Hepatitis A, B, C, D & E - Learn the difference

This is for Mr. Dosteo who makes efforts to help people in poor local community in South Sudan.

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Viral Hepatitis

Viral hepatitis is an infection that causes liver inflammation and damage. Several different viruses cause hepatitis, including hepatitis A, B, C, D, and E. The hepatitis A and E viruses typically cause acute infections. The hepatitis B, C, and D viruses can cause acute and chronic infections.

Hepatitis A

Hepatitis A causes only acute infection and typically gets better without treatment after a few weeks. The hepatitis A virus spreads through contact with an infected person’s stool. You can protect yourself by getting the hepatitis A vaccine.

Hepatitis B

Hepatitis B can cause acute or chronic infection. Your doctor may recommend screening you for hepatitis B if you are pregnant or have a high chance of being infected. You can protect yourself from hepatitis B by getting the hepatitis B vaccine.

Hepatitis C

Hepatitis C can cause acute or chronic infection. Your doctor may recommend screening you for hepatitis C if you have a high chance of being infected or were born between 1945 and 1965. Early diagnosis and treatment can prevent liver damage.

Hepatitis D

The hepatitis D virus is unusual because it can only infect you when you also have a hepatitis B virus infection. A coinfection occurs when you get both hepatitis D and hepatitis B infections at the same time. A superinfection occurs if you already have chronic hepatitis B and then become infected with hepatitis D.

Hepatitis E

Hepatitis E is typically an acute infection that gets better without treatment after several weeks. Some types of hepatitis E virus are spread by drinking water contaminated by an infected person’s stool. Other types are spread by eating undercooked pork or wild game.

Symptoms

Viral hepatitis symptoms are similar no matter which type of hepatitis you have. If symptoms occur, you might experience any or all of the following:

  • jaundice (yellowing of the skin and whites of the eyes),
  • fever,
  • loss of appetite,
  • fatigue,
  • dark urine,
  • joint pain,
  • abdominal pain,
  • diarrhea,
  • nausea,
  • vomiting.

Very rarely, a recently acquired case of viral hepatitis can cause liver failure and death. Sometimes in these instances, a liver transplant (if a liver is available) can save a life.

Note: For all types of viral hepatitis, symptoms are less common in children than in adults, and for people of any age with HCV infection, they are less likely to experience symptoms.

In Hepatitis A, most (70%) of infections in children younger than age 6 are not accompanied by symptoms. When symptoms are present, young children typically do not have jaundice; most (>70%) older children and adults with HAV infection have this symptom.

Symptoms of hepatitis A usually last less than 2 months, although 10%–15% of symptomatic persons have prolonged or relapsing disease for up to 6 months.

In Hepatitis B, the presence of signs and symptoms varies by age. Most children under age 5 years and newly infected immunosuppressed adults are generally asymptomatic, whereas 30%–50% of persons aged ≥5 years have signs and symptoms.

Approximately 20%–30% of those newly infected with HCV experience fatigue, abdominal pain, poor appetite, or jaundice.

 

Hepatitis A

How is it spread?

Hepatitis A virus(HAV) is found in the feces (poop) of people with hepatitis A and is usually spread by close personal contact (including sex or living in the same household).

It can also be spread by eating food or drinking water contaminated with HAV. Uncooked foods contaminated with HAV can be a source of outbreaks, as well as cooked foods that are not heated to temperatures capable of killing the virus during preparation (i.e., 185 degrees F [>85 degrees C] for one minute) and foods that are contaminated after cooking, as occurs in outbreaks associated with infected food handlers. Waterborne outbreaks are infrequent in developed countries with properly maintained sanitation and water supplies.

Freezing does not inactivate HAV.

HAV can live outside the body for months, depending on the environmental conditions. In the environment, HAV can be killed by cleaning household or other facility surfaces with a freshly prepared solution of 1:100 dilution of household bleach to water.

Who should be vaccinated?

  • People who wish to be protected from HAV infection
  • All children at age 1 year (12–23 months)
  • Men who have sex with men
  • Users of street drugs (injecting and non-injecting)
  • People who travel or work in any area of the world except the U.S., Canada, Western Europe, Japan, New Zealand, and Australia
  • People who will have close personal contact with an international adoptee, from a country where HAV infection is common, during the first 60 days following the adoptee’s arrival in the U.S.
  • People with chronic liver disease, including HCV
  • People working with HAV in a laboratory
  • People with clotting factor disorders (e.g., hemophilia)

Incubation period

15 to 50 days, average 28 days.

