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Viral hepatitis is an infection of the liver. There are several different viruses that cause hepatitis. They are called hepatitis A , B , C , D, and E viruses. The viruses are transmitted in different ways. Complications include chronic liver disease, liver failure, and liver cancer .
Hepatitis |
Hepatitis A
Hepatitis A is caused by the hepatitis A virus (HAV), which is usually found in the stool (bowel movements) of infected people. It is spread by:
- Putting something in your mouth that has been infected with the hepatitis A virus
- Drinking water contaminated by raw sewage
- Eating food contaminated by the hepatitis A virus, especially if it has not been properly cooked
- Eating raw or partially cooked shellfish contaminated by raw sewage
- Changing diapers and not adequately washing your hands. Food or work areas can be contaminated by the hepatitis A virus when food is handled.
- Having sex with a partner infected with the hepatitis A virus (particularly anal sex)
Hepatitis B
Hepatitis B is caused by the hepatitis B virus (HBV). This virus is spread through contact with bodily fluids of an infected person, such as blood, semen, vaginal fluids, and saliva. Hepatitis B can be spread by:
- Having sex with someone infected with hepatitis B or who is a carrier of hepatitis B
- Injecting illicit drugs, especially with shared needles
- Having a job that involves contact with bodily fluids
- Childbirth (A woman infected with hepatitis can pass the virus on to her baby during childbirth.)
- Receiving a blood transfusion (especially prior to 1992 when better screening tests for hepatitis viruses were developed) or multiple transfusions of blood or blood products—This risk is greatly reduced with careful blood screening using modern techniques.
- Being bitten by someone whose saliva contains the virus
- Long-term kidney dialysis treatment (The dialysis machine can be tainted with HBV-infected blood.)
- Receiving a tattoo, body piercing, or acupuncture with unsterilized or improperly sterilized equipment
- Receiving an HBV-infected organ transplant
- Sharing toothbrushes, razors, nail clippers, or other personal hygiene items that have HBV-infected blood or body fluids on them
Hepatitis C
Hepatitis C is caused by the hepatitis C virus (HCV). Hepatitis C virus is carried in the blood of people infected with the virus. It is primarily spread through contact with infected blood. It can occasionally be spread other ways. HCV can be spread by:
- Injecting illicit drugs with shared needles or sharing inhalation tubes when inhaling drugs
- Receiving HCV-infected blood transfusions, especially before 1992 when better screening tests were developed
- Receiving blood clotting products, especially older types that have not gone through modern purification and production methods
- Receiving an HCV-infected organ transplant
- Receiving long-term kidney dialysis treatment (The dialysis machine can be tainted with HCV-infected blood.)
- Sharing toothbrushes, razors, nail clippers, or other personal hygiene items that have HCV-infected blood on them
- Being accidentally stuck by an HCV-infected needle (a concern for healthcare workers)
- Receiving a tattoo, body piercing, or acupuncture with unsterilized or improperly sterilized equipment
- Childbirth (A woman infected with hepatitis can pass the virus to her baby during childbirth.)
- Having sexual contact with someone infected with HCV
Hepatitis D
Hepatitis D is caused by the hepatitis D virus (HDV). It occurs only in people who have hepatitis B. Patients may have more severe disease and a higher risk of liver damage than those infected with HBV alone. It is spread through contact with infected blood and through:
- Sexual contact with someone infected with HDV
- Living with an HDV-infected person (Close personal contact has been found to cause hepatitis D.)
- Sharing toothbrushes, razors, nail clippers, or other personal hygiene items that have HDV-infected blood on them
Hepatitis E
Hepatitis E is caused by the hepatitis E virus (HEV), which can be found in the stool (bowel movements) of infected people. It is uncommon in the US, but it is a risk to international travelers. The virus is spread by:
- Putting something in your mouth that has been infected with the hepatitis E virus
- Drinking water contaminated by raw sewage
- Eating food contaminated by the hepatitis E virus, especially if it has not been properly cooked
- Eating raw or partially cooked shellfish contaminated by raw sewage
What are the risk factors for hepatitis?
[What are the symptoms of hepatitis?
[What are the treatments for hepatitis?][13]
Are there screening tests for hepatitis?
[How can I reduce my risk of hepatitis?
References:
American Liver Foundation website. Available at: http://www.liverfoundation.org/ .
Centers for Disease Control and Prevention (CDC) website. Available at: http://www.cdc.gov/ .
