The ABCs of Hepatitis

You’ve likely heard of hepatitis C, since it’s the most common type, and you’ve probably heard of hepatitis A and B. But, did you know that you can also become infected with hepatitis D and E?

In the past, we’ve explained why hepatitis testing is important. To help recognize World Hepatitis Day on July 28, this guide will give you a comprehensive look at the five types of hepatitis, which hepatitis treatment options are available and how you can keep yourself and your family safe from these diseases.

What is hepatitis?

Hepatitis is inflammation of the liver that can occur from alcohol use, toxins, medications, bacteria and viruses. We’ll be covering viral hepatitis, a broad term used to describe liver diseases caused by the various forms of the hepatitis virus.

When the hepatitis virus attacks your liver, it produces an inflammatory response that makes it hard for your liver to function, leading to chronic issues if the inflammation goes untreated. Your liver has many functions, including removing harmful toxins. A liver that doesn’t function properly can lead to liver cancer and other liver diseases.

Many people are unaware they have hepatitis. Acute symptoms can appear anywhere from two weeks to six months after exposure. If you do have symptoms, they vary from fever and fatigue to abdominal pain and jaundice.

Different types of hepatitis

Hepatitis A, B and C are most common, while hepatitis D and hepatitis E are rare. Viral infections caused by these hepatitis viruses are usually short term (acute) or long term (chronic).

Hepatitis A

Hepatitis A shows up most in undeveloped countries, but in the U.S. this disease occurs among people in high-risk groups and as community-wide outbreaks. In 2018, a total of 12,474 hepatitis A cases were reported in the U.S. but experts think actual numbers are twice that amount.

The hepatitis A virus usually occurs when someone unknowingly ingests fecal matter, even microscopic amounts, through close personal contact or eating or drinking contaminated food. It is not spread by coughing or sneezing. Generally, you see more global cases of hepatitis A in countries without proper sanitation systems. If you’re traveling to these countries, take extra precautions to avoid drinking tap water and eating fresh fruits, vegetables or shellfish. You can also become infected through sexual contact.

People at increased risk for hepatitis A:

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

In the event you become infected, hepatitis A usually isn’t a long-term, chronic ailment, although symptoms can last from a few weeks to two months. Most patients recover with no lasting damage.

The best way to prevent hepatitis A is by getting vaccinated. To get the full benefit of the hepatitis A vaccine, more than one shot is needed. The number and timing of these shots depends on the type of vaccine you are given. Practicing good hand hygiene — including thoroughly washing hands after using the bathroom, changing diapers, and before preparing or eating food — plays an important role in preventing the spread of hepatitis A.

Hepatitis B

Unlike hepatitis A, the hepatitis B virus spreads by entering your bloodstream through bodily fluids such as blood or semen and can occur in people who use drugs and share needles or syringes. Mothers can also pass it down through birth.

Hepatitis B is not spread through breastfeeding, sharing eating utensils, hugging, kissing, holding hands, coughing, or sneezing. Unlike some forms of hepatitis, hepatitis B is also not spread by contaminated food or water.

Up to 80,000 Americans will become newly infected with hepatitis B each year and more than two million Americans are chronically infected. Most instances of hepatitis B remain acute with no long-term effects. Risk for chronic infection is related to age at infection: about 90% of infants with hepatitis B go on to develop chronic infection, whereas only about 5% of people who get hepatitis B as adults become chronically infected and have liver issues such as cirrhosis, liver failure or liver cancer. 

The best way to prevent hepatitis B is by getting vaccinated. The hepatitis B vaccine is typically given as a series of three shots over a period of six months.

Hepatitis C

Hepatitis C is spread through contact with blood from an infected person. Today, most people become infected with the hepatitis C virus by sharing needles or other equipment used to prepare and inject drugs.

For some people, hepatitis C is a short-term illness, but for more than half of people who become infected with the hepatitis C virus, it becomes a long-term, chronic infection. Chronic hepatitis C can result in serious, life-threatening health problems like cirrhosis and liver cancer.

