Viral Hepatitis Overview

What is hepatitis?

Hepatitis is inflammation of the liver that results in liver cell damage and destruction.

Illustration of the anatomy of the biliary system

Hepatitis can be categorized in 2 groups:

  • Acute hepatitis

  • Chronic hepatitis

There are 6 main types of the hepatitis virus that have been identified:

  • Hepatitis A. This type of hepatitis is usually spread by fecal-oral contact, or fecal-infected food and water. It may also be spread by blood-borne infection (which is rare). The following is a list of modes of transmission for hepatitis A:

    • Consuming food made by someone who touched infected feces

    • Drinking water that is contaminated by infected feces (a problem in developing countries with poor sewage removal)

    • Touching an infected person's feces, which may occur with poor handwashing

    • Outbreaks may occur in large childcare centers, especially when there are children in diapers

    • Residents of American Indian reservations or Native Alaskan villages where hepatitis A may be more common

    • Sexual contact with an infected person

    A highly protective vaccine for hepatitis A has been developed and is now available.

  • Hepatitis B. Hepatitis B (HBV) has a wide range of clinical presentations. It can be mild, without symptoms, or it may cause chronic hepatitis and, in some cases, can lead to liver failure and death. Transmission of hepatitis B virus occurs through body fluid exposure such as blood, semen, vaginal secretions, or saliva. Needle sticks, sharp instruments, sharing items (razors, toothbrushes), and sex with an infected person are primary modes of transmission in developed countries. Mother-to-baby transmission is the predominant mode of transmission worldwide. Infants are highly likely to develop the disease if they are born to a mother who has the virus and if they are not vaccinated within 24 hours of birth. Further protection is provided if the baby receives hepatitis B immune globulin. Infected children often spread the virus to other children if there is frequent contact, or if a child has many scrapes or cuts. The following describes people who are at risk for developing hepatitis B:

    • Children born to mothers who have hepatitis B (the illness may present at any time after the child is born)

    • Children who are born to mothers who have immigrated 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 participate in high-risk activities such as intravenous (IV) drug use and/or unprotected heterosexual or homosexual sexual contact

    • People who have jobs that involve contact with human blood

    • People who received blood transfusions or blood products before the early 1990s

    A vaccine for hepatitis B does exist and is now widely used for routine childhood immunization and for catchup immunization for teenagers as well as high-risk individuals. The CDC now recommends that universal infant hepatitis B vaccination should begin at birth. Hepatitis B is treatable. It is controllable, but not curable. 

  • Hepatitis C. The symptoms of hepatitis C are usually mild and gradual. Children and adults often show no symptoms at all. Transmission of hepatitis C occurs primarily from contact with infected blood, but can also occur from sexual contact, or from an infected mother to her baby. Although hepatitis C has milder symptoms initially, it leads to chronic liver disease in a majority of people who are infected. According to the CDC, hepatitis C is the leading indication for liver transplantation and is the number one cause of liver cancer in the United States. With some cases of hepatitis C, no mode of transmission can be identified. 

The following describes people who may be at risk for contracting hepatitis C:

  • 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

  • Individuals who received a blood transfusion before 1992

  • People who participate in high-risk activities such as intravenous drug use and/or unprotected heterosexual or homosexual sexual contact

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 monitored closely for signs of chronic hepatitis and liver failure. There is a current treatment for HCV that has a very high cure rate and changes patients' health and future prognosis. 

  • Hepatitis D. This form of hepatitis can occur only in the presence of hepatitis B. If an individual 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 occur at the same time as the initial infection with B, or it may show up much later as a new superinfection. Transmission of hepatitis D occurs the same way as hepatitis B, except the transmission from mother to baby is less common. Hepatitis D is curable with treatment in about 15% of patients. 

  • Hepatitis E. This form of hepatitis is similar to hepatitis A, in that transmission occurs through fecal-oral contamination. It is less common than hepatitis A. Hepatitis E is most common in poorly-developed countries and is seen in the United States. There is no vaccine for hepatitis E at this time in the United States, but there is a vaccine in China that has a high protective level.

How often does hepatitis occur?

In the United States:

  • Hepatitis A rates have declined by 92% since the hepatitis A vaccine first became available in 1995.

