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Viral Hepatitis Overview

What is hepatitis?

Hepatitis is inflammation of the liver. The liver is located in the upper right part of the belly (abdomen). It can be caused by a virus. It leads to damage of liver cells.

Front view of torso showing liver.

Hepatitis has 2 types:

Acute hepatitis. This type starts suddenly and lasts a few weeks.
Chronic hepatitis. This type lasts for months or years.

There are 5 main kinds of the hepatitis virus. They are:

Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E

You can learn more about these below.

Hepatitis A

This type of hepatitis is often spread by infected stool that comes in contact with the mouth. Or it is spread by food and water that has been tainted by stool. In rare cases, it may be spread by infection from contact with blood. In other rare cases, it may be spread by blood-borne infection. Here are some ways that hepatitis A can be spread:

Eating food made by someone who touched infected stool
Drinking water that is tainted by infected stool. This is a problem in developing countries with poor sewage removal.
Touching an infected person's stool. This may happen with poor handwashing.
Outbreaks may happen in large childcare centers, especially when there are children in diapers
Sexual contact with an infected person

A highly protective vaccine for hepatitis A is now available. It's advised for U.S. babies 12 months and older. Adults who are at risk are advised to be vaccinated. But any adult who wants the vaccine can get it.

Hepatitis B

Hepatitis B (HBV) has a wide range of symptoms. It can be mild, with no symptoms. Or it may cause long-term (chronic) hepatitis. In some cases, it can lead to liver failure and death. Hepatitis B virus can spread through body fluids. This includes blood, semen, vaginal fluids, or saliva.

In developed countries, the main ways to get hepatitis B are:

Cuts from sharp tools or needles tainted with hepatitis B
Using an infected person's personal items (razors, toothbrushes)
Having sex with an infected person

Around the world, the main way babies get hepatitis B is from their mothers. Infants are very likely to get the disease if they are born to a mother who has the virus. They are also very likely to get the disease if they are not vaccinated within 24 hours of birth. More protection is provided if the baby receives hepatitis B immune globulin. The mother is often treated during pregnancy to reduce the risk of giving hepatitis B to the baby. Infected children often spread the virus to other children through contact. The virus can also spread if a child has many scrapes or cuts.

People who are at risk for hepatitis B include:

Children born to mothers who have hepatitis B
Children who are born to mothers who have emigrated from a region where hepatitis B is widespread, such as Africa, Russia, Eastern Europe, the Middle East, India, Southeast Asia, and China
People who live in long-term care facilities or who are disabled
People who live in households where another member is infected with the virus
People who have a blood-clotting disorder such as hemophilia
People who need dialysis for kidney failure
People who take part in IV (intravenous) drug use or unprotected sex
People who have jobs that include contact with human blood
People who had blood transfusions or blood products before the early 1990s

A vaccine for hepatitis B does exist. It is a routine childhood vaccine. It is also a catchup vaccine for teens as well as high-risk people. The CDC now advises that all babies should have the hepatitis B vaccine at birth. Hepatitis B is treatable. It is controllable. But it is not curable.

Hepatitis C

The symptoms of hepatitis C are often mild and happen slowly. Children and adults often show no symptoms at all. Hepatitis C is mainly spread from contact with infected blood. It can also happen from sexual contact. Or it can be spread from an infected mother to her baby. In some cases, it's not clear how it was spread. Hepatitis C has milder symptoms at first. But it leads to long-term (chronic) liver disease in most people who are infected. According to the CDC, hepatitis C is the main reason for needing a liver transplant. It is also the main cause of liver cancer in the U.S.

People who may be at risk for hepatitis C include:

People born between 1945 and 1965
Children born to mothers who are infected with the virus
People who have a blood-clotting disorder such as hemophilia and received clotting factors before 1987
People who need dialysis for kidney failure
People who had a blood transfusion before 1992
People who take part in IV drug use or unprotected sex

There is no vaccine for hepatitis C. People who are at risk should be checked regularly for hepatitis C. People who have hepatitis C should be watched closely for signs of chronic hepatitis and liver failure. There is a treatment for HCV. It has a very high cure rate and changes a person's health and future outlook.

Hepatitis D

This form of hepatitis can happen only if you have hepatitis B. If a person has hepatitis B and does not show symptoms, or shows very mild symptoms, infection with hepatitis D can put that person at risk for liver failure and liver cancer that progresses rapidly. Hepatitis D can happen at the same time as the first infection with B. Or it may show up much later as a new "superinfection." Hepatitis D spreads the same way as hepatitis B. But it is less common for an infected mother to spread it to her baby. Hepatitis D is curable with treatment in about 15% of people.

Hepatitis E

This form of hepatitis is similar to hepatitis A. It is spread by infected stool that comes in contact with the mouth. Or it is spread by food and water that has been tainted by stool. It is less common than hepatitis A. Hepatitis E is most common in developing countries. It is also seen in the U.S. There is no vaccine for hepatitis E at this time in the U.S. But there is a vaccine in China that has a high protective level. Hepatitis E is a serious health concern in pregnant women.

How often does hepatitis happen?