More than three million people in the U.S. are living with chronic hepatitis C, and most do not feel ill or know they are infected. There are approximately 17,000 new hepatitis C cases each year in the U.S., many of which go unreported.

Part of the reason hepatitis C is so common is because the virus can spread through asymptomatic carriers. People with chronic hepatitis C can often have no symptoms and don’t feel sick. They remain unaware until they donate blood or get lab work done during an annual physical examination. When symptoms appear, they often are a sign of advanced liver disease. 

Getting tested for hepatitis C is important, because treatments can cure most people with hepatitis C in 8 to 12 weeks. The CDC now recommends one-time hepatitis C testing of all adults (18 years and older) and all pregnant women during every pregnancy. CDC continues to recommend people with risk factors, including people who inject drugs, be tested regularly. There is no vaccine for hepatitis C.

Hepatitis D

This type of hepatitis isn’t as common, but it’s the most severe as it can cause liver cancer or liver failure. Hepatitis D is directly tied to hepatitis B, as you can only contract this disease if you have hepatitis B.

If your hepatitis B infection causes hepatitis D, it leads to superinfection, a type of ailment that becomes chronic in 80% of people. Superinfection is the most common way to contract hepatitis D, but in certain cases, you can contract both at the same time, known as coinfection.

Americans are unlikely to come in contact with hepatitis D. The disease is most common in parts of Africa, Asia, Europe, the Middle East and South America.

Hepatitis E

Hepatitis E is another uncommon type of hepatitis in the U.S. You’re most likely to get hepatitis E by living in or visiting countries with poor sanitation. The hepatitis E virus is found in the stool of an infected person. It is spread when someone unknowingly ingests the virus – even in microscopic amounts. In developing countries, people most often get hepatitis E from drinking water contaminated by feces from people who are infected. Certain areas of Africa, Asia, Central America and the Middle East, where crowded living spaces are common, are more at risk.

While not common, there’s a chance those in the U.S. and developed countries may get hepatitis E by eating raw or undercooked meat, such as boar, deer or pork meat or shellfish. No vaccine for hepatitis E is currently available in the United States.

More information about vaccines

You can receive only a vaccine for hepatitis A and hepatitis B infections. The best way to avoid hepatitis D is by getting a hepatitis B vaccine. You can lower your chances of contracting hepatitis C and E by avoiding the risks associated with each infection. For example, don’t drink tap water or eat raw and undercooked meat when visiting countries where hepatitis E is common.

Should you get vaccinated for hepatitis A?

The CDC recommends that all children between ages 12 months and 23 months get this vaccine as well as for any infant aged 6 to 11 months who is traveling internationally. They should also receive the vaccine if they’re ages 2-18 and haven’t previously been vaccinated. The following people are also at risk for the disease and should be vaccinated.

• Children and teens through age 18 who live in states or communities that have made this vaccination routine because of a high rate of disease
• Men who have sex with men
• Anyone who uses illegal drugs
• People with chronic (long-term) liver disease
• Anyone treated with blood clotting drugs, such as people with hemophilia
• People who work with HAV-infected primates or in HAV research laboratories. (HAV is like HIV in animals.)
• Travelers to countries where hepatitis A is common. A good source to check is the CDC’s travelers’ health website, which you can search by the country you’re going to.
• People adopting or close to a child adopted from a country where hepatitis A is common

Should you get vaccinated for hepatitis B?

The CDC recommends it for all babies, who should get their first dose as newborns. Other people who need it include:

• People younger than age 19 who haven't been vaccinated
• Anyone who has a sex partner with hepatitis B
• People who are sexually active but aren’t in a long-term relationship in which both partners are monogamous
• Anyone being evaluated or treated for an STD
• Men who have sex with men
• People who share needles used to inject drugs
• Anyone who lives with someone who has hep B
• Anyone whose job routinely puts them at risk for coming in contact with blood or blood-contaminated body fluids
• People with end-stage kidney (renal) disease
• People who live and work in facilities for people who are developmentally disabled
• Travelers to regions with moderate to high rates of hepatitis B
• People with chronic liver disease
• People with HIV infections