| Hepatitis is inflammation of the liver. Several
different viruses cause viral hepatitis. They are named the
hepatitis A, B, C, D, and E viruses. All of these viruses
cause acute, or short-term, viral hepatitis. The hepatitis B, C,
and D viruses can also cause chronic hepatitis, in which the
infection is prolonged, sometimes lifelong.
Other viruses may also cause hepatitis, but they have yet to
be discovered and they are obviously rare causes of the disease.
Hepatitis A
Disease Spread
Primarily through food or water contaminated by feces from an
infected person. Rarely, it spreads through contact with
infected blood.
People at Risk
International travelers; people living in areas where
hepatitis A outbreaks are common; people who live with or have
sex with an infected person; and, during outbreaks, day care
children and employees, men who have sex with men, and injection
drug users.
Prevention
The hepatitis A vaccine; also, avoiding tap water when
traveling internationally and practicing good hygiene and
sanitation.
Treatment
Hepatitis A usually resolves on its own over several weeks.
|
Description |
Hepatitis A is a liver disease caused by the hepatitis A
virus. Hepatitis A can affect anyone. In the United
States, hepatitis A can occur in situations ranging from
isolated cases of disease to widespread epidemics.
Good personal hygiene and proper sanitation can help
prevent hepatitis A. Vaccines are also available for
long-term prevention of hepatitis A virus infection in
persons 12 months of age and older. Immune globulin is
available for short-term prevention of hepatitis A virus
infection in individuals of all ages. |
|
SIGNS & SYMPTOMS |
Adults will have signs and symptoms more often than
children. |
-
jaundice
-
fatigue
-
abdominal pain
-
loss of appetite
|
|
|
CAUSE |
|
|
LONG-TERM EFFECTS |
-
There is no chronic (long-term) infection.
-
Once you have had hepatitis A, you cannot get it
again.
-
About 15% of people infected with HAV will have
prolonged or relapsing symptoms over a 6-9 month
period.
|
|
TRANSMISSION |
-
HAV is found in the stool (feces) of persons with
hepatitis A.
-
HAV is usually spread from person to person by
putting something in the mouth (even though it might
look clean) that has been contaminated with the
stool of a person with hepatitis A.
|
|
PERSONS AT RISK for INFECTION |
-
Household contacts of infected persons
-
Sex contacts of infected persons
-
Persons, especially children, living in areas with
increased rates of hepatitis A during the baseline
period of 1987-1997
-
Persons traveling to
countries where hepatitis A is common
-
Men who have sex with men
-
Users of injection and non-injection drugs
|
|
PREVENTION |
-
Hepatitis A vaccine is the best protection.
-
Short-term protection against hepatitis A is
available from immune globulin. It can be given
before and within 2 weeks of coming in contact with
HAV.
-
Always wash your hands with soap and water after
using the bathroom, changing a diaper, and before
preparing and eating food.
|
|
VACCINE
RECOMMENDATIONS |
Vaccine is recommended for the following persons from 12
months of age and older:
-
All children at age 1 year (i.e., 12–23 months)
-
Travelers to
areas with increased rates of hepatitis A
-
Men who have sex with men
-
Users of injection and non-injection drugs
-
Persons with clotting-factor disorders (e.g.,
hemophilia)
-
Persons with chronic liver disease
-
Children living in areas with increased rates of
hepatitis A during the baseline period of 1987-1997
(view
map)
-
Persona who work with HAV in a laboratory setting
|
|
TRENDS & STATISTICS
|
-
Hepatitis A occurs in epidemics both nationwide and
in communities.
-
Before hepatitis A vaccine became available, the
number of reported cases reached 35,000 per year.
-
In the late 1990s, hepatitis A vaccine was more
widely used and the number of cases reached historic
lows.
-
One-third of Americans have evidence of past
infection (immunity).
|
Source:
http://www.cdc.gov/ncidod/diseases/hepatitis/a/fact.htm
Summary: Hepatitis A
Description
Hepatitis A is a viral infection of the liver caused by
hepatitis A virus (HAV). HAV infection may be asymptomatic
or its clinical manifestations may range in severity from a
mild illness lasting 1-2 weeks to a severely disabling
disease lasting several months. Clinical manifestations of
hepatitis A often include fever, malaise, anorexia, nausea,
and abdominal discomfort, followed within a few days by
jaundice (1).
Occurrence
HAV is shed in the feces of persons with HAV infection.