Hepatitis Information Network website. Available at: http://www.hepnet.com/ .
National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/ .
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Viral hepatitis is an infection of the liver. There are several different viruses that cause hepatitis. They are called hepatitis A , B , C , D, and E viruses. The viruses are transmitted in different ways. Complications include chronic liver disease, liver failure, and liver cancer .
Hepatitis |
Hepatitis A
Hepatitis A is caused by the hepatitis A virus (HAV), which is usually found in the stool (bowel movements) of infected people. It is spread by:
- Putting something in your mouth that has been infected with the hepatitis A virus
- Drinking water contaminated by raw sewage
- Eating food contaminated by the hepatitis A virus, especially if it has not been properly cooked
- Eating raw or partially cooked shellfish contaminated by raw sewage
- Changing diapers and not adequately washing your hands. Food or work areas can be contaminated by the hepatitis A virus when food is handled.
- Having sex with a partner infected with the hepatitis A virus (particularly anal sex)
Hepatitis B
Hepatitis B is caused by the hepatitis B virus (HBV). This virus is spread through contact with bodily fluids of an infected person, such as blood, semen, vaginal fluids, and saliva. Hepatitis B can be spread by:
- Having sex with someone infected with hepatitis B or who is a carrier of hepatitis B
- Injecting illicit drugs, especially with shared needles
- Having a job that involves contact with bodily fluids
- Childbirth (A woman infected with hepatitis can pass the virus on to her baby during childbirth.)
- Receiving a blood transfusion (especially prior to 1992 when better screening tests for hepatitis viruses were developed) or multiple transfusions of blood or blood products—This risk is greatly reduced with careful blood screening using modern techniques.
- Being bitten by someone whose saliva contains the virus
- Long-term kidney dialysis treatment (The dialysis machine can be tainted with HBV-infected blood.)
- Receiving a tattoo, body piercing, or acupuncture with unsterilized or improperly sterilized equipment
- Receiving an HBV-infected organ transplant
- Sharing toothbrushes, razors, nail clippers, or other personal hygiene items that have HBV-infected blood or body fluids on them
Hepatitis C
Hepatitis C is caused by the hepatitis C virus (HCV). Hepatitis C virus is carried in the blood of people infected with the virus. It is primarily spread through contact with infected blood. It can occasionally be spread other ways. HCV can be spread by:
- Injecting illicit drugs with shared needles or sharing inhalation tubes when inhaling drugs
- Receiving HCV-infected blood transfusions, especially before 1992 when better screening tests were developed
- Receiving blood clotting products, especially older types that have not gone through modern purification and production methods
- Receiving an HCV-infected organ transplant
- Receiving long-term kidney dialysis treatment (The dialysis machine can be tainted with HCV-infected blood.)
- Sharing toothbrushes, razors, nail clippers, or other personal hygiene items that have HCV-infected blood on them
- Being accidentally stuck by an HCV-infected needle (a concern for healthcare workers)
- Receiving a tattoo, body piercing, or acupuncture with unsterilized or improperly sterilized equipment
- Childbirth (A woman infected with hepatitis can pass the virus to her baby during childbirth.)
- Having sexual contact with someone infected with HCV
Hepatitis D
Hepatitis D is caused by the hepatitis D virus (HDV). It occurs only in people who have hepatitis B. Patients may have more severe disease and a higher risk of liver damage than those infected with HBV alone. It is spread through contact with infected blood and through:
- Sexual contact with someone infected with HDV
- Living with an HDV-infected person (Close personal contact has been found to cause hepatitis D.)
- Sharing toothbrushes, razors, nail clippers, or other personal hygiene items that have HDV-infected blood on them
Hepatitis E
Hepatitis E is caused by the hepatitis E virus (HEV), which can be found in the stool (bowel movements) of infected people. It is uncommon in the US, but it is a risk to international travelers. The virus is spread by:
- Putting something in your mouth that has been infected with the hepatitis E virus
- Drinking water contaminated by raw sewage
- Eating food contaminated by the hepatitis E virus, especially if it has not been properly cooked
- Eating raw or partially cooked shellfish contaminated by raw sewage
What are the risk factors for hepatitis?
What are the symptoms of hepatitis?
What are the treatments for hepatitis?
Are there screening tests for hepatitis?
How can I reduce my risk of hepatitis?
