Viral Hepatitis

What is hepatitis?

Hepatitis refers to inflammation of the liver. Inflammation is a tissue’s reaction to irritation or injury which generally results in swelling and can cause pain.

There are many causes of hepatitis. Viral hepatitis is caused by a virus and can either be acute (lasting less than six months) or chronic (lasting more than six months). Viral hepatitis can be spread from person to person. Some types of viral hepatitis can be spread through sexual contact.

There are five known hepatitis viruses which are categorized by the letters A through E.

Several viruses are known to cause hepatitis. Common forms of viral hepatitis include:

• Hepatitis A: According to the Centers for Disease Control and Prevention, there were about 2,007 instances of acute hepatitis A infections in the U.S. in 2016. This form of hepatitis does not lead to a chronic infection and usually has no complications. The liver usually heals from hepatitis A within several months. However, occasional deaths from hepatitis A have occurred due to liver failure, and some people have required a liver transplant for acute hepatitis A infection. Hepatitis A can be prevented by vaccination.
• Hepatitis B: Around 22,000 new cases of hepatitis B occurred in 2017, and around 900,000 people are living with the disease in the US. Approximately 95% of adults recover from hepatitis B and do not become chronically infected. However, a few cases cause a life-long, chronic infection. The earlier in life hepatitis B is contracted, the more likely it is to become chronic. People can carry the virus without feeling sick but can still spread the virus. Hepatitis B can be prevented by getting a vaccine.
• Hepatitis C: Hepatitis C is one of the most common causes of liver disease in the U.S., and used to be the number one reason for liver transplant. About 75% to 85% of patients with hepatitis C develop a chronic liver infection. Roughly 2.4 million people in the U.S. are estimated to have chronic hepatitis C infection. It often does not show any symptoms. No vaccine is yet available to prevent hepatitis C.
• Hepatitis D: Hepatitis D only happens to people who are infected by the hepatitis B virus. If you are vaccinated against hepatitis B, you will be protected against hepatitis D virus.
• Hepatitis E: This type of hepatitis is spread by ingesting contaminated food or water. Hepatitis E is common throughout the world. Even though vaccines exist, they are not available everywhere.

Healthcare providers might not be able to identify the virus causing hepatitis as one of these. Other viruses, such as CMV, EBV, and HSV can also cause hepatitis.

Most people recover from hepatitis, and the disease is often preventable. However, it is still considered a serious health risk because it can:

• Destroy liver tissue.
• Spread easily from person to person.
• Weaken the body's immune system.
• Cause the liver to fail.
• Cause liver cancer.
• Cause death (in rare cases).

How does someone get or spread hepatitis?

Hepatitis A can be spread through food or drinking water carrying the virus through bits of fecal matter from an infected person. (This is called the fecal-oral route.) You can also get hepatitis A from sexual contact.

A person can get hepatitis B in many ways, including:

• Having sex with an infected person.
• Sharing dirty needles.
• Being in direct contact with infected blood.
• Getting needle stick injuries.
• Being transferred from a pregnant person to a fetus.
• Being in contact with an infected person's body fluids.

An infected pregnant person has a high chance of giving hepatitis B to her child during or after birth. All pregnant people should be tested for hepatitis B. Within 12 hours of birth, infants born to parents with hepatitis B need to receive treatment with hepatitis B antibody and hepatitis B vaccine.

A person can get hepatitis C from:

• Sharing dirty needles.
• Being in direct contact with infected blood.
• Getting needle stick injuries.
• Having sex with an infected person (less common).

Blood products are currently tested for hepatitis B and C, so it is not likely that a person will get hepatitis from receiving them. However, blood transfusions or organ transplants before 1992 might have not been tested for hepatitis (in particular, hepatitis C). If you received a procedure before 1992, you might want to get tested for hepatitis.

Additionally, “baby boomers,” born in the U.S. between 1945 and 1965, are at increased risk of having hepatitis C. If you are part of this group, you should be screened for hepatitis C even in the absence of risk factors listed above. The US Preventive Services Task Force expanded the one-time screening population for hepatitis C to adults from the ages of 18-79, but this recommendation has not been finalized.

You can get hepatitis D from:

• Being passed from pregnant person to child during childbirth.
• Having contact with infected body fluids or blood.

You can only get hepatitis D if you have hepatitis B. Hepatitis D is not common in the U.S.

You can get hepatitis E by eating or drinking food or water contaminated with the virus (the fecal-oral route). You can also be infected from under-cooked foods like pork, venison, or shellfish. Hepatitis E is uncommon in the U.S. but can occur after travel to a country where this infection is common. Hepatitis E can be particularly dangerous and even fatal in pregnant people.

What are the symptoms of hepatitis?

