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Home , Hepatitis D, Viral hepatitis

Viral : A through E and Beyond

National Digestive Diseases Information Clearinghouse

What is ? • Viral hepatitis is inflammation of the • low grade caused by a . Several different , named the , B, C, D, and E • NATIONAL INSTITUTES viruses, cause viral hepatitis. However, some people do not have OF HEALTH All of these viruses cause , or short- symptoms. term, viral hepatitis. The , C, and D viruses can also cause chronic hepatitis, Hepatitis A in which the is prolonged, some­ times lifelong. Chronic hepatitis can lead to How is hepatitis A spread? , , and . Hepatitis A is spread primarily through U.S. Department food or water contaminated by from of Health and Researchers are looking for other viruses an infected person. Rarely, it spreads Human Services that may cause hepatitis, but none have through contact with infected . been identified with certainty. Other viruses that less often affect the liver include Who is at risk for hepatitis A? ; Epstein-Barr virus, also People most likely to get hepatitis A are called ; herpesvi­ rus; parvovirus; and adenovirus. • international travelers, particularly those traveling to developing countries What are the symptoms of • people who live with or have sex with viral hepatitis? an infected person Symptoms include • people living in areas where children are not routinely vaccinated against • , which causes a yellowing hepatitis A, where outbreaks are more of the skin and eyes likely • fatigue • day care children and employees, • abdominal pain during outbreaks • loss of appetite • men who have sex with men • • users of illicit drugs • How can hepatitis A be • immigrants and children of immigrants prevented? from areas with high rates of hepatitis B The hepatitis A offers to adults and children older than age 1. The • infants born to infected mothers Centers for Disease Control and Prevention • health care workers recommends routine hepatitis A vaccina­ tion for children aged 12 to 23 months and • hemodialysis patients for adults who are at high risk for infec­ tion. Treatment with immune globulin can • people who received a transfusion of provide short-term immunity to hepatitis A blood or blood products before 1987, when given before exposure or within when better tests to screen blood 2 weeks of exposure to the virus. Avoiding donors were developed tap water when traveling internationally and • international travelers practicing good hygiene and sanitation also help prevent hepatitis A. How can hepatitis B be prevented? What is the treatment for The offers the best pro­ hepatitis A? tection. All infants and unvaccinated chil­ Hepatitis A usually resolves on its own over dren, adolescents, and at-risk adults should several weeks. be vaccinated. For people who have not been vaccinated, reducing exposure to the can help prevent hepatitis B. Reduc­ ing exposure means using latex condoms, How is hepatitis B spread? which may lower the risk of transmission; Hepatitis B is spread through contact with not sharing drug needles; and not sharing infected blood, through sex with an infected personal items such as toothbrushes, razors, person, and from mother to child during and nail clippers with an infected person. childbirth, whether the delivery is vaginal or via cesarean section. What is the treatment for hepatitis B? Who is at risk for hepatitis B? Drugs approved for the treatment of People most likely to get hepatitis B are chronic hepatitis B include alpha • people who live with or have sexual and peginterferon, which slow the replica­ contact with an infected person tion of the virus in the body and also boost the , and the antiviral drugs • men who have sex with men , dipivoxil, , and . Other drugs are also being • people who have multiple sex partners evaluated. Infants born to infected mothers • injection drug users should receive hepatitis B immune globulin and the hepatitis B vaccine within 12 hours of birth to help prevent infection.

2 Viral Hepatitis: A through E and Beyond People who develop acute hepatitis B are How can generally not treated with antiviral drugs be prevented? because, depending on their age at infec­ tion, the disease often resolves on its own. There is no vaccine for hepatitis C. The Infected newborns are most likely to prog­ only way to prevent the disease is to reduce ress to chronic hepatitis B, but by young the risk of exposure to the virus. Reduc­ adulthood, most people with acute infection ing exposure means avoiding behaviors like recover spontaneously. Severe acute hepa­ sharing drug needles or personal items such titis B can be treated with an as toothbrushes, razors, and nail clippers such as lamivudine. with an infected person. What is the treatment for Hepatitis C hepatitis C? How is hepatitis C spread? Chronic hepatitis C is treated with pegin­ Hepatitis C is spread primarily through con­ terferon together with the antiviral drug tact with infected blood. Less commonly, . it can spread through sexual contact and If acute hepatitis C does not resolve on its childbirth. own within 2 to 3 months, drug treatment is Who is at risk for hepatitis C? recommended. People most likely to be exposed to the are • injection drug users How is hepatitis D spread? Hepatitis D is spread through contact with • people who have sex with an infected infected blood. This disease only occurs at person the same time as infection with hepatitis B • people who have multiple sex partners or in people who are already infected with hepatitis B. • health care workers Who is at risk for hepatitis D? • infants born to infected women Anyone infected with hepatitis B is at risk • hemodialysis patients for hepatitis D. Injection drug users have • people who received a transfusion of the highest risk. Others at risk include blood or blood products before July • people who live with or have sex with a 1992, when sensitive tests to screen person infected with hepatitis D blood donors for hepatitis C were introduced • people who received a transfusion of blood or blood products before 1987 • people who received clotting factors made before 1987, when methods to manufacture these products were improved