References:
Hepatitis Foundation International website. Available at: http://www.hepfi.org/ .
Hepatitis Information Network website. Available at: http://www.hepnet.com/ .
National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ .
References:
Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ .
Hepatitis Information Network website. Available at: http://www.hepnet.com/ .
National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/ .
It is possible to develop viral hepatitis with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing viral hepatitis. If you have a number of risk factors, ask your doctor what you can do to reduce your risk.
Risk factors for hepatitis vary, depending on the type of hepatitis.
People at Greater Risk
- Infants born to mothers with hepatitis B or C
- Children in daycare centers
- Childcare workers who change diapers or toilet train children
- Men who have sex with men
- People who have anal sex
- People who have multiple sex partners
- People who inject illicit drugs and share needles
Lifestyle Factors
- Close contact with someone who has the disease
- Using household items that were used by an infected person and not properly cleaned
- Sexual contact with multiple partners
- Sexual contact with someone who has hepatitis or a sexually transmitted disease
- Injecting drugs, especially if you use shared needles
- Use of intranasal cocaine
- Getting a tattoo or body piercing (because the needles may not be properly sterilized)
- Having a job that involves contact with bodily fluids, such as:
- Caring for children who aren’t toilet-trained
- First aid or emergency worker
- Funeral director
- Healthcare workers
- Dentist
- Dental assistant
- Firefighter
- Police personnel
- For hepatitis A or E: traveling to (or spending long periods of time in) a country where hepatitis A or E is common or where there is poor sanitation
Medical Conditions and Procedures
Health conditions and procedures that increase the risk of hepatitis include:
- Hemophilia or other disorders of blood clotting
- Kidney disease requiring hemodialysis
- Receiving a blood transfusion , especially prior to 1992 when better screening tests were developed (Even today, screening is not 100% effective in eliminating hepatitis, though it is dramatically safer than in the past).
- Receiving multiple transfusions of blood or blood products
- Receiving a solid organ transplant, especially prior to 1992 when improved screening tests were developed
- Persistent elevation of certain liver function tests (found in people with undiagnosed liver problems)
- Sexually transmitted disease
References:
American Liver Foundation website. Available at: http://www.liverfoundation.org/ .
Hepatitis Information Network website. Available at: http://www.hepnet.com/ .
National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ .
Hepatitis is a contagious disease that is preventable. Basic preventive principles include avoiding contact with other people’s blood or bodily fluids and practicing good sanitation. In addition, vaccines are available to prevent some types of hepatitis. They are given to people at high risk of contracting the disease.
Avoid Contact With Blood and Bodily Fluids
Infected blood and bodily fluids can spread hepatitis. To avoid contact:
- Do not inject illicit drugs , especially with shared needles. Seek help to stop using drugs.
- Do not have sex with partners who have hepatitis or other sexually transmitted diseases .
- Practice safe sex (use latex condoms ) or abstain from sex.
- Limit your number of sexual partners. A mutually monogamous relationship is best.
- Avoid sharing personal hygiene products (eg, toothbrushes, razors).
- Avoid handling items that may be contaminated with hepatitis-infected blood.
- Donate your own blood before elective surgery so it can be used if you need a blood transfusion.
- It is best that you avoid tattoos or body piercing. If you get a tattoo or body piercing, make sure the artist or piercer properly sterilizes the equipment. You might get infected if the tools have someone else's blood on them.
- Healthcare professionals should always follow routine barrier precautions and safely handle needles and other sharp instruments and dispose of them properly.
- Wear gloves when touching or cleaning up bodily fluids on personal items, such as:
- Bandages
- Band-aids
- Tampons, sanitary pads, diapers
- Linens
- Cover open cuts or wounds.
- Use only sterile needles for drug injections, blood draws, ear piercing, and tattooing.
- If you are pregnant, have a blood test for hepatitis B. Infants born to mothers with hepatitis B should be treated within 12 hours after birth.
- When traveling to countries where the risk of hepatitis is higher, follow proper precautions, such as:
- Drinking bottled water only
- Not using ice cubes
- Avoiding certain foods, like shellfish, unpasteurized milk products, and fresh fruits and vegetables
Practice Good Sanitation
Good sanitation can prevent the transmission of some forms of hepatitis.
- Wash your hands with soap and water after using the bathroom or changing a diaper.
- Wash your hands with soap and water before eating or preparing food.
- Carefully clean all household utensils after use.
