What are your chances of being infected with hepatitis? There are five types and they all mean you have an inflammation of the liver.

Some forms of hepatitis are mild. Others are more serious and can lead to severe complications such as cirrhosis or liver cancer. That’s why it’s important to know if you’re infected. You may not realize you are because you feel perfectly fine. In other cases, you can experience symptoms.

The body can fight off some forms of hepatitis. Others may require a treatment protocol. In all but one strain, the hepatitis virus has an acute phase and can move into a chronic phase. If a person develops a chronic form, they will have it their entire lives, although may not experience any symptoms for decades. Vaccinations are available for some types of hepatitis and are the best preventative measure.

Out of the all people living with viral hepatitis globally, 9 out of 10 (325 million) are, “living with hepatitis B or C without knowing it.” [1]

The World Health Organization believes hepatitis can be substantially reduced by 2030 and eventually eradicated. [2] By being screened and working toward prevention there is an opportunity to reduce the incidence and mortality rates associated with hepatitis.

Five types of hepatitis

There are five types of hepatitis, some of which are more common than others. Specific populations such as healthcare workers are more at risk of contracting and spreading the virus. Other types of hepatitis are common in developing countries even though they may be rare where you live. So if you’re traveling, take the suggested precautions as outlined in the article.

Hepatitis A

What is it?

Like all five types of hepatitis, hepatitis A (HAV) is an inflammation of the liver. Individuals who contract hepatitis A usually get better in a few weeks to several months without any treatment. Because it only lasts for a little while, it’s rare that complications occur.

Risk factors associated with hepatitis A and how it spreads

Anyone who isn’t immune to HAV can get the hepatitis A infection. Beyond that, some people are at higher risk of contracting the virus. It is more common in countries where sanitation is problematic, and the availability of clean water is scarce.

HAV is not an airborne virus. Nor can you become infected by sitting next to or hugging a person who is infected.

Symptoms and complications of hepatitis A

Two to six weeks after coming in contact with the virus, some people will experience symptoms which can last up to six months. [3] 30% of adults and older children who become infected with hepatitis A will be asymptomatic. [4]

In spite of the more moderate statistics, however, 70% of the people with HAV will develop at least one symptom from the following list, although it will be mild.[4]

• Abdominal pain.
• Dark yellow urine (not attributed to any nutrients or supplements).
• Fatigue.
• Fever.
• Gray or clay-colored stools.
• Jaundice.
• Joint pain.
• Loss of appetite.
• Nausea.
• Vomiting.

While most people heal entirely from hepatitis A infection, a small number, usually those with pre-existing liver disease, suffer significant liver damage which can results in death. If you experience symptoms and they persist after six months, see your doctor.

Treatment of hepatitis A

You can alleviate symptoms of HAV by staying hydrated and eating healthy foods. There may be some medications that can help but talk to your doctor before taking any over-the-counter drugs or nutrients since some can cause liver damage. Avoid drinking alcoholic beverages until you know your body is virus-free.

If you suspect you have HAV, your healthcare professional can confirm it, or rule it out, through a blood test.

Prevention of hepatitis A

Vaccination – The simplest way to prevent hepatitis A is through vaccination which consists of two shots injected 6-12 months apart. [4] Children as young as 12 months can be vaccinated. A vaccine for HAV has been available since 1995, reducing this infection in the United States by 95%. In 2014 only about 2500 HAV cases were reported in the U.S. [1]

If you are planning on traveling to a developing country, it’s recommended you get the vaccine. Even if you don’t have time for both shots, one injection can afford some protection within two weeks. As an extra precaution, drink bottled water and use it to brush your teeth, make ice cubes and to wash food.

Personal hygiene – Good personal hygiene can prevent HAV and also reduce how it spreads. Wash your hands thoroughly with soap and warm water before and after handling food, changing diapers, or going to the restroom.

Avoid contaminated food and water – This is especially true if you are caring for or living with individuals infected with HAV, caring for infants, and traveling to underdeveloped countries where sanitation isn’t prevalent.

If you have had HAV in the past, you are immune. However, you can still contract other forms of hepatitis.

Hepatitis B

What is it?

Hepatitis B (HBV) is also an inflammation of the liver caused by a virus. It spreads through contact with the bodily fluids of an infected person.

Unlike hepatitis A, HBV has two forms – acute and chronic.

