Five important facts about Hepatitis

hepatitis liver photoPhoto © AdobeStock

Hepatitis is an inflammation of the liver that can be self-limiting, or it can progress to scarring (cirrhosis) or even liver cancer. The most common cause of hepatitis are viruses, but other causes include other infections, toxic substances (i.e. alcohol, certain drugs), and autoimmune diseases.

There are five main hepatitis viruses, types A, B, C, D, and E. Because of the burden of illness and death they cause, and the potential for outbreaks and epidemic spread, they are of utmost concern. Types B and C, specifically, lead to chronic disease in hundreds of millions of people and are the most common cause (together) of liver cirrhosis and cancer.

Let’s look at each type in closer detail.

Hepatitis A

Hepatitis A is a highly contagious liver infection, which can consist of a mild illness lasting a few weeks to a severe illness lasting several months. Rarely, it can cause death in some people.


Hepatitis A is caused by the hepatitis A virus that infects your liver cells and causes inflammation. This inflammation affects your liver function and causes the symptoms of hepatitis A.

The virus typically spreads when you eat or drink something contaminated with even a small amount of fecal matter. It doesn’t spread through sneezing or coughing, but may spread by:

  • Eating food handled by someone with the virus who doesn’t thoroughly wash their hands after using the toilet;
  • Drinking contaminated water;
  • Eating raw shellfish from water polluted with sewage;
  • Being in close contact with a person who’s infected (even if they have no symptoms); and
  • Having sex with someone who has the virus.

Usually hepatitis A symptoms don’t appear until you’ve had the virus for a few weeks. You may not even develop them. If you do, symptoms may include:

  • Fatigue;
  • Sudden nausea and vomiting;
  • Abdominal pain or discomfort, especially on the upper right side beneath your lower ribs (by your liver);
  • Clay-colored bowel movements;
  • Loss of appetite;
  • Low-grade fever;
  • Dark urine;
  • Joint pain;
  • Yellowing of the skin and whites of your eyes (jaundice); and
  • Intense itching.

Symptoms may be relatively mild and go away in a few weeks. Sometimes, your infection may be severe and last several months.

Your risk for developing hepatitis A increases if you:

  • Travel or work in areas of the world where hepatitis A is common;
  • Attend child care or work in a child care center;
  • Live with another person who has hepatitis A;
  • Are a man who has sexual contact with other men;
  • Have any type of sexual contact with someone who has hepatitis A;
  • Are HIV positive;
  • Have a clotting-factor disorder (i.e. hemophilia); and
  • Use any type of illegal drugs (not just those that are injected).

Generally, people recover from hepatitis A without any complications. In rare cases, though, hepatitis A may lead to liver failure. This situation is more common in adults older than 50 and in people who have another liver disease.

The best way to prevent hepatitis A is by getting the hepatitis A vaccine. All children should receive the vaccine between the ages 12 and 23 months. If you are at a higher risk of infection or have chronic liver disease, you should also receive the vaccine. If you are unvaccinated and traveling to a developing country where hepatitis A is common, you should try to get vaccinated before you go.

The vaccine is given in two shots separated by six to 12 months. To be fully protected from the virus you need both shots.

Other ways to reduce your risk of transmission include washing your hand thoroughly with soap and warm water for 15 to 30 seconds after using the toilet, after changing diapers, and before and after handling or preparing food. While traveling in developing countries, use bottled water to brush your teeth, make ice cubes, and wash fruits and vegetables.

Treatment for hepatitis A infection involves resting, drinking plenty of fluids, and eating healthy foods. Depending on your symptoms, your healthcare provider may recommend specific medications.

It is very important to discuss with your healthcare provider any prescription or over-the-counter (OTC) medications, vitamins, or herbal supplements you take because they could damage your liver. You will also need to avoid alcohol until your healthcare provider tells you it’s safe to consume.

Hepatitis B

Hepatitis B is a viral infection that causes liver inflammation and damage. The virus can cause an acute or chronic infection.

Acute hepatitis B is short-term, with any symptoms lasting several weeks up to six months. Sometimes your body fights off the infection so the virus goes away. Most healthy adults and children older than five get better without treatment.

Chronic hepatitis B is long-lasting and occurs when your body can’t fight off the virus, so it doesn’t go away. If you’re infected as a young child, your chances of developing chronic hepatitis B are much greater.

