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The ABCs of – for Health Professionals

HEPATITIS A is caused is caused by the hepatitis B is caused by by the (HAV) virus (HBV) the (HCV)

U.S. Statistics • Estimated 24,900 new • Estimated 21,600 new in 2018 • Estimated 50,300 new infections infections in 2018 • Estimated 862,000 people living with chronic in 2018 HBV in 2016 • Estimated 2.4 million people living with HCV infection in 2016

Routes of Fecal-oral route. Percutaneous, mucosal, or nonintact Direct percutaneous exposure to exposure to infectious , semen, and other infectious blood. HAV is transmitted through: body fluids. HBV is concentrated most highly in exposures to blood can also result in • Close person-to-person contact blood, and percutaneous exposure is an efficient transmission, although this route is with an infected person mode of transmission. less efficient. • Sexual contact with an infected person HBV is transmitted primarily through: HCV is transmitted primarily through: •  of contaminated • Birth to an infected mother • Sharing contaminated needles, or • Sexual contact with an infected person , or other equipment to inject drugs Although occurs early in • Sharing contaminated needles, syringes, or infection, bloodborne transmission other injection-drug equipment Less commonly through: of HAV is uncommon. Less commonly through: • Birth to an infected mother • Needle-sticks or other sharp instrument injuries • Sexual contact with an infected • transplantation and person • Interpersonal contact through sharing items • Unregulated tattooing such as razors or toothbrushes or contact with • Needle-sticks or other sharp open sores of an infected person instrument injuries

Incubation Period 15–50 days 60–150 days 14–182 days (average: 28 days) (average: 90 days) (average range: 14–84 days)

Symptoms of Symptoms of all types of are similar and can include one or more of the following: Infection • • Loss of appetite • • Abdominal pain • Dark • Clay-colored stool • (HAV only)

Likelihood of • <30% of children <6 years • Most children <5 years of age do not have • Jaundice might occur in 20%–30% Symptomatic of age have symptoms symptoms of people Acute Infection (which typically do not include • 30%–50% of people ≥5 years of age develop • Nonspecific symptoms (e.g., jaundice) symptoms , malaise, or abdominal • >70% of older children and • Newly infected immunosuppressed adults pain) might be present in adults have jaundice generally do not have symptoms 10%–20% of people

Potential for None Chronic infection develops in: Chronic infection develops in over Chronic Infection • 90% of infants after acute infection at birth 50% of newly infected people after Acute • 25%–50% of children newly infected at ages Infection 1–5 years • 5% of people newly infected as adults

Continued on next page HEPATITIS A HEPATITIS B HEPATITIS C

Severity • Most people with acute • Most people with acute disease recover with no • Approximately 5%–25% of persons recover with no lasting lasting liver damage; acute illness is rarely fatal with chronic hepatitis C will damage; death is uncommon • 15%–25% of people with chronic infection develop over 10–20 years but occurs more often among develop chronic , including • People with hepatitis C and older people and/or those with cirrhosis, , or liver cirrhosis have a 1%–4% annual underlying liver disease risk for

Serologic Tests for • IgM anti-HAV • HBsAg, plus • No serologic marker for acute Acute Infection • IgM anti-HBc infection

Serologic Tests for • Not applicable—no chronic Tests for chronic infection should include three •  for anti-HCV Chronic Infection infection HBV seromarkers: • Qualitative and quantitative nucleic • HBsAg acid tests (NAT) to detect and • anti-HBs quantify presence of virus (HCV • Total anti-HBc RNA)

Testing • Not applicable—no chronic • All pregnant women should be tested for HBsAg • All adults aged 18 years and older, Recommendations infection during an early prenatal visit in each at least once for Chronic Note: testing for past acute • Infants born to HBsAg-positive mothers (HBsAg • All pregnant women during each pregnancy Infection infection is generally not and anti-HBs are only recommended) recommended • People born in regions with intermediate and • People who currently inject drugs high HBV endemicity (HBsAg ≥2%) and share needles, syringes, or • People born in U.S. not vaccinated as infants other drug preparation equipment whose parents were born in regions with high (routine periodic testing) HBV endemicity (≥8%) • People who ever injected drugs • Household or sexual contacts of people who are • People with HIV HBsAg-positive • People who receive maintenance (routine periodic • Men who have sex with men testing) • People who inject, or have injected, • People who ever received drugs maintenance hemodialysis • Patients with alanine aminotransferase levels • People with persistently abnormal (≥19 IU/L for women and ≥30 IU/L for men) of ALT levels unknown etiology • Prior recipients of transfusions or • People with end-stage renal disease including organ transplants, including: hemodialysis patients - people who received clotting • People receiving immunosuppressive factor concentrates produced • People with HIV before 1987 • Donors of blood, plasma, organs, tissues, or - people who received a semen 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

Continued on next page HEPATITIS A HEPATITIS B HEPATITIS C

Treatment • No available • Acute: no medication available; best addressed • Acute: AASLD/IDSA recommend • Best addressed through through supportive treatment treatment of acute HCV without a supportive treatment • Chronic: regular monitoring for signs of liver waiting period disease progression; antiviral drugs are • Chronic: over 90% of people with available hepatitis C can be cured regardless of HCV with 8–12 weeks of oral therapy

Vaccination Children • All infants • There is no hepatitis C Recommendations • All children aged 12–23 months • All unvaccinated children and adolescents aged • Unvaccinated children and <19 years adolescents aged 2–18 years • Sex partners of HBsAg-positive people People at increased risk for • Sexually active people who are not in a mutually HAV infection monogamous relationship • International travelers • Anyone seeking evaluation or treatment for a • Men who have sex with men sexually transmitted infection • People who use injection or • Men who have sex with men noninjection drugs • Anyone with a history of current or recent • People with occupational risk injection-drug use for exposure • Household contacts of people who are HBsAg- • People who anticipate close positive personal contact with an • Residents and staff of facilities for international adoptee developmentally disabled people • People experiencing • Health care and public-safety personnel with homelessness reasonably-anticipated risk for exposure to People at increased risk for blood or blood-contaminated body fluids, severe disease from HAV • Hemodialysis, predialysis , and infection home dialysis patients • People with chronic liver • People with mellitus aged <60 years disease and people with diabetes mellitus aged ≥60 • People with HIV infection years at the discretion of the treating clinician Other people recommended for • International travelers to countries with high or intermediate levels of HBV infection • Pregnant women at risk for HAV (HBsAg prevalence of ≥2%) infection or severe outcome • People living with hepatitis C from HAV infection • People with (including • Any person who requests cirrhosis, , alcoholic liver vaccination disease, , and an ALT or Vaccination during outbreaks AST level greater than twice the upper limit of normal) • Unvaccinated people in outbreak settings who are at • People living with HIV infection risk for HAV infection or at risk • People who are incarcerated for severe disease from HAV • Pregnant women who are identified as being at Implementation strategies for risk for HBV infection during pregnancy settings providing services to • Anyone else seeking long-term protection adults • People in settings that provide services to adults in which a high proportion of those people have risk factors for HAV infection

Vaccination • Single- hepatitis A • Infants and children: 3–4 doses given over a • No vaccine available Schedule vaccine: 2 doses given 6–18 6- to 18-month period depending on vaccine months apart depending on type and schedule manufacturer • Adults: 2 doses, 1 month apart or 3 doses over a • Combination HepA-HepB 6-month period (depending on manufacturer) vaccine: typically 3 doses given over a 6-month period

Updated 2020 www.cdc.gov/hepatitis