What is Viral Hepatitis?

Magnified image of a virus

Hepatitis means inflammation of the liver. The liver is a vital organ that processes nutrients, filters the blood, and fights infections. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can cause hepatitis. However, hepatitis is often caused by a virus. In the United States, the most common types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C.

What causes it?

Hepatitis A virus

Hepatitis B virus.

Hepatitis C virus.

Number of U.S. cases

  • About 24,900 new infections in 2018
  • About 22,600 new infections in 2018
  • Estimated 862,000 people living with hepatitis B
  • About 50,300 new infections in 2018
  • Estimated 2.4 million people living with hepatitis C

Key facts

  • Effective vaccine available
  • Outbreaks still occur in the United States; currently there are widespread person-to-person outbreaks
  • Recent foodborne outbreaks in US traced to imported food
  • Common in many countries, especially those without modern sanitation
  • Effective vaccine available
  • About 2 in 3 people with hepatitis B do not know they are infected
  • About 50% of people with hepatitis B in the U.S are Asian
  • Hepatitis B is a leading cause of liver cancer
  • About 50% of people with hepatitis C do not know they are infected
  • Hepatitis C is a leading cause of liver transplants and liver cancer

How long does it last?

Hepatitis A can last from a few weeks to several months.

Hepatitis B can range from a mild illness, lasting a few weeks, to a serious, life-long (chronic) condition. More than 90% of unimmunized infants who get infected develop a chronic infection, but 6%–10% of older children and adults who get infected develop chronic hepatitis B.

Hepatitis C can range from a mild illness, lasting a few weeks, to a serious, life-long (chronic) infection. Most people who get infected with the hepatitis C virus develop chronic hepatitis C.

How is it spread?

Hepatitis A is spread when a person ingests fecal matter—even in microscopic amounts—from contact with objects, food, or drinks contaminated by feces or stool from an infected person.

Hepatitis B is primarily spread when blood, semen, or certain other body fluids- even in microscopic amounts – from a person infected with the hepatitis B virus enters the body of someone who is not infected. The hepatitis B virus can also be transmitted from:

  • Birth to an infected mother
  • Sex with an infected person
  • Sharing equipment that has been contaminated with blood from an infected person, such as needles, syringes, and even medical equipment, such as glucose monitors
  • Sharing personal items such as toothbrushes or razors
  • Poor infection control has resulted in outbreaks in health care facilities

Hepatitis C is spread when blood from a person infected with the Hepatitis C virus – even in microscopic amounts – enters the body of someone who is not infected. The hepatitis C virus can also be transmitted from:

  • Sharing equipment that has been contaminated with blood from an infected person, such as needles and syringes
  • Receiving a blood transfusion or organ transplant before 1992 (when widespread screening virtually eliminated hepatitis C from the blood supply)
  • Poor infection control has resulted in outbreaks in health care facilities
  • Birth to an infected mother

Who should be vaccinated?

Children

  • All children aged 12–23 months
  • All children and adolescents 2–18 years of age who have not previously received hepatitis A vaccine (known as “catch up” vaccination)

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

People at increased risk for severe disease from hepatitis A infection

  • People with chronic liver disease, including hepatitis B and hepatitis C
  • People with HIV

Other people recommended for vaccination

  • Pregnant women at risk for hepatitis A or risk for severe outcome from hepatitis A infection

Any person who requests vaccination

  • All infants
  • All children and adolescents younger than 19 years of age who have not been vaccinated
  • People at risk for infection by sexual exposure including: people whose sex partners have hepatitis B, sexually active people who are not in a long-term, mutually monogamous relationship, people seeking evaluation or treatment for an STD, and men who have sex with men
  • People at risk for infection by exposure to blood including: people who inject drugs, people who live with a person who has hepatitis B, residents and staff of facilities for developmentally disabled people, health care and public safety workers at risk for exposure to blood or blood-contaminated body fluids on the job
  • Hemodialysis patients and predialysis, peritoneal dialysis, and home dialysis patients
  • People with diabetes aged 19–59 years; people with diabetes aged 60 or older should ask their doctor.
  • International travelers to countries where hepatitis B is common
  • People with hepatitis C
  • People with chronic liver disease
  • People with HIV
  • People who are in jail or prison
  • All other people seeking protection from hepatitis B virus infection

There is no vaccine available for hepatitis C.

How serious is it?

