Timothy Yarboro, M.D.
Viral hepatitis is an inflammation of the liver. There are five major types of viral hepatitis – A, B, C, D and E. All of these viruses cause acute liver inflammation, which often resolves on its own without treatment after a period of time. However, some people with hepatitis B or C develop a chronic infection that damages the liver. Left untreated, hepatitis can cause cirrhosis (scarring) of the liver, liver failure or liver cancer. These conditions are potentially fatal.
Hepatitis A and E are primarily spread through contact with the fecal matter of people infected with these viruses. Hepatitis B, C and D are primarily spread through contact with the bodily fluids of people infected with these viruses, either through sexual contact, intravenous drug use or childbirth. In the United States, hepatitis A, B and C are far more common than hepatitis D or E. Other types of hepatitis may exist that have not yet been identified.
Many people with hepatitis may not experience any symptoms and never know they have been infected with the virus or have the disease. When symptoms do occur, they can be general enough to be mistaken for another condition. These symptoms include fatigue, nausea, abdominal pain and jaundice. Physicians may diagnose the different types of hepatitis through blood tests.
Some types of hepatitis do not require treatment or can be treated with medications. Others cannot be treated, but may worsen and damage the liver. If the liver experiences sufficient cirrhosis, liver failure may occur.
Most forms of hepatitis can be prevented with good hygiene and safe-sex practices. Avoidance of contaminated food and water and careful hand washing can prevent transmission of the foodborne types of hepatitis. Practices that minimize contact with the blood or body fluids of others can prevent transmission of the bloodborne types of hepatitis. Vaccines have been developed to help prevent hepatitis A and B. Women who have viral hepatitis – particularly hepatitis B – can pass this virus on to their children during childbirth, often with devastating consequences. For this reason, it is important that pregnant women have a blood test to screen for hepatitis as part of their prenatal care. If the mother tests positive, the baby can be given medicines shortly after birth that can reduce the long-term risk to the child’s health.
About viral hepatitis
Viral hepatitis is an inflammation of the liver caused by a virus. The liver, the largest internal organ in the body, is responsible for more than 500 functions. When the liver swells from the infection, it cannot effectively complete its essential tasks, which include:
- Digestion. The liver produces bile, the greenish fluid stored in the gallbladder that helps digest fats.
- Energy storage. The liver processes most of the nutrients absorbed in the intestine.
- Removal of poisons. The liver metabolizes or breaks down and eliminates drugs, alcohol and other harmful substances from the blood.
- Production of other important chemicals. The liver produces cholesterol, vitamin A, blood-clotting factors and certain proteins.
There are five basic types of viral hepatitis: A, B, C, D and E. The virus is transmitted in a number of different ways, depending on the form of hepatitis. In most cases, hepatitis is the result of contact with bodily fluids from an infected person during sexual intercourse, shared use of needles or exposure to blood. However, hepatitis A and E are also transmitted through consuming food or water contaminated with feces from an infected person. Some studies have shown that, unlike many other viral infections, the damaged caused by viral hepatitis may be due to the immune response to the virus, rather than the virus itself.
People who contract viral hepatitis may experience it in two forms:
- Acute viral hepatitis. Initially, all forms of viral hepatitis are experienced as short-term viral infection. In many cases, this form of hepatitis will resolve on its own without the need for treatment, and in some cases the patient may not experience symptoms or even be aware of the infection.
- Chronic viral hepatitis. In some cases, acute viral hepatitis will develop into this longer-lasting viral infection that is present for at least six months and often for a lifetime. Hepatitis B and C can develop into chronic viral hepatitis. In some cases, patients can be unaware of these infections for decades before they start to cause serious illness.
Chronic viral hepatitis can lead to cirrhosis of the liver, in which liver cells die and are replaced by scar tissue and fat. In addition, patients may go on to develop liver failure or liver cancer. There is no cure for this form of viral hepatitis, although treatments can help keep the virus at bay and prevent further damage to the liver. In some cases, patients require liver transplants.
Most forms of viral hepatitis cannot be transmitted through casual contact, such as hugging or shaking hands. However, it is possible for people to contract hepatitis A by touching their mouth after touching an infected person (e.g., after shaking hands). A, B and C are the most common types of viral hepatitis in the United States. Blood testing can help a physician determine which form of hepatitis a patient has. Left untreated, viral hepatitis can lead to serious health disorders, and even death.
