

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 may carry the virus their whole lives as a chronic infection which can lead to liver cirrhosis, liver cancer, and death. Hepatitis B is spread when blood and bodily fluids from an infected person enters the body of someone who is not infected. This can happen through sexual contact; sharing needles or syringes; or from an infected mother to her infant during pregnancy or delivery.

For some people, acute infection leads to chronic infection. Those with chronic HBV infection typically do not feel sick for many years but will develop symptoms with serious complications from hepatitis B, like cirrhosis or liver cancer. A person infected with the virus can pass it on to others even if they do not feel sick or have symptoms. The best way to prevent hepatitis B is by getting vaccinated.

Burden

Hundreds of thousands of individuals in the US have long-term or chronic HBV infection, which can lead to liver cirrhosis, liver cancer, and death
HBV infection kills thousands of people in the US each year, usually as a result of complications from liver disease
Those living with chronic hepatitis B have a 15% to 25% risk of premature death from cirrhosis or liver cancer without monitoring and antiviral treatment as indicated
Of those infected with HBV infection in the US; as many as two-thirds may be unaware of their infection

Causes/Transmission

Hepatitis B is spread through exposure to infected blood or body fluids as follows:

From an infected mother to her infant during pregnancy or delivery
Sexual contact with an infected partner
Injection drug use that involves sharing needles or syringes
Contact with blood or open sores
Exposures through needle sticks or sharp instruments
Sharing items that can break the skin or mucous membranes such as toothbrushes, razors, or medical equipment (like a glucose monitor)
Through poor infection control practices in healthcare settings

The risk for chronic infection with hepatitis B also varies greatly by age. The younger a person is when infected with hepatitis B virus, the greater the chance of developing chronic infection.

Symptoms

Not all people with acute hepatitis B infection (HBV) have symptoms and symptoms can vary by age. Infants, children less than age 5 years, and immunosuppressed adults with acute HBV infection are typically asymptomatic. Symptoms of acute HBV infections can include:

Fever
Fatigue
Loss of appetite
Nausea
Vomiting
Abdominal pain
Dark urine
Light-colored stools
Joint pain
Jaundice (yellow color in the skin or eyes)

Symptoms typically last for several weeks but can persist for up to 6 months.

Prevention

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

Hepatitis B vaccination is recommended for all infants, older children and adolescents who were not previously vaccinated, all adults age 19-59 years, and adults age 60 years or older with risk factors or for those seeking protection from hepatitis B.

Universal hepatitis B vaccination is also recommended in certain settings including:

Sexually transmitted infection (STI) treatment facilities
HIV testing and treatment facilities
Facilities providing drug-abuse treatment and prevention services
Correctional facilities
Healthcare settings targeting services to men who have sex with men
Chronic hemodialysis facilities and end-stage renal disease programs
Institutions and nonresidential day care facilities for those with developmental disabilities

Vaccination is particularly important for those with risk factors for hepatitis B, including people with diabetes.

Screening and Treatment

In the US, there is currently no approved medication to treat acute hepatitis B. For those with mild symptoms, healthcare professionals typically recommend rest, adequate nutrition, and plenty of fluids. Those with more severe symptoms may need to be hospitalized.

Those with chronic hepatitis B should be monitored regularly for signs of liver disease and evaluated for possible treatment

CDC recommends that all adults age 18 years and older get tested at least once for hepatitis B

Infants born to pregnant women who are infected with HBV or who have other evidence of infection should be tested at age 9-12 months or 1-2 months after vaccine series completion if the series is delayed.

Periodic testing is recommended for those with ongoing risk for exposure and should also be available to anyone who requests HBV testing.

Hepatitis C

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV), which is a blood-borne virus. Hepatitis C can range from a mild illness, lasting a few weeks, to a serious, life-long (chronic) infection. More than half of those who become infected with HCV will develop a chronic infection which can result in long-term health problems, even death. Many of those infected are unaware 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 more than 40,000 cases of acute hepatitis C occur in the US each year
Between 2013 and 2020, acute HCV infections more than doubled, 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 usually spread through contact with infected blood. Transmission can occur through:

Sharing needles and syringes
Birth from a mother who is infected with hepatitis C
Getting a tattoo or body piercing in an unregulated setting
Sharing personal care items that may have come in contact with infected blood such as razors, nail clippers, or toothbrushes
Needlestick injuries in healthcare settings
Having sex with an infected person (reported more often among men who have sex with men)
Blood transfusions and organ transplants (rare in the US since blood screening became available)

Symptoms

Many people with acute hepatitis C infection do not have symptoms, do not look or feel sick, and therefore do not know they are infected. For those who develop symptoms, they usually appear 2-12 weeks after exposure and may include:

Fever
Fatigue
Loss of appetite
Nausea
Vomiting
Abdominal pain
Dark urine
Light-colored stools
Joint pain
Jaundice (yellow color in the skin or eyes)

Most people with chronic HCV infections do not experience symptoms, making it difficult to diagnose and treat. Many eventually develop chronic liver disease, which can range from mild to severe and include cirrhosis and liver cancer. Chronic liver disease in those with hepatitis C usually happens slowly, without any signs or symptoms, over several decades.

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 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. More than 90% 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). Only those infected with the hepatitis B virus can get hepatitis D which is uncommon in the US. Hepatitis D can cause severe symptoms and serious illness that can lead to life-long liver damage and even death. There is no vaccine for hepatitis D, but getting vaccinated against hepatitis B also protects against hepatitis D.

View additional information about hepatitis D from the Centers for Disease Control and Prevention

Hepatitis E

Hepatitis E is a liver infection caused by the hepatitis E virus (HEV). Most people infected with HEV fully recover from the disease without any long-term complications. Hepatitis E is rare in the US but common in many parts of the world. No vaccine for hepatitis E is currently available to protect against hepatitis E. The risk for HEV infection can be lowered by drinking only purified water when visiting countries where hepatitis E is common and by avoiding raw or undercooked meats.

View additional information about hepatitis E from the Centers for Disease Control and Prevention

Updated March 2024

Source: Centers for Disease Control and Prevention