In the U.S.:

Hepatitis A rates have dropped by 92% since the hepatitis A vaccine came out in 1995.
About 800,000 to 2.2 million people have chronic hepatitis B infections.
About 3.6 million people have chronic hepatitis C infections.

What is acute hepatitis?

What is chronic hepatitis?

Acute hepatitis is quite common in the U.S.

Causes. Common causes of acute hepatitis may include:

Infection with a virus (viral hepatitis A, B, C, D, or E)
Overdose of medicines (such as acetaminophen)
Chemical exposure (such as dry cleaning chemicals)

Symptoms. Acute hepatitis often starts with flu-like symptoms.

Each person may have different symptoms. They may include:

Yellow color in the skin or eyes (jaundice)
Nausea
Vomiting
Loss of appetite
Fever
Tenderness in the right, upper belly
Sore muscles
Joint pain
Clay-colored bowel movements
Itchy, red hives on skin

The symptoms of acute hepatitis may be like those of other health problems. See your healthcare provider for a diagnosis.

Diagnosis. A healthcare provider will ask about your health history. They will also give you a physical exam. You may have blood tests to check liver function and damage.

Treatment. Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment varies depending on the type of acute hepatitis (viral or nonviral). You may need to stay in the hospital if you have severe, acute hepatitis.

People who have had acute viral hepatitis may become chronic carriers of the disease. You will need to take special care to prevent the spread of the disease.

Some people don't recover fully from acute hepatitis. They develop chronic hepatitis. This means the liver continues to have more damage and inflammation. Hepatitis is called chronic if symptoms last longer than 6 months. Chronic hepatitis can last years.

Types of chronic hepatitis include:

Alcohol-induced chronic hepatitis. This causes damage all over the liver from heavy alcohol use.
Chronic active hepatitis. This is a severe inflammation and damage of liver cells. This can lead to cirrhosis. It has many causes.

Causes. Some viruses, genetic disorders, autoimmune diseases, and medicines may cause chronic hepatitis in some people, but not in others. Some common causes include:

Viral hepatitis B, C, and D
Heavy alcohol use
The body attacks its own tissues (autoimmune disorder)
Reaction to certain medicines
Nonalcoholic fatty liver disease. This is seen most often in people with metabolic conditions such as diabetes, hypertension, obesity, and high cholesterol.
Metabolic disorders (such as hemochromatosis or Wilson disease)

Symptoms. Symptoms are often mild. The liver damage continues. But its progression is often slow. Each person may have different symptoms. Some people may have no symptoms. Others may have symptoms such as:

Feeling ill
Poor appetite
Extreme tiredness (fatigue)
Low-grade fever
Upper belly pain
Yellow color in the skin or eyes (jaundice)
Enlarged spleen
Thin blood vessels showing in the skin
Fluid retention

The symptoms of chronic hepatitis may be like those of other health problems. See your healthcare provider for a diagnosis.

Diagnosis. A healthcare provider will ask about your health history. They will also give you a physical exam. You may also have tests such as:

Liver enzyme tests
Liver function tests
Ultrasound, CT, or MRI of the liver
Serologic, genetic, and other tests
Liver biopsy, to find a cause and look at severity of inflammation, scarring, and cirrhosis

Treatment. Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

The goal of treatment is to stop damage to the liver and ease symptoms. Treatment may include:

An antiviral agent. When caused by hepatitis B or C, liver inflammation may be stopped with a variety of antiviral agents. Hepatitis C can often be cured.
Corticosteroids. These may be used to treat chronic liver disease caused by an autoimmune disorder. Inflammation is suppressed, but scarring of the liver may continue. These may be combined with other medicines.
Stopping certain medicines. When chronic hepatitis is caused by certain medicines, stopping those medicines often clears up any symptoms.
Stopping alcohol use. This improves alcoholic liver disease. But it's also helpful to stop alcohol use if you have other liver conditions.
Managing metabolic conditions. Hepatitis can affect metabolic conditions. These include diabetes, high cholesterol and triglycerides, obesity, and high blood pressure. These conditions will be treated as well.

Preventing the spread of viral hepatitis

Having good personal health (hygiene) habits is the key to preventing the spread of many diseases, including hepatitis. Other preventive measures include:

Getting vaccines. A hepatitis B vaccine is given to newborns, babies, and toddlers. It is part of the routine vaccine schedule. A hepatitis A vaccine is available for people at risk for the disease while traveling. There are no vaccines for hepatitis C, D, or E at this time.
Blood transfusion screening. Blood for transfusions is routinely screened for hepatitis B and C to reduce the risk of infection.
Antibody treatment. If a person has been exposed to hepatitis, an antibody treatment can be given to help protect them from the disease.
Safe sex. Practice safe sex, including using condoms.
Safe needle use. Don't share or reuse needles, syringes, or other equipment.
Not sharing personal items. Don't use personal items that may have even a small amount of an infected person's blood. These include nail clippers, toothbrushes, glucose monitors, or razors.
Getting tattoos safely. If you plan on getting a tattoo, use a licensed facility only. Don't get tattoos in an unsafe setting.