Get a Vaccine, If Recommended
If you are in a high risk group, ask your doctor about getting a hepatitis vaccine. Vaccines are available for hepatitis A and B .
- Hepatitis A vaccine is recommended for all children aged 12 months. The following people should also get vaccinated:
- Children age 12 months or greater in high-risk areas
- People traveling to areas where hepatitis A is prevalent
- People who engage in anal sex
- Drug users
- People with chronic liver disease
- People with blood-clotting disorders, like hemophilia
- Children who live in areas where hepatitis A is prevalent
- People who will have close contact with an adopted child from a medium- or high-risk area *¹
- Hepatitis B vaccine is recommended for everyone aged 18 and younger and adults over the age of 18 who are at risk. Adults who are at risk include:
- People who have had more than one sex partner in six months
- Men who have sex with other men
- Sex partners of infected people
- People who inject illegal drugs
- Healthcare and public safety workers who might be exposed to HBV-infected blood or body fluids
- Those living with people with chronic HBV infection
- People receiving dialysis
Talk to your doctor to find out if you should receive the vaccines.
Get Immune Globulin (IG) Injection, If Recommended
IG, available for hepatitis A and B, is an injection that contains antibodies, which help provide protection. This shot is usually given:
- Before exposure to the virus, or
- As soon as possible after exposure to the virus
References:
Centers for Disease Control and Prevention (CDC) website. Available at: http://www.cdc.gov/ .
National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ .
- Hepatitis A —This infection may or may not cause symptoms. Adults are more likely to have symptoms than children. Incubation is from 15-45 days. Hepatitis A does not progress to chronic liver disease.
- Hepatitis B —With this form of hepatitis, symptoms usually appear within 25-180 days following exposure to the virus. Hepatitis B may progress to carrier state or chronic liver disease.
- Hepatitis C —About 80% of people with hepatitis C have no symptoms. Over time, however, the disease can cause serious liver damage. Hepatitis C may progress to chronic hepatitis. Incubation is from 15-60 days.
Symptoms common to all types of viral hepatitis include:
- Fatigue
- Loss of appetite
- Fever
- Nausea and vomiting
- Diarrhea
- Weight loss
- Abdominal pain or discomfort
- Aches and pains
- Headache
- Jaundice (yellowing of the eyes and skin)
- Darker-colored urine
- Lighter-colored stool
- Itching
- Rash
The doctor will ask about your symptoms and medical history and perform a physical exam.
Tests to diagnose hepatitis may include the following:
- Blood tests—Your blood is checked for the presence of hepatitis antigens and antibodies. Antigens are foreign proteins that are part of the hepatitis viruses. Antibodies are proteins that your body has made to fight the infectious agents.
- Liver function studies—The levels of various liver enzymes, bilirubin, and clotting factors in your blood are measured to determine how your liver is functioning.
- Liver biopsy —A sample of liver tissue is removed and examined under a microscope.
Placement of Liver Biopsy Needle |
References:
Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ .
Hepatitis Foundation International website. Available at: http://www.hepfi.org/ .
Hepatitis Information Network website. Available at: http://www.hepnet.com/ .
Kohnle D. Hepatitis A vaccine. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated January 2009. Accessed May 12, 2009.
McCoy K. Hepatitis B vaccine. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated January 2009. Accessed May 12, 2009.
National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ .
Stahl R. Hepatitis prevention for travelers. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81 . Updated February 2009. Accessed May 12, 2009.
¹9/25/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Updated recommendations from the Advisory Committee on Immunization Practices (ACIP) for use of hepatitis A vaccine in close contacts of newly arriving international adoptees. *MMWR Morb Mortal Wkly Rep.2009;58:1006.
American Liver Foundation (ALF)
Address:
75 Maiden Lane, Suite 603
New York, NY 10038
Phone:
212-668-1000
Internet Address:
http://www.liverfoundation.org/
Description of Services Provided:
The American Liver Foundation provides educational materials to the public and healthcare professionals. Through a network of local chapters, it offers support groups. The foundation supports research into the cure and prevention of liver diseases.