Hepatitis B is caused by the hepatitis B virus, which spreads through contact with an infected person’s blood, semen, or other body fluids. Contact can occur by:

  • Being born to a mother with hepatitis B;
  • Having unprotected sex with an infected person;
  • Sharing drug needles or other drug materials with an infected person;
  • Getting an accidental stick with a needle that was used on an infected person;
  • Being tattooed or pierced with tools that were used on an infected person, and weren’t properly sterilized or cleaned in a way that destroys all viruses and other microbes;
  • Having contact with the blood or open sores of an infected person; and
  • Using an infected person’s razor, toothbrush, or nail clippers.

You can’t, however, get hepatitis B from being coughed or sneezed on, through food or water, hugging or shaking hands, sharing eating utensils, sitting beside someone, or as a baby breastfeeding.

Symptoms can range from mild to severe, but usually appear about one to four months after infection. You can see symptoms as early as two weeks post-infection. Some people (usually young children) don’t have symptoms, which may include:

  • Abdominal pain;
  • Dark urine;
  • Fever;
  • Joint pain;
  • Loss of appetite;
  • Nausea and vomiting;
  • Weakness and fatigue; and
  • Yellowing of the skin and whites of your eyes (jaundice).

If you are born to a mother who has hepatitis B, you are more likely to get hepatitis B – the virus can spread from mother to child during birth.

Your risk for hepatitis increases if you were born in a part of the world where hepatitis B is more common or if you were born in the United States, didn’t receive the hepatitis B vaccine as an infant, and have parents who were born in an area where hepatitis B was especially common.

You are also more likely to have hepatitis B if you:

  • Are infected with HIV (hepatitis B and HIV are spread in similar ways);
  • Have lived with or had sex with someone who has hepatitis B;
  • Have had more than one sex partner in the last six months or have a history of sexually transmitted disease;
  • Are men who have sex with men;
  • Are injected drug users;
  • Work in a field (i.e. healthcare) where you have contact with blood, needles, or body fluids at work;
  • Have lived in or travel often to parts of the world where hepatitis B is common;
  • Have been on kidney dialysis;
  • Are taking medications that weaken the immune system (i.e. steroids or chemotherapy medications);
  • Have worked or lived in a prison; and
  • Had a blood transfusion or organ transplant before the mid-1980s.

In the United States, the most common way hepatitis B spreads among adults is sexual contact. Injected drug use is another important way it spreads, too.

Chronic hepatitis B infection can lead to serious complications, such as scarring of the liver (cirrhosis), liver cancer, liver failure, and other conditions (i.e. kidney disease or inflammation of blood vessels).

Primary prevention of hepatitis B is with the hepatitis B vaccine, which is given as three or four injections over six months. The vaccine is recommended for:

  • Newborns;
  • Children and adolescents not vaccinated at birth;
  • Those who work or live in a center for people who are developmentally disabled;
  • People who live with someone who has hepatitis B;
  • Healthcare workers, emergency workers, and other people who come into contact with blood;
  • Anyone who has a sexually transmitted infection, including HIV;
  • Men who have sex with men;
  • People who have multiple sexual partners;
  • Sexual partners of someone who has hepatitis B;
  • People who inject illegal drugs or share needles and syringes;
  • People with chronic liver disease;
  • People with end-stage kidney disease; and
  • Travelers planning to go to an area of the world with a high hepatitis B infection rate.

Other ways to decrease your risk include:

  • Know the hepatitis B status of any sexual partner;
  • Use a new latex or polyurethane condom every time you have sex;
  • Don’t use illegal drugs;
  • Be cautious about body piercing and tattooing; and
  • Ask about the hepatitis B vaccine before you travel.

Treatment for hepatitis B depends on your specific situation.

If you know you’ve had hepatitis B virus exposure and aren’t sure about your vaccination status, you should call your doctor immediately. An injection of immunoglobulin (an antibody) that’s given within 12 hours of your exposure to the virus can help protect you from getting hepatitis B. This treatment is only good for short-term protection, so if you never received the hepatitis B vaccine you will get that shot, as well.

If you have an acute hepatitis B infection, you may not need treatment. Most likely, your healthcare provider will recommend rest, proper nutrition, and plenty of fluids. In severe cases, you might need antiviral drugs or a hospital stay to prevent complications.