Acute HBV – Acute hepatitis B is the initial phase of HBV and lasts anywhere from a few weeks to six months. 90% of people who suffer from acute hepatitis B do not suffer from any symptoms. The immune system successfully fights off the infection. [6]

Chronic HBV – 5-10% of individuals who contract HBV move into the chronic stage which persists throughout the lifespan.

Of special note: If you had HBV as a child, your risk of contracting persistent hepatitis B increases.

• About 90% of infants infected with HBV develop a chronic infection.
• Approximately 25-50% of children aged 1-5 years develop chronic infections. [6]

Risk factors associated with hepatitis B and how it spreads

In many parts of the world, hepatitis B virus infects more than 8% of the population. HBV enters the body through blood-to-blood contact.

Approximately 850,000 to 2.2 million people in the United States have chronic HBV, which is why medical professionals recommend children receive the vaccine. Since it was available in 1991, the rate of new HBV infections has dropped to 82%. [7] Many individuals who are living with chronic HBV were infected before the availability of the vaccine.

In the United States, sexual contact is the most common way that hepatitis B spreads among adults. [8]

As with other forms of hepatitis, there are misconceptions about how you can become infected. Since it only spreads through blood-to-blood contact, you cannot contract the virus in any of the following ways:

• Being sneezed or coughed on by a person who is infected.
• Drinking water or eating food with a person who is infected.
• Proximity to or touching a person who is infected.
• Sharing eating utensils.

Blood donors and blood products are now tested for HBV, so donating blood or receiving blood transfusions are no longer typical means of infection.

Symptoms and complications of hepatitis B

Usual symptoms of acute HBV are mild and are similar to those of hepatitis A. In some cases, symptoms won’t develop for anyone unless there are complications. Children younger than 5 generally don’t exhibit signs of acute HBV.

If HBV becomes chronic, it progresses quietly. A person with chronic HBV may be asymptomatic for ten to twenty years before signs of cirrhosis, liver failure or liver cancer appear.

Since chronic symptoms lie dormant for so long, HBV screening could be vital to ongoing good health. A blood test will let you know if you have the virus, or if you are immune or susceptible. However, if you experience any symptoms of chronic hepatitis B, see your healthcare professional immediately.

Treatment of hepatitis B

Standard treatment of HBV is through Interferon or an anti-viral medication recommended by your healthcare professional.

Prevention of hepatitis B

Vaccination – The best way to prevent hepatitis B is with immunization, especially if you have more than one risk factor or if a blood test reveals you are susceptible. The vaccine consists of three doses of the vaccine over the course of six months and offers protection from HBV at least 18-20 years.

The American Academy of Pediatrics recommends all children receive the hepatitis B vaccine starting at birth. The CDC recommends the vaccine for persons traveling to countries where HBV is common.

Personal Hygiene – Through good personal hygiene, you can reduce your risk of becoming infected with HBV. You can further reduce your risk in the following ways:

• Never share needles or any other item involved in an injection process, including substances, body piercing or acupuncture.
• Do not share personal care items that might have blood on them (razors, toothbrushes).

Universal Precautions – Following some standard practices of universal care can go a long way toward prevention and spreading of HBV.

• Clean up any spilled blood.
• Healthcare and public safety workers should follow universal blood/body fluid precautions and safely handle needles and other sharps.
• Protected sexual contact through use of latex condoms. This can prevent the spread of sexually transmitted diseases, viral hepatitis and HIV.

Hepatitis C

What is it?

Like all forms of hepatitis, hepatitis C (HCV) is a contagious liver infection. When initially discovered, hepatitis C was referred to as non-A or non-B hepatitis because the virus was unidentifiable. But in 1989 it was isolated and renamed hepatitis C. [9]

HCV has both an acute and chronic form.

Acute HCV – Acute hepatitis C is the initial phase. Most people do not suffer from any symptoms, and if they do, they generally won’t associate them with HCV. In 15-40% of individuals, the immune system clears the body of the virus in six months. [9]

Chronic HCV – The remaining 60-85% percent of individuals who contract HCV can’t fight off the infection. It becomes chronic and lasts for life. [12] During this phase, the liver becomes increasingly inflamed and scarred. The speed with which chronic HCV progresses varies from person to person. A third of this population will develop cirrhosis of the liver within 20 years. Another third may take up to 30 years while the final third may not experience any significant problems with their liver during their lifetime. [9]

Risk factors associated with hepatitis C and how it spreads

The hepatitis C virus enters the body through blood-to-blood contact. In 1992 dependable blood tests for HCV became available. [9] Until that time, people usually got hepatitis C from blood products and blood transfusions. Now that those are tested for HCV, this method of transference is no longer the typical means of infection.