Transmission can occur through direct person-to-person
contact; through exposure to contaminated water, ice, or
shellfish harvested from sewage-contaminated water; or from
fruits, vegetables, or other foods that are eaten uncooked
and that were contaminated during harvesting or subsequent
handling.
HAV infection is common (high or intermediate endemicity)
throughout the developing world, where infections most
frequently are acquired during early childhood and usually
are asymptomatic or mild. In developed countries, HAV
infection is less common (low endemicity), but communitywide
outbreaks still occur in some areas of the United States.
Map 4-3 indicates the seroprevalence of antibody to HAV
(total anti-HAV) as measured in selected cross-sectional
studies among each country’s residents. The seroprevalence
of anti-HAV provides an estimate of the endemicity of HAV
infections, including asymptomatic infections, within a
population (2).
Hepatitis B
Disease Spread
Through contact with infected blood, through sex with an
infected person, and from mother to child during childbirth.
People at Risk
People who have sex with an infected person, men who have sex
with men, injection drug users, children of immigrants from
disease-endemic areas, infants born to infected mothers, people
who live with an infected person, health care workers,
hemodialysis patients, people who received a transfusion of
blood or blood products before July 1992 or clotting factors
made before 1987, and international travelers.
Prevention
The hepatitis B vaccine.
Treatment
For chronic hepatitis B: drug treatment with alpha
interferon, peginterferon, lamivudine, or adefovir dipivoxil.
Acute hepatitis B usually resolves on its own. Very severe
cases can be treated with lamivudine.
|
DESCRIPTION |
Hepatitis B is a serious disease caused by a virus that
attacks the liver. The virus, which is called hepatitis
B virus (HBV), can cause lifelong infection, cirrhosis
(scarring) of the liver, liver cancer, liver failure,
and death.
Hepatitis B vaccine is available for all age groups to
prevent hepatitis B virus infection. |
|
SIGNS
& SYMPTOMS |
About 30% of persons have no signs or symptoms.
Signs and symptoms are less common in children than
adults. |
-
jaundice
-
fatigue
-
abdominal pain
|
-
loss of appetite
-
nausea, vomiting
-
joint pain
|
|
CAUSE |
|
|
TRANSMISSION |
Persons
at risk for HBV infection might also be at risk for
infection with hepatitis C virus (HCV) or HIV.
|
|
RISK
GROUPS
|
-
Persons with multiple sex partners or diagnosis of a
sexually transmitted disease
-
Men who have sex with men
-
Sex contacts of infected persons
-
Injection-drug users
-
Household contacts of chronically infected persons
|
|
|
PREVENTION |
-
Hepatitis B vaccine is the best protection.
-
If you are having sex, but not with one steady
partner, use latex condoms correctly and every time
you have sex. The
efficacy of latex condoms in preventing
infection with HBV is unknown, but their proper use
might reduce transmission.
-
If you are pregnant, you should get a blood test for
hepatitis B. Infants born to HBV-infected mothers
should be given HBIG (hepatitis B immune globulin)
and vaccine within 12 hours after birth.
-
Do not shoot drugs; if you shoot drugs, stop and get
into a treatment program; if you can't stop, never
share drugs, needles, syringes, water, or "works",
and get vaccinated against hepatitis A and B.
-
Do not share personal care items that might have
blood on them (razors, toothbrushes).
-
Consider the risks if you are thinking about getting
a tattoo or body piercing. You might get infected if
the tools have someone else's blood on them or if
the artist or piercer does not follow good health
practices.
-
If you have or had hepatitis B, do not donate blood,
organs, or tissue.
-
If you are a health-care or public safety worker,
get vaccinated against hepatitis B, and always
follow routine barrier precautions and safely handle
needles and other sharps (view
current post-exposure prophylaxis recommendations).
|
|
VACCINE RECOMMENDATIONS |
-
Hepatitis B vaccine has been available since 1982.