  • An estimated 800,000 to 2.2 million people have chronic hepatitis B infections.

  • An estimated 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 drugs (such as acetaminophen)

  • Chemical exposure (such as drycleaning chemicals)

Symptoms: Acute hepatitis usually starts with flu-like symptoms. The following are the most common symptoms of acute hepatitis. However, each person may experience symptoms differently. Symptoms may include:

  • Jaundice (yellow color in the skin and/or eyes)

  • Nausea

  • Vomiting

  • Loss of appetite

  • Fever

  • Tenderness in the right, upper abdomen (belly)

  • Sore muscles

  • Joint pain

  • Clay-colored bowel movements

  • Itchy, red hives on skin

The symptoms of acute hepatitis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

Diagnosis: In addition to a complete medical history and medical examination, diagnostic procedures for acute hepatitis may include the following:

  • Specific laboratory tests

  • Liver function tests

Treatment: Specific treatment for acute hepatitis will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment varies depending on the type of acute hepatitis (viral versus nonviral). Severe, acute hepatitis may require hospitalization.

People who have had acute viral hepatitis may become chronic carriers of the disease. Proper precautions need to be taken to prevent the spread of the disease.

Some people do not recover fully from acute hepatitis and develop chronic hepatitis, as the liver continues to sustain more damage and inflammation. Hepatitis is considered chronic if symptoms persist longer than 6 months. Chronic hepatitis can last years.

Types of chronic hepatitis:

  • Alcohol-induced chronic hepatitis. This type is characterized by continued damage throughout the liver from heavy alcohol consumption.

  • Chronic active hepatitis. An aggressive inflammation and destruction of liver cells, which can lead to cirrhosis and has a myriad of causes. 

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

  • Viral hepatitis

  • Heavy alcohol consumption

  • Autoimmune disorder (when the body attacks its own tissues)

  • Reaction to certain medications

  • Metabolic disorders (such as hemochromatosis or Wilson disease)

Symptoms. Symptoms of chronic hepatitis are usually mild. Although the liver damage continues, its progression is usually slow. The following are the most common symptoms of chronic hepatitis. However, each person may experience symptoms differently. Some people may experience no symptoms, while others may experience:

  • Feeling ill

  • Poor appetite

  • Fatigue (extreme tiredness) 

  • Low-grade fever

  • Upper abdominal (belly) pain

  • Jaundice

  • Symptoms of chronic liver disease (such as enlarged spleen, spider-like blood vessels in the skin, and fluid retention)

The symptoms of chronic hepatitis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

Diagnosis. In addition to a complete medical history and medical examination, diagnostic procedures for chronic hepatitis may include:

  • Specific laboratory tests

  • Liver enzymes: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP) and gamma-glutamyl transpeptidase (GGT) 

  • Liver function tests: albumin, bilirubin, and international normalized ratio (INR) 

  • Ultrasound of the liver 

  • Serologic, genetic, and other tests to focus on the disease 

  • Liver biopsy (to determine severity of inflammation, scarring, cirrhosis, and underlying cause)

Treatment. Specific treatment for chronic hepatitis will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Cause of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

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, inflammation of the liver may be stopped with a variety of antiviral agent.

  • Corticosteroids. Corticosteroids may be used to treat chronic liver disease caused by an autoimmune disorder. Inflammation is suppressed, but scarring of the liver may continue. This may be combined with other medications, such as azathioprine. 

  • Discontinuation of certain drugs. When chronic hepatitis is caused by certain drugs, discontinuing those drugs usually clears up any symptoms.

Preventing the spread of viral hepatitis

Proper hygiene is the key to preventing the spread of many diseases, including hepatitis. Other preventive measures include the following:

  • Vaccinations. A hepatitis B vaccine is routinely given to newborns, infants, and toddlers as part of their immunization schedule. A hepatitis A vaccine is available for people at risk for contracting the disease while traveling. (There are no vaccines for hepatitis C, D, or E at this time.)

  • Blood transfusion. Blood for transfusions is routinely screened for hepatitis B and C to reduce the risk of infection.

  • Antibody preparation. If a person has been exposed to hepatitis, an antibody preparation can be given to help protect them from the disease.

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