The most common symptoms of hepatitis include:

• Dark urine.
• Stomach pain.
• Yellow skin or eye whites, called jaundice.
• Pale or clay-colored stool.
• Low-grade fever.
• Loss of appetite.
• Fatigue.
• Feeling sick to your stomach.
• Aching joints.

Contact your healthcare provider as soon as possible if you have any or a combination of these symptoms.

How is hepatitis diagnosed?

Your healthcare provider will ask about your symptoms and do a physical exam. There are blood tests that will find out if you have a form of hepatitis caused by a virus.

Can hepatitis be treated?

There are no treatments to cure hepatitis A, aside from carefully monitoring liver function. If you know you have hepatitis A early enough, you might be able to stop the infection if you get a dose of the hepatitis A vaccine or something called hepatitis A immune globulin.

Hepatitis B, when chronic, can often be treated successfully. The most commonly used drugs to treat chronic hepatitis B are:

• Entecavir (Baraclude®).
• Telbivudine (Tyzeka®).
• Tenofovir alafenamide (Vemlidy®).
• Tenofovir disoproxil fumarate (Viread®).
• Interferon alfa-2b (Intron A®).
• Peginterferon alfa-2a (Pegasys®).

For hepatitis C, the following drugs are used:

• Simeprevir (Olysio®).
• Daclatasvir (Daklinza®).
• Sofosbuvir (Solvadi®); sofusbuvir/velpatasvir (Epclusa®); sofusbuvir/velpatasvir/voxilaprevir (Vosevi®); ledipasvir/sofosbuvir (Harvoni®).
• Ombitasvir/paritaprevir/ritonavir (Technivie®); ombitasvir/paritaprevir/ritonavir/dasabuvir (Viekira® Pak, Viekira® XR).
• Elbasivir/grazoprevir (Zepatier®).
• Glecaprevir/pibrentasvir (Mavyret®).

These new drugs are sometimes given with older drugs like ribavirin and peginterferon alfa-2a and peginterferon-2b. You might have to take these medicines for some time, even as long as six months.

If you have chronic hepatitis D, your doctor may prescribe drugs with interferons and might also add medicines for hepatitis B. Hepatitis E treatments include peginterferon alfa-2a and ribavirin.

Who is at risk of getting hepatitis?

You are at a higher risk of getting hepatitis if you:

• Share needles to take drugs.
• Practice unprotected oral and/or anal sex.
• Have many sex partners.
• Drink significant amounts of alcohol.
• Have poor nutrition.
• Work in a hospital or nursing home.
• Receive long-term kidney dialysis.
• Travel to areas with poor sanitation.

How can I protect myself against viral hepatitis?

There are many ways you can reduce your chances of getting hepatitis:

• Get the vaccines for hepatitis A and hepatitis B.
• Use a condom during sex.
• Don't share needles to take drugs.
• Practice good personal hygiene such as thorough hand-washing with soap and water.
• Don't use an infected person's personal items.
• Take precautions when getting any tattoos or body piercings.
• Take precaution when traveling to areas of the world with poor sanitation. (Make sure to get your vaccines.)
• Drink bottled water when traveling.

It is very important that you take these preventive measures if you participate in risky behaviors. Take preventive steps, too, if you work in places like a nursing homes, dormitories, daycare centers, or restaurants where there you have extended contact with other people and a risk of coming into contact with the disease.

Is there a vaccine for hepatitis?

There are vaccines for hepatitis A and hepatitis B that are available in the U.S. There is no vaccine for hepatitis C. Since you can only get hepatitis D if you have hepatitis B, getting the vaccine against B should protect you against hepatitis D. There is no FDA approved vaccine against hepatitis E, but vaccines against hepatitis E exist overseas (for example, in China).

What is the outlook for hepatitis?

Hepatitis A and E usually only cause short-term (acute) infections that your body can overcome. The others (B, C and D) can also cause acute infections, but might also cause chronic (long-term) infections. The chronic forms are more dangerous. Hepatitis non-E is usually acute, but can become chronic.

Most people recover fully from hepatitis even though it might take several months for the liver to heal. To help improve your health and to help speed up your recovery:

• Avoid alcohol.
• Practice good nutrition.
• If you feel sick, rest.
• Talk to your healthcare provider about your medicines, even over-the-counter drugs or vitamins and supplements, to know which ones you should take and which to avoid until you are recovered.

With hepatitis, your healthcare provider will also be looking for long-term damage to the liver in the forms of cirrhosis or liver failure. You may be asked to take other types of tests, such as liver function tests, imaging tests or possibly a liver biopsy.

If you have questions, new symptoms, or worsening of any existing symptoms, you should call the office of your healthcare provider.

In the U.S., A, B and C are the most common viral forms of hepatitis. It doesn’t matter how you were infected—what matters is taking care of yourself once you have been diagnosed and taking care not to spread the infection to anyone else.