According to the World Health Organization, “1.75 million adults were newly infected with HCV in 2015, largely due to injecting drug use and due to unsafe injections in health care settings in certain countries.” [11]

Symptoms and complications of hepatitis C

Symptoms vary in each person and can change if an individual moves from the acute to a chronic form of HCV. Acute symptoms are usually mild. During the chronic phase, HCV progresses silently. A person may not feel or see any symptoms for 10-20 years. Once a person becomes symptomatic, signs of cirrhosis may appear.

Since indications of hepatitis C are normally undetected, people in danger for HCV contamination ought to be tested. Individuals who have HCV will demonstrate positive antibodies on a blood test. If you think you have hepatitis C or are at risk for hepatitis C, you should contact your doctor.

Treatment of hepatitis C

For individuals who start developing liver damage, treatment with direct anti-viral drugs is available. Unfortunately, the procedure is complicated and lasts for many months. When treatment is successful, liver scarring and damage lessen.

Prevention of hepatitis C

There is no vaccine to prevent hepatitis C. However, you can adopt safe practices to reduce your risk.

Personal Hygiene – Through good personal hygiene, you can reduce your risk of becoming infected with HCV. You can further reduce your risk in the following ways:

• Never share needles or any other item involved in the injection process, including substances, body piercing or acupuncture.
• Do not share personal care items that might have blood on them (razors, toothbrushes).

Universal Precautions – Following standard practices of universal care can go a long way toward prevention of HCV.

• Clean up any spilled blood.
• Allied health professionals and public safety workers should safeguard themselves by following all blood/body liquid universal precautions and cautiously handle needles and different sharps.
• Protected sexual contact through use of latex condoms can prevent the spread of sexually transmitted diseases, viral hepatitis and HIV.

Hepatitis D

What is it?

The hepatitis D virus (HDV) is unusual because it can only infect you when you also have the hepatitis B virus infection. Unlike other forms of hepatitis, not only can it move from acute to chronic, but it also can become a coinfection or a superinfection. Due to the additional factors, hepatitis D is very complicated and intense.

Coinfection – If a person contracts both HBV and HDV at the same time, it is considered a coinfection.

Superinfection – If an individual already has chronic HBV and then contracts HDV, they have what is called a superinfection.

Acute HDV – Acute hepatitis D is a short-term infection, from which most people recover. About 5 percent of individuals who develop a coinfection won’t heal and advance to the chronic phase of both HBV and HDV. [12]

Of  special note:

• A person with a coinfection with acute HBV and HDV can usually fight it off, although the symptoms are more severe. [13]
• 90 percent of individuals with a superinfection can’t fight off HDV, and it becomes chronic [14]. When this happens, hepatitis B also becomes chronic.

Chronic HDV – Chronic hepatitis D lasts over a person’s lifetime. People who have chronic hepatitis B and D develop complications more often and more quickly than people who have chronic hepatitis B alone. [14]

Risk factors associated with hepatitis D and how it spreads

The hepatitis D virus spreads through contact with an infected person’s blood or other body fluids. Hepatitis D is not typical in the United States and is more common in other parts of the world.

The hepatitis D virus rarely spreads from mother to child during birth. Additionally, you cannot contract HDV from:

• Being sneezed or coughed on by a person who is infected.
• Drinking water or eating food with a person who is infected.
• Proximity to or touching a person who is infected.
• Sharing eating utensils.

Symptoms and complications of hepatitis D

Most people with acute hepatitis D have symptoms. In contrast, most people with chronic HDV have few symptoms until complications develop. Complications may not arise until several years have passed since the initial infection.

Although acute liver failure is uncommon with acute HDV, hepatitis D and B infections are more likely to lead to acute liver failure than the hepatitis B infection alone. [15] Chronic hepatitis D may lead to cirrhosis, liver failure, or liver cancer. People who have chronic hepatitis B and D are more likely to develop these complications than people who have chronic hepatitis B alone. [14]

Early diagnosis and treatment of chronic hepatitis B and D can lower your chances of developing severe health problems.