3 Viral Hepatitis: A through E and Beyond How can hepatitis D Who is at risk for ? be prevented? People most likely to be exposed to the People not already infected with hepatitis hepatitis E virus are B should receive the hepatitis B vaccine. • international travelers, particularly Other preventive measures include avoiding those traveling to developing countries exposure to infected blood, contaminated needles, and an infected person’s personal • people living in areas where hepatitis items such as toothbrushes, razors, and nail E outbreaks are common clippers. • people who live with or have sex with What is the treatment for an infected person hepatitis D? How can hepatitis E Chronic hepatitis D is usually treated with be prevented? pegylated interferon, although other poten­ There is no U.S. Food and Drug Adminis­ tial treatments are under study. tration (FDA)-approved vaccine for hepa­ titis E. The only way to prevent the disease Hepatitis E is to reduce the risk of exposure to the virus. How is hepatitis E spread? Reducing risk of exposure means avoiding tap water when traveling internationally and Hepatitis E is spread through food or water practicing good hygiene and sanitation. contaminated by feces from an infected person. This disease is uncommon in the What is the treatment for United States. hepatitis E? Hepatitis E usually resolves on its own over several weeks to months.

Points to Remember • offer protection from hepa­ titis A and hepatitis B. • Viral hepatitis is inflammation of the liver caused by the hepatitis A, B, C, • No vaccines are available for hepati­ D, or E viruses. tis C, D, and E. Reducing exposure to the viruses offers the best protec­ • Depending on the type of virus, viral tion. hepatitis is spread through contami­ nated food or water, contact with • Hepatitis A and E usually resolve on infected blood, sexual contact with their own. Hepatitis B, C, and D can an infected person, or from mother be chronic and serious. Drugs are to child during childbirth. available to treat chronic hepatitis.

4 Viral Hepatitis: A through E and Beyond What else causes viral For More Information hepatitis? American Liver Foundation Some cases of viral hepatitis cannot be 75 Maiden Lane, Suite 603 attributed to the hepatitis A, B, C, D, or E New York, NY 10038–4810 viruses, or even the less common viruses Phone: 1–800–GO–LIVER (465–4837), that can infect the liver, such as cytomega­ 1–888–4HEP–USA (443–7872), lovirus, Epstein-Barr virus, herpesvirus, or 212–668–1000 parvovirus, and adenovirus. These cases Fax: 212–483–8179 are called non-A–E hepatitis. Scientists Email: [email protected] continue to study the causes of non-A–E Internet: www.liverfoundation.org hepatitis. Centers for Disease Control and Prevention Division of Viral Hepatitis Hope through Research 1600 Clifton Road Mail Stop C–14 The National Institute of Diabetes and Atlanta, GA 30333 Digestive and Kidney Diseases, through its Phone: 1–800–CDC–INFO (232–4636) Division of Digestive Diseases and Nutri­ Fax: 404–371–5488 tion, supports basic and clinical research Email: [email protected] into the nature and transmission of the hep­ Internet: www.cdc.gov/hepatitis atitis viruses, and the activation and mecha­ nisms of the immune system. Results from Hepatitis Foundation International these basic and clinical studies are used in 504 Blick Drive developing new treatments and methods of Silver Spring, MD 20904–2901 prevention. Phone: 1–800–891–0707 or 301–622–4200 Fax: 301–622–4702 Email: [email protected] Internet: www.hepatitisfoundation.org

5 Viral Hepatitis: A through E and Beyond You may also find additional information about this National Digestive Diseases topic by visiting MedlinePlus at www.medlineplus.gov. Information Clearinghouse This publication may contain information about used to treat a health condition. When this publication was prepared, the NIDDK included 2 Information Way the most current information available. Occasion- Bethesda, MD 20892–3570 ally, new information about is released. Phone: 1–800–891–5389 For updates or for questions about any medications, please contact the U.S. Food and Drug Administra- Fax: 703–738–4929 tion at 1–888–INFO–FDA (463–6332), a toll-free Email: [email protected] call, or visit their website at www.fda.gov. Consult Internet: www.digestive.niddk.nih.gov your doctor for more information. The National Digestive Diseases Informa- tion Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and The U.S. Government does not endorse or favor any Digestive and Kidney Diseases (NIDDK). specific commercial product or company. Trade, proprietary, or company names appearing in this The NIDDK is part of the National Insti- document are used only because they are considered tutes of Health of the U.S. Department of necessary in the context of the information provided. If a product is not mentioned, the omission does not Health and Human Services. Established in mean or imply that the product is unsatisfactory. 1980, the Clearinghouse provides informa- tion about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organi- zations and Government agencies to coordi- nate resources about digestive diseases. Publications produced by the Clearinghouse are carefully reviewed by both NIDDK sci- entists and outside experts.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health

NIH Publication No. 08–4762 February 2008