Types and differences of viral hepatitis
There are five primary types of viral hepatitis: A, B, C, D and E. Hepatitis A (HAV) is caused by eating food or drinking water contaminated with the feces of a person infected with hepatitis A virus. For example, people can contract hepatitis A by eating raw or undercooked seafood harvested from contaminated waters, by eating produce that was fertilized with human waste, by eating at restaurants where employees did not wash their hands after using the restroom or even by touching their mouth after shaking hands with an infected person. Anal-oral contact can also cause hepatitis A. Hepatitis A is rarely passed from a mother to her baby. It may play a role in premature labor.
Although hepatitis A causes the liver to swell, the damage is not usually permanent, and the condition generally improves on its own. About 15 percent of patients may have prolonged or relapsing symptoms over a six- to nine-month period, according to the U.S. Centers for Disease Control and Prevention (CDC). However, hepatitis A does not develop into a chronic form of the virus. After a person recovers from hepatitis A, the virus no longer remains in the body and the person cannot become infected with hepatitis A again. However, they may remain vulnerable to infections from other forms of hepatitis.
Hepatitis B (HBV) is caused by contact with bodily fluids of a person infected with the hepatitis B virus. It can be contracted by having sexual intercourse or (in intravenous drug users) through sharing needles with an infected person. It can also be transmitted from an infected mother to her baby during childbirth.
About 1.25 million people are chronically infected with the virus in the United States, according to the CDC. It is about 100 times more infectious than the human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS).
Hepatitis B causes the liver to swell, and in some cases liver damage occurs. It also raises the risk for infection with hepatitis C and HIV. In most cases, the body rids itself of the virus after several months, and the body becomes immune to further hepatitis B viral infections. However, in other cases, the infection may become chronic, scarring the liver (cirrhosis), causing liver failure or causing liver cancer.
According to the CDC, the risk of chronic infection with hepatitis B decreases with age, affecting very few individuals over the age of 5. Chronic infection occurs in:
- 90 percent of infants infected at birth
- 30 percent of children infected between ages 1 and 5
- 6 percent of people infected after age 5
Approximately 15 percent to 25 percent of patients with chronic hepatitis B infection die from the disease.
Of all the hepatitis viruses, hepatitis B poses the greatest risk in pregnancy. In some cases, mothers with hepatitis B transmit the infection to their child when their infected blood enters the baby’s body during the birthing process. In other cases, the child may obtain the virus during the pregnancy. There are no treatments to prevent this from happening. According to the March of Dimes Birth Defects Foundation, up to 20,000 women with hepatitis B give birth each year.
Mothers who have hepatitis B can breastfeed their child as long as the baby receives a shot called HBIG (hepatitis B immune globulin) and a shot of hepatitis B vaccine within the first 12 hours after birth.
Hepatitis B shots help the baby fight off the virus and make the baby much less likely to get the infection. Without treatment, approximately half of babies of mothers with hepatitis B may acquire the infection, according to the March of Dimes Birth Defects Foundation. The majority of these babies become lifelong carriers of the virus, with a high risk of developing serious liver disease and liver cancer as adults.
The shots are administered in three stages:
- At birth – hepatitis B vaccine and HBIG shot
- 1 month to 2 months old – hepatitis B vaccine
- 6 months old (not before 24 weeks, but not after 6 months) – hepatitis B vaccine
Hepatitis C (HCV) is most often transmitted through sharing needles with an infected person during illegal drug use or through other contact with infected blood. Less commonly, it is spread through sexual contact or to dialysis patients by contaminated equipment. The virus can also be transmitted from mother to child during childbirth, although this is rare. An estimated 4.1 million Americans are infected with hepatitis C, and 3.2 million Americans are chronically infected with the virus, according to the CDC.
During the 1970s and 1980s, researchers were aware of transmission of what was called ‘non-A, non-B hepatitis.’ Many people contracted it from blood transfusions during surgery. This virus was identified as hepatitis C in the late 1980s and screening for it in the blood supply began in the early 1990s.
Hepatitis C is the leading reason for cirrhosis, liver cancer and liver transplants in the United States, according to the U.S. Department of Health and Human Services. In some cases, hepatitis C gets better on its own. However, the virus kills between 1 percent and 5 percent of those infected with it. People with hepatitis C infections are at higher risk for being infected with hepatitis B or HIV.
Hepatitis D (HDV) is caused by contact with a person infected with this virus. It can occur through having sex or sharing needles with an infected individual. Hepatitis D can also be transmitted from an infected mother to her baby during childbirth. However, a person must be positive for hepatitis B to become infected with hepatitis D.
Hepatitis D causes swelling of the liver and it can lead to liver disease and cirrhosis. Acute liver failure is more likely in patients with hepatitis D than in those who have hepatitis B alone. In some cases, hepatitis D resolves on its own.