Treatment of hepatitis D

Doctors may treat chronic hepatitis D with medicines called interferons and may add medication for hepatitis B if necessary.

If cirrhosis develops, it is treated with medicines, surgery, and other medical procedures. If you have cirrhosis, you have a higher chance of developing liver cancer. If acute hepatitis D leads to acute liver failure, or if chronic hepatitis D leads to liver failure or liver cancer, you may need a liver transplant.

Prevention of hepatitis D

Vaccination – The easiest way to avoid HDV is to get the hepatitis B vaccine, which, by default, also protects you from hepatitis D. If you don’t get HBV, you can’t get hepatitis D.

Personal Hygiene – If you already have hepatitis B, you can take steps to prevent hepatitis D infection with good personal hygiene. You can further reduce your risk in the following ways:

• Never share needles or any other item involved in the injection process, including substances, body piercing or acupuncture.
• Do not share personal care items that might have blood on them (razors, toothbrushes).

Universal Precautions – Following some standard practices of universal care can go a long way toward prevention of HDV.

• Clean up any spilled blood.
• Healthcare and public safety workers should follow universal blood/body fluid precautions and safely handle needles and other sharps.
• Wear gloves if you have to touch another person’s blood or open sores.

Additional Best Practices – Protect others from getting infected with HDV, and prevent its spread by following a few extra practices.

• If you have hepatitis D, follow the steps above to avoid spreading the infection.
• Your sex partners should get a hepatitis B test and, if they aren’t infected, get the hepatitis B vaccine.
• Inform all your healthcare professionals that you have HDV.
• Don’t donate blood or blood products, organs, tissue or other bodily fluids.
• If you have hepatitis D, you should eat a balanced, healthy diet.
• Avoid alcohol because it can cause additional liver damage.

Hepatitis E

What is it?

Hepatitis E (HEV) is a viral infection that causes liver inflammation and damage. Like most of the other hepatitis strains, HEV has two phases.

Acute HEV – Acute hepatitis E is a short-term infection. Most people get better after several weeks without treatment.

Chronic HEV – Chronic hepatitis E occurs when your body can’t fight off the virus. It remains in the body for life. Chronic hepatitis E is uncommon and only occurs in people with compromised immune systems. For example, HEV may become chronic in people taking medicines that weaken their immune system after an organ transplant, or in people who have HIV or AIDS.

Risk factors associated with hepatitis E and how it spreads

Hepatitis E is more common in developing countries where sanitation is poor, and access to clean water is limited. Although experts used to think hepatitis E was rare in the United States, recent research suggests that about 20% of the population has had hepatitis E. [16]

The types of hepatitis E that are common in developing countries are likely to cause severe infections, especially in pregnant women. However, in developed countries, symptoms are often mild and not noticeable. [17]

Research suggests that hepatitis E can also spread through blood transfusion, but this is very rare. It is uncommon for people to spread hepatitis E directly to other people.

Symptoms and complications of hepatitis E

Many people infected with hepatitis E have no symptoms. Some people have symptoms 15 to 60 days after they become infected with the virus. [18] These symptoms may include:

• Darkening of the color of urin or lightening of the color of stool.
• Fatigue.
• Jaundice.
• Nausea and vomiting.
• Pain over the liver, in the upper part of the abdomen.
• Poor appetite.

Complications are different for acute HEV than they are for chronic HEV.

Treatment of hepatitis E

Treatment for acute hepatitis E includes resting, drinking plenty of liquids, and eating healthy foods to help relieve symptoms. Mild symptoms can be alleviated with over-the-counter medications, but talk with your doctor first about this step. Some vitamins or other dietary supplements, or complementary or alternative medicines could damage your liver. Avoid alcohol until your doctor confirms you are entirely recovered from hepatitis E. Physicians may treat persistent hepatitis E with ribavirin or peginterferon alfa-2a (Pegasys).

Prevention of hepatitis E

There is no vaccine for hepatitis E. But you can take certain precautions to prevent it.

Best Practices – Some standard practices will reduce your risk of contracting HEV.

• When traveling in an underdeveloped country, drink filtered or bottled water and use it to brush your teeth and make ice cubes. Wash all fruits and vegetables.
• Thoroughly cook all pork or deer regardless of the region in which you live.
• Always wash hands with warm, soapy water after using the restroom and before preparing food.
• Talk with a blood donation center before you donate blood to ensure you don’t have HEV. Bear in mind that you may have the virus but be asymptomatic.