-
Routine vaccination of 0-18 year olds
-
Vaccination of risk groups of all ages
|
|
LONG-TERM EFFECTS WITHOUT VACCINATION |
Chronic
infection occurs in:
-
90% of infants infected at birth
-
30% of children infected at age 1–5 years
-
6% of persons infected after age 5 years
Death from chronic liver disease occurs in:
-
15%–25% of chronically infected persons
|
|
CONTRAINDICATIONS TO VACCINE |
-
A serious allergic reaction to a prior dose of
hepatitis B vaccine or a vaccine component is a
contraindication to further doses of hepatitis B
vaccine. The recombinant vaccines that are licensed
for use in the United States are synthesized by
Saccharomyces cerevisiae (common bakers' yeast),
into which a plasmid containing the gene for HBsAg
has been inserted. Purified HBsAg is obtained by
lysing the yeast cells and separating HBsAg from the
yeast components by biochemical and biophysical
techniques. Persons allergic to yeast should not be
vaccinated with vaccines containing yeast.
|
|
TREATMENT & MEDICAL MANAGEMENT |
-
HBV infected persons should be evaluated by their
doctor for liver disease.
-
Adefovir dipivoxil, interferon alfa-2b, pegylated
interferon alfa-2a, lamivudine, entecavir, and
telbivudine are six drugs used for the treatment of
persons with chronic hepatitis B.
-
These drugs should not be used by pregnant women.
-
Drinking alcohol can make your liver disease worse.
|
|
TRENDS & STATISTICS
|
-
Number of new infections per year has declined from
an average of 260,000 in the 1980s to about 60,000
in 2004.
-
Highest rate of disease occurs in 20-49-year-olds.
-
Greatest decline has happened among children and
adolescents due to routine hepatitis B vaccination.
-
Estimated 1.25 million chronically infected
Americans, of whom 20-30% acquired their infection
in childhood.
|
Source:
http://www.cdc.gov/ncidod/diseases/hepatitis/b/fact.htm
Hepatitis C
Disease Spread
Primarily through contact with infected blood; less commonly,
through sexual contact and childbirth.
People at Risk
Injection drug users, people who have sex with an infected
person, people who have multiple sex partners, health care
workers, infants born to infected women, hemodialysis patients,
and people who received a transfusion of blood or blood products
before July 1992 or clotting factors made before 1987.
Prevention
There is no vaccine for hepatitis C; the only way to prevent
the disease is to reduce the risk of exposure to the virus. This
means avoiding behaviors like sharing drug needles or sharing
personal items like toothbrushes, razors, and nail clippers with
an infected person.
Treatment
Chronic hepatitis C: drug treatment with peginterferon alone
or combination treatment with peginterferon and the drug
ribavirin.
Acute hepatitis C: treatment is recommended if it does not
resolve within 2 to 3 months.
|
SIGNS & SYMPTOMS |
80% of persons have no signs or symptoms. |
-
jaundice
-
fatigue
-
dark urine
|
-
abdominal pain
-
loss of appetite
-
nausea
|
|
CAUSE |
|
|
LONG-TERM EFFECTS |
-
Chronic infection: 55%-85% of infected persons
-
Chronic liver disease: 70% of chronically infected
persons
-
Deaths from chronic liver disease: 1%-5% of infected
persons may die
-
Leading indication for liver transplant
|
|
TRANSMISSION
|
-
Occurs when blood from an infected person enters the
body of a person who is not infected.
-
HCV is spread through sharing needles or "works"
when "shooting" drugs, through needlesticks or
sharps exposures on the job, or from an infected
mother to her baby during birth.
|
|
Recommendations for
testing based on risk for HCV infection |
Persons at risk for HCV infection might also be at risk
for infection with hepatitis B virus (HBV) or HIV.
Recommendations for Testing Based on Risk for HCV
Infection
|
PERSONS |
RISK OF INFECTION |
TESTING RECOMMENDED? |
|
Injecting drug users |
High |
Yes |
|
Recipients of clotting factors made before 1987 |
High |
Yes |
|
Hemodialysis patients |
Intermediate |
Yes |
|
Recipients of blood and/or solid organs before
1992 |
Intermediate |
Yes |
|
People with undiagnosed liver problems |
Intermediate |
Yes |
|
Infants born to infected mothers |
Intermediate |
After 12-18 mos. old |
|
Healthcare/public safety workers |
Low |
Only after known exposure |
|
People having sex with multiple partners |
Low |
No* |
|
People having sex with an infected steady
partner |
Low |
No* |
*Anyone who wants to get tested should ask their doctor.
|
|
PREVENTION |
-
There is no vaccine to prevent hepatitis C.
-
Do not shoot drugs; if you shoot drugs, stop and get
into a treatment program; if you can't stop, never
share needles, syringes, water, or "works", and get
vaccinated against hepatitis A & B.