Chronic infection

There is no chronic infection. Once you have had HAV infection, you cannot get it again. About 15 out of 100 people infected with HAV will have prolonged illness or relapsing symptoms over a 6–9 month period.

Treatment

There is no treatment for HAV other than supportive care.

Avoid alcohol. It can worsen liver disease.

How is it prevented?

  • Get vaccinated! Safe and effective vaccines to prevent HAV infection have been available in the U.S. since 1995.
  • Always wash your hands with soap and water after using the toilet, changing a diaper, and before preparing or eating food.
  • For a recent exposure to someone with HAV or if travel is soon (leaving in less than 2 weeks) to an area of the world where hepatitis A is common, see your healthcare provider about your need for hepatitis A vaccine or a dose of immune globulin (IG).
  • IgG antibodies to HAV, which appear early in the course of infection, provide lifelong protection against the disease. A person can not become re-infected.

Vaccination

Vaccination with the full, two-dose series of hepatitis A vaccine is the best way to prevent HAV infection. Immune globulin can provide short-term protection against hepatitis A, both pre- and post-exposure. Immune globulin must be administered within 2 weeks after exposure for maximum protection.

 

Hepatitis B

How is it spread?

Hepatitis B virus(HBV) is found in blood and certain body fluids. The virus is spread when blood or body fluid from an infected person enters the body of a person who is not immune. HBV is spread through having unprotected sex with an infected person, sharing needles or “works” when shooting drugs, exposure to needlesticks or sharps on the job, or from an infected mother to her baby during birth. Exposure to infected blood in ANY situation can be a risk for transmission.

HBV is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing, or sneezing.

HBV can survive outside the body at least 7 days and still be capable of causing infection. Any blood spills — including dried blood, which can still be infectious — should be cleaned using 1:10 dilution of one part household bleach to 10 parts of water for disinfecting the area. Gloves should be worn when cleaning up any blood spills.

Who should be vaccinated?

  • All infants, children, and teens ages 0 through 18 years
  • Any adult who wants to be protected from HBV infection
  • Sexually active people who are not in long-term, mutually monogamous relationships
  • Men who have sex with men
  • People seeking evaluation or treatment for a sexually transmitted disease
  • Healthcare or public safety workers who might be exposed to blood or body fluids
  • Residents and staff of facilities for developmentally disabled people
  • Adults younger than 60 years of age with diabetes
  • Dialysis and pre-dialysis patients
  • People infected with HIV
  • People in close personal contact (i.e., household or sexual) with someone who has chronic HBV infection
  • Current or recent injection-drug users
  • Travelers to regions of the world where hepatitis B is common (Asia, Africa, the Amazon Basin in South America, the Pacific Islands, Eastern Europe, or the Middle East)
  • People with chronic liver disease

Incubation period

60 to 150 days, average 90 days.

Acute infection

Some acute HBV infections will resolve on their own, but some will develop into chronic infection. Acute infection ranges from asymptomatic or mild disease to — rarely — fulminant hepatitis. Disease is more severe among adults aged >60 years.

Chronic infection

Chronic infection occurs in up to 90% of infants infected at birth; in about 30% of children infected at ages 1–5 years; and less than 5% of people infected after age 5 years. In the U.S., about 2,000 people die each year from hepatitis B. Death from chronic liver disease occurs in 15%–25% of chronically infected people. People who have chronic HBV infection have a much higher risk of liver failure and liver cancer.

Treatment

For acute infection, no medication is available; treatment is supportive.

There are several antiviral medications for persons with chronic infection.

  • Peg-IFN-a-2a(adult)IFN-a-2b(children)
  • Entecavir
  • Tenofovir
    • dipovoxil
    • fumarate
  • Tenofovir
    • alafenamide

Avoid alcohol. It can worsen liver disease.

How is it prevented?