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References

[1] https://www.worldhepatitisalliance.org/world-hepatitis-day/world-hepatitis-day-2018. Accessed May 28, 2018.
[2] Kabiri M, Jazwinski AB, Roberts MS, Schaefer AJ, Chhatwal J. The changing burden of hepatitis C virus infection in the United States: model-based predictions. Annals of Internal Medicine. 2014;161(3):170–180. Accessed May 14, 2018.
[3] Hepatitis A Questions and Answers for the Public. Centers for Disease Control and Prevention, Division of Viral Hepatitis website. www.cdc.gov/hepatitis/hav/afaq.htm . Updated May 23, 2016. Accessed May 13, 2018.
[4] https://www.sfcdcp.org/infectious-diseases-a-to-z/d-to-k/hepatitis-a/. Accessed May 28, 2018.
[5] Hepatitis A Questions and Answers for Health Professionals. Centers for Disease Control and Prevention, Division of Viral Hepatitis website. www.cdc.gov/hepatitis/hav/havfaq.htm. Updated July 13, 2016. Accessed May 13, 2018.
[6] What is Hepatitis B? Population Health Division, San Francisco Department of Health. Disease Prevention and Control. https://www.sfcdcp.org/infectious-diseases-a-to-z/d-to-k/hepatitis-b/. Accessed May 14, 2018.
[7] Hepatitis B FAQs for health professionals. Centers for Disease Control and Prevention website. www.cdc.gov/hepatitis/hbv/hbvfaq.htm Updated August 4, 2016. Accessed May 23, 2018.
[8] Roberts H, Kruszon-Moran D, Ly KN, et al. Prevalence of chronic hepatitis B virus (HBV) infection in U.S. households: National Health and Nutrition Examination Survey (NHANES), 1988-2012. Hepatology. 2016;63(2):388–397. Accessed May 23, 2018.
[9] https://www.sfcdcp.org/infectious-diseases-a-to-z/d-to-k/hepatitis-c/. Accessed May 28, 2018.
[10] Hepatitis C FAQs for health professionals. Centers for Disease Control and Prevention, Division of Viral Hepatitis website. www.cdc.gov/hepatitis/HCV/HCVfaq.htm . Updated July 21, 2016. Accessed May 19, 2018.
[11] https://www.who.int/campaigns/hepatitis-day/2017/event/en/. Accessed May 28, 2018.
[12] Roy PK. Hepatitis D. Medscape website. https://emedicine.medscape.com/article/178038-overview . Updated March 16, 2017. Accessed May 13, 2018.
[13] Farci P, Niro GA. Clinical features of hepatitis D. Seminars in Liver Disease. 2012;32(3):228‒236. Accessed May 13, 2018.
[14] Ahn J, Gish RG. Hepatitis D virus: a call to screening. Gastroenterology & Hepatology. 2014;10(10):647‒686. Accessed May 13, 2018.
[15] Negro F, Lok ASF. Pathogenesis, epidemiology, natural history, and clinical manifestations of hepatitis D virus infection. UpToDate website. https://www.uptodate.com/contents/pathogenesis-epidemiology-natural-history-and-clinical-manifestations-of-hepatitis-d-virus-infection . Updated July 20, 2016. Accessed May 13, 2018.
[16] Remy P. Hepatitis E. Medscape website. https://emedicine.medscape.com/article/178140-overview#a6 . Updated September 27, 2016. Accessed May 13, 2018.
[17] Hoofnagle JH, Nelson KE, Purcell RH. Hepatitis E. The New England Journal of Medicine. 2012;367(13):1237-1244. Accessed May 14, 2018.
[18] Centers for Disease Control and Prevention. Hepatitis E FAQs for Health Professionals. https://www.cdc.gov/hepatitis/hev/hevfaq.htm . Updated December 18, 2015. Accessed May 14, 2018.

Also see:

Hepatitis C FAQs for health professionals. Centers for Disease Control and Prevention, Division of Viral Hepatitis website. www.cdc.gov/hepatitis/HCV/HCVfaq.htm . Updated July 21, 2016. Accessed October 19, 2016. Accessed May 19, 2018.

What is Viral Hepatitis? U.S. Department of Health and Human Services website. https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/what-is-viral-hepatitis. Updated May 2017.