  • People can be sick for a few weeks to a few months
  • Most recover with no lasting liver damage
  • Although very rare, death can occur
  • 15%–25% of chronically infected people develop chronic liver disease, including cirrhosis, liver failure, or liver cancer
  • More than 50% of people who get infected with the hepatitis C virus develop a chronic infection
  • 5%-25% of people with chronic hepatitis C develop cirrhosis over 10–20 years

Treatment

Supportive treatment for symptoms

Acute: No medication available; best addressed through supportive care Chronic: Regular monitoring for signs of liver disease progression; some patients are treated with antiviral drugs

Acute: There is not a recommended treatment for acute hepatitis C. People should be considered for treatment if their infection becomes chronic. Chronic: There are several medications available to treat chronic hepatitis C. Current treatments usually involve 8-12 weeks of oral therapy (pills) and cure over 90% of people with few side effects

Who should be tested?

Testing for hepatitis A is not routinely recommended.

CDC recommends hepatitis B testing for:

  • People born in countries with 2% or higher HBV prevalence
  • Men who have sex with men
  • People who inject drugs
  • People with HIV
  • Household and sexual contacts of people with hepatitis B
  • People requiring immunosuppressive therapy
  • People with end-stage renal disease (including hemodialysis patients)
  • People with hepatitis C
  • People with elevated ALT levels
  • Pregnant women
  • Infants born to HBV-infected mothers

CDC recommends hepatitis C testing for:

  • All adults aged 18 years and older
  • All pregnant women during each pregnancy
  • People who ever injected drugs and shared needles, syringes, or other drug preparation equipment, including those who injected once or a few times many years ago. Regular testing is recommended for people who currently inject and share needles, syringes, or other drug preparation equipment.
  • People with HIV
  • People who have ever received maintenance hemodialysis. Regular testing is recommended for people who currently receive maintenance hemodialysis.
  • People with persistently abnormal ALT levels
  • People who received clotting factor concentrates produced before 1987
  • People who received a transfusion of blood or blood components before July 1992
  • People who received an organ transplant before July 1992
  • People who were notified that they received blood from a donor who later tested positive for HCV infection
  • Healthcare, emergency medical, and public safety personnel after needle sticks, sharps, or mucosal exposures to HCV‑positive blood
  • Children born to mothers with HCV infection
  • Any person who requests hepatitis C testing should receive it.

ABC Table

What causes it?

Hepatitis A Hepatitis B Hepatitis C
Hepatitis A virus Hepatitis B virus Hepatitis C virus

Number of U.S. cases

Hepatitis A Hepatitis B Hepatitis C
  • About 24,900 new infections each year
  • About 22,600 new infections in 2018
  • Estimated 862,000 people living with hepatitis B
  • About 50,300 new infections in 2018
  • Estimated 2.4 million people living with hepatitis C

Key facts

Hepatitis A Hepatitis B Hepatitis C
  • Effective vaccine available
  • Outbreaks still occur in the United States; currently there are are widespread person-to-person outbreaks
  • Recent foodborne outbreaks in US traced to imported food
  • Common in many countries, especially those without modern sanitation
  • Effective vaccine available
  • About 2 in 3 people with hepatitis B do not know they are infected
  • About 50% of people with hepatitis B in the U.S are Asian
  • Hepatitis B is a leading cause of liver cancer
  • About 50% of people with hepatitis C do not know they are infected
  • Hepatitis C is a leading cause of liver transplants and liver cancer

How long does it last?

Hepatitis A Hepatitis B Hepatitis C
Hepatitis A can last from a few weeks to several months. Hepatitis B can range from a mild illness, lasting a few weeks, to a serious, life-long (chronic) condition. More than 90% of unimmunized infants who get infected develop a chronic infection, but 6%–10% of older children and adults who get infected develop chronic hepatitis B. Hepatitis C can range from a mild illness, lasting a few weeks, to a serious, life-long (chronic) infection. Most people who get infected with the hepatitis C virus develop chronic hepatitis C.

How is it spread?

Hepatitis A Hepatitis B Hepatitis C
Hepatitis A is spread when a person ingests fecal matter—even in microscopic amounts—from contact with objects, food, or drinks contaminated by feces or stool from an infected person. Hepatitis B is primarily spread when blood, semen, or certain other body fluids- even in microscopic amounts – from a person infected with the hepatitis B virus enters the body of someone who is not infected. The hepatitis B virus can also be transmitted from:
  • Birth to an infected mother
  • Sex with an infected person
  • Sharing equipment that has been contaminated with blood from an infected person, such as needles, syringes, and even medical equipment, such as glucose monitors
  • Sharing personal items such as toothbrushes or razors
  • Poor infection control has resulted in outbreaks in health care facilities
Hepatitis C is spread when blood from a person infected with the Hepatitis C virus – even in microscopic amounts – enters the body of someone who is not infected. The hepatitis C virus can also be transmitted from:
  • Sharing equipment that has been contaminated with blood from an infected person, such as needles and syringes
  • Receiving a blood transfusion or organ transplant before 1992 (when widespread screening virtually eliminated hepatitis C from the blood supply)
  • Poor infection control has resulted in outbreaks in health care facilities
  • Birth to an infected mother

Who should be vaccinated?