Centers for Disease Control and Prevention (CDC)
Address:
1600 Clifton Road
Atlanta, Georgia 30333
Phone:
1-800-311-3435
Internet Address:
http://www.cdc.gov/
Description of Services Provided:
The CDC provides educational materials. Its mission is to protect the health and safety of people in the US and abroad. It works with partners around the world to monitor, detect, and investigate health problems, while promoting healthful behaviors.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Address:
Office of Communications and Public Liaison, NIDDK, NIH
Building 31, Room 9A04
Center Drive, MSC 2560
Bethesda, MD 20892-2560
Internet Address:
http://www.niddk.nih.gov/
Description of Services Provided:
The NIDDK is a part of the National Institutes of Health. It provides information about hepatitis as well as other liver and digestive diseases.
References:
Centers for Disease Control and Prevention (CDC) website. Available at: http://www.cdc.gov/ .
Nissen D. Mosby’s Drug Consult. St. Louis, MI: Mosby Inc; 2002.
National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ .
The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions. During screening, invasive tests, such as biopsies , are not done.
Screening is a method of finding out if you have hepatitis before you begin to have any symptoms. Screening involves:
- Assessing your medical history and lifestyle habits that may increase or decrease your risk of hepatitis
- Undergoing tests to identify early signs of hepatitis, including blood tests for hepatitis antigens and antibodies
Screening Tests
Blood tests can screen or routinely check for hepatitis in people who are at increased risk for infection. These tests involve checking for the presence or absence of hepatitis antigens and antibodies. Antigens are foreign proteins; antibodies are proteins that your body has made to fight infectious agents.
Screening Guidelines
The Centers for Disease Control and Prevention (CDC) recommends screening for hepatitis in pregnant women at their first prenatal visit, and in people at high risk for the disease. Common risk factors for hepatitis B and hepatitis C include:
- IV drugs (or having sex with someone that used IV drugs)
- Recipients of blood clotting products (especially older types that have not gone through modern purification and production methods).
- Recipients of blood, especially prior to 1992
- Recipients of a solid organ transplant, especially prior to 1992 when improved screening tests were developed
- Persistent elevation of certain liver function tests
- Chronic hemodialysis
- People who have ever shared a personal item (toothbrush, razor, or other item that had blood on it, even if not visible) with someone who has hepatitis
- Sexual partner who has hepatitis
- Sexual partner who has or had a sexually transmitted disease (STD)
- Anyone with an STD
- Undiagnosed liver problems
- Healthcare workers exposed to blood or bodily fluids
- Infants of mothers with hepatitis
You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with hepatitis. By talking openly and regularly with your doctor, you can take an active role in your care.
General Tips for Gathering Information
Here are some tips that will make it easier for you to talk to your doctor:
- Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
- Write out your questions ahead of time, so you don't forget them.
- Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
- Don't be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know .
Specific Questions to Ask Your doctor
About Hepatitis
- What type of hepatitis do I have?
- Is it possible to have more than one type of hepatitis?
- How might I have contracted hepatitis?
- What medications, dietary supplements, or herbal preparations should I avoid that may worsen hepatitis?
- Are there other substances I should avoid (such as alcohol)?
- What can I do to avoid passing hepatitis on to other people?
- What are some of the short term and long term complications of hepatitis?
- What symptoms should I watch out for and should I report?
About Your Risk of Developing Hepatitis
- Based on my medical history, lifestyle, and family background, am I at risk for hepatitis?
- How do I best prevent hepatitis?
- Does my job put me at risk for hepatitis?
- What can I do to decrease my risk for hepatitis?
- Should I be vaccinated?
- Should I be screened for hepatitis?
- How often should I be screened if I do not have any symptoms?
About Treatment Options
- How do I best treat hepatitis?
- What medication options are available to help me?
- What are the benefits and side effects of these medications?
- Will these medications interact with other medications, over-the-counter products, or dietary or herbal supplements I am already taking for other conditions?
- Are there any alternative or complementary therapies that will help me?
About Lifestyle Changes
- Is it safe for me to have a baby?
- What kind of protection should my sexual partner(s) and I use?
- Are there habits I should develop in order to avoid passing hepatitis to people with whom I live?
- Why do I need to avoid alcohol?
- How do I find help to stop drinking?
- Should I engage in exercise?
About Outlook
- When will I stop feeling so tired?
- Will my hepatitis go away?
- Will it become a chronic problem?
- Will I develop long-term liver problems?
- Will I develop liver cancer?
- Will I need a liver transplant?
- How will I know that my treatment program is effective?
- Am I now immune to hepatitis viruses?
- What types of hepatitis viruses am I now immune to (A, B, C, D, or E)?