-
Do not share personal care items that might have
blood on them (razors, toothbrushes).
-
If you are a health care or public safety worker,
always follow routine barrier precautions and safely
handle needles and other sharps; get vaccinated
against hepatitis B.
-
Consider the risks if you are thinking about getting
a tattoo or body piercing. You might get infected if
the tools have someone else's blood on them or if
the artist or piercer does not follow good health
practices.
-
HCV can be spread by sex, but this is rare.
If you are having sex with more than one steady sex
partner, use latex condoms* correctly and every time
to prevent the spread of sexually transmitted
diseases. You should also get vaccinated against
hepatitis B.
-
If you are HCV positive, do not donate blood,
organs, or tissue.
|
|
TREATMENT & MEDICAL
MANAGEMENT
AASLD Practice Guideline: Diagnosis, Management, and
Treatment of
Hepatitis C
|
-
HCV positive persons should be evaluated by their
doctor for liver disease.
-
Interferon and ribavirin are two drugs licensed for
the treatment of persons with chronic hepatitis C.
-
Interferon can be taken alone or in combination with
ribavirin. Combination therapy, using pegylated
interferon and ribavirin, is currently the treatment
of choice.
-
Combination therapy can get rid of the virus in up
to 5 out of 10 persons for genotype 1 and in up to 8
out of 10 persons for genotype 2 and 3.
-
Drinking alcohol can make your liver disease worse.
|
|
STATISTICS & TRENDS
|
- Number of new
infections per year has declined from an average of
240,000 in the 1980s to about 26,000 in 2004.
- Most infections
are due to illegal injection drug use.
-
Transfusion-associated cases occurred prior to blood
donor screening; now occurs in less than one per 2
million transfused units of blood.
- Estimated 4.1
million (1.6%) Americans have been infected with HCV,
of whom 3.2 million are chronically infected.
-
The risk for perinatal HCV transmission is about 4%
-
If coinfected with HIV the risk for perinatal
infection is about 19%
|
Source:
http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm
Hepatitis D
Disease Spread
Through contact with infected blood. This disease occurs only
in people who are already infected with hepatitis B.
People at Risk
Anyone infected with hepatitis B: Injection drug users who
have hepatitis B have the highest risk. People who have
hepatitis B are also at risk if they have sex with a person
infected with hepatitis D or if they live with an infected
person. Also at risk are people who received a transfusion of
blood or blood products before July 1992 or clotting factors
made before 1987.
Prevention
Immunization against hepatitis B for those not already
infected; also, avoiding exposure to infected blood,
contaminated needles, and an infected person's personal items
(toothbrush, razor, nail clippers).
Treatment
Chronic hepatitis D: drug treatment with alpha interferon.
|
SIGNS & SYMPTOMS |
|
-
jaundice
-
fatigue
-
abdominal pain
-
loss of appetite
|
-
nausea, vomiting
-
joint pain
-
dark (tea colored) urine
|
|
CAUSE |
|
LONG-TERM EFFECTS
WITHOUT VACCINATION |
-
HDV can be acquired either as
-
a co-infection (occurs simultaneously) with
hepatitis B virus (HBV) or
-
as a superinfection in persons with existing
chronic HBV infection.
-
HBV-HDV co-infection:
-
may have more severe acute disease and a higher
risk (2%-20%) of developing acute liver failure
compared with those infected with HBV alone
-
HBV-HDV superinfection
-
chronic HBV carriers who acquire HDV
superinfection usually develop chronic HDV
infection
-
progression to cirrhosis is believed to be
more common with HBV/HDV chronic infections
|
|
TRANSMISSION |
-
Occurs when blood from an infected person enters the
body of a person who is not immune.
-
HBV is spread through having sex with an infected
person without using a condom (the efficacy of
latex condoms in preventing infection with HBV
is unknown, but their proper use may reduce
transmission);
-
By sharing drugs, needles, or "works" when
"shooting" drugs;
-
Through needlesticks or sharps exposures on the job;
or
-
From an infected mother to her baby during birth.