  • Get vaccinated! Hepatitis B vaccination is the best protection. Two or three shots are given over a period of one to six months, depending on brand.
  • Whenever a woman is pregnant, she should be tested for hepatitis B (HBsAg blood test); infants born to HBV-infected mothers should be given HBIG (hepatitis B immune globulin) and vaccine within 12 hours of birth.
  • Tell your sex partner(s) to get vaccinated too, and always follow “safer sex” practices (e.g., using condoms)

Vaccination

The vaccination schedule most often used for children and adults is 3 intramuscular injections, the second and third doses administered at 1 and 6 months, respectively, after the first dose.

Studies indicate that immunologic memory remains intact for at least 30 years among healthy vaccinated individuals who initiated hepatitis B vaccination >6 months of age. The vaccine confers long-term protection against clinical illness and chronic hepatitis B virus infection. Cellular immunity appears to persist even though antibody levels might become low or decline below detectable levels.

Hepatitis B vaccine can be given to immunocompromised persons, such as persons on hemodialysis or persons with HIV infection. A larger vaccine dose is required to induce protective antibody in hemodialysis patients.

After a person has been exposed to HBV, appropriate prophylaxis, given as soon as possible but preferably within 24 hours, can effectively prevent infection.

 

Hepatitis C

How is it spread?

Hepatitis C virus(HCV) is found in blood and certain body fluids. The virus is spread when blood or body fluid from an HCV-infected person enters another person’s body. HCV is spread through sharing needles or “works” when shooting drugs, through exposure to needlesticks or sharps on the job, or sometimes from an infected mother to her baby during birth. It is possible to transmit HCV during sex, but it is not common.

Who should be vaccinated?

There is no vaccine to prevent HCV.

Testing for HCV is recommended for the following groups of people.

  • People born during 1945–1965
  • Injecting drug users
  • Recipients of clotting factors made before 1987
  • Hemodialysis patients
  • Recipients of blood or solid organ transplants before 1992
  • Infants born to HCV-infected mothers
  • People with undiagnosed abnormal liver test results
  • People with HIV infection – although HCV is not commonly spread through sex, individuals having sex with multiple partners or with an infected steady partner may be at increased risk of HCV infection.

Incubation period

14 to 180 days, average 45 days.

Acute infection

Approximately 15%–25% of people clear the virus from their bodies without treatment and do not develop chronic infection; the reasons for this are not well known.

Chronic infection

HCV infection becomes chronic in approximately 75%–85% of cases.

Of every 100 people infected with HCV, approximately 10-20 will go on to develop cirrhosis over a period of 20-30 years, among them there is 1-5% annual risk of hepatocellular carcinoma, and 3-6% annual risk of hepatic decompensation, for which the risk of death in the following year is 15-20%.

Chronic HCV infection is a common reason for liver transplants in the United States.

Treatment

New treatment guidelines recommend no treatment of acute hepatitis C. Patients with acute HCV infection should be followed and only considered for treatment if HCV RNA persists after 6 months.

There are plenty of medications for chronic hepatitis C –

  • Daclatasvir (Daklinza)
  • Elbasvir-Grazoprevir (Zepatier
  • Glecaprevir-Pibrentasvir (Mavyret)
  • Ledipasvir-Sofosbuvir (Harvoni
  • Ombitasvir-Paritaprevir-Ritonavir (Technivie)
  • Ombitasvir-Paritaprevir-Ritonavir and Dasabuvir (Viekira Pak)
  • Peginterferon alfa-2a (Pegasys)
  • Peginterferon alfa-2b (PegIntron)
  • Ribavirin (Copegus, Rebetol, Ribasphere)
  • Simeprevir (Olysio)
  • Sofosbuvir (Sovaldi)
  • Sofosbuvir-Velpatasvir (Epclusa)
  • Sofosbuvir-Velpatasvir-Voxilaprevir (Vosevi)

Because of recent reports of HBV reactivation in HCV co-infected patients receiving direct acting antiviral (DAA) therapy for HCV, all patients initiating HCV DAA therapy should be tested for HBV with HBsAg, anti-HBs, and anti-HBc. Persons testing positive for HBsAg and/or anti-HBc should be monitored while receiving HCV treatment.

Viral genotyping is necessary because there are seven distinct genotypes and more than 67 subtypes of HCV, genotype information is helpful in defining the epidemiology of hepatitis C and in making recommendations regarding appropriate treatment regimen.

How is it prevented?