Hepatitis A Hepatitis B Hepatitis C
Children
  • All children aged 12–23 months
  • All children and adolescents 2–18 years of age who have not previously received hepatitis A vaccine (known as “catch up” vaccination)

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

People at increased risk for severe disease from hepatitis A infection

  • People with chronic liver disease, including hepatitis B and hepatitis C
  • People with HIV

Other people recommended for vaccination

  • Pregnant women at risk for hepatitis A or risk for severe outcome from hepatitis A infection
  • Any person who requests vaccination
  • All infants
  • All children and adolescents younger than 19 years of age who have not been vaccinated
  • People at risk for infection by sexual exposure including: people whose sex partners have hepatitis B, sexually active people who are not in a long-term, mutually monogamous relationship, people seeking evaluation or treatment for an STD, and men who have sex with men
  • People at risk for infection by exposure to blood including: people who inject drugs, people who live with a person who has hepatitis B, residents and staff of facilities for developmentally disabled people, health care and public safety workers at risk for exposure to blood or blood-contaminated body fluids on the job
  • Hemodialysis patients and predialysis, peritoneal dialysis, and home dialysis patients
  • People with diabetes aged 19–59 years; people with diabetes aged 60 or older should ask their doctor.
  • International travelers to countries where hepatitis B is common
  • People with hepatitis C
  • People with chronic liver disease
  • People with HIV
  • People who are in jail or prison
  • All other people seeking protection from hepatitis B virus infection
There is no vaccine available for hepatitis C.

How serious is it?

Hepatitis A Hepatitis B Hepatitis C
  • People can be sick for a few weeks to a few months
  • Most recover with no lasting liver damage
  • Although very rare, death can occur
  • 15%–25% of chronically infected people develop chronic liver disease, including cirrhosis, liver failure, or liver cancer
  • More than 50% of people who get infected with the hepatitis C virus develop a chronic infection
  • 5%-25% of people with chronic hepatitis C develop cirrhosis over 10–20 years

Treatment

Hepatitis A Hepatitis B Hepatitis C
Supportive treatment for symptoms Acute: No medication available; best addressed through supportive care Chronic: Regular monitoring for signs of liver disease progression; some patients are treated with antiviral drugs Acute: There is not a recommended treatment for acute hepatitis C. People should be considered for treatment if their infection becomes chronic. Chronic: There are several medications available to treat chronic hepatitis C. Current treatments usually involve 8-12 weeks of oral therapy (pills) and cure over 90% of people with few side effects

Who should be tested?

Hepatitis A Hepatitis B Hepatitis C
Testing for hepatitis A is not routinely recommended. CDC recommends hepatitis B testing for:
  • People born in countries with 2% or higher HBV prevalence
  • Men who have sex with men
  • People who inject drugs
  • People with HIV
  • Household and sexual contacts of people with hepatitis B
  • People requiring immunosuppressive therapy
  • People with end-stage renal disease (including hemodialysis patients)
  • People with hepatitis C
  • People with elevated ALT levels
  • Pregnant women
  • Infants born to HBV-infected mothers
CDC recommends hepatitis C testing for:
  • All adults aged 18 years and older
  • All pregnant women during each pregnancy
  • People who ever injected drugs and shared needles, syringes, or other drug preparation equipment, including those who injected once or a few times many years ago. Regular testing is recommended for people who currently inject and share needles, syringes, or other drug preparation equipment.
  • People with HIV
  • People who have ever received maintenance hemodialysis. Regular testing is recommended for people who currently receive maintenance hemodialysis.
  • People with persistently abnormal ALT levels
  • People who received clotting factor concentrates produced before 1987
  • People who received a transfusion of blood or blood components before July 1992
  • People who received an organ transplant before July 1992
  • People who were notified that they received blood from a donor who later tested positive for HCV infection
  • Healthcare, emergency medical, and public safety personnel after needle sticks, sharps, or mucosal exposures to HCV‑positive blood
  • Children born to mothers with HCV infection
  • Any person who requests hepatitis C testing should receive it.

Symptoms:

Many people with hepatitis do not have symptoms and do not know they are infected. If symptoms occur with an acute infection, they can appear anytime from 2 weeks to 6 months after exposure. Symptoms of chronic viral hepatitis can take decades to develop. Symptoms of hepatitis can include: fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain, and jaundice.