|
|
RISK
GROUPS |
-
Injection drug users
-
Men who have sex with men
-
Hemodialysis patients
-
Sex contacts of infected persons
|
-
Health care and public safety workers
-
Infants born to infected mothers
(very rare)
|
|
PREVENTION |
-
Hepatitis B vaccination
-
HBV-HDV coinfection
-
pre- or post-exposure prophylaxis (hepatitis B
immune globulin or vaccine) to prevent HBV
infection
-
HBV-HDV superinfection
-
education to reduce risk behaviors among persons
with chronic HBV infection
|
|
VACCINE
RECOMMENDATIONS |
-
Hepatitis B vaccine should be given to prevent HBV/HDV
co-infection
|
|
TREATMENT & MEDICAL MANAGEMENT |
-
Acute HDV infection
-
Chronic HDV infection
-
interferon-alfa
-
liver transplant
|
|
TRENDS & STATISTICS
|
-
Routine surveillance data are not available.
|
Source:
http://www.cdc.gov/ncidod/diseases/hepatitis/d/fact.htm
Hepatitis E
Disease Spread
Through food or water contaminated by feces from an infected
person. This disease is uncommon in the United States.
People at Risk
International travelers; people living in areas where
hepatitis E outbreaks are common; and people who live or have
sex with an infected person.
Prevention
There is no vaccine for hepatitis E; the only way to prevent
the disease is to reduce the risk of exposure to the virus. This
means avoiding tap water when traveling internationally and
practicing good hygiene and sanitation.
Treatment
Hepatitis E usually resolves on its own over several weeks to
months.
|
SIGNS & SYMPTOMS |
Highest attack rate among persons aged 15-40 years
|
-
jaundice
-
fatigue
-
abdominal pain
|
-
loss of appetite
-
nausea, vomiting
-
dark (tea colored) urine
|
|
CAUSE |
|
LONG-TERM EFFECTS
WITHOUT VACCINATION |
-
There is no chronic (long-term) infection
-
Hepatitis E is more severe among pregnant women,
especially in third trimester
|
|
TRANSMISSION |
-
HEV is found in the stool (feces) of persons and
animals with hepatitis E.
-
HEV is spread by eating or drinking contaminated
food or water.
-
Transmission from person to person occurs less
commonly than with hepatitis A virus
-
Most outbreaks in developing countries have been
associated with contaminated drinking water.
|
|
RISK
GROUPS |
-
Travelers to developing countries, particularly in
South Asia and North Africa
|
-
Rare cases have occurred in the United States among
persons with no history of travel to endemic
countries
|
|
PREVENTION |
-
Always wash your hands with soap and water after
using the bathroom, changing a diaper, and before
preparing and eating food
-
Avoid drinking water (and beverages with ice) of
unknown purity, uncooked shellfish, and uncooked
fruits or vegetables that are not peeled or prepared
by the traveler.
|
|
TREATMENT & MEDICAL MANAGEMENT |
|
|
TRENDS & STATISTICS
|
-
Hepatitis E remains uncommon in the United States.
Routine surveillance data are not available.
|
Source:
http://www.cdc.gov/ncidod/diseases/hepatitis/e/fact.htm
Other Causes of Viral Hepatitis
Some cases of viral hepatitis cannot be attributed to the
hepatitis A, B, C, D, or E viruses. This is called non A-E
hepatitis. Scientists continue to study the causes of non A-E
hepatitis.
Hope Through Research
The National Institute of Diabetes and Digestive and Kidney
Diseases, through its Division of Digestive Diseases and
Nutrition, supports basic and clinical research into the nature
and transmission of the hepatitis viruses, and the activation
and mechanisms of the immune system. Results from these studies
are used in developing new treatments and methods of prevention.
For More Information
American Liver Foundation (ALF)
75 Maiden Lane, Suite 603
New York, NY 10038–4810
Phone: 1–800–GO–LIVER (465–4837),
1–888–4HEP–USA (443–7872),
or 212–668–1000
Fax: 212–483–8179
Email:
info@liverfoundation.org
Internet:
www.liverfoundation.org
Centers for Disease Control and Prevention (CDC)
Division of Viral Hepatitis
1600 Clifton Road
Mail Stop C-14
Atlanta, GA 30333
Phone: 1–800–443–7232 or 404–371–5900
Email: ncid@cdc.gov
Internet:
www.cdc.gov/hepatitis
Hepatitis Foundation International (HFI)
504 Blick Drive
Silver Spring, MD 20904–2901
Phone: 1–800–891–0707 or 301–622–4200
Fax: 301–622–4702
Email: hfi@comcast.net
Internet:
www.hepatitisfoundation.org
[Top] |
(National
Institute of Diabetes and Digestive and Kidney Diseases)