About viral hepatitis

Hepatitis is an inflammation of the liver, most commonly caused by a viral infection. It’s one of the leading causes of death globally, killing more people each year than AIDS and malaria combined.

Viral hepatitis is not found in just one location; millions of people around the world are living with this disease. Only 10% of people who live with the disease are aware of their diagnosis, which may result in them developing fatal liver disease at some point in their lives or, in many cases, unknowingly transmitting the infection to others.

Viral hepatitis kills 1.4 million people every year and two thirds of all liver cancer deaths are caused by hepatitis B and C. These deaths are preventable; the availability of vaccines for hepatitis A, B and E, effective treatments for hepatitis A and B and a cure for hepatitis C means that we can make elimination a reality by 2030.

Hepatitis A

What is hepatitis A?

Hepatitis A is a viral liver disease that can cause mild to severe illness. Most people make a full recovery from hepatitis A, and develop lifelong immunity after infection. However, the virus can cause debilitating symptoms, and a small proportion of people who contract hepatitis A could die from fulminant hepatitis. Hepatitis A epidemics can be prolonged and can have significant economic and societal consequences.

How is hepatitis A transmitted?

In low-and middle-income countries, hepatitis A is spread mainly through eating food or drinking water that has been contaminated by the faeces of an infected person. It can also be spread by eating raw shellfish that have come from water contaminated by sewage. Infection rates are lower in high-income countries with good sanitary and hygienic conditions, but outbreaks of hepatitis A may occur among men who have sex with men, people who inject drugs, and homeless people.

Preventing hepatitis A

There is a safe and effective vaccine for hepatitis A. The risk of exposure can also be reduced with a safe water supply and improved sanitation. You can reduce your risk of exposure by washing your hands and avoiding drinking water or eating food that has come from a potentially unsafe source.

Treating hepatitis A

There is no specific treatment for hepatitis A. As the hepatitis A virus only causes acute hepatitis, the body is usually able to clear the infection itself within a few weeks, but in some cases recovery may take several weeks or months.

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Hepatitis B

What is hepatitis B?

Hepatitis B is a potentially life-threatening viral infection that attacks the liver. The hepatitis B virus can cause both acute and chronic disease. The World Health Organization (WHO) estimates that 257 million people worldwide are living with chronic hepatitis B, and that almost 900,000 people die as a result of the virus each year, mainly from cirrhosis and liver cancer.

How is hepatitis B transmitted?

Hepatitis B is transmitted through contact with the blood or other body fluids (i.e. saliva, semen and vaginal fluid) of an infected person. In highly endemic areas, it is most commonly passed from mother to child at birth, or from mother or an infected child to an uninfected child within the first five years of life. Infants who contract the virus at birth or within the first five years of life are very likely to develop chronic disease.

Hepatitis B is not transmitted casually. It cannot be spread via toilet seats, doorknobs, sneezing, coughing, hugging or eating meals with someone who has hepatitis B.

Preventing hepatitis B

There is a safe and effective vaccine against hepatitis B. WHO recommends that all infants receive the hepatitis B vaccine, preferably within 24 hours of birth.

If you have not been vaccinated, you can reduce your risk of exposure by using condoms, avoiding sharing needles or items such as toothbrushes, razors or nail scissors, and avoiding getting tattoos or body piercings from unlicensed facilities.

Treating hepatitis B

Medicines, including oral antiviral agents, are used to treat chronic hepatitis B. These medications suppress the replication of the virus, and can slow the progression of cirrhosis, reduce incidence of liver cancer and improve long term survival. However, not everyone living with chronic hepatitis B will require treatment, and many people worldwide have limited access to diagnosis and care.

There is no specific treatment for acute hepatitis B.

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Hepatitis C

What is hepatitis C?

Hepatitis C is a viral liver disease caused by the hepatitis C virus. It is a major cause of liver cancer.

Hepatitis C infection can be acute or chronic and severity can range from short-term, mild illness to a serious, lifelong and potentially fatal illness. There an estimated 71 million people living with chronic hepatitis C worldwide, a significant number of whom will develop cirrhosis or liver cancer.

How is hepatitis C transmitted?

Hepatitis C is a blood-borne virus spread through blood-to-blood contact. It is most commonly transmitted through unsafe injecting practices, sharing drug paraphernalia, inadequate sterilisation of medical equipment, and the use of contaminated blood products.  In rare cases it can be transmitted through certain sexual practices  and during childbirth.

Preventing hepatitis C

There is no vaccination for hepatitis C. It is therefore necessary to reduce risk of exposure by avoiding sharing needles and drug equipment, as well as other items such as toothbrushes, razors or nail scissors. It is also wise to avoid getting tattoos or body piercings from unlicensed facilities.

Treating hepatitis C

Many people ask “is hepatitis C curable?”. The good news is that hepatitis C can be cured with effective direct-acting antiviral (DAA) treatments that usually have few to no side effects. Hepatitis C is considered “cured” if the virus is undetectable in the blood three months after treatment is completed. This is known as a sustained virologic response (SVR), and most people will remain virus free once they reach SVR. However, it is possible to contract hepatitis C again after you have been cured, so it is important to take measures to protect yourself from infection.

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Hepatitis D

What is hepatitis D?

Hepatitis D is a liver disease caused by the hepatitis D virus, which can be both acute and chronic. The hepatitis D virus requires the hepatitis B virus for its replication, and only affects people who already have hepatitis B. Hepatitis B/Hepatitis D co-infection is considered the most serious form of chronic viral hepatitis due to more rapid progress towards liver cancer and liver-related death.

How is hepatitis D transmitted?

Hepatitis D is transmitted through contact with blood or other body fluids.

Preventing hepatitis D

As hepatitis D only affects people already living with hepatitis B, people not already infected with hepatitis B should get the hepatitis B vaccination. Babies should be given the hepatitis B birth dose vaccine as soon as possible after birth.

You can also reduce exposure by avoiding sharing needles and other items such as toothbrushes, razors or nail scissors, or getting tattoos or body piercings from unlicensed facilities.

People living with chronic hepatitis B infection should be regularly monitored for hepatitis D coinfection, also known as superinfection.

Treating hepatitis D

WHO guidelines generally recommend Pegylated interferon alpha for at least 48 weeks, however treatment is often not very effective.

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Hepatitis E

What is hepatitis E?

Hepatitis E is an acute liver disease caused by the hepatitis E virus. Most people will clear the infection within two to six weeks, but on occasion it can lead to fulminant hepatitis which may be fatal. There are an estimated 20 million hepatitis E infections each year, leading to more than three million symptomatic cases.

How is hepatitis E transmitted?

Hepatitis E is mainly transmitted through eating food or drinking water that has been contaminated by the faeces of an infected person.

Hepatitis E is most common in low- and middle-income countries which have limited access to essential water, sanitation, hygiene and health services. Outbreaks have occurred in areas of conflict and humanitarian emergency.

Preventing hepatitis E

There is a vaccine to prevent hepatitis E, but it is not widely available.

The spread of hepatitis E can be reduced through proper sanitation and water infrastructure, including quality standards for public water supplies and proper disposal systems for human waste.

Individuals can reduce their risk of exposure by maintaining good hygiene and sanitation practices (including hand washing), and avoiding drinking water that has come from a potentially unsafe source.

Treating hepatitis E

There is no treatment for hepatitis E. However it is usually self-limiting.

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What next?

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