Hepatitis E (HEV) occurs after consuming food or water contaminated with feces from an infected person. The risk of infection is higher in areas of the world outside the United States that have high rates of hepatitis E infection. Hepatitis E cannot develop into a chronic infection.
Hepatitis E causes swelling of the liver, but usually does not do permanent damage and goes away on its own. However, pregnant women and their babies are at increased risk of dying from infection. Pregnant women are especially at risk during their third trimester. The mortality rate among pregnant women is 20 percent, according to the National Women’s Health Resource Center.
In some cases, viral hepatitis cannot be attributed to any of these primary types. Such cases are classified as non-A-E hepatitis. The cause of this form of hepatitis remains unknown. There are also nonviral forms of hepatitis, which may be caused by various factors, including alcohol, drugs, toxins such as industrial chemicals, bacteria, syphilis, toxoplasmosis, and other viruses, including cytomegalovirus and Epstein-Barr (mononucleosis).
Risk factors and causes of viral hepatitis
Viral hepatitis is most commonly spread through contact with infected blood, stool or other bodily fluids. Because of this, any activity that involves contact with these substances – such as sexual intercourse, intravenous drug use, or poor personal hygiene – increases the risk of contracting viral hepatitis. Certain groups are at a higher risk of infection, including:
- People who live in or travel to areas that are experiencing an outbreak of hepatitis
- Men who have sex with men, especially during an outbreak
- People who have close contact or sexual relations with someone who is infected
- Children who were born to infected mothers
In addition, because hepatitis C in particular has been shown to increase the risk for infection with hepatitis B and HIV, people who are in certain high-risk groups should undergo testing for hepatitis C. These groups include:
- Intravenous drug users
- Kidney patients who are on hemodialysis
- Patients who received a blood transfusion or organ transplant before 1992
- Patients who received blood clotting factors made before 1987
- People with certain types of liver problems
- Healthcare and public health safety workers with needle stick or exposure to HCV positive blood
- People with multiple sex partners
- Children aged 12 to 18 months born to a mother who is HCV positive
Signs and symptoms of viral hepatitis
In some cases, people with viral hepatitis will not experience any symptoms. However, as liver function begins to fail, chemicals may buildup in the blood and symptoms may appear, including:
- Dark-colored urine that may resemble tea
- Fever (low-grade)
- Loss of appetite
- Muscle aches
- Nausea and vomiting
- Pain in the stomach
- Bowel movements that are pale or gray
- Fatigue and malaise
- Yellowing of the skin and the whites of the eyes (jaundice)
Many of these symptoms can indicate conditions other than viral hepatitis. Individuals experiencing any of these symptoms should notify their physician.
Diagnosis and treatment of viral hepatitis
A physician will compile a medical history and perform a physical examination. Though some patients will experience symptoms, many others will not. As a result, blood testing is an important way of diagnosing viral hepatitis, especially for people in high-risk groups. If a person is infected with viral hepatitis, a blood test will reveal the presence of both antigens (in acute infections) and antibodies to the virus.
In most cases, acute forms of viral hepatitis resolve without treatment. However, it may take months for the liver to heal. Chronic hepatitis requires treatment with various forms of medication. People known to have hepatitis C should have their blood monitored for any changes in the amount of antibodies. They will require treatments when the antibody level rises significantly, indicating they have a substantial amount of virus present. These treatments come in injection and pill form and may last several weeks or several months, with the nature of the treatment dependent upon the severity of infection.
Treatment plans for the various forms of viral hepatitis include:
- Hepatitis A. Resolves on its own, usually after a few weeks. There is no medical treatment for hepatitis A.
- Hepatitis B. Acute hepatitis B usually resolves on its own, although in some cases it can be treated with a drug called lamivudine. Chronic forms of the virus can be treated with drugs such as alpha interferon, entecavir, lamivudine or adefovir dipivoxil. These drugs should not be used by pregnant women.
- Hepatitis C. Acute hepatitis C usually resolves within two to three months. Chronic hepatitis C is treated with pegylated interferon and ribavirin.
- Hepatitis D. Antiviral drugs such as alpha interferon sometimes are used to treat hepatitis D.
- Hepatitis E. Usually resolves on its own over several weeks or months.
Patients diagnosed with viral hepatitis should avoid alcohol until they recover from the virus and the liver is healthy. Certain medications such as anticoagulants (drugs that help prevent blood from clotting) may have to be discontinued because liver impairment may prevent proper metabolism of the drugs, allowing them to build up in the body. Patients with hepatitis should not start or discontinue using any medications without first consulting their physician.