When you have a chronic hepatitis B infection, you will likely need treatment for the rest of your life to reduce the risk of liver disease and prevent you from passing the infection to others. Treatments include:

  • Antiviral medications: Baraclude, Viread, Epivir, Hepsera, Tyzeka, etc.;
  • Interferon injections: Intron A, etc.; and
  • Liver transplant.

Hepatitis C

Hepatitis C is a contagious liver disease that can range from mild illness lasting a few weeks to a serious, lifelong illness that attacks your liver. It can be either acute or chronic.

Acute hepatitis C is a short-term illness that occurs within the first six months of exposure to the hepatitis C virus. Most of the time, it leads to a chronic infection.

Chronic hepatitis C is a long-term illness that occurs when the hepatitis C virus stays in your body. The infection can last a lifetime and lead to serious liver complications.

Hepatitis C infection is caused by the hepatitis C virus, which spreads when contaminated blood enters the bloodstream of an uninfected person. The hepatitis C virus has several different forms, called genotypes.  In North America and Europe, the most common genotype is type 1. Less commonly, type 2 occurs in the United States and Europe.

Until the virus damages your liver enough to cause the symptoms of liver disease, chronic hepatitis C is usually “silent” for many years. These symptoms may include:

  • Bleeding easily;
  • Bruising easily;
  • Fatigue;
  • Poor appetite;
  • Yellow discoloration of the skin and eyes (jaundice);
  • Dark-colored urine;
  • Itchy skin;
  • Fluid buildup in your abdomen (ascites);
  • Swelling in your legs;
  • Weight loss;
  • Confusion, drowsiness, and slurred speech (hepatic encephalopathy); and
  • Spider-like blood vessels on your skin (spider angiomas).

Every chronic hepatitis C infection starts with an acute phase, which usually goes undiagnosed due to lack of symptoms. If there are symptoms, they could be jaundice, fatigue, nausea, fever, and muscle aches. Acute symptoms tend to appear one to three months after exposure to the virus and last for two weeks up to three months.

Some people with acute hepatitis C infections don’t progress to chronic ones, though. Known as spontaneous viral clearance, these people clear the virus from their bodies after an acute phase.

You have an increased risk for hepatitis C if you:

  • Are a healthcare worker who has been exposed to infected blood (i.e. if an infected needle pierces your skin);
  • Have ever injected or inhaled illicit drugs;
  • Have HIV;
  • Received a piercing or tattoo in an unclean environment using unsterile equipment;
  • Received a blood transfusion or organ transplant before 1992;
  • Received clotting factor concentrates before 1987;
  • Received hemodialysis treatments for a long period of time;
  • Were born to a woman with a hepatitis C infection;
  • Were ever in prison; and
  • Were born between 1945 and 1965, the age group with the highest incidence of hepatitis C infection.

Chronic hepatitis C infection can lead to serious complications, such as scarring of the liver (cirrhosis), liver cancer, and liver failure.

While there are several ways to protect yourself from hepatitis C, unfortunately there is no vaccine at this time. Don’t share drug needles or other drug materials, wear gloves if you need to touch another person’s blood or open sores, ensure your tattoo artist or body piercer uses sterile tools, don’t share personal items (i.e. toothbrushes, razors, or nail clippers), and use a latex or polyurethane condom during sex.

Treatment for hepatitis C is with antiviral medications that attack the virus and (in some newer drugs) cure the disease. You will need to take the medications for 12 to 24 weeks to cure the hepatitis C infection. Which drug you take will depend on what genotype you have, how much liver damage you have, and whether you have been previously treated for hepatitis C. Some of the medications are listed below:

Hepatitis D

Hepatitis D is a viral infection that causes inflammation and damage to the liver. It’s unusual because it can only infect you when you also have a hepatitis B virus infection. It can cause an acute or chronic infection.

Acute hepatitis D is a short-term illness, with the symptoms being the same as any type of hepatitis and often more severe. Sometimes your body can fight off the infection so the virus goes away.

Chronic hepatitis D is a long-lasting illness where your body can’t fight off the virus. If you have chronic hepatitis B and D, you’ll develop complications more often and more quickly than if you have chronic hepatitis B alone.

Hepatitis D is caused by the hepatitis D virus, which is spread by contact with an infected person’s blood or other body fluids. Contact can be through:

  • Sharing drug needles or other drug materials with an infected person;
  • Having unprotected sex with an infected person;
  • Getting an accidental stick with a needle that was used on an infected person.