  • There is no vaccine to prevent HCV infection.
  • HCV can be spread by sex, but this is not common. If you are not in a mutually monogamous relationship, use latex condoms correctly and every time to prevent the spread of sexually transmitted diseases. (The efficacy of latex condoms in preventing HCV infection is unknown, but their proper use may reduce transmission.)
  • In addition to getting hepatitis A vaccine, you should also get hepatitis B vaccine.

Hepatitis C can affect more than liver

A small percentage of people with chronic HCV infection develop medical conditions due to hepatitis C that are not limited to the liver. Such conditions can include:

  • Fatigue
  • Diabetes mellitus
  • Glomerulonephritis
  • Essential mixed cryoglobulinemia
  • Porphyria cutanea tarda
  • Non-Hodgkin’s lymphoma

 

Hepatitis D

How is it spread?

Hepatitis D is transmitted through percutaneous or mucosal contact with infectious blood and can be acquired either as a coinfection with HBV or as superinfection in people with HBV infection.

Hepatitis D only occurs in people who are infected with the hepatitis B virus because HDV is an incomplete virus that requires the helper function of HBV to replicate.

There is no vaccine for hepatitis D, but it can be prevented in people who are not already HBV-infected by hepatitis B vaccination.

 

Hepatitis E

How is it spread?

Hepatitis E is a self-limited disease that does not result in chronic infection. While rare in the United States, Hepatitis E is common in many parts of the world. It is transmitted from ingestion of fecal matter, even in microscopic amounts, and is usually associated with contaminated water supply in countries with poor sanitation.

Hepatitis E is most common in developing countries with inadequate water supply and environmental sanitation. Large hepatitis E epidemics have been reported in Asia, the Middle East, Africa, and Central America. People living in refugee camps or overcrowded temporary housing after natural disasters can be particularly at-risk.

HEV genotypes, characteristics, geographic location

Characteristics Genotype 1 Genotype 2 Genotype 3 Genotype 4
Geographic Location Africa and Asia Mexico, West Africa Developed Countries China, Taiwan, Japan
Transmission route Water-borne Fecal- oral  Person to Person Water-borne Fecal-oral Food-borne Food-borne
Groups at high risk for infection Young Adults Young Adults Older Adults (>40 years) and Males
Immuno-compromised persons
Young Adults
Zoonotic transmission No No Yes Yes
Chronic Infection No No Yes No
Occurrence of Outbreaks Common Smaller scale outbreaks Uncommon Uncommon

There is a possibility of zoonotic spread of the virus. HEV RNA (genotypes 3 and 4) had been extracted from pork, boar, and deer meat. Foodborne infection, could occur from consumption of uncooked/undercooked meat or organs from infected animals.

Who should be vaccinated?

There is currently no FDA-approved vaccine for Hepatitis E. In 2012 a recombinant vaccine was approved for use in China.

Symptomatic Hepatitis E in developing countries commonly occurs among older adolescents and young adults (aged 15–44 years). Pregnant women are more likely to experience severe illness including fulminant hepatitis and death.

In developed countries, sporadic cases due to HEV genotype 3 mainly affect older men (>40 years of age). Acute and chronic HEV infection occur in solid organ transplant recipients on immunosuppressant therapy.

Incubation period

15 to 60 days, average 40 days.

Treatment

There is no specific antiviral therapy for acute Hepatitis E. Physicians should offer supportive therapy. Patients are typically advised to rest, get adequate nutrition and fluids, avoid alcohol, and check with their physician before taking any medications that can damage the liver, especially acetaminophen. Hospitalization is sometimes required in severe cases and should be considered for pregnant women.

Most people with Hepatitis E recover completely. During HEV outbreaks, the overall case-fatality rate is about 1%. However, for pregnant women, Hepatitis E can be a serious illness with mortality reaching 10%–30% in their third trimester of pregnancy. Hepatitis E could also be serious among persons with preexisting chronic liver disease resulting in decompensated liver disease and death. Similarly high mortality occurs solid organ transplant recipients on immunosuppressive therapy.

How is it prevented?

Prevention of Hepatitis E relies primarily on good sanitation and the availability of clean drinking water.

Boiling and chlorination of water will inactivate HEV.

Avoiding raw pork and venison can reduce the risk of HEV genotype 3 transmission.

Immune globulin is not effective in preventing Hepatitis E.

 

 

* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.