There is no cure for viral hepatitis, although medications can reduce copies of the virus to the point that they are undetectable. If the virus remains undetectable for six months after treatment is finished, the patient is considered to have a sustained virologic response and is unlikely to experience further liver problems.
Prevention methods for viral hepatitis
Basic precautions can go a long way toward preventing infection with viral hepatitis. Vaccinations are among the most effective methods of preventing hepatitis A and B. The vaccine for hepatitis A is administered in two doses, six to 18 months apart. The hepatitis B vaccine is administered in three doses over a six-month period. In the United States, most states now require vaccination for hepatitis A and B during childhood, and many require prenatal screening for hepatitis B.
Vaccination for hepatitis A and B is recommended for:
- All children up to age 18
- Men who have sex with other men
- Drug users (including those who inject and those who do not)
Vaccination for hepatitis A is recommended for:
- People traveling in areas with high rates of hepatitis A
- Individuals with clotting-factor disorders such as hemophilia
- People with chronic liver disease
- Workers at daycare facilities during reported outbreaks of the hepatitis A virus.
Vaccination for hepatitis B is recommended for:
- People recently diagnosed with a sexually transmitted disease (STD)
- Individuals with sex partners who have chronic hepatitis B
- People with multiple sex partners
- Individuals who live with someone who has chronic hepatitis B
- People whose jobs expose them to human blood
There is currently no vaccine for hepatitis C, although this may change soon due to promising clinical trials. There is also no way to prevent a mother from passing the virus on to her child during pregnancy. However, people with hepatitis C infection are urged to get vaccinated for hepatitis A and B. There is also no vaccine for hepatitis D and E, although it is recommended that individuals who have hepatitis D infection get vaccinated for hepatitis B.
Other ways to protect against viral hepatitis include:
- Get an immune globulin (IG) shot for hepatitis A and B. This offers short-term protection and is a good option for those traveling for less than four weeks in areas that have high levels of hepatitis A. This type of shot can help people for up to two weeks after they have been exposed to hepatitis A and B. Newborns may also be treated with an IG shot if the mother has symptoms of hepatitis A around the time of birth.
- Get tested for hepatitis B during pregnancy. Women who find they are positive for the virus should make sure their child receives hepatitis B immune globulin (HBIG) shot and vaccine within 12 hours of birth. Mothers should also make sure their child receives the third and final vaccine shot at 6 months of age. According to the American Liver Foundation, these measures prevent 90 percent to 95 percent of transmission of the hepatitis B virus and provide life-term protection for the child.
- Avoid drinking tap water or beverages with ice made from tap water in countries with unsafe water supplies. Also, be careful about eating uncooked foods – particularly raw shellfish and uncooked fruits or vegetables that are not peeled – when traveling internationally. This can lower the risk of contracting hepatitis A and E.
- Wash hands thoroughly after using the toilet or changing a diaper, and before preparing and eating food. This can lower the risk of infection with hepatitis A and E.
- Use latex condoms during sex. This can lower – but not eliminate – the risk of contracting hepatitis B, C and D.
- Avoid objects that have an infected person’s blood on them, which can transmit the hepatitis B, C and D viruses. This may include toothbrushes, razors, nail clippers and washcloths.
- Cover cuts and open sores.
- Use care when getting tattoos or body piercings. Tools infected with someone else’s blood can transmit the hepatitis B, C and D viruses.
- Safely handle needles and other sharps used on infected patients.
- Seek professional help to stop using intravenous drugs. Shared needles, syringes and other paraphernalia can transmit hepatitis B, C and D.
In addition, individuals who get hepatitis A one time cannot become reinfected with the virus. People who have hepatitis B can prevent the spread of the infection by not donating blood, tissues or organs.
Questions for your doctor about viral hepatitis
Preparing questions in advance can help patients have more meaningful discussions regarding their conditions. Patients may wish to ask their doctor the following questions about viral hepatitis:
- Should I be tested for viral hepatitis? What factors put me at risk for the infection?
- How can I reduce my risk of becoming infected with viral hepatitis?
- Should I be vaccinated against hepatitis A and B?
- I was diagnosed with hepatitis A and recovered. Am I still at risk for hepatitis?
- I have viral hepatitis. Now that I am pregnant, how can I protect my child from getting the virus from me?
- Will infection with one form of viral hepatitis put me at risk for contracting other forms? Does it increase my risk of getting HIV?
- What treatment is best for my type of hepatitis? Are there any side effects with this treatment?
- When will I recover from my form of hepatitis?
- Will my liver recover completely after my bout of hepatitis?
- I live with someone who is infected with hepatitis. How can I reduce my chances of contracting the virus?
- Will my form of hepatitis affect future pregnancies?