Hepatitis D rarely spreads from mother to child during birth. You also can’t get the virus from being coughed or sneezed on, through drink or food, hugging or shaking hands, sharing eating utensils, or sitting beside an infected person.

When you get infected with the hepatitis D virus, it can worsen your symptoms of hepatitis B virus infection or hepatitis B-associated liver disease. It can also cause symptoms to occur if you never had them before. Symptoms are similar to hepatitis B virus infection ones and may include:

  • Yellowing of the skin and eyes (jaundice);
  • Gastrointestinal issues (i.e. nausea, vomiting, and abdominal pain);
  • Tiredness;
  • Loss of appetite;
  • Dark-colored urine; and
  • Joint pain.

If you have chronic hepatitis B and then develop hepatitis D, usually you will develop chronic hepatitis D virus infection.

Risk factors for hepatitis D include:

  • Abusing injected drugs;
  • Being infected while pregnant (the mother can pass the virus to the baby);
  • Carrying the hepatitis B virus;
  • Men having sexual intercourse with other men; and
  • Receiving many blood transfusions.

Possible complications of hepatitis D include scarring of the liver (cirrhosis), liver failure, and liver cancer.

The best way to protect yourself from hepatitis D virus infection is to get the hepatitis B vaccine – if you don’t have hepatitis B, you can’t get hepatitis D. Other steps you can take include not sharing drug needles or other drug materials, wearing gloves if you have to touch another person’s blood or open sores, and not sharing personal items (i.e. toothbrushes, razors, or nail clippers).

Your doctor may treat your chronic hepatitis D with medications called interferons, as well as medication for hepatitis B. Some interferon medications are listed below:

  • Intron A;
  • Pegasys; and
  • PegIntron.

Hepatitis E

Hepatitis E is a viral infection that causes liver inflammation and damage; it has different types that spread in different ways. Typically, it causes an acute infection, but it can also cause a chronic one.

Acute hepatitis E is a short-term illness that most people’s bodies are able to fight off and the virus goes away. People typically get better without any treatment after a few weeks.

Chronic hepatitis E is a long-lasting illness that occurs when your body can’t fight off the virus and is very rare. It usually only occurs in people with weakened immune systems.

Hepatitis E is caused by the hepatitis E virus. The virus usually spreads through contaminated drinking water in developing countries (i.e. parts of Africa, Asia, Central America, and the Middle East). In developed countries (i.e. the United States, Australia, Japan, and parts of Europe and East Asia), the virus usually spreads from animals to people (i.e. when people eat undercooked pork or wild game). Research suggests that very rarely hepatitis E can spread through blood transfusion.

While some people don’t have any symptoms, if you do have symptoms they may include:

  • Fever;
  • Fatigue;
  • Loss of appetite;
  • Nausea and vomiting;
  • Abdominal pain;
  • Dark urine;
  • Clay-colored bowel movements;
  • Joint pain; and
  • Yellowing of the skin or eyes (jaundice).

Travelers to areas with poor sanitation are at a higher risk for hepatitis E. If you have a weakened immune system or are a solid organ transplant recipient, you’re also at an increased risk.

The majority of people with acute hepatitis E don’t experience complications. Sometimes, though, acute hepatitis E may cause acute liver failure (i.e. your liver suddenly fails). This situation is more common in pregnant women and people who have other liver diseases.

Pregnant women with hepatitis E may also experience other complications, such as stillbirth, premature birth, or low birthweight.

Chronic hepatitis E is rare, and may lead to complications like cirrhosis or liver failure.

Unfortunately, there is no vaccine to prevent hepatitis E. The best way to protect yourself is to always wash your hands with soap and water after using the bathroom, changing a diaper, or before preparing and eating food.

Treatment for acute hepatitis E consists of resting, drinking plenty of fluids, and eating healthy foods. It is very important to discuss with your healthcare provider any prescription or OTC medications, vitamins, or herbal supplements you take because they could damage your liver. You will also need to avoid alcohol until your healthcare provider tells you it’s safe to consume.

Doctors may treat your chronic hepatitis E with Ribavirin or Pegasys.

About the Author

Julie Kaplan, Pharm. D.
Julie Kaplan is a licensed pharmacist in Virginia and the District of Columbia. She received a Bachelor’s of Arts in English from The College of William and Mary and a Doctor of Pharmacy from Virginia Commonwealth University. She has experience in patient communication from working as a retail pharmacist.